APPENDIX

 

APPENDIX (Aan~pucC)

INTRODUCTION:

This is a worm like Diverticulum arising from the posteromedial wall of the Caecum.

LENGTH:

·        Average length- 9 c.m.

·        It is 5mm in diameter.

·        It is longer in children than in adults.

·        The lumen is quite narrow and may be obliterated after mid-adult life.

POSITONS:

It lies in the Right Iliac Fossa. The base of the Appendix is fixed. The tip of the Appendix can point in any of the following directions-

·        11 o’clock or PARACOLIC POSITION (Upwards and Right)

·        It may lie behind the Caecum or Colon (RETROCECAL or 12 o’clock position). This is the most commonest position of the Appendix (about 65%)

·        2 o’clock or SPLENIC POSITION. The Appendix enters upward and medially (Pre-ileal) or (Post-ileal).

·        3 o’clock or PROMONTORIC position.

·        4 o’clock or PELVIC position. This is the second most common position of the Appendix (about 30%).

·        SUBCAECAL or MIDINGUINAL or 6 o’clock position.

APPENDICULAR ORIFICE:

·        It is situated 2cm below the ILEOCAECAL ORIFICE.

·        The appendicular orifice is occasionally guarded by an indistinct semilunal fold of mucus membrane, known as “Valve of Gerlach”.

·        The Orifice is marked on the surface by a point situated 2cm below the junction of TRANSTUBERCULAR and RIGHT LATERAL Planes.

PERITONEAL RELATIONS:

The Appendix is suspended by a small triangular fold of Peritoneum, called the MESOAPPENDIX.

BLOOD SUPPLY:

The APPENDIULAR ARTERY is a branch of the Lower Division of the ILEOCOLIC ARTERY.

NERVE SUPPLY:

·        Sympathetic Nerves are derived from segments T9 to T10 through the Coeliac Plexus

·        Parasympathetic Nerve supply by the Vagus Nerve.

 

APPLIED ANATOMY:

·        APPENDICITIS - Inflammation of the Appendix is known as Appendicitis.

·        APPENDICECTOMY -   The operation for the removal of the Appendix is called Appendicectomy.

·        STEPS -

1.      Progression Of Pain-

§  Pain is first felt in the region of the Umbilicus. This is a referred pain.

§  With increasing inflammation pain is felt in the Right Iliac Fossa.

2.      Sign-

§  MC Burney’s Point is the site of maximum tenderness in Appendicitis (Base of Appendix).

§  The point lies at the junction of the lateral 1/3^rd and medial 2/3^rd of the line joining the Umbilicus to the Right Anterior Superior Iliac Spine.

 

3.      Diagnosis  Of the Position of Appendix-

§  When the Appendix is RETROCAECAL, extension of the hip joint may cause pain because the Appendix is disturbed by stretching of the Psoas Major Muscle.

§  In Pelvic Appendicitis, pain may be felt when the thigh is flexed and medially rotated because the Obturator Internus muscle is stretched.

 

 

 

 

Liver Ayurvedic Part

 

LIVER(yakRt)

Ayurvedic:

A)     Avayava:It Is Matruj Avayav      Su.Sha. 3/43

B)     Utpatti:

gaBa-sya yakRtPlaIhanaaO SaaoiNatjaaOlSu. Sha. S 4/24

Its utpatti occurs from Rakta

C)     Srotas:

r@tvaho vdo tyaaomaU-laM yakRtPlaIhanaaO r@tvaaihnyaSca Qamanya : l  Su. Sha. 9/16

It is Moolsthan of Raktavaha srotas.

D)     Ashaya: It is one of the Ashaya.

E)      Koshtanga: Yakrut is one of the Koshtanga among Panchdash Koshtangas

Liver ( Ayurvedic Part, Introduction And Development)

Ayurvedic:

A)     Avayava:It Is Matruj Avayav      Su.Sha. 3/43

B)     Utpatti:

gaBa-sya yakRtPlaIhanaaO SaaoiNatjaaOlSu. Sha. S 4/24

Its utpatti occurs from Shonit ( Blood)

C)      Srotas:

r@tvaho vdo tyaaomaU-laM yakRtPlaIhanaaO r@tvaaihnyaSca Qamanya : l  Su. Sha. 9/16

It is Moolsthan of Raktavaha srotas.

D)     Ashaya: It is one of the Ashaya.

E)      Koshtanga: Yakrut is one of the Koshtanga among Panchdash Koshtangas

Introduction

·        Liver is a large, solid gland situated in right upper quadrant of abdominal cavity.

·        Colour: Reddish brown ( In living subjects)

·        It is largest gland, soft in consistency & very friable.

·        Wt. – 1600gm. In males, 1300gm in females.

·        It secretes bile &performs various other metabolic functions.

System

Liver is a part of:-

·        Digestive system ( accessory  )(on the basis of development & bile)

·        Reticular endothelial system.

Location

Right hypochondrium, epigastrium, and left hypochondrium up toleft lateral line.

Most of liver covered by ribs &costal cartilages except epigastrium.

 

Another name- Liver is also called ‘Hepar’

 

Development

·        Liver developes from an endodermal bud that arises from the ventral aspect of the foregut (junction between foregut & midgut). Again this bud divide into a large cranial part called pars hepatic & smaller caudal port called pars cystica.

Pars hepatic divides into Right and left parts, each of which forms one lobe of the 

Coeliac Trunk

1. THE COELIAC TRUNK (artery of foregut)

v  DERIVATIVES OF THE FOREGUT: Lower part of Esophagus, Stomach AND Upper part of the Duodenum.2.Liver .3.Spleen 4.Greater part of Pancreas.

At the level: T12 to L1

v  Main 3 branches :

1) Left Gastric 2) Hepatic 3)Splenic

1)Left Gastric

v  IT RUNS ALONG THE LESSER CURVATURE OF STOMACH.

v  IT ENDS BY ANASTOMOSING THE RIGHT GASTRIC ARTERY.

v  IT GIVES OFF : a)Oesophageal branches b)Numerous Gastric branches

2) Hepatic

It terminates by dividing into right and left Hepatic branches

A)The Gastroduodenal artery:.The part of hepatic artery proximal to the origin of the Gastroduodenal artery is called the Common Hepatic artery.

Gastroduodenal artery divides into: 1)Right Gastroepiploic. And Superior PancreatoDuodenal.

2)Superior PancreatoDuodenal artery runs down and ends by anastomosing with Inferior Pancreatoduodenal artery

B)The right Gastric artery: It is a small branch.it runs along the lesser curvature and ends by anastomosing with left Gastric Artery.

3. The Splenic Artery

v  It is the largest and runs behind the lesser sac.It reaches the Helium of the spleen. Branches:

v  A)Numerous Pancreatic branches B)5 to 7 short Gastric arteries.

v  C)Left Gastroepiploicruns along the greater curvature of stomach and ends by anastomosing with the right Gatsroepiploic arteries.

Introduction of Thorax and Abdomen/////////

THORAX AND ABDOMEN

For descriptive purpose, the human body is divided into head, neck, trunk and limbs. The trunk is divided by the diaphragm into an upper part called the thorax, and the lower part is called the abdomen.

THE SKELETON OF THE THORAX (thoracic cage).-  It is an osseocartilaginous, elastic cage.

1.  Formation:-      Anteriorly-  by the sternum.                                                                                                               Posteriorly- by the 12 thoracic vertebrae and intervertebral discs.                                                       one each side- by 12 ribs with their cartilage.

2.      THE SUPERIOR APERTURE(INLET)OF THE THORAX:The narrow upper end of the thorax, which is continuous with the neck ,is called the inlet of the thorax.

     3. DIAPHRAGM OF THE INLET OF THE LIVER:  The diaphragm is in two halves, right and left. Each half is also known as Sibson’s fascia or supra pleural membrane. The membrane is triangular in shape. Its apex is attached to the tip of the transverse process of C7 vertebra and base to the inner border of 1^st rib.

BOUNDARIES:-   Anteriorly- upper border of manubrium sterni .                                                         Posteriorly – superior surface of body of 1^st thoracic vertebra.                                                                         On each side- 1^st rib with its costal cartilage.

4. INFERIOR APERTURE (OUTLET) OF THORAX: It is the broad end of the thorax which surrounds the upper part of the abdominal cavity, but is separated from it by the diaphragm.

BOUNDARIES: Anteriorly-    Infra sternal angle .                                                                                      Posteriorly- inferior surface of the body of the 12^th thoracic vertebra.                                                             On each side- coastal margin formed (7, 8,9,10) and 11^th to 12^th ribs.

DIAPHRAGM OF THE OUTLET OF THORAX:-The outlet is closed by a large musculotendinous partition, called the diaphragm-which separates the thorax from the abdomen .                           Structure passing through the inlet:

§  Trachea, oesophagus, apices of the lungs.

§  Brachiocephalic artery, left common carotid artery and subclavian artery, right and left brachiocephalic veins.

§  Right phrenic nerve, right and left vagus nerve.                                                                            Structure passing through the outlet: Large openings: in the diaphragm.

§  Aortic openings: It transmits 1. The aorta, 2. The thoracic duct,(level-12^th thoracic vertebra).

§  The oesophageal openings: It transmits 1.oesophagus 2. The vagus nerve (level-10^th thoracic vertebra).

§  The vena caval opening: It transmits 1. Inferior vena cava, 2. Branches of right phrenic nerve (level- 8^th thoracic vertebra).

INTRODUCTION OF ABDOMEN:-

It is the lower part of the trunk and lies below the diaphragm. It is divided by the plane of the pelvic inlet into a larger upper parts, the abdomen proper and the smaller lower part the true (lesser)pelvis.

ABDOMINAL WALL:- Extends

1.      In the anterior median plane the abdominal wall extends from xiphoid process to the pubic symphysis.

2.      Superolateral margins of anterior abdominal wall are formed by right and left coastal margins.

3.      The iliac crest forms the lower limit of the abdominal wall at the side.

4.      Inguinal ligament extends from the anterior superior iliac spine to pubic tubercle. It is placed at the junction of the anterior abdominal wall with the front of the thigh.

5.      Transpyloric plane is an imaginary transverse plane, it passes through the tips of the 9^th coastal cartilage, and posteriorly through the lower part of the body of the 1^st lumber vertebra.

NINE REGIONS OF ABDOMEN:-

For the purpose of describing the location of viscera, the abdomen is divided into nine regions by imaginary planes, two horizontal and two vertical.

1.      Transpyloric plane:- passes midway between the suprasternal notch and the pubic symphysis. Anteriorly it passes through the tips of 9^th coastal cartilages and Posteriorly through the body of vertebra L1.(lower)

2.      Trans tubercular plane:- passes through the tubercles of the iliac crest and body of vertebra L5 (upper) .

3.      Right and left lateral planes:- passes through the mid inguinal point and crosses the tip of the 9^th coastal cartilage.

NINE REGION:- epigastric , umbilical, hypogastric, right and left hypochondriac, right and left lumbar (lateral) and right and left iliac(Inguinal).

(Median regions are….. Rt. & Lt. regions are……..)

///////////

Skeletal System

SKELETAL SYSTEM

DEFINITION:

The framework of bones and cartilages that protects the organs and allows movement is called the Skeletal System.

TYPES OF BONES:

1.       Long Bones-Long Bones have greater length than width and consist of a shaft and a variable number of extremities (ends). Long Bones include those in the thigh (Femur), leg (Tibia and Fibula), toes (Phalanges), arm (Humerus), forearm (Radius and Ulna) and the fingers (Phalanges).

2.       Short Bones-Short Bones are somewhat cube shaped and nearly equal in length and width. E.g. - Carpal and Tarsal bones.

3.       Flat Bones-Flat Bones are generally thin and composed of two nearly parallel plates of compact bone enclosing a layer of spongy bone. Flat Bones afford considerable protection and provide extensive areas of muscle attachment. E.g. - Cranial Bones, Sternum and ribs, and Scapula.

4.       Irregular Bones-Irregular Bones have complex shapes and cannot be grouped into any of the three categories just described. E.g. - Vertebrae.

5.       Sutural Bones-Sutural Bones are small bones located within the joints (Sutures) of certain Cranial Bones.

6.       Sesamoid Bones-Sesamoid Bones are small bones that are embedded in tendons. E.g.- Patellae (Knee Cap).

DIVISIONS OF SKELETAL SYSTEM:

*        Total No. - 206

*        Acc. to Sushruta – 300

*        Acc. to Charaka – 360

Grouped in Two Principal Divisions-

1.       The Axial Skeleton.

2.       The Appendicular Skeleton.

THE AXIAL SKELETON:

·         The Longitudinal Axis or center of the human body is a straight line that runs through the body’s center of gravity.

·         This imaginary line extends through the head and down to the space between the feet.

THE APPENDICULAR SKELETON:

The Appendicular Skeleton contains the bones of the upper and lower limbs, plus the bones called Girdles whose function is to connect the limbs to the axial skeleton.

AXIAL SKELETON

1.       Skull- i) Cranium – 8,  ii) Face – 14

2.       Hyoid – 1

3.       Auditory Ossicles – 6

4.       Vertebral Column – 26

5.       Thorax- i) Sternum – 1  ii) Ribs – 24

SUBTOTAL= 80

                                                                             APPENDICULAR SKELETON

1.       Pectoral (Shoulder Girdles)-

                                 i.            Clavicle – 2

                               ii.            Scapula – 2

2.       Upper Limbs-

                                 i.            Humerus – 2

                               ii.            Radius – 2

                              iii.            Ulna – 2

                             iv.            Carpals – 16

                               v.            Metacarpals – 10

                             vi.            Phalanges – 28

3.       Pelvic (Hip) Girdle-

Hip, Pelvic, or Coxal Bone – 2

4.       Lower limbs-

                                 i.            Femur – 2

                               ii.            Fibula – 2

                              iii.            Tibia – 2

                             iv.            Patella – 2

                               v.            Tarsals – 14

                             vi.            Metatarsals – 10

                            vii.            Phalanges – 28

SUBTOTAL= 126

अस्थीप्रकार:एतानिपंचविधानिभवन्ति; तद्यथा–कपाल रुचक तरुणवलयनलकसंज्ञानि।-सुशा५/२२

·         कपाल– Flat Bones , eg – Skull Bones, Scapula, Hip Bone.

·         रुचक– Teeth.

·         तरुण–Cartilages, eg – Nasal Cartilage, Ear Auricle.

·         वलय– Vertebrae and Ribs.

·         नलक– Long Bones, eg – Humerus, Radius, Ulna etc.