Medical Journals

sheet 39 ::: the final one ::: edited :)

2008-05-22T10:46:00.010+03:00

---The final anatomy sheet----
*In the name of Allah*

SPLEEN

What is the spleen ??
- its largest lymphoid gland in the body

Where is it?
It is located in the left hypochondriac region
Sheltered below left dum of diaphragm

It has three function:
1. storing your extra R.B.Cs
2.storing the old (worn-out) R.B.S
3. important for immunity.

Note: it is a completely intraperitoneal organ , except at its hilum.

Now let us have a glance on its parts :

It has the following parts :

2 surfaces : (1) convex diaphragmatic surface related to the left 9th , 10th , 11th Ribs
- with its axis parallel to left tenth rib -

) Concave visceral surface related to the stomach

2 Poles : (1) upper pole
(2) lower pole

please see page 2..

2 Borders : (1) superior border ( notched )
(2) inferior border ( sharp , smooth)

what about its arterial supply and venus drainage ???

Arterial supply ----> splenic artery (which is a branch from ciliac artery )

Venus drainage ----> Splenic vein ( which end at the portal vein )

Do know, my dear colleague ,that the Spleen follow the [ all or none ] rule !
That means that when its ruptured it should be removed , because if not it will cause a huge internal bleeding..

That’s enough about the spleen ….. lets talk briefly about pancreas

Pancreas

Little notes :
- acompound retroperitoneal endocrine and exocrine gland ( about 15 cm )
- comma-shaped extending from the 2nd of duodenum to the hilum of spleen
- located in the epigastric and left hypochondriac regions.

Has the following part :

1- HEAD : within concavity of the dudenum , received common and accessory pancreatic duct , bile duct course from behind !
2 -NECK : having the portal vein located behind it

please see page 3…..
3 - BODY : logest part , triangular in C.S splenic vein passing behind it
Splenic artery passing superior to it.

We said before that it is an endocrine and an exocrine gland at the same time.…..

Endocrine part : with in islets of langerhands : secreting 2 hormones :
1. Insulin : lowering the suger level in the blood
2. glucagon: elevating the suger level in the blood
Exocrine part :pancreatic duct : secrete to 2nd part of dudenum by :
- main pancreatic duct - accessory pancereatic duct

4 - TAIL : located at the hilum of spleen

good note : in future when you have a patient you should lay him/her on his/her back this is called “ supine ( recompetent) position “
**********************************

First you should all meet Nerdoosh ! He is an expert at embryology and he is helping us out with the last embryo sheet !!

Nerdoosh : before I start I feel I should straighten out a couple of things !

1-Blast : Original
2-Cyst: Sac
1+2 = BLASTOYCYST = ORIGINAL SAC

3-Mere : Subdivision
1+3= Blastomere = ORIGINAL SUBDIVISION

And with this my lecture shall begin !

This is a Continuation of the series of events of day 13 :

By the end of the second week the blastocyst is completely implanted and the endometrial implantation defect is healed .

Bleeding might occur occasionally !

Nerdoosh : it is around the 28th day of the lady's menstrual cycle !
14, ovulation day + ~ 13 days of pregnancy = 28!!!!!

Cellular columns from Cytotrophoblast invade the Syncytiotrophoblast forming the Primary Villi which is the beginning of placenta.

** I think you should start concentrating! New stuff starts here!

Primary villi will form secondary villi and then tertiary villi which is the final form of placenta.

At this time the intercommunication between the embryo – embryonic blood to be specific – and its mother's blood starts . However ,this communication is not complete ! Both are separated by a highly selectively permeable membrane.

*Nerdoosh : This permeable membrane is selective ! Not all that comes into mommy's blood will pass through… Nutrients are an exception and unfortunately so are the viral particles of measles and AIDS.

** :) If you guys just take a look at the hand out of this lecture you will notice something called "Connecting stalk" , this stalk forms the umbilical cord later on ! :) **

Once the embryo enters its third week , at day 15 , Gastrulation occurs .

Nerdoosh : Gastrulation is a process during which the morphology of the embryo is restructured by cell migration . It will change from a Bilaminar embryonic disk into a Trilaminar embryonic disk.

** You might want to take a look at your hand outs :) **

*Rapid development marks the beginning of the embryonic period : 3rd week – 8th week

*********************

Gastrulation explained!

1-At the beginning of the 3rd week a narrow line called the primitive streak is formed at the middle of the still Bilaminar embryonic disk.

2-Epiblast from the periphery will migrate towards the primitive streak, forming an elevation or a groove called "primitive groove".
3- Some of the migrating epiblast cells will migrate downward in the groove forming mesoderm ( it is between epiblast and hypoblast )
4-some will go down further to replace the hypoblast and give endoderm
5- Remaining cells will replace the epiblast and form the ectoderm. And with this the embryo is Trilaminar :)

Nardoosh: at this point I think we all arrived at the same conclusion! All body layers are derived from the epiblast!!

· Each layer is responsible for the formation of certain organs during the embryonic development.
1- Ectoderm: Nervous system + Epidermis of the skin.
2- Endoderm: Endothelial lining of digestive system, respiratory system etc.
3- Mesoderm: muscles, tendons, ligaments, bones, cartilage & blood vessels !

Nardoosh: Mesoderm is obviously the most important layer of all 3 layers ( AKA: germ layers ) .

With this I shall bid you farewell and leave room for Wa3d's and 3attili's longest dedication ever! Those 2 are breaking the record of the longest dedication written in the history of sheet writing if there is such a thing !

We, wa3d w 3abdelra7man , hope that we introduced a understandable and easy-to-study sheet :)

We feel obliged to thank Dr. Maher Hadidi for all the effort he exerted in teaching this course :)

We also wish you people the best grades in this course and future ones … Inshallah we will all make amazing doctors in the future ! Just remember: If you are going through hell , keep going on ! ** WE DIDN'T MAKE IT UP , SUM1 REALLY SAID THAT ! **

AND Finally we want to dedicate this sheet to our beloved friends and to all our colleagues in this faculty……

Shu r2yak 3attili nebda bel ladies be ma eno ladies first ?

Zein Najada ( eta oshkot ) , Haya Qudah ( finally a dedication … Yeppieeeee w 3attili b7gezlik el marah ele jay ! ) , Jamila 7iesat ( a7la ta7yeh la sokan jomhoriet al sal6 al sha8i8a ) , Suzan Mbydeen ( sum people r still waiting 4 that mansaf gurl ) , As7ar Tarawna , ala2 7jazi , Shatha 3attili ( 3ala rasi che guevara ) Dania Dahmash , Bayan 5door,saja 3r3r , Suzan Momani , Ruba al mu7taseb , Lamoosh jamal , Sawsan tabaza , Sondos al 5ateeb , Elham Qudah (dedication ^2 :P) , Batoul 3toom , Nadine 3adayleh , , Dana mel7em Tamara Darweesh , raya 7alawani , magd 5adr, amal 7osban ,Manar Jwainat , Fara7 mashagbeh , 3abeer 5watra, samar 68a68a , muna talal ( 3al 3afyeh:P) , ala2 jabre ( el m63m mo elhm :) ) , dana 6awalbieh ,Samar al ra7meh , nisreen abu 3osbeh , rawan 3'azal , rasha jabra , ala2 3abid, jeelan , suzan al musa , Isra2 zawawi , dina 3ammari , aya bani kinana , rozana ziadat , asma , lana 7adadin , ruba halaseh, dina ramini , razan abu dieh , rawan ( lovek 4 taking psycho :D ) ,ala2 7laisi, aseel abu shanab , du3a2 jara7 , du3a2 abu jame3, aseel al sayed ,dima , nadia ,rawan sale7,nuha, ,yasmeen el so5on , anne nimri !!

And with no further delay, the guys :

Ahmed el isa ,(abuel3ss) , ,fr7an el kooz ( jovial ) ,) wa2el 6o8an (alf mabrook:P) , ayyoub (yellow smile ), , 5alid 7gair (4-2-4) , m7md abu hanieh ( abu gor3a ;) , w aseem samara ( kasha6a),shaker borhm , hammam realat , m7md shawaf ( 3a rasi kol el i6allieh )fadi halaseh, yezan 3tom( ml7 3l sala6a) , martin qaqesh(kef el shbab) , bashar el rama7i , 3omar el lozzi ( neshfat el mae) , nidal matani (no visa,no league, no thing :D), 3’aleb 5rfan , 7amzeh 9araiera , m2moon sha3ban (ma bnnsak) , yazeed neef , abu 7alaweh , mo2ayad kettane ,sami 3abdeen , a7mad 3abed, 3amer 7ajaj,m7md saree3 , m7md maslamani , Bandar maslamani, 7amzeh jassar ( elsalam la allah ;p) , m7md el sboo3 , 7amzeh 9bai7 , , rami yagi, hashim abu m7fooz, zain rostom ( 3ala rasi walla) , nemer sh5shier , 3mr el 5alili , 3esa 38el , zaid 8ndeel, 3omar dodeen , bashar sharma ,7anna barghoth , tamimi ,8osai abu 3azzam , zaidon , 3bdelr7man el 56eeb , m7md 3’naem (pre-sheet), mostafa aburahmeh , a7mad abu 5adegieh, , m7md 8awasme , abu qamar , abu d3aig ( allah be3en 3l basa6 ), a7mad shalabe , el shareef , 3omar radaiedeh , yazan radaideh ( m5drat ) , , laith 7addad , osama , yazeeed 8aesieh , waleed 8adre , osama farrogeh ( farrogte) , mohanned ( ya 7abibi la t3eed wrae) ,A7mad 7orani ( hay dedication 3ashan ma t7ke 3an el sheet tb3tna!)

Ma azon nsena 7ada… :P

Wa 5etamoha mesk m3 wa3d Sweilmyeen w 3bdelra7man 3attili :D ….
Best wishes..

---WE LOVE YOU ALL, THANK YOU ALL---

Note:- organic final exam will be from (3:00-5:00) PM
-islamic culture final exam will be on 4/6/2008 at 11:30 in IT

** Corrections are in purple bold...becareful !!

sheet no.38

2008-05-22T10:03:00.006+03:00

sheet6بعد النجاح الباهر الذي حققته

و بعد تزايد الطلب من كثير من الطلبة على تكرار التجربة فقد عزمنا و بسم الله نبدأ

Accessory digestive glands:

(1) LIVER:

- It is the largest gland in the body.
- It is located in the:
* Right hypochondriac region.
* Epigastric region.
* May extend to left hypochondriac region.
- It weighs about 1.5 kg.
- In newborn it represents about 10% of weight because it produces RBCs.
- In adults it weighs about 2% of their weight.
- Before birth and until the 3rd month we depend on liver in the production process of RBCs and that is why it represents 10% of newborn weight.
- It is completely an intraperitoneal organ except for 3 areas.

#Divisions:

- Divided into: - Right lobe (large)
- Left lobe (small)
by falciform ligament (c-shaped) "الرباط المنجلي" which is a double layer of Peritoneum between anterior abdominal wall and liver.
- At the free margin of falciform ligament there located ligamentum teres (الرباط الدائري) which was containing umbilical vein.

#Shape:

* From anterior view it is triangular in shape with:
- Superior border.
- Right border.
- Inferior border.
To look nearly like “La Vache qui rit” .

* The inferior border divides the liver into 2 surfaces:
1- Diaphragmatic surface: which is large and convex.
2- Visceral surface: which is concave.
* Below visceral surface we have the right kidney, that is why the right kidney is lower in position than left one, and right lung is higher than the left one due to the large mass of the liver.

-At visceral surface there is an H-shaped area formed by the following:
* right limb of the “H” formed by:
- inferior vena cava (superior).
- Gallbladder (inferior).
* left limb formed by:
- inferior fissure (for ligamentum teres).
- superior fissure (for ligamentum venosus).
* cross bar formed by:
- porta hepatis (the umbilicus of the liver) which contains the hepatic duct, hepatic artery, portal vein. (the duct is anterior / the artery is itermedial / the vein is posterior)

- Since the liver at the visceral surface has an H-shaped area it is divided into 4 lobes:

(1) Right lobe.
(2) Left lobe.
(3) Caudate lobe:
Boundaries:
- inferior: porta hepatis.
- superior: superior border.
- right: inferior vena cava.
- left: fissure for ligamentum venosum.

(4) Quadrate:
Boundries:
- inferior: inferior border.
- superior: porta hepatis.
- right: gallbladder.
- left: ligamentum teres.

- Functionally quadrate + cudate lobes are parts of the left lobe according to arterial supply, venous drainage and bile secretion.

#Arterial and venous supply of the liver:
1- Hepatic artery (branch from celiac artery) brings about 20% of blood to the liver itself.
2- Portal vein brings about 80% of deoxygenated blood from digestive tract for filtration and detoxication.

#The liver is completely intraperitoneal except for 3 retroperetorial parts:
1- Port hepatis.
2- Between Gallbladder and right lobe of the liver.
3- Bare area of the liver at superior border between liver and diaphragm. (important in cancer and from there the disease can go to the posterior mediastinum.

#Pain from liver is usually felt in right side, epigastric region.
- You should differentiate between pain from stomach and the pain from liver:
If the pain is coming from right side and going up towards the right lung >> then the problem is in the right lobe. (left lung > left lobe)

#Function:
· Main function of the liver is filtration.
· Other important functions:
1- Pile formation and secretion (for fat digestion)
2- RBCs’ formation in the embryo and the first three months after birth.
3- Detoxification (e.g. after drinking alcohol)
4- Storage of glycogen.
5- Important in blood clotting. (if we have a patient with تليف الكبد then the healing of the bleeding will be not easy)

(2) GALLBLADDER:

- Elongated pear-shaped sac.
- Close to the visceral surface of the right lobe of the liver.
- Normal capacity: 30 ml.
- Function: Storage and concentration of bile for about 10 times.
- Parts:

1) Fundus:
- Projects beyond inferior border of the liver.
- Completely intraperitoneal.
- Located below the tip of the right 9th rib.
- If the patient has a pain in the tip of the right 9th rib region then we should think of inflammation of Gallbladder which is called (colisitisis)

2) Body:
- The largest part.
- concentration area.

3) Neck.

4) Cystic duct
(قناة الحويصلة) which unites
with common hepatic
duct to form the common bile duct. (cystic duct + common hepatic duct = common bile duct)

- Arterial supply of Gallbladder is through a branch of celiac artery.

اخيرا و ليس اخرا اود ان اهنئ جميع زملائي بالدفعة بمناسبة انتهاء الفصل الثاني من السنة الاولى فلم يبق الكثير (هانت كلهم 16 فصل:D)

و اتمنى للجميع التوفيق في امتحاناتهم و دراسة ممتعة للجميع :) ولو اردت ذكر جميع الاخيار(او الشطار) لاحتجت الى مئات الجدران و لكني اذكر من تذكرت (فأحلى تحية لكل الشباب

وبما انها الsheet

قبل الاخيرة فحبيت اتذكر اكبر قدر ممكن و اخص بالذكر:

Razan 3moosh (w hay awal wa7adeh betmoni :P) , YAZAN 3TOOM , 3bdelra7man 3attili , Far7an Elkooz , Martin Qaqish , 3’aleb 5erfan , Wa2el 6o8an, Yasmine Elsukhon , Aseel Zein Eddin , 7amzeh Sarayra , Raya 7alawani , M7mmd 3arabeyyat , Zaid 8endeel , Elham El8dah , Dina 3mmari , Bandar Maslamani ,Ayoub 3ennabi, M7mmd Maslamani , Muna Talal , Samar Taqatqa , Fadi Halaseh , M7mmd Abu 5alaf , M7mmd Shawaf Qtaishat , Hammam Ryalat , Sami 3abdeen , A7mad 3abed , 3omar Abu Gamar , Rami Salameh , Ayman D3ja , Yazeed 8ayseyyeh , Osama , 7amzeh Jassar , Ma2moon Sha3ban , A7mad Abu 7alaweh , Yazeed Elnaif , 5aled 7ajir , Mo2ayyad Kettaneh , Yousef Kettaneh , Feras Elnemer , Walid El8adiri , Yazan Radaydeh , 3omar Radaydeh , Dana 6walbeh , A7mad 7ara7sheh , 3omar Ellowzi , Bashar Elrama7i , Bashar Sharma , 7amzeh Sbai7 , 3bdallah Tayyem , M7mmd Elmomani , Shatha El3attili , Amr El5alili , Tamara Darweesh , M7mmd Fadel , Zakareyya , Bilal Abu Dhaim , M7mmd Abu Haneyyeh , Waseem Samara , Shaker Barham , A7mad Elshalabi , Ala2 Jabri , Noorhan , 3amer 7ajjaj , Zain El3abedeen , Nemer Sha5sheer , Nidal Matani , 3eesa 3a8eel , M7mmd 8awasmi , Majd 5ader , Amal 7osban , 3omar Dodin , Zaid Shmaisani , 7anna Bar3’oot, Mus6afa Abu Ra7meh & for all Jubilians :D

best wishes;

A7mad El3eesa

sheet no.37

2008-05-20T23:31:00.004+03:00

Notes for the last lecture:

-Outer cell (trophoblast) mass is nutritious.

-blastocyst cavity is the pool that allows the embryo to grow the way he wants freely.

Implantation

-Pregnancy starts when the Blastocyst loosely attached to the endometrium at Day 6(from fertilization)---->anchored implantation.

-Trophoblastic cells above inner cell mass attached to uterine wall by invading its epithelium and underlying stroma.

-At Day 7 implanted Blastocyst interrupted the regular sexual cycle affected by hCG hormone production from trophoblastic cells of the implanted Blastocyst.

*hCG---> (human Chorionic Gonadotropin)

-Chorion: Fetal portion of placenta.

-Gonad : sex organ (ovary here).

This hormone prevents degeneration of corpus luteum (C.L.)--->in the first 3 months, and maintains it as C.L. of pregnancy.

*Remember that C.L. will degenerate at Day 28 (from ovulation) and become corpus Albicans if no fertilization occurs.

-So we can detect pregnancy at Day 7.

At Day 8:

The trophoblastic cells differentiate into 2 layers:

Inner layer: Cytotrophoblast (mononucleated distinct cells).
Outer layer: Syncytiotrophoblast (multinucleated protoplasmic mass lacking cells) which is highly energetic.
Both 2 layers become part of the chorion.

The inner cell mass (Embryoblast) differentiates into 2 layers:

1- Hypoblast (with cuboidal cells) àendoderm to be.

2-Epiblast (with columnar cells) àectoderm to be.

Both layers form the Bilaminar embryonic disc.

A small cavity appears within epiblast then enlarges to be the Amniotic cavity.

Notes:

-The embryo has 3 layers:

Ectoderm (outermost).
Mesoderm (middle).
Endoderm (innermost).

-In Day 8 it will forms 2 layers & 2 cavities (Weak 2 loves no. 2).

-Until now there is no complete implantation.

Day 9:

Notice that:

-Syncytiotrophoblast will spread around(beldozer).

-Blastocyt embedded deeply in endometrium.

-Sycytium show small fluid-filled cavities (vacuoles)àfuseàto form trophoblastic lacunae.

* Lacunae mean---->cavities / small lakes.

Days 11 & 12:---->complete implantation

Trophoblastic lacunae fused to form lacunar network which communicate with maternal sinusoids to establish the Uteroplacental circulation which is the first communication between the mother & the embryo.

Day 13:

It has 3 main events:

Endometrial implantation defect healed.
Bleeding occasionally occurs at implantation site at Day 28 (from ovulation) of normal cycle?
*The bleeding may fool the lady and make her think that she is having her period.

Cellular columns from Cytotrophoblast invading Syncytiotrophoblast forming Primary Villi which is the beginning of placenta.
Cytoplast will form finger like pillar & penetrate inside forming Primary Villi.

*Now we have completely implantation (implantation ends at day 13).

Note: Fertilization occurs at Day 13 of ovulation so when we want to do the math we add 13.

e.g.: Day 8 from fertilization = (8+13=21) Day 21 from ovulationàsecretory phase of uterine cycle.

-so by day28(13 from fertilization) the embryo differentiates into 2 layers(endoderm-ectoderm) and placenta will have started then.

"Two little mice fell in a bucket of cream. The first mouse quickly gave up and drowned. The second mouse, wouldn't quit. He struggled so hard that eventually he churned that cream into butter and crawled out. As of this moment, I am that second mouse."

I want to dedicate this sheet to:

Children of Palestine, Iraq & Lebanon (You are the real men).

And to all my friends who:

-Study on medicine faculty:

5aled 7ajeer(Mr.”bla 10 3la al shagarah”),Ebraheem Abo Dya, M2moon sha3ban, Ahmad Abo Hallawah, Osamah 5aleel, Ahmad Abo Khadeegah ,5aled Daye3, Yazeed Al-naif , Yazeed Qaisyah , M2yad Ketaneh,7amzeh jassar , Qosay 3zzam ,Moh. Tamimy, Moh. Momany , Yazan 3toom(y36eek el 3afyeh) ,3dnan Al-3aref (ya 7ram Chelsea) , mo2men K7aleh , Abd Allah Tayyem ,Ebraheem Al-Sa3eedy , Moh. Al-quasmeh ,Moh. Abo 3rjah, Ahmad 7ra7shah , Ahmad 7na6y , 9ohayb Al-3bady , samy 3bdeen , Ahmad Al-shalabi, Moh sbo3, Zaid mal7ees .

-Study on other faculties:

Sa2ed kharoob, Moh. Bdar, J3fary (The tall) ,Ahmad (Sokkar) , Mahmood & ahmad Abo Znai6, Monther, Ahmad hamshary , 6ohayb, shukri, 30mar semreen,Wael 3lawneh,Muhannad,Nusaiba .

-Study on other Universities:

3la2 mara3’y, Wael Abo Hassan, Fat7y, Moh. Faroq, 7osam.

-Study on other countries:

Abo hmade (King kong) , Marwan 5amees.((In Egypt)).

J3fary”the short” (sht2nalak wala) ((In U.S.A.)).

-And to Dr. Maher Al-Hadidi.

-And to my little brother Hashem Al-Faqih.

*And to people who are special to my heart*

Mohammad Al-Faqih

sheet no . 36

2008-05-12T22:53:00.003+03:00

Small Intestine:

- It is a complete intraperitoneal tube, about 6M in length.
- Extending from duodenojejunal junction to the ileocecal junction.
- It extends from the left side(beginning) to the right side(end) of vertebral column.
- They are anchored to the posterior abdominal wall via fan-shaped double layer of peritoneum called mesentery of small intestine.

- Divided into 2 parts:

1. Jejunum.
2. Ileum.
These parts are known by their specific features,,
--> Jejunum:
* Representing 2/5 of small intestine = 2.5m.
* Larger in diameter.
* Thick in wall.
* Red in color (because of high vascularity; high absorption).
--> Ileum:
* Representing distal 3/5 of small intestine = 3.5m.
* Smaller in diameter.
* Thin in wall.

* Pale in color (less vascularity; no need for efficient absorption; semi-solid food).
- Arterial supply of small intestine: by Superior Mesenteric Artery.
- Venous drainage of small intestine: to the portal vein.

- Location: located around umbilicus, that's why colicky pain from small intestine is usually felt around umbilicus.

Large Intestine:

- Forms a frame around small intestine.
- Consist of:
(1) Appendix.
(2) Cecum (one-way tube).
(3) Ascending colon.
(4) Hepatic angle.
(5) Transverse colon.
(6) Splenic angle.
(7) Descending colon.
(8) Sigmoid colon.
(9) Anal canal and rectum.
- All of it is intraperitoneal except: ascending colon and descending colon, acting as pillars.
* Appendix:
- Intraperitoneal blind tube (highly mobile), with mesentery.
- Longer in children, shorter in old ages, that's why appendicitis is more common in children and young adults.
- Has base, which is fixed, and apex, which is mobile.
- Positions of the tip of appendix (apex):
1) Retrocecal (behind Cecum, as Retro ≡ behind) at 12 o'clock à (64%).
2) Pelvic (in the pelvis) at 6 o'clock à (32%).
3) In the left side at 3 o'clock à (1%).
4) In the right side at 9 o'clock à (2%).

♣NOTE:
- Below appendix we have the femoral nerve, so a patient with appendicitis:
• who is flexing his hip as he couldn't extend it because that will irritates the femoral nerve causing pain --> Retrocecal Appendicitis.

• who has problems in urination, problems in uterus or ovary in female, and constipation or diarrhea --> Pelvic Appendicitis.

- Appendicitis is less common in old ages also because the appendix is transferred into fibrous tissue in old adults [Atrophy], and it's shorter.
- By a line extending from anterior superior iliac spine to umbilicus, we can allocate the base of appendix : at the point between the medial 2/3 and the lateral 1/3.

* Cecum:
- Intraperitoneal blind tube.
- Located in the right iliac fossa (over iliacus).
- Recieves ileum, and gives appendix and ascending colon.

♣ It is the site involved in constipation, so any problem of constipation will affect iliacus and femoral nerve, and vice versa.

* Ascending colon:

- Retroperitoneal.
- Close to right kidney and right ureter (in the right lumbar region).

* Hepatic angle (Right angle):

- Between ascending and transverse colon.
- It is related to visceral surface of liver (in the right hepatic region).

* Transverse colon:

- Intraperitoneal.
- Extending from hepatic angle to Splenic angle ( from liver to spleen).
-->Proximal 2/3 is supplied by Superior Mesenteric Artery.
--> Distal 1/3 is supplied by Inferior Mesenteric Artery.

*splenic angle:

- higher in position than the hepatic angle, that's why gases are collected in the splenic angle, causing pain in the left side of abdomen that is exaggerated when the patient is standing and fades when he lies on his back.

* Descending colon:

- Retroperitoneal.
- Related to left kidney and left ureter (in the left lumbar region).

* Sigmoid colon:
- S-shaped tube.
- Intraperitoneal.
- located in the left iliac fossa.

** Cecum is located in the right iliac fossa, opposite to it is the sigmoid colon in the left iliac fossa.
* Specific features of Large intestine
--> Haustra (Sacculation); bulges.

They are the site of fermentation of fibers by a bacteria located there.
• Crohn's Disease is caused by the laze of mucosa of the GI tube.

"Education is replacing closed minds with opened ones..."

Sawsan Tabaza . .
I'd like to dedicate this sheet to all my friends, especially:
Sondos Alkhatib (Sannnoon), Ruba Almohtaseb (Apple vs. Carrot :D), Lama Jamal (kf o ana a3rf :p,, o a5eran.. Mabroook Elro5sa :D !!!), Aya Bni-Kenanah:D, Samar Alrahmeh (J), Nisreen Abu-osbeh, Haneen Shraideh, Dania Dahmsh, Ruba Halaseh, Shatha Atteli, Waed Swaelmeen, Suzan Mbaydeen, Jamela, Najd Quraan, Rawan Saleh, Zein, Ala' abd alra'ouf, Bayan Alkhdoor, Rasha Jabra, Aseel.

And to all my colleagues.
Special thanks for: Yezan 3toom, Ahmed Abu-khadigh, and Hamza Jassar.

sheet no . 35

2008-05-12T22:23:00.002+03:00

*The Stomach*
it is the upper dilated part of the GI tube.
Located in the epigastric, umbilical & left hypochondriac regions.
Its normal shape is (J) shape.
It's size small when empty, larger when filled--->it's size & shape depends on habits of eating.
It is a completely intraperitoneal organ with the following parts:
two ends:

→ cardiac end which receives Esophagus.
→ pyloric end which controls evacuation of stomach & continue as duodenum.

*between these two ends stomach is relatively fixed (like a plastic bag filled with water between 2 hands), the rest of it is mobile(expandable).

two surfaces:
→ anterior parietal surface (related to anterior abdominal wall).
→ posterior visceral surface (related to viscera).
SO after eating if you want to lie you should lie on the RIGHT side because when lying on your face you will push the anterior abdominal wall & when lying on back you will push the viscera.
3.two curves:
-Greater curvature: attached with large double layer of peritoneum called GREATER OMENTUM.
-Lesser curvature: it is indented at its bottom forming (Angular notch), attached with double layer of peritoneum called LESSER OMENTUM.
Stomach is attached to its neighbors through Greater & Lesser omentums.

*Parts of Stomach:

Fundus:

Highest (upper) part of stomach, always filled with gas.
Note: If you eat large amount of food the gas will push the diaphragm then to the left lung so you cannot breathe properly.

Body (main part):
Largest part of stomach, it is the blender & mixer of food with gastric juices like HCl.

Pylorus:

Start at Angular notch THAT'S WHY angular notch is a good clinical landmark to separate Pylorus from Body of stomach.
it has 3 parts:
1.Pyloric Antrum
2.Pyloric Canal → through which food transferred from stomach to duodenum.
3.Pyloric Sphincter → control evacuation of stomach.
Note: when the milk return back in new born baby that's because the Sphincter is closed (the stomach will appear soup-dish like → stomach dilation will cause feed back).

*The wall of stomach formed of the following layers: (from in to out)

I. Mucosa: thrown into longitudinal folds called RUGAE to increase the surface area for efficient absorption & digestion.

*Opposite lesser curvature there are 2 permanent longitudinal folds having a canal between them called (Gastric Canal) which is the common site of Gastric Ulcer. BECAUSE the 1st sip of food is passing through gastric canal so we should begin eating with water or anything that soothes mucosa (milk, salad…) & the other food then will go without causing Gasteritis.

II. Submucosa
III. Muscolosa: (Muscular layer)
Formed of 3 layers:
→ outer longitudinal
→ middle circular to form Sphincter
→ inner oblique
IV. Serousa
-Arterial Supply: stomach supplied through branches from Celiac artery.
-Venous Drainage: stomach drainage from GI tube is carried through Portal Vein loaded with products of digestion & foreign substances to be carried to the liver then to inferior vena cava for filtration from harmful substances absorbed.

*Duodenum*

-(G) shaped tube, about 10 inches in length
-extending from stomach at Pyloroduodenal junction & end at small intestine in Duodenojejunal junction.
-surrounding(embracing/framing) the head of Pancreas.
-Divided into 4 parts:
The 1st part
- Crossing L1
- horizontal part
- 2 inches in length → the 1st inch is intraperitoneal
→ the 2nd inch is retroperitoneal
The 2nd part
- Parallel to right side of L1,L2,L3
- descending part
- 3 inches in length, retroperitoneal
- it is important part because receives CBD (Common Bile Duct) & Pancreatic Duct.
- site of digestion of Protein & Fat.
*Site of interance of CBD divides the duodenum into:
1. Proximal part developed by Foregut → supplied by Celiac A.
2. Distal part developed by Midgut → supplied by SMA (superior mesenteric artery).
The 3rd part
- Crossing L3
- horizontal part
- 3 inches in length, retroperitoneal
- crossed by superior mesenteric vessels.
The 4th part
- extending from L3,L2 above (parallel to them)
- ascending part
- 2 inches in length
→ proximal inch is retroperitoneal
→ distal(last) inch is intraperitoneal (due to connection with small intestine to be in mobility)
THUS, all duodenum is retroperitoneal except the 1st & the last inches.
**the lengths of the 4 parts from 1st to 4th are (2-3-3-2)
Arterial Supply:
- Celiac Artery for proximal part.
- Superior Mesentric Artery (SMA) for distal part.

*****************
Finally, I want to dedicate this sheet to all medical students especially:
Nesreen Abu Osba(zoro is the best), Amal Al7elo(You're the best) ,Sawsan Tabaza(snsn thanks), Sondos Al5teeb(tararara!!), Heba Nemer(miss purple), Heba Abu 5eran, Lama Jamal(twirl!), Ruba Almo7tseb(wd3k bel7yah), Aya Bni Kenanah, Rawan Alrajbi, Rawan Sale7, Rawan Ghazal, Ala2 3bd Elr2of, Do3a2 Abu Jame3,Byan 5door, Zein Njada, W3d Swylmeen,Suzan Mbydeen, Jamela, Rasha Jabra, Nadia, Dima, Ala2 7jazi, As7ar,Rand Abu Lubdeh ,Lubna, Samar Taqatqa, Muna, Do3a2 jra7,Do3a2 Al3antri, Najd AlQur3an, Aseel ,Ruba Halaseh, Nuha.
"الزهور كائن هش جداً .. وحتى لا تتكسر أثناء الأمطار يجب أن تكون مغطاة .. كما أنها أيضاً تحتاج إلى ضوء الشمس حتى لا تذبل .. وإذا هبت العاصفة فلا فائدة من الغطاء..."
Best Wishes, *SSRH*
Samar Al-Rahmeh
ملاحظة: لقد تم تغيير موعد الامتحان النهائي لمادة الثقافة الاسلامية لطلاب الطب بحيث أصبح 4/6/2008 بدلا من 7/6/2008 الساعة 11:30 في مبنى ال
IT

Pictures : Fertalization

2008-05-07T22:40:00.005+03:00

sheet no.34

2008-05-07T18:10:00.005+03:00

At ovulation (day 14) the secondary oocyte usually come from the ovary due to the effect of surge (large amount) of luteinizing hormone, at that time it is ready for fertilization.
Each ovulated secondary oocyte at that time is covered by 2 layers :-
-outer layer (corona radiata) which is part of the follicular cells.
-inner layer (zona pellucida) a transparent layer which is produced by the outer follicular cells and composed of glycoprotein.
(the secondary oocyte is in 2nd meiotic stage)

Fertilization:

A process by which haploid male gamete fuse with female gamete to give single diploid nucleus.
Normally occurs 12-24 hours after ovulation while the ovum in the upper part of uterine tube.
N.B
(-only 300-500 sperms out of 300 million can reach ampulla where only one of these fertilize the oocyte
-the trip from cervix to oviduct needs 2-7 hours)
Arrived sperms are unable to fertilize oocyte except after 7 hours of conditioning in female genital tract for
1. capacitation: epithelial interaction between sperms and mucosa.
Only capacitated sperms can enter corona radiata and undergo acrosomal reaction
2. acrosome reaction:
Acrosome which is located at the head of sperm enter the ovum in 3 steps:
*penetration of corona radiata :( not all of sperms enter the corona radiata but only many of them enter) by entering the corona radiata, corona radiata will change interaction with other sperm
*penetration of the zona pellucida: the acrosome will secrete digestive enzyme locate in the acrosome which called acrosomal enzyme specially acrosin which is received by receptors on zona pellucida called ZP3 glycoprotein which act as sperm receptors that trigger acrosin to digest a path through zona pellucida.
*fusion of membranes: after gametes are contacted membranes of gametes fused, head and tail of the sperm penetrated into the cytoplasm
Oocyte response
1- cortical and zona reaction:-depolarization of oocyte membrane prevent poly spermy(entering of more than one sperm) -inactive ZP3
2-resumption of 2nd meiotic division: female pronucleus + 2nd polar body
3-meta bolic activation of oocyte
Result of fertilization:
1-restore diploid number of chromosomes
2-stimulate resuming 2nd meiotic division
3- determines the genetic sex of the new individual
4-initiates cleavage about 24 hours post-fertilization

After fertilization of secondary oocyte it will form female pronucleus and there will be a male pronucleus

Male pronucleus will approximate female and sharing same membrane and chromosome will intermediate (the DNA will duplicate) , then the 2 pronucleii fused forming onr membrane (one nucleus) with male and female chromosome which will aline at equator , then division will occur to give two-cell stage.

Morula: a ball of cells appearing from outside and (the number of cells is 16 at the early morula but it will become 32 at late marula) it will start entering the uterine tube.
At day 6 it will wander inside uterus
(N.B the uterus at that time is in secretary stage under control of progesterone)
When arrive this area the secretion will enter inside the marula
The fluid of uterine will enter between the marular cells separating it into:
-inner cell mass (Embryoblast) which give the embryo
-outer cell mass (trophoblast)
-cavity

At this stage the morula is ready for implantation.

To all my friends specially:

A7md 2bo-7lawe, yazeed al-naif, 5aled 7ajjir, mo2ayyad kettane ,yazeed qayseye, osama 5aleel, qusai al 3azzam, a7md 2bo 5deje, a7md al-shalabi,
Amjd 3yyash (el 8a2ed el ramz), 7amze jassar,m7md al faqeeh, 3omar el 7aj,
Yazan 3toom, nidal matani, m7md qteshat(mesh naseek ylle nasene), m7md sboo3, a7md 7ra7she, 9ohaib el 3badi, ibrahim 2bo deyye ,ibrahim el 93idi, hmmam ryalat, 7azem, m7md tyseer, sami 3abdeen, a7md el 3esa, 3bd el ra7man 3attili, mo3ath el zo3bi, martin qaqeesh, 3'aleb 5erfan, m7md bdr,
m7md 2bo haneye, zaid qandeel, 3amer 7jaj, 3omar el-lozi, mo2men k7aleh, m7md qawasmeh
w slam 5a9 la el shbab msh el 6eb:
Muhannad bdair(Hannood)
Wa2el 3lawne
Nusaiba el jalodi
3omar smrain
Special thanks to yazan 3toom

****With best wishes from
Ma2moun sha3ban

"don't limit your challenges ,but challenge your limits"

sheet no.33

2008-05-06T15:40:00.003+03:00

Nerve Supply of The Anterior Abdominal Wall:

▪ Skin of the anterior abdominal wall supplied by lower six intercostals nerves ( T7- T12 ) and first lumbar ( L1 ).
▪ Umbalical level supplied by T10.
▪ Infrasternal angel supplied by T7.
▪ L1 supply the skin above inguinal ligament(commonly involved in acr accidents).
→ pain around umbilicus is carried through T10.

PERITONEUM

• a thin serrus complete membrane that lines the walls ( inner surface ) of the abdominal cavity and the abdominal organs either completely or partially.
• it divided into two layers:
parietal layer: lining inner surface(wall) of the abdominal cavity.
visceral layer: lining abdominal organs(viscera).

ABDOMINAL CAVITY

It is a potential space between the two layers, vacuumed ( no air, no pressure )
If anything collected there as air, blood or fluid,it becomes true space.

ABDOMINAL ORGANS

• organs covered completely by peritoneum are called intraperitonial organs, these organs are highly mobile.
e.g. small intestine.
• organs covered partially by peritoneum are called retroperitoneal organs, these organs have restricted mobility.
e.g. duodenum, kidney.

AORTA

- Abdominal aorta is the direct continuation of the thoracic aorta.
- begins at aortic opening in the diaphragm at the level of T12.
- it will end at the level of the fourth lumbar vertebra ( L4 )[opposite to it] by dividing into right and left common iliac artery ( CIA ).
- it gives single branches and paired branches.
Single branches are three in number:
Celiac artery.
Superior mesenteric artery ( SMA ).
Inferior mesenteric artery ( IMA ).
Mesentery: double layer of peritoneum containing arterial supply, venous drainage, lymphatic drainage and nerve supply of a specific organ.-->hilum.
Gastrointestinal System ( GIS )
It divided into:
GI tube: extending from mouth to anus.
Accessory glands: like salivary glands, liver, gall bladder and pancreas.
*Tube is divided into three parts(thirds):
Proximal part called FOREGUT.
Mid part called MIDGUT.
Distal part called HINDGUT.
-Each of them compose of number of organs.
▪ Foregut is supplied by celiac artery.
▪ Midgut is supplied by superior mesenteric artery.
▪ Hindgut is supplied by inferior mesenteric artery.
Esophagus
A muscular tube about 10 inches in length= 25 cm, extending from distal(lower) end of pharynx to the cardiac opening of stomach.
It is passing in three regions: neck, thorax and abdomen so it has three parts: cervical, thoracic and abdominal.
Each region is responsible about arterial supply, venous drainage, lymphatic drainage and nerve supply of the part passing through it.

I want to dedicate this sheet to my friends:

Samar Alrahmeh ( wallah tobeh ☺), Amal Alhelo ( meloloppa ), Aya Bani kenana, Sawsan Tabaza, Ruba Almohtasib, Sondos Alkhateeb, Lama Jamal, Hiba Abu khairan, Rawan Alrajaby, Lubna Salameh, Rawan Ghazal, Rasha Jabra, Alaa Abd Alraouf, Doaa Abu jamea, Bayan khdoor, Rawan Saleh, Najd, Doaa Tawfeeq, Doaa Jarah, Suzan Mbydeen, Jameeleh, Waed Swaylmeen, Zain, Ala` Hjazi, Ashar, Nadia Hasan, Dema Abd Alkareem, Dania Dhmsh, Shereen, Aseel Alsayed, Lara Harahsheh, Doaa Mhmd, Muna, Samar Taqatqa, Rasha Husain, Abeer, Manar Jwainat, Noha, Rozan, Amani, Jeelan, Suzan Musa, Aseel Abu shanab, Lubna Abd Alhafeth, Rawan Keswani, Elham, Nadeen, Dina Break.

Nisreen Abu Osba

On our last embriology lecture

2008-05-05T18:53:00.002+03:00

Our colleague Amani Hijjeh stumbled upon an animation of our last embriology lecture and she wanted to share it with us !

Click here to check it :D

Thanks Amani ... Keep 'em coming gurl !

sheet no. 32

2008-05-05T17:48:00.003+03:00

Abdomen
Extends from thorax to pelvis with the following borders:

Superior border(roof) :diaphragm

Inferior border(floor): pelvis inlet “there is no real floor” it is imaginary

.
Anterior border: anterior abdominal wall.

Posterior border: posterior abdominal wall.

There is an abdominal cavity that contain inside it abdominal organs.
………………
Costal margin:

It forms by lower end of the inter connected costal cartilage - C.C - of (rip 7- rip10).

The lowest part(end) of the C.M is marking the tip of the 10th rip(subcostal line).

The line that inter connect the tips of both 10th ribs is called subcostal line. This line located at the level of L3 vertebra.

Intertubercular line:

It is a line that connects both iliac tubercles, located at level of L5.

-So we have 2 horizontal lines:

subcostal line

Intertubercular line

**These 2 horizontal lines divide the abdomen into 3 thirds: upper third/ middle third/ lower third.

**the center of the middle third is umbilicus.

-There are also 2 vertical lines called midclavicular lines, extending from mid point of clavicle to mid point of inguinal ligament(midinguinal point).
These 2 lines divide the abdomen into 3 thirds… right/central/ left.
- the 4 lines subdivide the abdomen into 9 abdominal regions called region of references.

So We have 9 referential regions.

Anterior Abdominal wall:

Form of the following layers:
Skin.
Fatty layer of super fiscal fascia.
Membranous layer of super fiscal fascia.
muscular layer that contain 3 layers of muscles:
external oblique
internal oblique
transeversus abdominis.
5. peritonium.
-The muscles of the anterior abdominal wall in the muscular layer divide into
1] 3 peripheral pairs --->(external, internal, transeversus).
-these are flat muscles in 3 different directions to strengthen the anterior abdominal wall..
-Each has fleshy (muscular fibers) origin and (aponeurotic) insertion. Supplied segmentaly by thoracic nerves .
-Ultimate goal of 3 pairs to meet at the central line of abdomen at linea alba (white line).
linea alba:
it forms by interdigitating fibers of aponeurosis of the 3 pairs of these muscles.( is the site of the fusion of the aponeurosis of the 3 pairs)
This line extends from xiphoid process to symphysis pubis
The abdomen from out side divide into right side and left side by this line.
Act as a zipper for these muscles.
-If the fusion is not complete at linea alba the contents of the abdomen will come out (hernia).
2] one central pair --->Rectus abdominis muscles
-2 strap ( like belt)muscles on both sides of linea alba each narrow inferior , wide superior located within the aponeurosis of the peripheral muscles.
-they are innervated segmentally.
(This muscle embraced by the aponerosis of the peripheral muscles on there way to lina alba) .
***All these muscles are design for support and protection of ant. Abdominal wall.

***********************
"كن كالنخلة عالية الهمة، بعيدة عن الأذى، إذا رميت بالحجارة ألقت رطبها"

حين يربينا الله يقول الرافعي: "ما أشبه النكبة بالبيضة تحسب سجنا لها ، وهي تحوطه وتربيه وتعينه على تمامه وليس عليه الا الصبر إلى مدة ، والرضى إلى غاية ، ثم تنقف البيضة فيخرج خلقا اخر، وما المؤمن في دنياه إلا كالفرخ في بيضته ، عمله أن يتكون فيها ، وتمامه أن ينبثق شخصه الكامل فيخرج إلى عالمه الكامل

"
أرى البلايا تحيط المرء تحصنه

حتى لئن صح ذوب الصخر لم يذب

أو صح أن قناة الصلب قد وهنت

فلا يلين إذا ما صب في اللهب

ما حصحص الحق إلا بعدما انسلخت

من عمر يوسف أعوام من النصب

سوف يتم تشكيل دوري كرة قدم لطلاب سنة أولى وأي شيء بخصوص هذا الموضوع يرجى مراجعة أحمد حراحشة-محمد شوّاف قطيشات***

sheet no. 31

2008-04-30T18:59:00.003+03:00

Notes about oogenesis

* Follicular cells: for maturation (maintenance, protection) of oocyte.

* Corpus Luteum (the yellow body): -It collects fat that’s why it's yellow in color

- Its center has blood

*Corpus albicans (the white body): It's fibrous tissue (useless)

**The last line in oogenesis's handout was missed, the whole sentence is:

(Ovulatory Stage: At ovulation 2ry oocyte enter Meiosis II but arrested in Metaphase, only completed at fertilization to five mature ovam otherwise, it degenerate after 24 hours)

Female Reproductive Cycle

*It's a continuous monthly cycle from day 1 of Puberty till day 1 of menopause.

*The ovary is not controlled by it self it's controlled by Hypothalamus, pituitary gland (they are controlling the ovary and the ovary will control the uterus).

*Female Reproductive Cycle involves Hypothalamus, pituitary gland, ovaries and uterus. It includes monthly cyclic changes in structure and function of ovaries and uterus in preparation for pregnancy.

*At puberty hypothalamus secretes Gonadotropin Releasing hormone (= GnRH) that give the command to Anterior Pituitary gland to secrete 2 hormones:

1- Follicle stimulating hormone (FSH)

2- Luteinizing hormone (LH)

Note that (Gonadotropin) =

(Gonado –) it means: Main sexual organs "In male they are testis and in female they are the ovaries)

(- tropin) it means stimulating

*Female Reproductive Cycle is divided into 2 cycles:

1- Ovarian cycle

2- Uterine cycle

Ovarian cycle

FSH & LH stimulate and control cyclic changes in ovaries (it affect the ovary by)

Growth and maturation of follicles (Proliferation of follicular cells)
Ovulation
Corpus Luteum

Uterine cycle

Ovarian hormones control monthly cyclic changes in the endometrium which involve 3 phases:

Menstrual phase ( Bleeding phase )
Proliferative phase
Secretory phase

*The typical cycle in female is 28 days starting by day 1 of bleeding (menstruation) till day 1 of next bleeding.

* The typical mid time of it is (day 14) which is ovulation time

* We can divide uterine cycle into 2 half's:

1- The first half is before day 14 (from day 1 to day 13)

2- The second half is after day 14 (from day 14 to day 28)

Uterus

The endometrium of uterus consist of 2 layers (from in to out ) :

Functional layer : it's formed of 2 parts ( compact layer , spongy layer ) because it's the layer that discarded ( removed ) every month .
Basal layer : Regenerative layer which regenerate formation of discarded functional layer .

* Uterine cycle controlling the structure and function of uterus specially endometrium by hormones released from the follicles or corpus Lutem.

Proliferative phase of uterine cycle

i.e.: regenerating (replacing) the discarded functional layer by basal layer which is controlled by ( Estrogen hormone ) secreted by follicle cells during the first 13 days .

That's why the first half of uterine cycle is controlled by Estrogen

* In Proliferative phase :

1- The epithelium is thicken 3 times

2- Glands will form

3- Arteries will reform ( repair )

About day 13 or 14 Luteinizing hormones will be secreted in large amount ( a surge of LH ) affecting the follicle which will rupture and burst to expel ( let go of ) 2ry oocyte at day 14 .

**at this time the epithelium is replaced to become 3 times in thickness, blood vessels will be repaired, glands enlarge, but uterus is still not 100% ready for implantation.

Secretory phase of uterine cycle

* After day 14 Corpus Luteum will take over of 2nd half of uterine cycle ( from day 14 to 28 ) by secretion of Progesterone .

Note that ( Progesterone ) =

(pro-) it means (with)

(gest-) it means (pregnancy)

(-on) it means (Formation)

In Secretory phase :

Progesterone will structure gland to swell and secrete more fluids
Blood vessels enlarge and congested with blood and will spiral
Secretion will be increased
The endometrium is ready for implantation ( healthy media )

* At day 28 if fertilization doesn't occur Corpus Luteum will degenerate and its cell will not secrete Progesterone è lower level of this hormone in blood will cause the blood vessels to leak blood from their wall or arteries will be constructed causing Ischemia ( Death of epithelium ) è there after blood will be collecting below epithelium and will be (sluft = يقشر) out within uterine cavity and will go out .

* By finish of day 28 the bleeding starts .

*blood amount in normal is80ml

Contraceptive Pills

* They mainly depend either on Progesterone or Estrogen by inhibiting or play games around ovulation

* If we don't want ovulation to occur we give Estrogen in the first half of the period è the level of Estrogen will raise and so it gives feed back to FSH and they will not secrete it ( False message )

* If we want pregnancy ( A lady with a problem ) è we give her FSH

I want to dedicate this sheet to all my colleges in our faculty specially to those who left their country and came to Jordan to study medicine, by the name of all Jordanians we say " Welcome to Jordan , it's your country so as it's our country, we all are one nation " , and they are :

From Syria : Khaled Daye3 , Moh'd Fadel

From Palestine : Moh'd Abo Haneyeh , Bolos Mansor , Waseem samara , Moh'd 3awwad , Rand Abo Lebda , Aseel Hoso , Mahmod Shalabi , Ayham Saleh

From Yemen : Mokhtar Al Warafe , Moh'd Shaye3

From Iraq : Fahed Adel , Moh'd Wazeer , Shahed Thaer , Sa7ar Basel , Senan Adnan , Bashar Yousef , Bashar Saba7 , Maryem .

And To whom I forgot …..

Special thanks to Our colleges who built the website for the sheets

( Wa3ed Swelmeen , Wael Tokan, hamza jassar)

Finally , A7la ta7eyeh men shabab el 6eb la morash7na el saneh el jay …. Arw3 shabab el dof3a ****( Ghaleb Kherfan )****

sheet no.30

2008-04-30T17:46:00.002+03:00

Arterial Supply Of The Heart:

*Heart is supplied by 2 coronary arteries (right&left) that branch from 1st part of aorta(ascending aorta).

1-Right coronary artery:
-smaller in size
-mainly to the right side of the heart(right atrium&right ventricle)
Less functional-
passing through right side of coronary sulcus (between right atrium&right ventricle)-

2-Left coronary artery:

More functional -
Larger-
mainly to the left side of the heart(left atrium &left -ventricle)

-passing through left side of coronary sulcus(between left atrium and left ventricle)
commonly affected by diseases(eg:thrombus/constriction/embolus/aneurusm/empolus)-

(embolus is caused when an unvaccumed needle is being injected into the coronary artery letting air in &causing stop in the blood flow)

(aneurusm occurs when vessels on both sides are dilated instead of being cylinder
(tube like))

(catheterization/stem/bypass/ballooning…on the left as it is more functional than the right
(empolus is caused when there is extra air in the lung)

Note: both coronary arteies are freely connected (anastomosed:tube with tube) for compensation.

Venous Drainage Of Structures Of The Heart:

*occurs through coronary vein(coronary sinus) which is:

5 cm in length

-draining most structures of the heart by carrying venous blood from the left side to the right side within coronary sulcus(waste) to end into the right atrium (opens/empties there)
directed from left to right-

-located on the posterior side of the waste
Cardiac Conducting System:

*a specialized (modified) myocardial cells that initiates & coordinates atrial & ventricular muscle contraction

Note: muscles in general have 2 main functions:

1-conducting (receiving impulses)
2-contracting (responding to these impulses)
But the myocardial cells that form the cardiac conducting system are modified to only conduct (receive the nerve pulses)& no longer contract

*it is organized into 4 basic components:

1-SAN(Sino-Atrial Node):

-located at superior end of crista terminalis at terminal end of superior vena cava (or close to the opening of superior vena cava)(upper part of right atrium)
-it initiates the impulse (excitation signals) then spread it through the atrial wall to reach the
atrioventicular node (AVN)
it is called the pacemaker of the heart-
-it is autorhythmic as it initiates the impulses of the heart by itself (75 beats/min)
(if the SAN is defected in a way to give a heart beat lower than normal(75) which is not enough to perform any action we use an artificial pacemaker that is replaced in the pectoral region & its wire is descended down to the right ventricle through tricuspid valve &the clampes are replaced on the anterior papllary muscles in the right ventricles because the filling (from atrium to ventricle) there is passive [notice that we didn’t replace it on SAN as it isn’t working efficiently])
(if the heart stopped beating (autorhythm of SAN stopped) or the beat increased to more than
150 "ARHYTHMIA" we returned it to normal by CPR or by DC Shock where SAN stopped for 1,2,3 sec then returned back to its normal rhythm)
(SAN is balanced between sympathetic & parasympathetic nervous systems which are basically related to the habits of eating,place & style of living)

2-AVN(AtrioVenticular Node):

located at inferior end of the interatrial septum (lower part of right atrium)
receives(converge)the impulse from the atrial wall & conducts it to the right & left bundle branches via AV bundle

3-AV Bundle (AtrioVenticular Bundle):

muscular connection acts as a cable transmitting impulses from AVN to RT&LT bundle branches

4-Right & Left Bundle Branches:

Conduct the impulses to the myocardium of the heart especially the papllary muscles through Purkinje Fibers

*RT bundle branch: ends at RT papillary muscle that contracts before contraction of the wall closing the tricuspid valve &allows RT ventricle to contract (systole)

*LT bundle branch: ends at LT papillary muscle that contracts before contraction of the wall closing the bicuspid valve&allows LT ventricle to contract(systoles)

(both systoles occurs at the same time)

5-Purkinje Fibers:

-Its final fibers forms the subendocardial plexus that spreads throughout ventricles to supply ventricular muscles including the papillary muscles
-Note:the myocardial cells that forms the cardiac conduction system are insulated from myocardium by connective tissue& they establish a unidirectional pathway of excitation & contraction.

Mediastinum:

*central portion of the thorax between 2 pleural sac compartments
*located behind sternum / anterior to all thoracic vertebrae
*extend from thoracic inlet to the thoracic outlet
*divided into 2 main parts(superior & inferior)by an imaginary line extending from sternal angle to the intervertebral disk between t4 & t5
*each part has its own boundaries & contents
1-Superior Mediastinum:
Boundaries:Ant:manubrium sterni
Post:4 upper thoracic vertebrae
Sup: thoracic inlet
Inf: imaginary line between sternal angle & IVD between T4&T5
Contents: 1-midline structures(from post to ant):
vertebral column(skeletal)
esophagus(digestive)
trachea(respiratory)
aorta(circular)
thoracic duct
2-bilateral:
2 vagus nerves &2 phrenic nerves
(fraction of T3 will cause bulging on esophagus then trachea then aorta)
2-Inferior Mediastinum:
due to the presence of the heart which is surrounded by the pericardium it is divided into :
a-Anterior mediastinum:
Boundaries:Ant:body of sternum-
Post:anterior wall of pericardium
Sup:imaginary line between sternal angle and IVD of t4-t5
Inf:diaphragm(superior part anterior surface)
Contents:thymus gland-
(thymus gland is large in infants, newborn& children then by growing it starts to shrink(involution)& it is for immunity)
(sometimes you cant listen to the heart well(the sound is ambiguous to you)& by x-ray(lateral view) you find that the heart is shifted back due to the enlargement in thymus gland which is known as "thymomia"-"thymus cancer")
b-Middle mediastinum:
-Boundaries:Ant:anterior mediastinum
Post:posterior mediastinum
Sup:imaginary line
Inf:central tendon of diaphragm
-Contents:pericardium & its contents(heart & root of large vessels)
c-Posterior mediastinum
Pericardium:(resembles pleura of the lungs)
-it is a pyramidal-shaped sac (double-walled fibroseruos conical-shaped sac)
-has a base (inferior) attached to central tendon of diaphragm & apex (superior) attached to roots of large vessels(SVC/aortic arch /pulmonary trunk)
-divided into 2 layers:
1-Parietal layer (outside)
2-Visceral layer (inner): surrounds the heart itself
-there is a space between these 2 layers called "Pericardial Cavity" which is a potential space that contains a thin film of fluid that enables frictionless heart beats
(heart & pericardium forms a pyramid inside a pyramid in converted direction(apex of heart is ant to the lt &apex of pericardium is sup /base of heart is post &base of pericardium is inf)
**********************************************
انا حملنا الحزن أعواما و ما طلع الصباح
والحزن نار تخمد الأيام شهوتها وتوقظها الرياح
والريح عندك كيف تلجمها وما لك من سلاح
الا لقاء الريح والنيران في وطن مباح...
(محمود درويش/الحزن والغضب)
****
****
" ليس المهم أن تحقق فكرتك قبل أن تموت...
المهم أن تجد لنفسك فكرة قبل أن تموت..." غسان كنفاني

eI'd like to thank all my friends at ittihad & med school esp.:

Rasha Jabra, Wala Abushanab, Ala 3bd r2of,Aseel 7oso, Eman Remawi,R2a Samee7,Bayan 5dor,Sherin Alm3ali,Ruba M7taseb,Lama Jamal,Amal 7lo,Sndus 56eb,Ala 7jazi,Nisren Abu39be,Aya Bnyknana,Samar Alr7ma,D3a Abugame3,D3a jara7,Dania Dhmsh,W3d Swelmen,Zein Najada,Rawan Marwan,Samar 68a68a,Muna 6alal,Aseel Abushanab,Elham 8dah,Ala Jabri,Ala 7lesi,Rawan Sale7,D3a Tawfe8,Najd 8r3an , Aseel Sayed,Dima 3bdkreem,Nadia,Heba Mazen,Tala,Shahed 3amer,Rawan Mansour, Esra 3efan,Nouf Abuzeme3,Lara Dndn,Rana Njm,Dina Ba6ayna,Dana Ma6a7en,Shaden Sarayra,Muna N3emi,Yasmen 3bd3zez, ,Lina Taim,Laila D3as,Nansy 7yari,Dima 8nd7,Razan Magali, …

BEST WISHES TO U ALL……………………
*Rawan Ghazal*
Correction for sheet 29-page 4:
-the inflow part of the left ventricle is rough containing same >>>

Heart illustrations

2008-04-28T21:45:00.006+03:00

I will label the pictures ASAP !!

sheet no.29

2008-04-28T21:35:00.003+03:00

*Blood from right atrium pass through tricuspid valve to the right ventricle .

Right ventricle:
-form:
1- ant. Surface of the heart.
2- inf. Surface of the heart.
3- inf. Border of the heart.

-it receives blood through tricuspid valve then it pumps it to the lungs through pulmonary valve via pulmonary trunk.

-it divides into rough & smooth parts.

Rough part (ant.):

-consists of :

1- trabeculae carnea:

- it means network of trabeculae like carination arbitrarily
(i.e. they aren’t parallel to each other nor vertical to each other).
-they are a network of trabeculae of myocardium bulging into the cavity of the right ventricle, so as the heart should work as one
unit ( we call this syncytium = unisome = 1 unit).
-when the heart receives the impulse (or the pulse) from S.A.
nodes it should work as one unit .
-All of heart chambers are working at the same time (synchronously) , i.e., if one is working the other should work too,
if one is relaxing the other is contracting & if one is pumping the other is receiving. So heart won't stop working unless a person
dies.

2- papillary muscles:

-papilla like = nipple .
-their bases are projecting from the wall.
-their apexes are in the cavity.
*in other words papillary muscles are attached by their bases to
the wall & their apexes are swimming in the cavity.
-extending from papillary muscles cord like tendons called corda tendinea
.
3-corda tendinea:

Which attached to the free margin of the cusps of the valves.
*papillary muscles receive the impulse before the wall of the ventricle to contract before the contraction of the ventricle's
wall, so by the time the wall of the ventricle contracts, cusps should be approximated tightly to each other to prevent regurgitation (return back) of blood from ventricle to atrium, otherwise the valve or the papillary muscles or the corda tendinea or the wall are syndromes (defected).
-sometimes we hear that there’s a problem in the muscles of the heart which we call myopathy.

-it’s like a parachute man:

1-the man is the papillary muscle.
2-the parachute is cusps.
3-the ropes of parachute are the corda tendinea.
-if the cusps are defected(perforated), blood will return back and we will have valve stenosis or incompetent valve.

Smooth part(post.):

-called infundibulum or (conus arteriosus) .
-at the right side the smooth part is post. & the rough is ant.
-the only smooth part in the right ventricle is infundibulum.
-the coming blood is called inflow.
-the out coming blood is called outflow.
-the inflow should reach the rough part which is rocks like, so as the wall of the heart won’t bulge from that stream
-the splashes of blood which is coming should be spread (so rough part).
-but we need the outflow to be directed toward a tube that is why it’s directed that way (so smooth part).
-e.g: the body of the dam facing water always made of rocks
(rough part), not sands (smooth part) to work as shock absorber
& distributing the strength & power.

[THE INFLOW IS ROUGH, THE OUTFLOW IS SMOOTH]

LEFT ATRIUM:

-forming the base of the heart.
-receives oxygenated blood from both lungs via 4 pulmonary veins, then send it to the left ventricle via bicuspid valve (mitral valve).
-left & right auricles (auricle = dog ear) are the reserve part of the atrium & it is rough, it’s like the attic of the room, so if the blood flow increased in the room it will go to the attic.

Atrium ----> is the main chamber.

Auricle ----> is the attic.

LEFT VENTRICLE:

-main chamber of the heart.
-forming: apex, left border & share in the inf. Surface.
-the thickness of the wall is ~ 3x than right ventricle, so the blood pressure in the left is 6x than the right ventricle.
- the cavity(lumen) is circular, pushing the interventricular septum (IVS) towards the right.
*we can diagnose the right & left ventricles when we look to the computerized tomography (C.T) from the difference of their walls & cavities.
-right ventricle is 1/3 thickness, 1/6 blood pressure (B.P) & the lumen is crescent in shape.
-the inflow part of the right ventricle is rough containing same as right, but they are more powerful, larger (mega size) than the
right, because it is the main chamber so the left ventricle has :

1-trabecula carneae.
2-papillary muscle.
3-corda tendinae.
-the smooth part is called (aortic vestibule) which represents the outflow part.
-blood’s flow:

Left atrium ---->bicuspid valve
left ventricle (return back to) aortic vestibule ----> aorta.

-The current which enters the left ventricle comes towards the apex, so it has the max. heart beat.

-atrial side (the 2 atrii) separated from ventricle side by the atrioventricular septum (A.V.S) from inside, where, valves of the heart are built.(and this is the place where we put the artificial valves on the septum)

-from outside atria are separated from ventricles by coronary sulcus containing (transversing/transmitting) coronary arteries right & left.

I WANT TO DIDICATE THIS SHEET TO ALL MY FRIENDS SPICIALLY:
NAJD, RASHA, LARA , RUBA ,LAMA, SAWSAN, SONDOS, RAWAN, DO3A2, AYA, ALA2 7JAZEE, 2S7AR, DEENA, ALA2 7LAISEE, BAYAN, DO3A2 ALJARRA7, AMAL, MAJD, RUBA HALASE.
قل للطبيب تخطفه يد الردى ياشافي الأسقام من أرداك
قل للمريض نجا
Little addition to sheet 28: apex is located in the left 5th intercostal space>> ♦

sheet no.28

2008-04-24T16:37:00.005+03:00

♦ Heart has 3 borders and 3 surfaces.

**Borders :-

Right border:- form by right Atriumàrelated to right lung

Inferior border:- form mainly by right ventricle-->related to diaphragm

Left border:- form by left ventricleàrelated to left lung

* Apex of the heart is mainly form by left ventricle which is located in the 5th intercostal space about 9 cm from the sternum ---> This is the site of maximum Heart sound you hear.

4Surfaces :-

Sternocostal surface ((Anterior surface)) :-

- form by right ventricle .

- which is the easiest access for the heart to give intracardiac Injection(i.e:adrenaline)

-mainly one involved in CPR

Diaphragmatic surface ((Inferior surface)) :-

- Form by both ventricles – right and left - .

-Where the heart is resting on diaphragm precisely on central tendon of diaphragm.

3- Base ((posterior surface)) :-

- form by left atrium which is located anterior to esophagus .
- if a person swallow large bolus of food it may compress anterior on the base of heart.

.
- receives venous deoxygenated blood from all over the body through the

following veins :

Vein's name Convey blood from??

Superior vena cava Upper ½ of the body above diaphragm

Inferior vena cava Lower ½ of the body below diaphragm

Coronary sinus (coronary vein) Convey blood from the heart structure it self.

**The changing of the heart's direction

Before birth

-Heart was directed anterior with left side and right side

-Apex anterior and base posterior

After that

It turned 90° to the left converting :-
1)) Right surface to be anterior surface
2)) Left surface to be Base( posterior surface)
** So in adults' heart The right side of heart -->anterior surface.
The left side --->posterior surface.

Walls of the right atrium
1)) Anterior wall ---> rough wall.
2)) posterior wall ---> smooth wall / it forms by interatrial septum

** Anterior wall from inside
-Rough wall .
- Like a comb ::
* Its handle is called (crista terminalis) where its superior end is pin
pointing the SA node-Sinoatrial node- ((pacemaker of the heart))
* The teeth of the comb are called ( pectinate muscle or musculi pectinati ).

** smooth posterior wall consist firstly of fossa ovalis , i.e. remnants of foramen ovaliàshuttle blood from R.A to L.A to bipass the lungs.

FINALLY, I want to dedicate this sheet to all my friends specially:-
Bayan AL-khdor ,Doa' Abu jamea , Rasha jabra , Rawan Ghazal , Doa' Jarah , Israa AL-zawawi Dina Ammari , Dina Break, Ashar AL-Tarawneh , Samar Taqatqa, Muna , Samar Al- Rahmeh, Dania Dahmash, Sahar basel,Sawsan tabaza, Aseel, Nesreen , Shereen & Roaa , Amal , Heba nemer , Nadia , Doaa al-Ibraheem, Abeer , Asma'

And to every one whom I don't mention.

Special thanks to Dr . Maher AL-Hadidi

sheet no.27

2008-04-22T15:03:00.002+03:00

♦Root of the lung :
It is hilum , where it receives the following structures :
1. primary bronchus àaeration
2. one pulmonary artery à carry deoxygenated blood , that’s why it is darker in colour .
3. two pulmonary veins : sup , inf in each lung àsend ox. Blood from lungs to left atrium
4. pulmonary lymph nodesàefficient filters for foreign bodies and harmful microbes.
5. nerves ( autonomic nervous system ) : sympathetic ( increase respiration rateà when you exercise ) and para sympathetic (decrease respiration rateà while resting) .

Intercostal arteries and nerves
Each intercostal space is supplied by 1 nerve and 2 arteries(in upper 5)

Intercostal nerves :

They are 11 in no .
O : from ventral rami of the thoracic nerves , then each of these nerves will pass between 2 successive (sequential ) ribs , then it will continue between 2 layers (2nd and 3rd layers ) , then continue toward sternum .

-Each intercostal nerve will give 3 branches ( 2 sensory and 1 motor ) :
1. Lateral cutaneous branch : located at mid axillary line . supply sensory to skin of the sides .
2. Anterior cutaneous branch : supply sensory to front midline skin on both sides of sternum .
*( when a patient is involved in a car accident or in a disease , and we want to know at which level , before doing operation we will know from outside , if there is numbness , or less of sensation or pain in a space then we will know the nerve which was cut ).

3. Collateral branch : the nerve that passes with intercostal nerve ( branch of it ) , it’s to supply muscles of the intercostal space : external intercostal, internal intercostal, innermost intercostal .

♦Intercostal arteries :

Each intercostal space has 2 arteries :
Posterior intercostal artery :
-They are 11 in no : 1st and 2nd from subclavian artery , 3rd – 11th from aorta .
They supply the flanks ( slides ) .
2. Anterior intercostal artery : from internal thoracic artery which is branch from subclavian artery.
(in thorax we have artery outside called external thoracic artery(for breast) , and there is an artery inside called internal thoracic artery(for ribs) )

*breast is supplied by external intercostal artery * , inner to ribs we have internal intercostal artery passing on both sides of sternum ) .
It supplies the ventral midline of upper 5 intercostal spaces .

The heart

-It is a hollow muscular pump about the size of a person’s fist
- located in the mediastinum above diaphragm and both sides of lung
-has 3 borders/3 surfaces
-It is like pyramid on its side
-has apex ant , and base post.

-Form of 4 chambers :
1]Right atrium , left atrium separated by interatrial septum .
2]right ventricle, left ventricle separated by interventricular septum .
-The heart is divided into 2 sides :
1. Right venous side: consist of right atrium and ventricle , they are called receivers , they receive deoxygenated blood that’s why they are blue in colour. It’s low pressure side.
2. Left arterial side : consist of left atrium and ventricle ,they send oxygenated blood. it's high pressure side.

***The main chamber of the heart is left ventricle which can pump blood to every cell in the body .

Lama jamal …
I want to dedicate this sheet to my friends :
Ruba al- mo7taseb (best friend ever… )
Sondos el5atteb (kteer tabe3eye) , sawsan tbaza (asdek esab3a tab3a “ enshallah “) , hannen al-shraide (lady Diana) , shatha al-3attili (3a rasi Che Guevara), amal 7osban (mankoshe), majd (model),2aya , samara (konan), suzan mbaydeen, jameele, w3d al-swalmeen, zein, najd (a7la shabab J), ala2 al-3abed(3a rasi jerash), ro2a samee7 (enbeste J),ruba halase , rasha, rawan 3’zal, do3a2 al-jara7, assel .
Special thanks : yezan 3toom .
***mabrook ta2hol fre8 Fifa2008 la nesf eneha2e wa 3o2bal elk2as enshallah …

***********************************
Lamoosh Chose this for you guys :
she wants you to enjoy Jibran :-)
Lovek ya benet for this ;)

الإستقلال و الطرابيش لجبران خليل جبران

قرأت منذ أمدٍ غيرٍ بعيدٍ مقالاً لأديبٍ قام يعترضُ ويحتجُّ فيه على ربّان وموظفي باخرةٍ فرنسيّةٍ أقلّته من سورية على مصر. ذلا لأن هؤلاء قد أجبروه، أو حاولوا إجباره على خلع طربوشه أثناء جلوسه إلى مائدة الطعام، وكلّنا يعلم أنَّ خلع القبّعات تحت كلِّ سقفٍ عادةٌ مرعيّةٌ عند الغربيين.
ولقد أعجبني هذا الاحتجاجُ، لأنّه أبانَ لي تمسّكَ الشّرقي برمزٍ من رموزٍ حياته الخاصّة.
أعجبتُ بجرأةِ ذلكَ السّوري، كما أعجبتُ مرّة بأميرٍ هنديٍّ دعوتُه إلى حضور روايةٍ غنائيةٍ في مدينة ميلانو في إيطالي، فقال لي: "لو دعوتني إلى زيارةِ جحيم ِدانتي لذهبتُ معك مسروراً، ولكنّي لا أستطيع الجلوسَ في مكانٍ يحظّرون فيه عليّ استبقاءَ عمامتي وتدخين اللفائف".
أجل، يعجبني أن أرى الشّرقيَّ متمسّكاً ببعض مزاعمه، قابضاً ولو على ظلٍّ من ظلال عاداته القوميّة.
ولكنّ إعجابي هذا، لا، ولن يمحوَ ما وراءه من الحقائقِ الخشنةِ المتشبثةِ بذاتيّة الشّرقِ، ومنازع الشّرقِ، ومزاعم الشّرق.
لو فكّر ذلك الأديبُ الّذي استصعبَ خلعَ طربوشِه في الباخرةِ الإفرنجيّةِ، بأنّ ذلك الطّربوشَ الشّريفَ قد صُنِعَ في معملٍ إفرنجيّ، لهان عليه خلعه في أي مكانٍ في أيّة باخرةٍ إفرنجيّةٍ.
لو فكّرَ أديبُنا بأنّ الاستقلالَ الشّخصيّ في الأمورِ الصَّغيرةِ كان، وسيكونُ رهن الاستقلالِ الفنّي، والاستقلالِ الصناعيّ، وهما كبيران، لخلعَ طربوشَه ممتثلاً صامتاً.
لو فكّرَ صاحبُنا بأنَّ الأمَّةَ المستعبدةّ بروحِها وعقليّتها، لا تستطيعُ أن تكونَ حرَّةً بملابسِها وعاداتِها.
لو فكّرَ بذلكَ لما كَتَبَ مقالَه معترضاً.
لو فكَّرَ أديبُنا بأنَّ جدَّه السّوريّ كان يبحرُ إلى مصرَ على ظهرِ مركبٍ سوريٍّ مرتدياً ثوباً غزلتْه، وحاكتْه، وخاطتْه، الأيدي السّوريةُ لما تردّى بطلُنا الحُرُّ إلا بالملابسِ المصنوعةِ في بلادِه، ولما ركبَ سوى سفينةٍ سوريّةٍ ذاتِ ربّانٍ سوريٍّ، وبحّارةٍ سوريّين.
مُصابُ أديبِنا الشّجاعِ أنّه قد اعترضَ على النّتائجِ ولم يحفلْ بالأسبابِ، فتناولتْه الأعراضُ قبل أن يستميلَه الجوهرُ، وهذا شأنُ أكثرِ الشّرقيينَ الّذين يأبون أن يكونوا شرقيّين إلا بتوافِهِ الأمورِ وصغائرِها، مع أنّهم يفاخرونَ بما اقتبسوه من الغربيّينَ ممّا ليسَ بتافِهٍ أو صغير.
أقولُ لأديبِنا، وأقولُ لجميعِ المُتَطرْبشين: ألا فاصنَعوا طرابيشَكُمْ بيدكم، ثمّ تخيّروا في ما تفعلونَه بطرابيشِكمْ على ظهر الباخرةِ، أو على قمّةِ الجبل، أو في جوفِ الوادي.
وتعلمُ السّماءُ أنَّ هذه الكلمةَ لم تُكْتَبْ في الطّرابيشِ، أو في شأْنِ خَلْعِها، أو استبقائِها على الرؤوسِ تحتَ

sheet no. 26

2008-04-21T08:36:00.003+03:00

THORACIC CAVITY:

Divided into:
1-mediastinum: central part contains heart (in part), aorta & trachea.
2-pleural sacs: contains the lungs.

*Thoracic cavity is bounded sup. By thoracic inlet, inf. By outlet which is called the diaphragm.

LUNGS:
-each of them is a pyramidal shaped, red, spongy & softy organ.
-located inside the pleural cavity.

PLEURA:
-it's a thin translucent continuous membrane surrounding each lung & lining thoracic cavity, so it's divided into 2 parts:
1-visceral pleura: the inner part which is lining the lungs, closely fixed to the structure of the lung itself taking its shape.
2-parietal pleura: it's part of the pleura that lines the thoracic cavity, divided into 4 parts named according to structures related to them:
1-cervical p. (not thoracic): located above the level of clavicle @ the root of the neck, that’s why(try @ home☺) if a knife insert above clavicle it will insert cervical p., & the cavity won't stay potential space(vacuumed).

2-costal pleura: 2nd & largest part, lining the ribs & its CC. (costal cartilage).
THE LARGEST→ that’s why the commonest to be involved in diseases or exposed to air drafts

.
3-diaphragmatic p.: it lines superior Surface of the domes of diaphragm.
*diaphragm has 2 domes; right & left.

4-mediastinal p.: it's med. , related to the structures in the mediastinum especially The heart trachea and mediastinum.

*we divide them in these parts to know what are the related structures to them.
**suppose that we've a problem:
1-@ the neck → cervical p. will be involved.
2-@ the ribs (# rib) → costal p. will be involved.
3-in peritonium→ diaph. P. will be involved.
4-in the heart or trachea or mediastinum→ mediastinal will be involved.
*parietal p. is highly sensitive to pain & stretching, while visceral p. is insensitive because its supplied by A.N.S (autonomic nervous system).
**in pneumonia, the pain comes from bronchi not from pleura or tissue of the lungs, so we call them bronchitis (not lungitis) because of the reason above.

PLEURAL CAVITY:

-potential vacuumed space, if anything collected there as air or fluid or blood it will embarrass the lung & won't allow it to move freely.
*the lung has TIDAL VOLUME: means full capacity of inflation of lung, if it wont inflated full, this means the patient suffering from DYSPNEA.

TRACHEA:

-wind(air) pipe tube ~ 5 inches in length= 13 cm.
-extending from lower end of larynx (precisely from C6V) to the sternal angle where, it bifurcates into right & left primary bronchi (singular: bronchus).
-form of ~ 20 "C" shaped cartilaginous rings defected post. Where it replaced by a muscle called trachealis.
*the lower end of larynx located @ the level of C6.
**suppose we've a patient with bronchial asthma, his trachealis m. will compress the trachea causing constricted breath, but when he takes the inhaler trachealis will widen and relax.
***trachealis is involuntary m. → supplied by A.N.S → part of it sympathetic n. s. →so we give it sympathomimetic drugs.
****remember that trachea form of malleable (flexible) C shaped rings.

TRACHEA:
-located ant. To esophagus, that’s why if we swallow a large bolus of food, it 'll compress the trachealis & 'll cause hard breathing, so we should push him to bring that bolus in or out to allow trachealis & trachea returning back to its normal diameter.
-located post. to aorta.
-behind esophagus we've V.C.
*so we've this order from ant. To post.:
aorta → trachea→ esoph. → V.C
these are neighbors standing in front of each others, so any problem in one will affect the others because they 'll disturb their function & others.
-trachea bifurcated (bi=2) into right & left primary bronchi, each of them go to its specific lung:
1-right 1° bronchus:
-vertical in direction..
-wider in diameter.
-shorter in length.

*that’s why inhaled foreign body (e.g. chickpea) usually go to the right, because it's straight & wider→ examine the right not the left.
2-left 1° bronchus:
-horizontal.
-narrower.
-longer.
-crossing the curve of aortic arch (concavity of aortic arch), so problem in the left 'll affect blood current in aorta.

-each 1° bronchus 'll give finally 10 bronchial branches.
1(trachea) → 2(bronchi)→ each give 10

LUNGS:
GENERAL FEATURES:
1]apex @ the root of neck.
2]base over domes of diaph. (1,2 coz pyramidal)
3]3 borders:
a-ant. Sharp border.
b-inf. Border: which is sharp on the periphery of the domes of diaph.
c-post. border: smooth & rounded, located @ both sides of V.C.

*the lungs extending from sternum ant. To the post. part of V.C post., that’s why when we put our stethoscope we put it on the back to listen to the lunges clearly.
4]3 surfaces:
a-costal surface(sternocostal surface):the widest , below sternum, C.C & ribs ("C" shaped below them).
b-inf. Surface: called diaphragmatic surface, related to the domes of diaph.
c-mediastinal surface: med. & related to the structures in mediast.

LEFT LUNG:
-its ant border is notched by the heart forming cardiac notch to expose the ant surface of the heart.
-has 2 lobes: sup. & inf. Lobe separated by oblique fissure.
-it grows (developed) inside a small space, that’s why it's:
1-less functional than right..
2-has 2 lobes.
3-has 1 fissure.
4-longer.
5-narrower.
6-lighter in wt.
7-related to arterial supply of the heart à with the highest blood pressureà so receiving higher blow from heart.

RIGHT LUNG:
-it grow in larger space that’s why it's:
1-more functional than left.
2-heavier. 3-shorter. 4-wider.
5-has 3 lobes: sup. , middle & inf. Lobes.
6-separated by 2 fissures: oblique & horizontal fissures.
7-related to the right venous side of the heart, i.e , with the lower blood pressure.
*pressure on the right ~30 mmHg, while on the left ~120 mmHg .

New CS2 Worksheet Solution

2008-04-16T21:43:00.003+03:00

Another contribution from Mohammed Qtaishat....
Special Thanx To Him...

Click here

Link Made by Wael Toukan

This is another Link to download the answers as a Doc file just by clicking on it made by Yezan 3toom

Click here to download

sheet no.25

2008-04-16T09:24:00.001+03:00

♦The vertebral column consists of 33 vertebrae,

They are named according to region:
-cervical 7 in number(C1-C7)--->uppers▲shape/lowers ●
-thoracic 12 in number(T1-T12)
-lumbar 5 in number(L1-L5)--->▲shape
-sacral 5 in number(S1-S5)
-coccygeal 4 in number

some of them are typical and some of them are atypical
the typical vertebra consist of :

-body (anteriorly) for weight bearing
-vertebral arch (posteriorly) for protection of spinal cord

♦Specific features of thoracic vertebra:

-body: heart shaped with 2 superior facets for articula
tion ribs of same number, and 2 inferior facets for next number ribs--->[4 facets on each vertebra]
Vertebral foramen: circular in shape, for spinal cord-

♦Vertebral Arch

Consist of the following parts:
-2 pedicles
-2 lamina (right and left)
-Transverse process: extending at the meeting point between pedicle and lamina, in thoracic vertebra has a facet to articulate with the ribs of the same number.
-spinous process: form by the union of 2 lamini, , in thoracic vertebrae it is oblique

♦Intercostal spaces(not above R1 or belowR12)

Spaces between 2 sequential ribs, they are 11 in number,
They contains 3 intercostal muscles, and contains intercostal (V,A,N)
Inter costal muscles: they are 3 in number(in 3 layers)
-1st external intercostal
-2nd internal intercostal
-3rd innermost intercostal

They are muscles of respiration, their function to make the intercostal space rigid during inhale, all supplied by their own intercostal nerve, and supplied segmentally and sequentially from superior to inferior

*Neuro vascular bundle is passing within costal groove between internal and inner most layers(2nd and 3rd layers)

♦Thoracic cavity: extending from thoracic inlet to outlet, consists of :
-mediastinum (central part), power station of thorax, for supply,contains vital organs moving in harmony with each others and their neighbors.

-2 pleural sacs: which contains lungs inside

♦Lungs: they are 2 in number, located inside pleural sacs,
Lungs are pyramidal in shape, soft and spongy organs,
They are organs of respiration

♦Pleural sacs are a complete continuous sacs which was invaginated by the growing lung, its divided into 2 parts:

-viscera pleural: covering the lungs it self

-parietal pleura: that lines the inner surface of thoracic cavity

Pleural cavity: potential space between the 2 previous layers,
There is no air inside, and no pressure inside,

To allow the lung move freely

**N.B:if there is air inside we may have what we call air collapse
**N.B:2/3 heart is on left side----1/3 on right side

27LA TA7EYE LA 27LA SHBABB BEL JAM3A

FROM MEDICAL SCHOOL: A7md 2bo-7lawe, yazeed al-naif,5aled 7ajjir,mo2ayyad kettane(7abebe 3la 6ool), yazeed qayseye, Amjd 3ayyash(el za3eem),osama 5aleel, 7amze jassar, A7md al shalabi, 3omar el 7aj, m7md al faqeeh, qusai al 3azam(my heart),A7md 2bo 5deje, yazan 3toom,
Nidal matani (arsenal to the bone), Ibrahim 2bo deye, ibrahim al 9a3idi, A7md al 7ne6e, 9ohaib el 3badi, m7md qteshat, hmam ryalat, 7azem 2bo 39be, m7md taiseer,m7md 3bood, sami 3abdeen, A7md el 3esa,
3bd el rahman 3attili, Ayman d3ja, A7md 7ara7sheh, rami salame, aA7md 3abed, mo3ath el zo3bi, martin qaqeesh, 3'aleb 5erfan,3mr 5leely,
M7md bder, m7md 2bo haneye, zaid qandeel,m7md sboo3, 3amer 7jaj, mo2men k7aleh, Bandar, 5aled, m7md qawasmeh, 3'assan mbarak.

☺** (mo2ayad kettane)** ☺

*From another faculty :*Muhannad bdair*,wa2el 3lawne,nusaibah al-jalodi,3la2 el 8asi
☺ 3omar sumrien (koko al da3eef 9a7eb al 2nyab al 7adde) ☺
,m7md fozi,3la2 7(2),m7md shareef, a7md 3ode, zaid jayyosi

Form 2nd year: Na9er 3'raybeh
mazen sha3ban, 7osam 7awamde,3omar samee7, 7amze sumrien, mu3taz sha3ban, mo3ath 5ader, 5aled, feras qaqa, 3abdallha nsour, 7sain qudah, 3omar abu s3oud, me9ba7 el7anbaly, m7md bor3'ol , anas 7ijawi

And slam 5a9 la wa7sh el ente5abat
☼ I love you all, I thank you all ☼
With best wishes

Ma'moun Shaban

sheet no. 24

2008-04-15T16:26:00.004+03:00

Ribs:

- 12 pairs.

- Flat bones with spongy tissue, binding the vertebra
posterior to the sternum anterior, via costal cartilage.

- they are classified into: ( the international classification)

1. True ribs: the ribs connecting directly to the sternum,(ribs 1-7).

2. False ribs: those connecting indirectly to the sternum, (ribs 8-12).

{8, 9, and 10}: connecting indirectly, but {11, and 12}: are called floating ribs; only connecting to abdominal muscles.

- 2nd classification, depending on major parts of the rib, where they are classified into:

typical and atypical ribs.

* Typical ribs:

Each typical rib has the following parts:

1. Head: with 2 facets: superior and inferior, where the inferior facet articulates with vertebra of the same number, because the head is articulating with 2 sequential vertebrae.

2. Neck: constricted part, related to vital structures, especially sympathetic trunk.

*** If the neck of the rib is fractured, the sympathetic part of the nervous system is affected.

3. Tubercles: they are 2 in number:

- Articular, inferior: articulates with transverse process of the vertebra of the same number.

- Non articular, superior: for a ligament (acting as a spring between intercostal spaces,binding ribs together for recoil).

4. Costal angle: where the rib changes its direction.It gives origin to serratus anterior muscle.

5. Body (shaft), which has:

Anterior surface, posterior surface/ superior,smooth rounded border, and inferior sharp border.
*At the inferior border there is costal groove, lodging (transmitting) intercostal VAN (vein, artery, nerve).

* Atypical ribs:

- They are: 1, 2, 11, & 12.

- They have missed parts.

~ The 1st rib:

. The shortest, the widest, and the most curved of ribs.

. Has:

1. Anterior border, posterior border.

2. Superior surface, inferior surface.

3. NO, but no, costal groove.

*Related Structures to the Superior Surface (from anterior to posterior) are the following:

1) Subclavian Vein.

2) Subclavian Artery.

3) Lower trunk of the brachial plexus. {if injured, causes paralysis of Ulnar nerve.}à[claw hand]

*those structures may be injured if clavicle or first rib are fractured.

Thoracic Vertebra:

Each vertebra has 2 parts:

- Body, anterior à for weight bearing-act as a shock absorber.

- Vertebral arch, posterior à for protection of spinal cord.

Note:

Nervous system in the body is divided into:

1. Somatic nervous system (voluntary); central and peripheral.

2. Autonomic nervous system (involuntary);sympathetic {wasting} and parasympathetic {conservative}.

* The sympathetic trunk is located on both sides of the vertebral column, anterior to the neck of ribs.Extending from base of skull to coccyx. Its function is: coding the spinal nerve to be sympathetic.

Sawsan Tabaza ...

I'd like to dedicate this sheet to my friends:

Sondos alkhtib (la telqa2eyyan!!!), Ruba Almohtaseb (You mute,, you not succeed!), and Lama Jamal (eltamneh sabteh :p ,, Allah yeft7 3laiky ya rb!!!).and to all my colleages .....

sheet no. 23

2008-04-15T16:14:00.003+03:00

By the Name of ALLAH

Thorax

Thorax is the part of the body that extends from the root of the neck to the Diaphragm.
It has the following parts :
1-Skeleton which called (Thoracic cage)
2-Coverings which called (Thoracic wall) .
3-Toracic cavity And contents.
Thorax has inlet (Thoracic inlet) which is narrow and outlet(Thoracic outlet) which is wide covered by the Diaphragm that separates thoracic cavity from the abdominal cavity.

*Thorax is convex at all sides.

Coverings
1-Skin
2-Superficial fascia
3-Deep fascia
4-Three layers of muscles (Three intercostal muscles)---->soft structure
5-Ribs--->hard structure
6-Pleura( الغشاء البلوري للرئة ) which is a serous membrane containing fibrous tissue and proteins , this membrane in cold conditions become loose so (you can not breath)Because this pleura is highly elastic but in cold conditions it descended so the nerves would be tight causing a severe pain and can not complete the respiration this called (pleurisy).

Thoracic cage
Consist of:

1-Sternum (anterior).
2- Twelve thoracic vertebrae(T1-T12) (posterior)
3-Twelve pairs of ribs on both sides.

**Sternum (breast bone) it is like a knife or more specifically like a dagger So it has three parts:
1-Handle (Manubrium)
2-Body.
3-Tip which called(Xiphoid process)
**The Sternum is a flat bone with spongy tissue .

Manubrium Articulates with the first Rib and a half of the second rib.

Body Articulates with half of the second rib to the seventh rib.

Xiphoid process It is a hyaline cartilage And ossified after the age of 40
And before this age it is cartilaginous

Sternal angle(angle of Louis)

-It is located between The manubrium and body, it is at rib two level
- It is a good clinical land mark That marks the followings:
1-Rib number two to count ribs .
2-Biforkation site ( منطقة انقسام) of trachea .
3-Aoartic arch.
4-Inter vertebral disk between T4 and T5.
*Body of the sternum located anterior to the heart so in C.P.R(Cardio pulmonary resuscitation) we compress the heart between sternum and vertebral column.

[Embryo notes for the last lecture]

*Gonia = off spring (ذريِِِة) .
*Zoon = life.
*testis are outside but they form in the posterior abdominal wall then migrated out, why? Because they will not do its function on the body temperature
* Immigrated testis called undescended testical
* primordial germ cells arrive testis in the fifth week and start to enlarge(multiply) themselves by mitosis.
*Spermatogonia stay in rest until puberty (in males) but oogonia in females stay in rest until (birth) .
*Type B cells are committed to continue the course (fertilization).
*Multiplication started before birth
*spermatogonia and spermatocytes(1ry-2ry) are 2n the continue until they give 1n which is the sperm.
*Maturation begins at puberty.
*Spermatocyte cells are commited for formation of sperms
*Early spermatids are immature sperms.
*inactive=resting=dormantàlike dipluteen stage in females.
*spermatogonia type B is the which will continue the course.
*sex cords:àprimitive(without lumen)(before puberty)
àseminiferous(with lumen)(at puberty)

*some correction for sheet 22

1-Supplied by peronial artery , branch of posterior tibial artery
2-propulsive force by all muscles of the posterior comp. of the leg but the most powerful two are gastocnemius and musclessoleus
3- Tom has very nice doga and pigs >>>the muscles named from medially to laterally.

I want to dedicate this sheet to all my colleges in our faculty specially to those who are from al-ittihad school and they are:

Ahmad al-harahsha(captain), qusai al-azam(az az ya toto), yezan 3toom(wa7sh el-anatomy ), Ibrahim al-saeede(safe area!!) . mohammed al faqeeh , mohammed al tameme, abdallah tayem.
Ruba al-mohtaseb ,Do3a Al-jarah.Bayan al-khdoor ,Shatha al-attili ,Sondos al-khateeb , lama jamal , Rawan ghazal, Suzan mbaydeen , Rawan saleh,ro2a sameeh , 2la2 hijazee , Do3a abu jam3.

And to those who are special to me :

Adnan el-3aref(cute skalamboooo) , mo2men kahaleh , zaid malhees (el za3eem) , hazem abu 3sabeh , Omar el-haj omar, Yazeed al-neef(my heart),***Mo2ayad kettaneh***
Ma2moon shaban (snow white) , ahmad abu-halaweh.

And to those whom I Knew them in the university:

Sawsan tabaza , jeelan ,Dana mel7em, wa3d swaylmeen ,Fadi halsa ,Sali salman, mohammed ryalat ,mohammed qtayshat , mokhtaar,mo0hammed bader . mohammed abu haneh , ayham. ,waseem , shaker ,.

And please forgive me those whom I forgot .

Your college Ahmed abu-khadigh

Special thanks to my brother yezan 3toom

A lot thanks to our brilliant doctor :Dr. maher al-hadidi

sheet no. 22

2008-04-08T16:01:00.003+03:00

It takes 72 muscles to frown and only 14 to SMILE :)

Lateral Compartment of the leg:

- Located lateral to Fibula.
- Contains 2 muscles:
1. Peroneus longus.
2. Peroneus brevis.

Both of them:

* originate from Fibula.
* innervated by Superficial Peroneal nerve.
* supplied by Peroneal artery; branch of Peroneal tibial artery.
* function as:

1) Plantar flexors of ankle joint.

2) Eversion (sole out; standing on medial edge of foot).

* pass behind lateral malleolus.

(1) Peroneus longus:
-Groove cuboid at lateral side of footà cross to the medial side to insert to 1MT and first cuniform.
-Insertion: base of 1st metatarsal bone, and medial cuniform.

(2) Peroneus brevis:
-Insertion: base of 5th metatarsal bone.

Posterior Compartment of the leg:

- Located behind tibia, fibula, and interosseous membrane.
- Divided by deep transverse fascia into 2 layers.

A. Superficial layer:

Consists of 3 muscles:

1. Gastrocnemius.
2. Soleus.
3. Plantaris.

All of them:
- inserted into posterior surface of calcaneum, through calcaneal tendon.
- function as plantar flexors of the ankle joint.
- innervated by tibial nerve.
- supplied by posterior tibial artery.

(1) Gastrocnemius:

(Has 2 heads: medial and lateral).
-Origin: both heads from femur.
It forms calcaneal tendon, which is inserted into posterior surface of calcaneum.
-Action: plantar flexes the ankle joint. Besides, it gives the propulsive force while running or walking. (It is responsible for the position of standing on top of toes to initiate running in races, as a lever).

(2) Soleus {in Latin, means broad fish}:

-Origin: soleal line of tibia, upper quarter of fibula, and a tendon in between, which acts as a tunnel transmitting posterior tibial vessels and tibial nerve below.
-Action: - powerful plantar flexor.
- forms the main bulk of calcaneal tendon.

(3) Plantaris:

-Has small belly and long thin tendon.
-Origin: lateral condyle of femur.
-Action: plantar flexion of ankle joint, and flexion of knee joint.

B. Deep layer:

Consists of:

1. Tibialis posterior.
2. Flexor digitorum longus.
3. Flexor hallucis longus.
4. Popliteus.

- All originate from fibula, except Tibialis posterior.
- All pass behind medial malleolus.
-All innervated by tibial nerve

(1) Tibialis posterior:
-Origin: tibia.
-Insertion: into 8 bones, mainly tubrosity of navicular bone. Also to cuboid, all cuniforms, and the bases of 2nd,3rd, and 4th metatarsals.
-Action: plantar flexion, and inversion.

(2) Flexor digitorum longus:

-Gives 4 tendons to the lateral 4 toes.
-Insertion: distal phalanges of the lateral 4 toes.
-Action: plantar flexes the ankle joint, and flexes the lateral 4 toes.

(3) Flexor hallucis longus:

- Insertion: base of distal phalanx of big toe.
-Action: plantar flexes the ankle joint, and flexes the big toe.

(4) Popliteus:

Action: flexes the knee joint, and Unlocks the knee joint.
*** At the ankle joint:

- Anterior to lateral malleolus: "Tom Has Very Nice Dogs and Pigs" …
~Tom for Tibialis anterior.
~ Has for extensor hallucis longus.
~ Very for anterior tibial vessels.
~ Nice for deep Peroneal nerve.
~ Dogs for extensor digitorum longus.
~ Pigs for Peroneus tertius.
- Posterior to lateral malleolus: Peroneus longus and Peroneus brevis.
- Anterior to medial malleolus: great saphenous vein and saphenous nerve.

- Posterior to medial malleolus: "Tom Does Very Nice Hat" …
~ Tom for Tibialis posterior.
~ Does for flexor digitorum longus.
~ Very for posterior tibial vessels.
~ Nice for tibial nerve.
~ Hat for flexor hallucis longus.

Popliteal Artery:

. Starts at the adductor opening.
. Ends at lower border of Popliteus. There it divides into:
1) Anterior tibial artery: short and small, supplies the anterior compartment.
2) Posterior tibial artery: long and large, gives a branch called peroneal artery, which supplies the lateral compartment. Then posterior tibial artery continues to supply all posterior compartment, accompanied by tibial nerve, then descends to supply the sole of foot (inferior surface of the foot).

NOTES:

- There are:
* 2 invertors of the ankle joint: Tibialis anterior and Tibialis posterior.
* 3 evertors of the ankle joint: Peroneus longus, brevis, and tertius.
- Foot has 3 arches forming a capital a (A):
1. Medial longitudinal arch, supported by Tibialis anterior and tibialis posterior.
2. Lateral longitudinal arch.
3. Transverse arch, horizontal (formed by cuboid and cuniforms, with the tendon of Peroneus longus passing over {this tendon strengthens the arch}).
* Medial and lateral longitudinal arches meet at a point at the apex of letter A, positioned precisely on the inferior surface of calcaneum.
- All muscles of the leg cross 1 joint except 2: Gastrocnemius, and Plantaris.
- All muscles of the leg originate from fibula, except: tibialis anterior and posterior from tibia, Gastrocnemius and Plantaris from femur.

- About muscles of lateral and anterior compartments:
1) First of both inserted into 1st metatarsal bone + medial cuniforms:
[ Peroneus longus & Tibialis anterior (both elevate the arches of foot) ].
2) Last of both inserted into 5th metatarsal bone:
[ Peroneus brevis & Peroneus tertius ].
- Do you remember the law of muscles?! And how Sartorius was an exception. Here are another 2 exceptions … PLANTARIS and GASTROCNEMIUS!! (Despite crossing 2 joints: knee and ankle, they flex both.
- Like Palmaris longus, Plantaris, is sometimes missing. It is considered to be a spare part, used for tendon transplantation.
- All anterior compartment muscles dorsi flex (extend) the ankle joint.
All posterior compartment muscles plantar flex (flex) the ankle joint.
(Notice the difference between anterior and posterior compartments of both leg and forearm: anterior compartment muscles are flexors of the forearm, extensors of the leg. While posterior compartment muscles are extensors of the forearm, and flexors of the leg).

{Happiness is like a butterfly: the more you chase it, the more it will elude you, but if you turn your attention to other things, it will come and sit softly on your shoulder :D}

Ruba Almohtasib, Sawsan Tabaza...

We'd like to dedicate this sheet to:

Sondos alkhateeb (Xtra ketchup :D), Lama Jamal (302bal kol shi min doon 7aqebeh!), Haneen Shraydeh, Aya bani-kenanah, Samar Alrahmeh, Nisreen abu-osbeh, Dania Dahmash, Shatha Atteli, Amal Alhelo, Rasha Husain (7bebi ma azkah :D), Sonbol, Ruba Halaseh, Najd Alquraan (JTV.. sat 6:15pm :p), Aseel Alsayid ( no comment!!), Waed Swaylmeen, Jameleh, Zain, Suzan Mbaydeen, Rawan Ghazal, Rawan Salah, Duaa Tawfeeq ..
Special thanks for: yezan 3toom.

Corrections :

***about muscles of the lateral compartment both of them are supplied by peroneal artery; branch of POSTERIOR tibial artery !

***an addtion for the point saying (at the ankle joint): ALL ARRANGEMENTS at the ankle joint are from MEDIAL TO LATERAL ..* Muscles of the superficial layer of the the posterior compartment of the leg ALL INSERT into the poterior surface of calcaneum BUT not all through the calcaneal tendon; only gastrocnemius and soleus, plantaris has its tendon alone.

sheet no.21

2008-04-07T18:08:00.002+03:00

*Bones of the foot*

The foot consists of:

7 tarsal bones--->short bones
5 metatarsal bones--->long bones
14 phalanges--->long bones
.
♦Tarsal bones
1-Talus. (Bone of the ankle)
-It receives half of the person’s weight (for each talus) and divides it:
-->post. To calcaneus
-->ant. To head of metatarsals
-Position:
-superior To calcaneus

-part of calcaneus is post. And lat. To Talus.

-It is called the (key stone) of bones of the foot because of it's important position.

-If fractured flat foot resulted

-It articulates with:

Tibia ( inferior articular surface of it )

Medial malleolus ( of tibia )

Lateral malleolus ( of fibula )

To form ankle joint which is like a viseالملزمة))

That is why the ankle is very stable(balanced)

-It permits two types of movement.

Extension or dorsiflexion. (Toward your face).

Plantar flexion (standing on the tip of your toes).

2-Calcaneus bone (Heel bone)

-Position: below talus bone (part is lateral and posterior to it)
-Part of the weight transmitted through it to the ground i.e. it receives part of the weight (posterior part).
-largest in foot bones
Navicular bone
-small-boat shaped
- medial
-Receives part of the weight (anterior part)

4-Cuboid bone

-lateral
-articulates with calcaneus (posterior) and with 4th and 5th metatarsal bones (anterior).
-cuboidal-shaped
-ant. to Talus

5-cuniforms

-wedged bones
-They are 3 in number
-beside each other
-Named from medial to lateral:
( medial, inter medial and lateral)
or
(1st to 3rd)
-Articulates with navicular bone---> prox.
-articulates with bases 1st, 2nd and 3rd metatarsal bones respectively--->dist.

♦MetaTarsal bones

-5 in number.
-named from medial to lateral: 1st, 2nd, 3rd, 4th and 5th.
-bases are proximal.
-heads are distal.
- Bases of 1st, 2nd, and 3rd articulate with cuniform bones.
- Bases of 4th and 5th articulate with cuboid bone.
-In the foot there are two arches: (lateral and medial arches):-
1-lateral arch formed by calcaneus, cuboid, and (4th and 5th) metatarsal bones.
2- Medial arch formed by calcaneus, talus, cuniforms, navicular bone, (1-3) metatarsal bones.
-the medial arch is larger and stronger than lateral one.
- (If one of these bones of medial or lateral arch is fractured flat foot resulted).

♦Phalanges:

-2 for big toe
-3 for lat. 4 toes
-total=14

*The leg*

Covered by:

Skin.

Superficial fascia: contains:

A. small saphenus vein with sural nerve.
B. great saphenus vein with saphenus nerve.

3- Deep fascia: -extends from tibial condyles to both malleoli (lateral and medial malleoli).
- Thickened at the ankle (anterior), to form two retinaculums:-
1-superior extensor retinaculum.
2-inferior extensor retinaculum.
-it sends two intermuscular septi: (anterior and posterior) attached to fibula.
-these two intermuscular septi in addition to interosseus membrane and deep transverse fascia divide the leg into three compartments (anterior, posterior and lateral).
-The posterior compartment is subdivided into superficial and deep layers by deep transverse fascia with part of deep fascia.
-Each compartment has its own muscles, own action, own nerve supply, own arterial supply…
Muscles of the anterior compartment.

Consists of:

Tibialis Anterior muscle.
Extensor Hallucis Longus. (Of the big toe).
Extensor Digitorum Longus.
Peroneus Tertius.

(further details for theses muscles are in the HAND-OUT)

-N.B:

*Peroneus : fibula.
*Tertius : the third.
*Hallucis :of big toe
-all originate from fibula except tibialis ant. which originate from tibia.
-all innervated by deep peroneal nerve (branch from common peroneal nerve).
-all supplied by anterior tibial artery (branch from popletial artery).
-all extend the ankle (dorsiflex).

***(Tom Has Very Nice Doges and Pigs)***
T: tibialis, H: hallucis, V: ant. tibial vessels, N: deep peroneal nerve, D: extensor digitorum, P: peroneal tertius.

-N.B: dorsiflex=extension of ankle(up)
Plantarflex=flexion of ankle(down)
-N.B:standing on lat. Edge of foot is called inversion
-N.B: peroneus tertius is considered as a part of ext.digitorum longus.
-N.B: ant. Compartment is between 2 muscles and a tough fascia so it's painful when walking on leg for a long time.

To see more details see pages 410 and 426 Grant’s Atlas.

I’d like to dedicate this sheet to all my colleagues in medicine faculty especially to:
Medicine faculty:
(Osama a7mad 3abed 5aleel 3othman), a7mad abo 7alawe, 7amzeh jssar, m2moon, 5aled 7ajeer, mo2ayad kittaneh, yazeed eneef, a7mad shalabeh, abo 3eed, yazan 3toom, abo dieh, Sami 3abdeen, a7mad 3abed, a7mad el3eesa, rami salame, abo qamar, abo ed3aig, anas 3lean, a7mad 7nai6e, m7mmad sboo3.
Engineering faculty:
a7mad ya3’i, 3mar samreen, mohannad, a7mad jamal, malik abo 3’aneeme, , naser zeer, osama, abo sabreen (ABS), khoole, jihad, m7ammad 7osam, abo 7a6abe (abo 5ashabe). J

Special thanks for Dr. Maher Al-Hadidi

Some notes on the last Embrio lecture ....

2008-04-05T21:01:00.003+03:00

1-no pregnancy occurs--->carpus luteum will shrink until degenerateàprogesterone levels will go down--->C.luteum will be converted into C.albicans(nearly at day 27)àendometrium replaced by myometrium---> second period will start.

2-follicle:ovum surrounded by nourishing cells

3-estrogen--->first 14 days of period-->before ovulation
Progesterone--->second 14 days of period--->after ovulation

4-carpus luteum is formed by remains of 2ry oocyte after ovulation

5-carpus luteum is responsible for:
-second phase of female period
-pregnancy
-progesterone secretions

6-ovary forms before 5th week

7-ovulation(of 2ry oocyte) occurs at day 14

8-ovarian layers after modified peritoneum are:
-Germinal epithelium
-Tunica albuginea
-ovarian cortical region(cortex of ovary)
-medulla

9-hilum:receives arterial blood supply and sends Venus drainage to and from ovary--->by ovarian blood vessels

10-follicles--->primitive(primordial)
---->growing (secondary)

Corrections :)

2008-04-05T20:53:00.002+03:00

He who makes no mistakes , makes nothing .....
These are a few corrections on sheet no. 18 , no. 14 , no. 12

****************

♦Corrections and additions s for sheet 18

1-adductor opening:▲ space between the two insertions of adductor magnus muscle to allow femoral blood vessels(arteries + veins) to pass through it.

2-obturator nerveàit descend to cross pelvis then appear below the floor of femoral ▲ after passing through obturator foramen below pectineus.

3-pregnant ladies lay on their back at parturition(delivery) to decrease pain resulted by pressing on obt.n.

4-The hamstring head of adductor magnus will only extend the hip.

Correction for sheet 14♦

1-The angle between neck of femur and shaft is 123◦ in females and larger in males to give prominence for hip.

Correction for sheet 12♦
1-symphsis pubis is cartilaginous joint not fibrous joint.

Downloads , Downloads and more Downloads !!

2008-04-05T19:14:00.003+03:00

10 amazing slide shows sent in by our friend : Basheer Zghoul ....
The files concern the Upper Limb but they can come in handy later on :)

follow the link to download :

Upper limb slideshows(( compressed and direct )) :D

Upper limb slideshows

Thanks a lot Basheer ! keep sending us the good stuff ;)

PS: The files in the first link are compressed , you can download all 10 slide shows at once :) and it is a direct link ** Thanks Yezan for creating it ;)**

PSS: The second link allows you to download 1 file at a time ...

CS2 Home Work Answers!!!

2008-04-02T20:43:00.007+03:00

The latest CS2 homework is HERE!! Click Here
In appreciation of his great effort and well-done contribution, we are all pleased to recognize Mohammed Qtaishat, one of the finest colleagues in the Medicine school.

If you missed a muscle in the lab ....

2008-04-01T20:18:00.002+03:00

Do not worry , you can watch one of these Videos to double check it !!!

Credits to Yezan 3toom as usual :)

sheet no. 20

2008-04-01T15:43:00.004+03:00

Sciatic Nerve :

-largest nerve in the body
- about 2cm in diameter
O:L4, L5, S1, S2, and S3 Inside the pelvis
Then leave through greater sciatic Foremen, frequently (usually) below piriformis to appear in gluteal region, descend to reach popliteal fossa. There it divides into 2 terminal branches they are :
Tibial Nerve
Fibular Nerve (Common peroneal nerve).

-at the lower part of the gluteal region it pass between 2 land marks, they are:
1- ischial tuberosity (medial).
2 Greater Trochanter of femur (lateral) there it pass midway between 2 bones that’s why if neck of femur is fractured the nerve could be trapped and injured (sciatic nerve trap).
Sciatic bed (when patient on his face)
-i.e anterior relation of sciatic nerve

-sciatic nerve has the following anterior relations from superior to inferior
Ischial spine
Gemellus superior
Obturator internus muscle
Gemellus inferior
Quadratus femoris
Adductor magnus

Posterior compartment of the thigh

Has the following muscles form lateral to medial
Biceps Femoris

Semitendinosus

Semimembranosus

Hamstring part of adductor magnus

All originated from Ischial tuberosity.
All innervated by sciatic Nerve
All supplied by profunda femoris artery
Most extend thigh at hip joint
Most flex leg at knee Joint

[1]Biceps Femoris
-Long head
O : Ischial tubrosity
-Short head
O: linea aspra of femur
Ins: head of fibula(for both heads)
N.s: sciatic Nerve
Action: long head- Extend the hip
Both heads flex the Knee

[2]Semitendinosus
O: Ischial tuberosity
Ins: SGS area
N.s: sciatic Nerve
Action: extend the hip/ flex the knee

[3]Semimembranosus
O: Ischial tuberosity
Ins: medial condyle of Tibia
Some of its fibers will return back on posterior aspect of knee joint to strengthen it, they are called oblique popliteal ligament
N.s: sciatic nerve
Action; extend the hip/ flex the knee
[4]Hamstring part of ad.magnus
Ac: extend hip

Popliteal fossa :

Diamond shaped

-Behind the knee joint and has:
Borders ( boundaries)
Above and lateral--> biceps femoris
Above and medial--> semitendenous and semimembranosous
Lower and lateral --> lateral head of gastrocnemius.
Lower and medial--> medial head of gastrocnemius.
4 borders____ 4 angles

1-Roof
*Skin
*Superficial fascia
*Small saphenous vein
*Sural nerve
*Deep fascia

2-Contents from superficial to deep
*Sciatic Nerve and branches
*Popliteal vein and tributaries
*Popliteal artery and branches
*Popliteal lymph nodes
*Popliteal pad of fat

3-Floor from superior to inferior
*Popliteal surface of femur
*Capsul of knee joint
*Oblique popliteal ligament
*Popliteus muscle
*Popliteal Muscle

Its function to initiate flexion of knee joint (the key of flexion of knee)
As when start setting, jumping up, and landing ground .

With best dedication to all my friends especially,
Ro2a, Boshra, Bayan, Do3a2, Leen, Samar, Rawan & Dana

sheet no. 19

2008-03-31T19:04:00.004+03:00

The Gluteal Region :

*Bones of the gluteal region

Outer(external) surface of hip bone
sacrum
coccyx
upper part(half) of the femur

*Layers of gluteal region

1) skin * thick
* With large amount of sweat gland and hair of follicles
2) superficial fascia ((contain large amount of fat that increase the mass of the region &contain superficial vessels and nerves ))
3) deep fascia
4) muscles

*Skin of gluteal region is divided into 4-quarters

upper lateral
upper medial
lower lateral
lower medial

§ N.B §

( the common site of intramuscular injection (IM) is in the upper lateral quarter which is called the safest area for I.M injection )
Which can be marked by rule of Thumb ≈ by putting the thumb on ASIS
& the tip of the index is pointing toward the site of injection
Below this area there are minimal number of vessels & nerves

[The Muscles]

Gluteus maximus

Largest muscle in the body
It forms most of the mass of gluteal region
O : outer surface of ilium & sacrum & coccyx

INS : 1) upper quarter to linea aspra
2) lower 3 quarters to iliotibial tract
● N .S : inferior gluteal nerve branch from sacral plexus
● Action : 1) extention of the hip
2) lateral rotation of the hip

Gluteus medius

▲ in shape
Below(deep to) maximus
Above(superficial to) minimus
O : outer surface of ilium
Ins : greater trochanter of femur
N .S : superior gluteal nerve
Action : steady the pelvis while walking or when you left your foot of the ground by ABDUCTION of the hip ( other side hip )

Gluteus minimus

▲in shape
Below medius
O: outer surface of ilium
Ins : greater trochanter of femur
N.S : superior gluteal nerve
Action : same as medius BECAUSE both cooperate to perform common action to steady the pelvis
N.B : if the superior gluteal nerve is cut the result will be paralysis of medius & minimus leading to Tilting of the pelvis while walking called Duck Gaite

Piriformis

Pear- shaped
O: anterior surface of sacrum in site pelvis then leave through greater sciatic foramen to reach gluteal region
Ins : greater trochanter of femur
N.S : sacral plexus
Action : lateral rotation
N.B : -ALL Structure pass superior to piriformis are called superior ( gluteal V&A&N)
-Most structure pass below piriformis are called inferior gluteal V&A& N)
●N.B: Piriformis is the key identification of the structure in Gluteal region to mark or identify structure .

Obturator internus

Fan- shaped
O: inner margin of obturator foramen inside the pelvis then leave through lesser sciatic foramen
Ins: greater trochanter of femur
N.S : nerve to obturator internus from sacral plexus
Action : lateral rotation

Gemellus superior

Above obturator internus
O : spine of ischium
Ins : greater trochanter with obturator internus
N.S: nerve to obturator internus
Action : lateral rotation

Gemellus inferior

O: ischial tuberosity
Ins: greater trochanter
N.S: Nerve to quadratus femoris
Action : lateral rotation

Quadratus femoris

Quadrangular in shape
O: ischial tuerosity
Ins: intertrochanteric crest
N.S: nerve to quadratus femoris
Action : lateral rotation of femur

N.B : IF THE NECK OF FEMUR IS FRACTURED . THE PATIENT AT BED HIS FOOT WILL BE LATERAL IN ROTATED SO WE MUST tie the 2 thumb together>> to protect sciatic nerve because if fractured occure then the greater trochanter will close to ischial tuberosity so it may be cut the sciatic nerve which is located between them .

sheet no.18

2008-03-30T17:18:00.003+03:00

Medial Compartment of lower limb :

-located between med. And post. Intermuscular septi
-it consists of 5muscles
1-gracilis
2-add. Longus
3-add. brevis
4-add. Magnus
5-obturator externus

-all supplied by obturator N. except part of the add. Magnus that is supplied by the sciatic N. (hamstring head)
-all supplied by the profunda of the femoral and obturator A.
-all originate from the pubic bone and the ischium or both, except obturator exter. That originates from the outer surface of the obturator foramen
-all inserted to the femur except gracilis into tibia
-all add. The hip joint
-all cross only one joint except gracilis that crosses two joints (hip and knee)

Add. Longus
O: pubic bone
Ins: linea aspra of femur
Add. Brevis
-It is located below add. Longus and above add. Magnus i.e. it is sandwiched between them.
- It is also sandwiched between the ant. Division of obturator N. and the post. Division of the obturator N. (both of them supply it)
O:pubic bone and ischium
Ins: linea aspra of femur
Gracilis
O:pubic bone
Ins: upper medial surface of tibia (SGS area of tibia)
Ac: it add. The hip and lat. Rotate the knee because it crosses two joints(hip and knee)

** NOTE:SGS area: it is the insertion site of 3 M. with different N. supply)
S:sartoreus (N.S. femoral N.)
G:gracilis (N.S. obturator N.)
S:semitendinosis (N.S. sciatic N.)

Add. Magnus
Deepest, largest, most powerful muscle of the add. Group M. with two nerves supply that acts as between med. Comp. and post. Comp. of the thigh and represented by its nerve supply
-It has two heads:
1st: add. Head(part)
O: from inf. Pubic ramus and ischial ramus
Isn: upper 4\5 of the med.side of linea aspran
N.S.: obturator N.
Act: it add. The hip
2nd: hamstring head(part) and also it is the post. Comp. Part(flexors of hip).
- O:ischial tubrosity ( because all hamstring muscles originate from ischial tubrosity)
- Ins: lower part of med. Side of femur which specially in an area called add. Tubercle of femur located above med. Epicondile (named so because the add. Magnus is inserted in it)
N.S.: sciatic N.
Act: add. And extend the hip

NOTE: it has 2 parts because it is located between 2 compartments , one is the med.(add.) Comp. and the other is the post.(hamstring) Comp.. therefore, it is a midway muscle between these two comp. In embryological development.

Obturator N.
- O: ant. Divisions of the ventral rami L2 , L3 , L4 of lumbar spinous nerve
-then crosses the pelvis then leave through obturator foramen below pectineus ,there it divides into ant. Division and post. Division to sandwich the add. Brevis
Branches:
1-muscular branch
2-articular branch: to hip and knee joints
3-one coetaneous branch: to skin and med. Side of the thigh.

**NOTE: pregnant ladies lay on their back flexing there knee and hip in the last weak before labor and that is to decrease the pain because baby at that time is pressing at the obturator N. by his head that is located in the pelvic inlet which is painful.

I dedicate this sheet to all my friends and to all medicine students especially;
Dana twalbeh\ basher sharma \ bashar kako \ ous samer \ fahad naji \ sahar basil \ fahaf adel \ yazan radaydeh \ omar radaideh \ yezan 3toom
Special thanks for dr. Maher al-hadidi

Review questions!

2008-03-28T16:07:00.002+03:00

Sharing is caring :P

these are some questions on anatomy ... some are for the practical exam too ; )

Enjoy !

*What is attached to this line (soleal line)?
soleus muscle
*What is the muscle attached here ( radial tuberosity)?
Biceps
Scapula : right or left.*
*What is this muscle: flexor digitorum superficialis
*What is the nerve supply of this muscle?
Feres mahor : lower subscapular nerve .
Behind the medial epicondyl : ulnar nerve*
*What is the attached structure?
Femoral artery

The following form the proximal row of the carpal bones except :
1- lunate
2- pisiform
3- scaphoid
4- triquitrium
5- trapezium

All the following form the rotator cuff except:
1- teres minor
2- supraspinatus
3- subscapularis
4- teres major
5- infraspinatus

Boundries of the snuff box are all of the following except :
1- abductor pollicis longus
2- extensor pollicis longus
3- adductor pollicis brevis
4- extensor pollicis brevis

What is the nerve that divides at the opposite neck of radius :
Radial nerve

What are the boundries of the cubital fossa?
Brachiradialis + pronator teres

All of these muscles are related to the biceptal groove :
1- pectoralis major: lateral lip
2- teres major : medial lip
3- latissmus dorsi : floor
lady between 2 men *
4- long head of biceps : passing it !

Contents of cubital fossa from medial to lateral :
Median nerver , brachial artery , biceptal tendon and radial nerve

What are the boundries and contents of the femoral triangle?

All of the following muscles adduct the shoulder except :
1- pectoralis major
2- teres major
3- latismuss dorsi
4- pectoralis minor

All of the following relations are true except :
1- biceps --- main flexor of the elbow J.
2- deltoid --- axillary nerve
3- iliopsoas --- main flexor of the hip
4- ulnar nerve--- med. Epicondyle

median nerve supplies all these muscles except :
1- flexor carpi radialis
2- flexor digitorum superficialis
3- all flexor digitorum profunuds
4- pronator quadratus
5- palmaris longus

the Musculocutaneous nerve passes between : brachialis + biceps

superficial palmar arch is formed mainly from :
superficial unlar artery *What is attached to this line (soleal line)?
soleus muscle
*What is the muscle attached here ( radial tuberosity)?
Biceps
Scapula : right or left.*
*What is this muscle: flexor digitorum superficialis
*What is the nerve supply of this muscle?
Feres mahor : lower subscapular nerve .
Behind the medial epicondyl : ulnar nerve*
*What is the attached structure?
Femoral artery

The following form the proximal row of the carpal bones except :
1- lunate
2- pisiform
3- scaphoid
4- triquitrium
5- trapezium

All the following form the rotator cuff except:
1- teres minor
2- supraspinatus
3- subscapularis
4- teres major
5- infraspinatus

Boundries of the snuff box are all of the following except :
1- abductor pollicis longus
2- extensor pollicis longus
3- adductor pollicis brevis
4- extensor pollicis brevis

What is the nerve that divides at the opposite neck of radius :
Radial nerve

What are the boundries of the cubital fossa?
Brachiradialis + pronator teres

All of these muscles are related to the biceptal groove :
1- pectoralis major: lateral lip
2- teres major : medial lip
3- latissmus dorsi : floor
lady between 2 men *
4- long head of biceps : passing it !

Contents of cubital fossa from medial to lateral :
Median nerver , brachial artery , biceptal tendon and radial nerve

What are the boundries and contents of the femoral triangle?

All of the following muscles adduct the shoulder except :
1- pectoralis major
2- teres major
3- latismuss dorsi
4- pectoralis minor

All of the following relations are true except :
1- biceps --- main flexor of the elbow J.
2- deltoid --- axillary nerve
3- iliopsoas --- main flexor of the hip
4- ulnar nerve--- med. Epicondyle

median nerve supplies all these muscles except :
1- flexor carpi radialis
2- flexor digitorum superficialis
3- all flexor digitorum profunuds
4- pronator quadratus
5- palmaris longus

the Musculocutaneous nerve passes between : brachialis + biceps

superficial palmar arch is formed mainly from :
superficial unlar artery

Best Wishes,

the medical journals team :)

picture series 7

2008-03-24T18:11:00.006+02:00

Anterior Hip Muscle

Femoral Triangle :-)

Arteries of the L.L

sheet no .17

2008-03-24T07:49:00.002+02:00

Femoral triangle :

**Thigh is the part of the lower limb extending from the hip joint to the knee joint

**Great.S.V-->drains in femoral vien
Small.S.V-->drains in popliteal vien

*iliotibial tract:

O: iliac tubercle-

Ins: lateral condyle of tibia-

it receives the insertion of two muscles-

**All anterior compartment are supplied by femoral nerve
Except:

-Pectineus (usually femoral nerve/occasionally-->obturator nerve)
-Psoas major -->lumbar plexus
**Iliacus/psoas major
(connected by iliopsoas tendon)
-O: iliac fossa(iliacus)/ vertebral column(psoas)
-Ins: lesser trochanter (both)
-AC: prime flexors of hip

**Sartorius:
-O:ASIS(lat.)
-Ins: upper medial surface of tibia(SGS),(sartorius gracellec semi-tendonus)
-Ac: flex hip/flex knee
**rectus femoris:
-Ac: flex hip/extend knee

**Sartorius/rectus femoris-->the only two muscles crossing two joints.

**Vastus lat./ vastus med./ vestus in.m. à cross one joint up only.

**Law of muscles: if a muscle crossing the joint it must perform two different actions on them like rectus femoris (pro: flexion/ dis: extension) but sartorius is an EXCEPTION.

Inguinal ligament

- it is the lower enrolled part of the aponeurosis of the external oblique muscle of the abdomen

-this extends between ASIS and superior pubic ramus at an area called pubic tubercle .
-This will form a line of demarkation(land mark) between Abdomen and thigh.
-It also acts as a bridge which passing below it :( from lateral to medial):
(NAV)
1. Femoral nerve(N)
2. Femoral artery (A)
3-femoral vein(V)
4-ilicus
5-psoas major

Femoral triangle:

▲aspect at anteriomedial aspect of thigh.

1) Borders (boundaries):
- inguinal ligament(Sup.)
- Sartorius(Lat.)
- adductor longus(Med.)

2) Roof :(from superficial to deep)
1.skin
2.Superficial fascia
3. great saphenous vein
4.Saphenous opening
5.Deep fascia of the thigh

3) Floor:( from Med. to lat)

1. Adductor longus
2. Pectineus
3. psoas
4. illiacus

4) Contents: from Lat to Med:

1. femoral nerve and branches
2. femoral art. and branches
3. Femoral vein and tributaries
4. deep inguinal lymph nodes (they drain the deep structures of the lower limb).

Femoral artery

Above external iliac artery**
Below popliteal artery
**within femoral triangle superficial
Behind Sartorius deep

** Aorta gives two branches 1.right common iliac artery
2. left common iliac artery
*each one gives external illiac artery to the lower limbs
internal iliac artery to the pelvis
*femoral artery passing through the femoral triangle
*the main arterial supply of the L.L is femoral artery which is:

1- direct continuation of external illiac artery.
2-start behind the midinguinal point(good clinical mark) then it descend within femoral triangle
there, it is superficial compared to its distal part. (disappear below the sartorius muscle)
3-then it descend down behind sartorius to appear behind knee joint in a space called popliteal fossa there it is called popliteal artery
4- it's terminal end is where it pass through adductor opening to give popliteal artery

Importance:
1-feel the pulse because it is superficial
2-take blood samples
3-give fluids and drugs
4-cardiac catheterization(reach heart from femoral artery)

Branches:
1.profunda femoris artery
- largest branch of the femoral artery
- begins lateral then descend down giving four perforating arteries which will supply the Med. compartment and post. compartment of the thigh.

*4 perforating arteries pass through the 4 openings of the adductor mangus muscle to supply post.C
2. muscular branches: for all the muscles of the anterior compartment
3. articular branches: to the hip and knee joints
Femoral nerve
O: posterior divisions of ventral rami of the L2, L3, L4
(give extensorsàin Ant. C)

>>then leave the abdomen continue to pass below inguinal ligament to reach femoral triangle giving the following branches:
1. muscular branches
2. articular branches: to the hip and knee joints
3. cutaneous branches

*** The longest one of them is called saphenous n. that accompanies the great saphenous vein all through it's pathway.

***Notes:
1)Axilla resembles Femoral triangle
Cubita fossa resembles popliteal fossa
Cephalic.V resembles G.S.V
Basailic.V resembles S.S.V
2)some fibers of vastus lateralis and medialis form what we call retinaculum.
3)quadriceps femoris is inserted into tibial tuberositiy via patellar ligament

I dedicate this sheet to all my friends specially:

Dr.Shahed thaer / Dr.yazan radaideh / Dr. abeer khawatrah/ Dr. yezan 3toom/ Dr.omar radaideh/Dr. sami abdeen /Dr. ahmad abed /Dr. hamzeh saraireh /Dr. farah mshakbeh/Dr. manar jwainat/ najadeh,luma twal ,dina khozouz,omar semreen, ksa,wala2 karadsheh!!
Also:
Dr. abdallah nsoor/Dr. qais radaideh/Dr. khaled mosa/Dr tareq rfoo3 Dr. naser 3'raibeh/Dr abdallah shawabkeh from 2nd year!!

Special thanks to my brother RAMI TAWALBEH for printing this sheet for me!!!!

sheet no.16

2008-03-21T22:37:00.000+02:00

Cell Cycle

Consists of 2 major events:

a) Interphase.
b) Mitosis.

- Interphase is longer than Mitosis.

- In the Interphase the cell grows and duplicates its organelles and genetic material.
The Interphase stage consists of:
1) G1 phase: this phase is the major period of cell growth during its lifespan.
2) S phase: (synthesis) is the phase in which the cell duplicates its DNA.
3) G2 phase: is the phase in which the cell undergoes a period of rapid growth to prepare for mitosis.
M = Mitosis Stage
I = Interphase stage
- G0 phase: Some cells (like muscle cells) don’t divide more after mitosis and they become in a resting stage. Peripheral lymphocytes are stimulated to re-enter the cell cycle and divide after exposure to radiation, wounds, or diseases.
- Some cells leave the cell cycle(rest) permanently (like muscle cells(myocytes) and nerve cells(neurons)) while others leave it(rest) temporarily (like peripheral lymphocytes).

-In case of bone fracture:
a) Periosteum: is a membrane that lines the outer surface of all bones and it contains osteoprogenitor cells which produce osteoblasts. Periosteum is stimulated to produce osteoblasts when the bone is fractured.
b) Osteoblast: is the matrix formation of cell. It produces osteocytes.
c) Osteocyte: are maintenance cells.
d) Osteoclast: remodeling cells to reshape the fractured bones.

- How Cells Divide:

1) Somatic Cells – by Mitosisàgive 2 identical daughter cells
2) Reproductive Cells – by Meiosisàgive 2 in identical cells

Good Luck all !

2008-03-18T23:07:00.003+02:00

Exams are just around the corner , well , exams ARE HERE !

so we are wishing you all the very best luck , y3nee the bestest EVER !!

Rock on people !!

With our bestest wishes for every single one of you ,

The Medical Journals Team !

Sheet no. 15

2008-03-18T15:57:00.004+02:00

Layers of the lower limb

1.skin

2.superficial fascia its thick, contains:

- large amount of fat

- two superficial veins and there tributaries

- three superficial arteries

- lymph nodes (inguinal lymph nodes)

- cutaneous ( skin) nerves.

- two superficial veins (like cephalic and basilic veins in upper limb):

1. great saphenous vein:

- the longest vein in the body

- start at the medial side of the foot → pass anterior to medial malleolus → ascend up to med. Side of the leg → ascend up to medioposterior aspect of the knee → ascend anteriomedial to the thigh → passing through saphenous opening → end into femural vein.

- it is accompanied by saphenous nerve(longest nerve in the body)

- it’s the vein that used for coronary transplant(coronary artery bipass operation à as spare part)

Because it’s the longest vein, and deep veins will take over, and there is a communication between superficial and deep veins

- the part of great saphenous vein at ant. of med.malleolus is used instead of median cubital vein (when we cant find it) to give drugs or food.

2. small saphenous vein

- Started at lateral side of the foot → behind lat.malleolus → post. Surface of the leg → end at the popliteal vein (the father of femoral vein, it continues as femoral vein)

- its accompanied by sural nerve

Remember that cephalic vein end at the end of axilary vein*

Remember basilic vein end at the beginning of axilary vein*

And also

g.saphenous v end at the end of femoral v*

*s.saphenous v end at the beginning of femoral v

- each of them contain numerous valves to convey blood against the gravity by aiding of soleus muscle.

- If some of the valves become incompetent it will be dilated and then become tortous (winding) and painful which called varicose veins (caused by: repeated pregnancy, standing for along time, heavy weight…)

- The only veins in the body which don’t have valves are the veins of the face.

3.Deep Fascia

- Its like a panty hose (tight trouser), holding all structures of the lower limb

- Its thickened lateral forming iliotibial tract which confirm full extension of the knee, so you cant stay in a full extension for along time.

- its defected superomedial forming an open called saphenous open for the entrance of g.saphenous v

- It gives 3 intermuscular septa (med, lat, posterior) attached to linea aspera of the femur dividing the thigh into 3 compartments (ant. Extensors of knee/ med. Adductors of hip/ post. Flexors of knee ) each has its own muscles, arteries, veins , nerves and common action, these compartments are:

a. anterior compartment consists of 8 muscles :

1.Sartorius : tailors muscle, the longest muscle in the body

O: asis (lat.)

ins: tibia(med.).

Ac: cross knees

2.quadriceps femores : which consists of 4 muscles :

a.rectus femoris

b.vastus medialis: it prevent separation of patella laterally

c.vastus lateralis

d.vastus intermedius (below vastus lateralis)

3.iliacus:

o: iliac fossa

ins: lesser trochanter

4.psoas major (p is silent)

5.pectineus (comb- like)

O: sup.pubic ramus

Ins: linea aspera

Ac: adduction Assist in flexion

- Most of these muscles are supplied by femoral nerve

- All are supplied by femoral artery

- All are drained by femoral vein

- 3 and 4: prime flexors the hip

- 1 weakly flex the hip

- quadriceps muscles prime extensors of the knee

Finally I'd like to dedicate this sheet to all my colleagues in medicine faculty , specially :

M7md 3ssaf, Tamer albatsh, Khaled aldayne, Moadh alz3bi, Rami salame, Fadi halsa, Bilal samhory, Na2l haddad, M7md almomani, 7mze jassar, Yazan 3toom, M7moud wajeh, M7md 3awad, Abdelrahman alkhatib, Omar abu qamar, Qasim pu3ol…

done by :

Basheer Zghoul

Sheet no . 14

2008-03-17T17:50:00.005+02:00

** Click on image to enlarge

Femur

► bone of thigh.
►longest bone in the body.
►It’s length is presenting 1/4 of the person’s height.
►It’s bowing anteriorly to give it's strength for weight bearing [minimize the load].
►It is example of long bones.
►It is example of compact bone tissue.
►It has the following parts:

І-Proximal end:

A. Head:

►About 2/3 of a sphere
►Covered by hyaline cartilage
►Articulate with the acetabulum to form hip joint
►Located medial
►Has a small pit [cavity] called fovea capitis [head]

B. Neck:

►Narrow part
►Commonly fractured in old ladies [because of multiple pregnancies]àOsteoporosis
►Neck unites with shaft by forming an angel about 123ْ in males, but larger in
females [more space for pelvis]

C. Greater trochanter:

►Tubercle

D. Lesser trochanter:

►Small medial
►Conical in shape
►for muscle attachment
E. Intertrochanteric line:
►Rough line connect both trochanters anteriorly
F.Intertrochanteric crest:
►Connect both trochanters posteriorly

И-Shaft:

►Bowing anteriorly
►Has convex smooth anterior surface
►Rough concave posterior surface àForming a rough line called linea[line] aspra [rough] for muscle attachment

Ш-Distal end:

►Medial condyle: articulation
►Lateral condyle: articulation
►Medial epicondyle: muscle attachment
►Lateral epicondyle: muscle attachment
►Intercondylar notch (fossa): for cruciate ligaments
►Patellar surface of femur: for articulation with patella ,[if you move it, it move over the femur]

**All above covered by hyaline cartilage [smooth soundless frictionless movement , but in old people the smooth surface become rough again]

---------------------------------------------------

**Bones of the leg:

►2 in #

A. Tibia:

►long, The larger , located medial
►For weight bearing
►Has the following parts:

І- Proximal end:

1-Medial condyle

2- Lateral condyle

**Both condyles Articulate with condyles of femur(med. With med. / lat. With lat.)

3-Superior articular surface called "tibial plateau" : a shallow surface which is deepened by the 2 cartilages between femur and tibia.

►Some times one or both cartilages are torn due to excessive exercise or abuse.

4- Tibial tuberosity:

►It’s the insertion site for quadriceps femoris which extend the knee

►You cant extend your knee in these cases:
tendon of quadriceps was abused
Tibial tuberosity was dislocated because of running for long distances or as a result of servant disease [Osgood-schlatter disease]àOsteochondrosis of tibial tuberosity

5- Soleal line:

►Oblique , posterior

►Attachment for Soleus muscle àwhich act as pumpàpumping blood in the lower limb against gravity , and without it the blood in the lower limb will be stagnant(agglomerate).

И- Shaft of tibia :

►∆ in C.S

►Has 3 borders : anterior [subcutaneous] ,medial , lateral

►Has 3 surfaces: anterior ,medial [subcutaneous] , lateral

**Most of tibia is subcutaneous à poor in blood supply

Ш- Distal end :

1.Medial malleolusà rounded large processà subcutaneous

2.Inferior articular surface à it transmits half of the body weight to the tarsal bones [bones of the ankle ]

N.B: fractures of ankle take more time to heal than any other part in the body because of it's weight bearing function.

B.Fibula:

►Lateral smaller bone
►Not for weight bearing ,but for muscle attachment
►parts
-Proximal:

Head: articulate with lateral condyle of tibia
Neck

-shaft(body)

-Distal :

Lateral malleoulus subcutaneous

With my best wishes

Sheet no. 12

2008-03-13T22:18:00.002+02:00

Lower appendicular skeleton

Lower appendicular skeleton consist of:
1-pelvic girdle

2-bones of lower limb

Pelvic girdle (pelvis) consists of 4 bones united by 4 joint.

The 4 bones are:

1- Right hip bone.

2- Left hip bone.

3- Sacrum.

4- Coccyx.

The 4 joints are:

1- Right sacroiliac joint: its synovial joint and it join ilium
And sacrum.

2- Left sacroiliac joint: its synovial joint and it join ilium
And sacrum.

3- Sacrococcygeal joint: it’s cartilaginous joint and it join sacrum and coccyx.

4- Symphysis pubis: it’s fibrous joint and joins left & right pubic bone.

Hip bone:

Ø It’s contributed from 3 bones that united at its lateral side on the outer surface at a cup-shape cavity called acetabulum that ossified at age 17.

Ø The site of union forming Y-shape which is cartilaginous before 17 & it allow the X-rays to pass through it.

Ø It’s an example of flat bone which contain large amount of bone marrow and it is the common site to take bone marrow biopsy for bone marrow transplant especially for the case of cancer.

Ø It has outer surface (for muscle of thigh or lower limb) & inner surface (for pelvis).
Ø The 3 bones are: ilium, pubic, ischium.

Ilium:

like oriental fan, and it has the following part:

1- body: where it’s united at the acetabulum.

2- Wing or (blade) (in Latin it’s called ala):
· It has outer concavoconvex surface creating 3 elevated lines (convexities) for muscles attachment, the lines are called: anterior, middle, posterior gluteal lines, which give origin in gluteal region.
· It has inner surface which is concave and form iliac fossa which give origin to a muscle called iliacus.

3- Free margin: it’s called iliac crest and it has:
A- Anterior end called anterior superior iliac spine (asis).
B- Posterior end called posterior superior iliac spine (psis).
(The iliac crest extends from (asis) to (psis)).
C- iliac tubercle: located 2 inches behind anterior superior iliac spine.

4- Anterior inferior iliac spine: it’s located below (Sais), it’s not in iliac crest.

5- Posterior inferior iliac spine: it’s located below (psis), it’s not in iliac crest.

Note: ilium has 4 spines: anterior superior iliac spine & posterior superior iliac spine & anterior inferior iliac spine & posterior inferior iliac spine.

Pubic bone:

It’s like a letter (V) on its side and it has 3 parts:
1- body: medial and it united with the opposite one at
Symphsis pubis.
2- Superior pubic ramus: it is united with ilium at acetabulum. (Ramus mean small/short limb).
3- Inferior pubic ramus: it’s united with ischium.

Ischium:

It’s comma-shape bone, and has the following parts:
1- body: that united at acetabulum.
2- ischial tuberosity: it’s the weight bearing site while sitting on a chair.
3- ischial ramus: that unit with inferior pubic ramus.
4- ischial spine: triangular bone projecting medially.
Acetabulum:
· Cup shape cavity at the outer surface of hip bone.
· It’s the site of union of the 3 bones forming Y-shape area which is cartilaginous before age 17.
· The acetabulum is defected inferiorly forming acetabular notch that allows arterial supply to head of femur to pass through.
· It articulates with head of femur to form hip joint.

To see more figure about this lecture see these books:
-Clinical anatomy /by Snell/8th Ed/ page (557,558,645)
-Principles of human anatomy/by Tortora/10th Ed/
Page (213,214,215).

--------------------

Finally, I want to dedicate this sheet to all my friends specially:
M7md alwazeer,m7md sboo3,m7md taycer,m7md yousef,m7md almomany, nader 3oad,hashem aboma7fo’6, shaker barham, wasem samara, omar allozi, yezan al3tom, omar abo baker, 3amer sameer, qasma, ahmed, 3bd alrahman al5ateb, qusai abo 3azam, abo 5adega, zaid, 3adnan, mo2mn ,7amza jassar, zakarea, zaedon abo 5raes, mo5tar.

احر التعازي لاخونا وزميلنا في كلية الطب محمد المومني الذي فقد عمته
Best wishes for all medical students in ju.
M7md bader

Sheet no. 13

2008-03-11T21:28:00.003+02:00

Male Genital system :

Parts :

1)Two testis
2)Two vas deferens(ductus deferens)
3)Two epididymis
4)Two seminal vesicles
5)One prostate
6)One urethra

Testis: [1]
-Paired organs dedicated to produce the male hormone called Testosterone and spermatozoa(sperms).

-2cm wide/3cm thick/4cm long.

-Ovoid organs located within pouch of skin called Scrotum outside the body.

-To functionàthe testis does not function on body temperature(37 degree) but on 3 degrees below it(34 degree) for production of sperms to happen otherwise they will not function at all.

-That is why if testis does not migrate from it's original position (normally)which is located at posterior abdominal wall(the same as ovary)àwe have to descend it down to it's functional position(outside body) by surgical operation.

N.B: the ovary function inside the body at it's temperature(37 degree) unlikely to testis.

-Clinical Note: if the fetus has completed the full term(9 months) and testis or ovary remains in post.abd.wall then it must be descended down by surgical operation.
-testisàinside bodyà(zero-shaped) 0
àoutside bodyà(rounded)

***Testis is divided into parts called:
1-Testicular lobules:

>each is pyramidal in shape
>each testis contain 250 of them(for both 500)
>1-4 tubule in each
***each testicular lobule contain
2-Seminiferous tubules:
>highly coiled blind tube(blind tube: one way or direction tube)
>(30-70)cm long
>produce spermatozoa(sperms)
{spermatogenesis}
N.B: sperms move only in one direction inside S.t
***
Spermatogenesis (sperm production)start in male at puberty it ends nearly on age 60
Oomatogenisis (ovum production)start in female at birth
So it ends nearly on age 45.

[2]Epididyms

-Highly convoluted tubule
-6M in length(sperm will grow until maturation during passage through it)
-divided into head, body and tail
-it stores and matures sperms after being produced by testis

[3]Vas deferens

-long muscular tube
-45cm long
-It extends from tail of epididymis to ejaculatory duct close to seminal vesicle.
-It conveys mature sperms from…to…(mentioned in point 3).

[4]Seminal vesicle

-two horn-shaped organs
-on posterior surface of urinary bladder
-each form of 15cm coiled tube(not a sac)
-secrete Fructose important for sperm motility
-rich seminal fluid that constitute by 70% to ejaculate
-resemble testis where both contain tubes
-it is the only organ in body that secretes fructose so women doesn't secrete fructose at all.

N.B: Fructose is used in forensic medicine as evidence for sexual assault(rape).

N.B: our source of fructose is from plants.

[5]Prostate

-base above/apex below
-below urinary bladder
-pyramidal-shaped fibro muscular glandular organ(chestnut shaped)
-surrounds prostatic urethra that passes through it
-form of 5 lobes
-receive ejaculatory duct in urethra coming from vas deferens and seminal vesicle
-secrete alkaline fluid(alkaline phosphatase)to neutralize the vaginal acidic secretions
-secrete product that prevents infection

N.B: there must be two conditions for sperm motility
1)Fructose
2)Alkaline phosphatase
N.B: the contracepted pills prevent pregnancy either by
1)increase acidity of vagina(vagina dosh)
Or
2)decrease amount of progesterone/estrogen.

N.B: in both male and female the genital organs are posterior to urinary bladder and anterior to rectum with difference that female G.organs are larger because of uterus.

N.B: Aorta artery divides into right and left common iliac arteries and each of them gives also external and internal branches.
-internal: for pelvic organs and internal structures(U.B/Rectum/Vagina/prostate…etc).
-external: for lower limbs.

*************************************************
I'd like to dedicate my work to all my colleagues in faculty

16 days remaining for exam

God help us

With my best wishes

Yezan Atoom

Picture series 6

2008-03-10T17:56:00.007+02:00

Another set of pictures that Yezan 3toom sent for your delight people !
Enjoy ;)

** No more Latin numerals :P

Sheet no . 11

2008-03-10T17:40:00.003+02:00

Posterior compartment of forearm:

The muscles of this compartment are divided into 2 layers: - superficial layer.
- deep layer.

The muscles of Superficial layer of posterior compartment of forearm:
1-Brachioradialis
2-Extensor carpi radialis longus
3-Extensor carpi radialis brevis
4-Extensor digitorum
5-Extensor digiti minimi
6-Extensor carpi ulnaris
7-Anconeus

The muscles of Deep layer of posterior compartment of forearm:
1-Abductor pollicis longus
2-Extensor pollicis brevis
3-Extensor pollicis longus
4-Extensor indicis
5-Supinator

Abductor pollicis longus

Named according to action
Nerve supply: Radial nerve
Action: abduct the thumb

Extensor pollicis brevis

Nerve supply: radial nerve
Ins: Proximal phalanx of the thumb
Action: extend proximal phalanx of thumb

Extensor pollicis longus

Nerve supply: radial nerve
Ins: Distal phalanx of thumb
Action: extend distal phalanx of thumb (full extension of thumb)

*** there are 3 muscles for the thumb(F.P.L/E.P.L/E.P.B) and that’s why it can move in all directions.

Extensor Indicis

Nerve supply: radial nerve
Ins: extensor expansion of index
Action: full extension of index

Supinator

Winds (i.e. wraps) around proximal quarter of radius forming 1.5 circle.
Passing through it is the deep branch of radial nerve that will continue as posterior Interosseous nerve.
Ins: neck,shaft of radius.

*** the radial nerve divides into 2 parts: superficial branch and deep branch that then becomes posterior Interosseous nerve.

***If the muscles of the posterior compartment of forearm are paralyzed we will have "wrist drop", where the hand is pulled only by flexors and extension cannot be done.

___________________________________

Hand

The skeleton of hand is formed by metacarpals(5) and phalanges(14).
Has the following layers:
Palmer skin:
thick and full with sweat glands. The places where bends (18-81) are called skin crease, which are proximal and distal.
Superficial fascia:
contains large amount of fat within pockets to protect our hands from thorns, needles…
Deep fascia:
it is thickened to form a triangular part called palmer aponeurosis to protect underlying structures

muscles
Muscles of the hand
small muscles of the hand are arranged into 5 groups
The groups are:

1.Thenar muscles:3 in #
At base of thumb
(FAO):
-Flexor pollicis brevis
-Abductor pollicis brevis
-Opponens pollicis
Nerve supply: median nerve

2.Hypothenar muscles:3 in #
To little finger
(FAO):
-Flexor digitiminimi
-Abductor digitiminimi
-Opponens digitiminimi
Nerve supply: Ulnar nerve

3.Lumbrical muscles:4 in #
Named from lat. To med.
lumbrical :worm-like
Origin: flexor digitorum profundus
Ins: Extensor expansion of med. 4 fingers.
Nerve supply:
-2,3 digit>>>median nerve
-4,5 digit>>>ulnar nerve
Action: (writing position)
- flex MCPJS
-extend IPJS

4.Palmar Interossei:3 in #

named from lat. To med.
Nerve supply: ulnar nerve
Action: adduct medial 4 fingers(towards axial line)

5. Dorsal Interossei: 4 in #

named from lat. To med.
Nerve supply: deep ulnar branch
Action: abduct medial 4 fingers(away from axial line)
***N.B: due to the lateral muscles (adduction- group 4) and medial muscles (abduction- group 5) on the axis, or middle finger, it is centralized

______________________________
Arteries of forearm:

The brachial artery, ends at opposite neck of radius and divides into 2 arteries:

Radial artery: smaller branch/lateral

Ulnar artery: larger branch/ medial

Radial artery
It is the lateral smaller branch of brachial artery
Upon reaching the wrist it divides into
superficial branch
deep branch: It is the one located within the floor of the snuff box

***The snuff box:
A space between 3 tendons:
-2 tendons lateral ( abductor pollicis longus + extensor pollicis brevis).
-1 tendon medial (extensor pollicis longus).
It contains deep branch of radial artery
Its base is formed by scaphoid bone

Ulnar artery:
It’s the medial larger branch of brachial artery
It gives a branch called common interosseous artery which divides into
anterior interosseous artery to the anterior compartment
posterior interosseous artery to the posterior compartment
The proper Ulnar artery continues until it reaches the wrist at the pisiform where it divides into superficial branch + deep branch
Superficial palmar arch:
Contributed mainly from superficial ulnar artery and minimally from superficial radial artery.
Deep palmar arch:
Contributed mainly from deep radial artery and minimally from deep ulnar artery.

***N.B: Both arches are important for supplying the palm and finger.

*** N.B: the index is moved by 4 tendons(two flexors/two extensors).

***N.B: median nerve innervates 5 muscles only in hand (all thenar muscles+first,second lumbricals)

______________________

Special thanks to all my friends:
Mohammad 3awad, Muhanad rsheidat, Zaydoon 5raisat, 3abood , Rami ya3’i, omar abu baker. Mohammad al wazeer, mohammad abu haneya, waseem samara…. All of the rest.

Pictures series V

2008-03-07T20:13:00.009+02:00

These Pictures were also sent in by Yezan 3toom !

Thanks Yezan and keep 'em coming !

upper arm arterial supply

_________________________________________________________________

Veins

_______________________________________________________________________

Cubital Fossa

Picture Series IV : Arm- Forearm muscle pictures , separated !

2008-03-05T21:37:00.013+02:00

This is the rest of What Yezan sent !
We had to add them in 2 separate post

*************

Extensor Pollicis Brivis + Extensor Pollicis Longus

********

Flexor Carpi Radialis

**********

Flexor Digiti minimi brevis + Flexor pollicis brevis

Abductor digiti minime + abductor pollicis brevis

**************

Flexor Digitorum profundus

************

Flexor digitorum superficialis

*********

Abductor pollicis

***********

Deltoid

*********

Coracobrachialis

********

flexor pollicis longus

**************

Anconeus

Picture series III : Arm-Foream muscles , each one separated!

2008-03-05T20:18:00.021+02:00

These pictures were sent in by our friend Yezan 3toom who wanted us to include them in the related sheet but we thought it was better for you to see them separately for they are superb and very much helpful !!

******************

Pronators !

******************

Biceps Brachii

*************

Brachialis

**************

brachioradialis

***************

Extensor Carpi Radialis brevis

**************Extensor carpi radialis longus

**********

Extensor Carpi Ulnaris

*************

Extensor Digit minimi
**********

Extensor Digitorum

***********

Extensor Indicis

sheet no. 10

2008-03-05T14:41:00.004+02:00

Uterus:

Thicked wall pear-shaped muscular organ
Located between urinary bladder anterior and rectum posterior
Found in: -pelvis (non pregnant ladies)
-abdominal pelvic cavity (pregnant ladies)

Has the following parts :

Fundus:

Convex
Located above the entrance of fallopian tubes
It is tilting(bending) forward
Press urinary bladder<>

Body :

It is about 2 inch in length
Has a triangular cavity called uterine cavity with three openings
tow uterine tubes above
internal os of cervix below
has anterior wall and posterior wall
posterior wall is the common site for
implantation of fertilized ovum(zygote). That’s why a pregnant lady is advised to sleep on her back to avoid abortion in the first 3 months of pregnancy and to assure good implantation.
Anterior wall is not good site for implantation and in case of that pregnant lady is advised to sleep upside down.

Cervix:
The most sensitive part in the female genital system.
Cylindrical about one inch in length
Has the following parts (from out to in):

external opining(external os)
it is circular in a lady never delivered a baby (never pregnant) (nullipara)
it is horizontal in lady with multy pregnancy (multipara)
doctors measure the width of the external os by inserting their fingers
external os is important to know if the lady has been delivered a baby before or not

internal opening (internal os)
communicate the cervix with uterine body

cervical canal:
a spindle shaped canal
communicating vagina with uterine cavity between internal and external os
it is the part that dilate before birth
layers forming the walls of uterus :

1-inner layer (endometrium)
transitional epithelium
regenerated every month due to the period
all should removed for good implantation but sometimes part of this layer still exist causing bleeding . that’s why lady with this case her’s endometrium should be removed to build anew layer
the endometrium builds a lining periodically which, if no pregnancy occurs removed by lady’s body

2. myometrium: thickest layer

3.perimetrium : mostly is peritoneum (kind ofmembranes)

*********

Position of uterus:

Normally:
The uterus is a pelvic organ before pregnancy and abdominopelvic organ in pregnancy (that’s why the pregnant lady can easily be tired and cant lay in her back because baby press on anterior organs especially diaphragm)
The uterus is antiverted and antiflexed (bending forward on the cervix) touching the urinary bladder

Abnormally:
Uterus may be bending backward(retroflexed) and retroverted on itself compressing on rectum and that leads to severe low back pain or diarrhorea
Usually pregnancy will not occur leading to abortion
Ladies with this situation is advised to lay on her abdomen
Doctors can fix this situation by pulling uterus from two ligaments

The end

I want to dedicate this sheet to all my friends whom I love especially
Zaid el 7loo, 7anna bar3’ooth, zaid shmessanee, tamara darweesh, 7amzeh jssar,marten 8a8eesh,nidal matani(a7la arsenal….. ma3lesh 7anna mogamaleh),samee7 matani ,abo 86eesh(mohd shwaf)
, el shareef yoossf kettaneh ,3meer el 5aleele,wa2el 6oo8an,feraas nemer,mo2ayad keetaneh,basher el rama7i ,mohd 3abood, a7mad 3ababneh ,mo3ath el ze3be, mohd 3assaf,leena el gaberre-7aneen 5reees(mis 3la raseee wallah), ,hammam ryalat

By: hisham hirzallah

Picture by : Yezan 3toom

Sheet no. 9

2008-03-03T22:24:00.005+02:00

THE FOREARM

*Forearm is divided into 2 compartments by 2 intermuscular septi

ANTERIOR COMPARTMENT
(flexor pronator compartment)

- Most originated from medial epicondyle of humerous
- All enervated by median nerve except one and half by ulnar nerve.
- All flex the wrist except (pronator teres)
- Arranged in three layer.

&&& First layer (Superficial layer) ( consist of 4 muscles):*

1. Pronator teres: ( named according to action+shape)
- Nerve supply: median nerve
- Action: pronation of forearm

2. Palmaris longus :
- Nerve supply: median nerve
- Action: flexion of wrist.

3. Flexor Carpi Radialis : ( carpi = comes to carpals)

- Nerve supply: median nerve
- Action: flexion and abduction of wrist

4. Flexor Carpi Ulnaris :
- Nerve supply: ulnar nerve
- Action: flexion and adduction
- Insertion: pisiform bone.

&&& Second layer (intermediate layer):

1. Flexor Digitorum superficialis:

- Origin: medial epicondyle of humerous
- Insertion: it divides into 4 tendons , to the medial 4 fingers , where it insert into middle phalanx of these fingers
- Action: flex the middle phalanx in the medial 4 fingers.
- Nerve supply: median nerve.

&&& Third layer (deep layer):

1. Flexor digitorum profundus :

Note: this is the muscle which you use while typing, writing, painting , …..

- Insertion: it divides into 4 tendons to insert to the destal phalanx of medial 4 fingers.
- Action: flex the destal phalanx of the medial 4 fingers.
Note: the finger names (from medial to lateral) is
[little, ring, middle, index, thumb]
- Nerve supply: little and ring are supplied by ulnar nerve . middle and index are supplied by median nerve]

2. Flexor Pollicic longus : ( pollicies = to the thumb )

Note: the thumb is considered to be the half of the hand!!
- Insertion: Destal phalanx of the thumb
- Nerve supply: median nerve.
- Action: flex the destal end of thumbs

3. Pronator quadratus :

- It binds the destal end of Radius and Ulna.
- Nerve supply : median nerve.
- Action : Assist in pronation.

$$$ Little Note : Carpal bones consist of 2 rows proximal which is concave and distal which is convex.

** Flexor Retinaculum** :

- It is a thickened deep fascia between carpal bones forming a tunnel to traverse 9 tendons + 1 nerve:
9 tendons: 4 tendons from flexor digitorum superficialis
4 tendons from flexot digitorum profundus
1 tendon from flexor pollicis longus.

1 nerve: median nerve.

- Excessive work make this bridge to be thickened and tense , when it tense it will compress the underlying structures ( specially the median nerve ) , so you will lose feeling in that area !!!!

$$$ Good Notes:

* Median nerve is lateral to palmaris longus muscle.
* Radial artery is lateral to flexor carpi radialis
* Ulnar artery is lateral to flexor carpi ulnaris.
…………………………………………………………………..
POSTERIOR COMPARTMENT OF FOREARM
(extensor supinator compartment)

- There is 1 supinator only.
- All supplied by radial nerve (father of the extensors!)
- Most originated from lateral epicondyl of humerous (C.E.O)
- All extend the wrist and fingers.
- All supplied by Ulnar artery.
- consist of 2 layers.

&&& First layer : Superficial layer ( consist of 6 muscles)

1. Brachioradialis :
- Origin: Brachium.
- Insertion: styloid process of radius.
- Nerve supply: radial nerve.
- Action: Restore the midprone position of forearm.

2. Extensor carpi radialis longus :

- Insertion: 2 metacarpal bones.
- Origin: Humerous.
- Nerve supply: radial nerve.
- Action: extend the wrist.

3. Extensor carpi radialis brevis (brevis = short)

- Nerve supply: radial nerve.
- Action: extend the wrist.

4. Extensor digitorum (includes superficial+profundus)

- Nerve supply: radial nerve.
- Origin: lateral epicondyl of humerous.
- Insertion: by dividing into 4 tendons to medial 4 fingers this muscle insert into (middle + destal) phalanx of these fingers.
- when this muscle reaches the proximal phalanx it will flattened forminf a bird shape which has 1 central + 2 wings . (the central is short reaching the middle phalanx , and to 2 wings is long reaching destal phalanx )
- Action: extend the 4 fingers + wrist.

5. Extensor digiti minimi (to little finger)
6. Extensor carpi ulnaris..

7abb ahde hade el sheet la kol ahel 3'azzeh el 9am9'een wla kol el shohada2 …wla kol 97abe, 59o9an:

27mad El3eesa, Far7an el koz, Wa2el 6o8an, m7md shawaf, hammam ryalat ( abo shrek ), martin qaqeesh ( shoma5er :P) , bashar el rama7i , 3'aleb 5rfan , nidal matane ( no VISA :P), m7md abo hanieh , bilal abu dhaim , soso 3abdeen(el 7-1 btnrad) , a7mad 3abed , 3omar radaiedeh , Dina 3ammari , Raya 7alawani, magd 5adr , amal 7osban , 7neen 5alaf , aya , tamara darweesh, rania , waleed el8adry , 7amzeh jassar , 5aled 7jeer, 3eesa 38eel , zain, 3amer 7ajjaj, ma2moon sh3ban , laith 7addad,7mzeh 9araera , Bandar, 3bdel8ader, bashar sharma , m7md abo 5alaf, m7md 5alel (w7sh el mobarazeh) , 3koor , 3mr el 7amad , osama skools , hisham, zaid, 5aldoon elnsoor, Moh 9ob7i….. and to all JUBILIANS…..

Best wishes…
3bdelra7man 3attili…

* فلا تكترث بالناس في المدح والثنا ولا تخش غير الله والله اكبر
* من ذا إلى عدله انهي شكايتي سواك يا رافع السبع السماوات

sheet # 8

2008-03-03T19:38:00.009+02:00

Posterior compartment of the upper arm
Made of one muscle only: Triceps Muscle:
· Muscle with 3 heads forming the posterior compartment.
· Origin:
o Long head ( which is the most medial in position): infraglenoid tubercle of scapula.
o Lateral head: posterior surface of humerus above the radial groove.
o Medial head: posterior surface of humerus below the radial groove.
· Insertion: olecranon process of ulna.
· Nerve supply: radial nerve.
· Action: extension of elbow + long head acts on shoulder causing adduction.
· Arterial supply: profunda (deep) brachii artery.

***********

Revision of axilla
· Superficial veins in the upper limb are two in number:
1. Cephalic vein (upper)
§ Found in the superficial fascia.

2. Basilic vein (lower)
§ Found in the superficial fascia, and in the middle of the upper arm it leaves the superficial fascia deep to the deep fascia.

Ø Both end at the axillary vein.
· Axillary vein:

o Starts at the union of basilic vein with deep veins of brachial artery (the base of brachial artery), these veins accompany the brachial artery and commit themselves for that artery, that’s why they are called venae comitantes (singular: vena comitans)

o Only deep arteries in the body have accompanying veins (venae comitantes) which are two in number, because they are hard workers.

o While superficial arteries are accompanied by only one vein.

o After the mentioned union, the axillary vein continues in the axilla then it will end at the outer border of the 1st rib where it receives cephalic vein to continue as subclavian vein.

o Axillary vein accompanies the axillary artery throughout its course but in reverse direction.
Upper arm arterial supply

· Brachial artery:
o Starts at the lower border of teres major.
o It ends at the opposite neck of radius by dividing into radial artery (lateral) & ulnar artery (medial).
o Supplies the upper arm through 3 branches:
1. Deep brachial artery:
§ Called profunda (= deep in Latin) artery.
§ Supplies mainly posterior compartment of the upper arm.
2. Superior ulnar collateral artery:
§ Collateral = companion.
3. Inferior ulnar collateral artery:
Ø Both 2 and 3 accompany the ulnar nerve through its course.

*********

Wrist Bones (carpals)

· Carpal bones are 8 in number
· They are divided into 2 raws; proximal & distal each raw made of 4 bones, which have concave anterior surface (aspect), and convex posterior surface.
· They are examples of short bones.
1. Proximal raw (from lateral to medial)
I. Scaphoid (boat like)
II. Lunate (moon like)
III. Triquetrum (cube shaped)
IV. Pisiform
2. Distal raw (from lateral to medial)
I. Trapezium
II. Trapezoid
III. Capitates
IV. Hamate
Susan Leaning Toward Peter To Take Cold Hand
Samee7a Lazem Tel3ab Poker Te5sar Teksab Klo Halas

Metacarpals
· = after carpals
· 5 in number
· Named from lateral to medial (thumb to little) 1 à 5
Phalanges
· 2 for the thumb: proximal & distal
· 3 for the others: proximal, middle & distal.
**********
Cubital fossa
· Triangular space anterior to the elbow joint.
· Importance: in surgery you recognize what are the structures you will cut and what you will avoid.
· Borders:
§ Lateral border: contains brachioradialis muscle
o Origin: brachium
o Insertion: radius.
§ Medial border: contains pronator teres muscle.
§ Base: contains interepicondylar line.
· Roof: skin, superficial + deep fascia, median cubital vein.
o Median cubital vein:
§ It is a connection between cephalic (lateral), basilic (medial) at the roof
§ A common vein used to obtain samples of blood or to give fluids, drugs or blood. That’s why we tie it, because we want to stop the pathway of the blood.
§ New born children:
o Fat in superficial fascia is brown (while in adults it’s white or yellow), because there are many nuclei.
o We obtain blood from head (scarple) using a needle called butterfly.
· Floor: supinator muscle (lateral), brachialis ( medial)
· Contents (from medial to lateral)
§ medial nerve.
§ Brachial artery and branches.
§ Biceptal tendon (tendon of the biceps)
§ Radial nerve.

Forearm
· Divided into 2 compartments by 2 intermuscular septi (singular: septum) from the deep fascia:
§ Anterior compartment:
o Called flexor pronator group (or compartment)
o Most originate from medial epicondyle of humerus (CFO: Common Flexor Origin)
o All supplied by median nerve except 1 and half by ulnar nerve.
§ Posterior compartment:
o Called extensor supinator group ( or compartment)
o Most originate from lateral epicondyle of humerus (CEO: Common Extensor Origin)
o All supplied by radial nerve

**********

Anterior Forearm
· Muscles are divided into 3 divisions : superficial (S), intermediate (M), deep (D)
· Deep:

Superficial :
§ 1s: pronator teres:
o Nerve supply: median nerve
o Action: pronator of forearm
§ 2s: Palmaris longus:
o nerve supply: median nerve
o action: flexion of wrist
§ 3s: flexor carpi radialis:
o Nerve supply: median nerve
o Action: flexion and abduction of wrist
§ 4s: flexor carpi ulnaris:
o Nerve supply: ulnar nerve
o Action: flexion & adduction of wrist

Middle :
§ M: flexor digitorum superficialis:
o Origin: medial epicondyle
o Insertion: it divides into 4 tendons to the medial 4 fingers where it is inserted to the middle phalanges.
o Action: flex medial 4 fingers.
o Nerve supply: median nerve.

*************
To all our dear friends whom we loveeee:,
Yazeed neef (3la rasy abu sa5er),
Ma2moon sha3ban (king of our faculty), A7mad Abu-7lawa , 5aled 7ajjier(king of Jubile) , yazeed 8aisya, alshareef yousef kittaneh, hammam ryalat,hisham 7irzallah, m7md 8tishat, firas nimir , mos6afa abu ra7meh, nidal matani (we7dat o bas 5awa), amjad 3yyash, 3omar el7aj, m7md taiseer, 7azem abu 39beh(abu sala7), m7md al fa8eeh, a7mad shalabi, osama al5aleel, 3’azy allozy, 3omar allozy, m7md fozy, 3omar somrain , wa2el 3alawna, muhannad budair,3la2 el 8aisy, nosayba jalodi, anas, m7md 3abbod, samer demasy,samer ma7aree8,m7md karaky, naji abu rshaid,a7mad yousef, 7asan abu sokar, 3ammar 3arabyat, fares as3ad, fares ma6ar, 3bd elra7man roshdy, 3mr 5aleely,3omar 5aleel,wa2el 6ouqan, 3bd elra7man 3attili, far7an elkooz, martin qaqish,m7md sa3eed, m7md 3assaf, m7md bassam, fahed 3adel, m7md wazeer,9ohaib 3abbadi,Ibrahim abu deya, m7md abu sharkas,mo3ath ze3by,zaid,3omar qasem,5aled 6alab,mo3ath 3amer,3wamra,m7md 3ersan….
Special thanks 4: 7amza somrain & mazen sha3ban from 2nd year & a7la ta7yya 4 .3abderra7man 8asem from 3rd year.
A7ar al ta3azi for A7mad Abu-7alawa who lost his grandmother, and Majd who lost hers.
Palastine in our hearts, never forget, we will die for it. Ya rab sa3ed ahelna fee 3’azza
Best wishes 4 all medical students in ju.
Mo2ayad Kittaneh, 7amza Jassar
By the way, visit these sites:
jums.orgfree.com
medicaljournals89.blogspot.com

you can download it from here: http://jums.orgfree.com/anatomy/anatomy_sheet_8.doc

A Game for Doctors!!!!!

2008-03-01T10:51:00.004+02:00

a very nice game called DARK CUT

Dark Cut 2

as dr.hadidi said, "u gotta invent something from ur enviroment to help a patient"

SHEET NO. 7

2008-02-27T21:54:00.006+02:00

- We have 2 types of cells :
1. Somatic cells : myocytes / osteocytes / hepatocytes which grow in number by a division called by mitosis producing 2 equal daughter cells
2. Sex cells : in the ovary or testis divide using a process called meiosis in which a mother cell gives 2 none equal daughter cells

- In human cells we have 46 chromosomes each chromosome has a maternal part and maternal part joined by a centre part called a Centromere .
- Chromosomes has 2 parts each called a chromatid connected by the centromere

Female Genital system :

Consists of :
1. 2 Ovaries
2. 2 Uterine Tubes
3. Uterus
4. Vagina

A) Ovary : almond-shaped organ located on both sides of the uterus , covered by a modified layer of peritoneum to allow a mature egg to come out easily

- Egg-to-be start to form at age of 5 weeks ( through out pregnancy) . By the age of 3 months the number of egg will reach 7 million .

- At birth the number is around 700000 as the rest have degenerated
- At puberty the number is about 400000 . At this time the eggs are called mature eggs or are ready to be mature
- But only about 400 will succeed to mature and continue to the female cycle

Functions of Ovary :
1. To produce mature eggs ready for fertilization
2. To secrete estrogen and progesterone hormone

- FSH ( follicular stimulating hormone ) secreted by pituitary gland will stimulate the ovary to keep producing and enlarging follicles which in turn produce estrogen
- Estrogen is important because it prepares the uterus
- After ovulation the follicle will produce progesterone which prepares the indometrium to receive the fertalised ovum by increasing thickness and secretions

B) Uterine Tube :
- About 4 inches in length ( 10.16 cm)
- Communicates uterine cavity with abdominal cavity
- Divided into 4 parts :
1. Infundibulum : funnel-shaped umbrella over the ovary with finger-like processes to propel mature ovums from the ovary into the uterine tube
2. Ampulla : widest part , common fertilization site
3. Isthmus : narrowest part of the uterine tube
4. Intra-mural Part ( inside the wall part) : oblique in direction to act as a valve
( sometimes not to allow infection to pass onto to the ovaries , if infection of the uterine tube occurs it will close and infertility would occur)

- If ovum is implanted early in the uterine tube forming a uterine pregnancy causing severe bleeding and rupture of the uterine tube ( thus formed in an abnormal site of pregnancy)

To all my friends specially : Abulloz ( omar al lozi), Shmais ( zaid shmaisaini), Nidal matani ( arsenalawi ikhs ), Ghalib khirfan,waleed sharaf, Morsi( omar dodin),zaid qandeel, Shawaf(mohammad qtaishat),hammam ryalat,firas nimir,zaid amin,hussain asad.

By : Hanna Barghout

Pictures series II

2008-02-27T21:31:00.006+02:00

Bones of the Shoulder Girdle

Picture Series I

2008-02-27T20:55:00.012+02:00

Click on Image to enlarge !

(1)

****************** (2)

***************

(3)
*****************

(4)

****************

(5)

****************

(6)

*******************

1 , 2 ,3, : Axilla

4 : Axilla region

5: Brachial Plexus

6: Brachial Plexus - detailed

7 : Brachial Plexus - Simplified ;)

first six sheets

2008-02-27T11:10:00.002+02:00

it's kindda late, but any way ....
http://jums.orgfree.com/anatomy.htm

forgot to say, thnx for this great idea

Sheet number six !!

2008-02-26T00:04:00.013+02:00

The Upper limb consists of:
1- Forearm.
2- Upper arm.
3- Hand.

Forearm :
-Bones of the forearm are two in number: Radius and Ulna.

***********

1) Radius:
- Lateral bone.
- Long bone.
- Bowing laterally.
- Has 3 parts:
1- Proximal end.
2- Shaft.
3- Distal end.

1- Proximal end: has the following parts:
A- Head: disc-shaped, articulates with Capitulum.
B- Neck: narrow part, good clinical landmark marking the site of division of Brachial artery into Radial and Ulnar arteries.
C- Radial tuberosity: insertion site for biceps muscle.
2- Shaft: it’s bowing lateral at its summit located bronator tuberosity.
3- Distal end: has the following parts:
A- Styloid process.
B- Inferior articuler surface that articulates with Scaphoid and Lunate directly.
C- Anterior surface of the distal end: it’s the common side to feel the pulse of Radial artery.

2- Ulna:
- Medial bone.
- Long bone.
- Subcutaneous.
- Wrench-like: with a cavity to hold Trochlea.
- Has the following parts:
A) Proximal end.
B) Shaft.
C) Distal end.

A) Proximal end:
- It’s like the mouth with two teeth.
- It has the following parts:
1) Trochlear fossa: to articulate with Trochlea.
2) Olecranon process: insertion site for triceps.
3) Coronoid process.
4) Tuberosity of Ulna: insertion for Brachialis muscle.

B) Shaft:
- Subcutaneous.
C) Distal end: has the following parts:
1) Styloid process of Ulna.
2) Inferior articular surface that articulates Triquetrum and Pisiform indirectly, separated by atricular disc which acts as a shock absorber when we fall on out stretched hand.

Upper Arm:
- Extending between shoulder and elbow.
- Covered by the following layers:
1) Skin.
2) Superficial fascia that contains:
a- Cephalic vein.
b- Baselic vein.
c- Large amount of fat.
3) Deep fascia: forms a cylinder around the structures in the upper arm and gives two partitions to the Humerus:
a- Lateral intermuscular septum.
b- Medial intermuscular septum.
separating the deep condense into anterior compartment and posterior compartment. Each of these compartments has its own muscles, own nerve supply, own arterial supply and own common action.

Anterior compartment:
- Contains 3 muscles:
1-Biceps muscle.
2- Brachialis muscle.
3- Coracobrachialis muscle.
- Nerve supply: musculocutaneous nerve (MCN).
- Arterial supply: Brachial artery.
- Common action: flexion of elbow.

Biceps:
- Origin: 2 heads:
a) Short from Coracoid process.
b) Long from Supraglenoid tubercle of Scapula.
- Insertion: Radial tuberosity.
- Action: - prime supinator of elbow.
- assist in flexion of elbow.
- adduct and flex the shoulder joint
- Nerve supply: musculocutaneous nerve (MCN).

Brachialis:
- Deep to biceps.
- Origin: Brachium.
- Insertion: Ulnar tuberosity.
- Nerve supply: musculocutaneous nerve (MCN).
- Action: prime flexor of the elbow.

Coracobrachialis:
- Named according to origin and insertion.
-Origin: Coracoid process of Scapula.
- Insertion: midshaft of Humerus.
- Nerve supply: musculocutaneous nerve (MCN).
- Action: Assists in flexion and adduction of the shoulder.

NOTE:
# The muscles which are attached to Coracoid process are:
- Pectoralis minor.
- Coracobrachialis.
- Biceps.
# Coracoid process receives muscle innervated by the following nerves:
- Pecto. minor: medial pectoral nerve.
- Coraco & short head: musculocutaneous nerve (MCN).

T H E E N D

A7la ta7eya for all my friends, specially:
Wa2el Towqan, Far7an, 3bdelra7man 3attili, Fadi Halasa, Ayoub 3ennabi, Soso 3abdeen, A7mad 3abed, 7amza Jassar, Bashar Alrama7i, Bashar Sharma, Summer, Muna, 5aled 7ajir, Martin Kakish, Hammam Ryalat, Mohammed Shawaf, 3esa 3akeel, Elham El8dah, Batool El3toom, 3’aleb 5erfan, Dina 3ammari (Dair), 3omar Radayda, Abu Haneye, Bilal Abu Dhaim, 3amer 7ajjaj, Bandar,Ma2mon Sha3ban, Momani, Ayman D3ja, M. Abu 5alaf(docor saydali), Amr Elfar (Engineering), Moh 5alil (Mo2ta uni.), Laith Bdour(JUST), Amr El7amad (Somayya uni.), 3koor (Sumayya uni.), Tsonami(a7la salam min 3attili ;-) and for all JUBILIANS. I HOPE I MENTIONED THEM ALL…..

Best Wishes
A7mad El3esa

Think it Over

2008-02-22T17:35:00.003+02:00

Hello every one !

I have started this blog for us to share our lectures .. Instead of going to and from Al-Ra2ed thrice a week to get the sheets we make, We can use blogger to publish them !

If you like this idea , cast ur vote ! there is a poll on the side bar ! I already voted and you got only 6 days to do that!!
So hurrrryyyyyyy!!!

Leave a comment with your name and email so that I can invite you to be a blog author!!

Yella people ! It will be huge fun ;)