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

---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.37

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

Pictures : Fertalization

sheet no. 31

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 )****

Heart illustrations

I will label the pictures ASAP !!

picture series 7

Anterior Hip Muscle

Femoral Triangle :-)

Arteries of the L.L

Picture series 6

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

** No more Latin numerals :P