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.38

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

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 . 35

*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

sheet no.34

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

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

sheet no. 32

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

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

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 >>>

sheet no.29

*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.27

♦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

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 .

sheet no.25

♦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

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 .....