(BQ) Part 1 book Human anatomy presents the following contents: An Introduction to anatomy, the cell, tissues and early embryology, the integumentary system, the skeletal system - osseous tissue and skeletal structure, the skeletal system - osseous tissue and skeletal structure, the skeletal system - appendicular division,....
Trang 2Clinical ConsultantRalph T HutchingsBiomedical Photographer
Trang 3Copyright © 2012, 2009, 2006 by Frederic H Martini, Inc., Michael J Timmons, and Robert B.
Tallitsch Published by Pearson Education, Inc., publishing as Pearson Benjamin Cummings All
rights reserved Manufactured in the United States of America This publication is protected by
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Library of Congress Cataloging-in-Publication Data
Martini, Frederic.
Human anatomy/Frederic H Martini, Michael J Timmons, Robert B Tallitsch; with William C.
Ober, art coordinator and illustrator; Claire W Garrison, illustrator; Kathleen Welch, clinical
consultant; Ralph T Hutchings, biomedical photographer.—7th ed.
p ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-321-68815-6 (student ed.)
ISBN-10: 0-321-68815-5 (student ed.)
ISBN-13: 978-0-321-73064-0 (exam copy)
ISBN-10: 0-321-73064-X (exam copy)
1 Human anatomy 2 Human anatomy—Atlases I Timmons, Michael J II Tallitsch, Robert B III.
Title.
[DNLM: 1 Anatomy—Atlases QS 17 M386h 2012]
QM23.2.M356 2012
Editorial Assistant: Nicole McFadden
Senior Managing Editor: Deborah Cogan
Production Project Manager: Caroline Ayres
Director of Media Development: Lauren Fogel
Media Producer: Aimee Pavy
Production Management and Composition: S4Carlisle Publishing Services, Inc.
Copyeditor: Michael Rossa
Art Coordinator: Holly Smith
Design Manager: Marilyn Perry
Interior Designer: Gibson Design Associates
Cover Designer: Yvo Riezebos
Photo Researcher: Maureen Spuhler
Senior Manufacturing Buyer: Stacey Weinberger
Marketing Manager: Derek Perrigo
Cover Illustration Credit: Bryan Christie
Credits and acknowledgments borrowed from other sources and reproduced, with
permission, in this textbook appear on the appropriate page within the text or on page 845.
ISBN 10: 0-321-68815-5 (Student edition) ISBN 13: 978-0-321-68815-6 (Student edition) ISBN 10: 0-321-76626-1 (Exam copy) ISBN 13: 978-0-321-76626-7 (Exam copy)
1 2 3 4 5 6 7 8 9 10—DOW—14 13 12 11 10
Trang 4Frederic (Ric) Martini
Author
Dr Martini received his Ph.D from Cornell
University in comparative and functional
anatomy for work on the pathophysiology of
stress In addition to professional
publica-tions that include journal articles and
con-tributed chapters, technical reports, and
magazine articles, he is the lead author of
nine undergraduate texts on anatomy or
anatomy and physiology Dr Martini is
cur-rently affiliated with the University of Hawaii
at Manoa and has a long-standing bond with
the Shoals Marine Laboratory, a joint venture
between Cornell University and the
Univer-sity of New Hampshire Dr Martini is a
Pres-ident Emeritus of the Human Anatomy and
Physiology Society, and he is a member of the
American Association of Anatomists, the
American Physiological Society, the Society
for Integrative and Comparative Biology, and
the International Society of Vertebrate
Mor-phologists
Michael J Timmons
AuthorMichael J Timmons received his degrees fromLoyola University, Chicago For more thanthree decades he has taught anatomy to nurs-ing, EMT, and pre-professional students atMoraine Valley Community College He washonored with the Professor of the Year Award
by MVCC and the Excellence Award from theNational Institute for Staff and OrganizationalDevelopment for his outstanding contribu-tions to teaching, leadership, and studentlearning He is the recipient of the Excellence inTeaching Award by the Illinois CommunityCollege Board of Trustees Professor Timmons,
a member of the American Association ofAnatomists, has authored several anatomy andphysiology lab manuals and dissection guides
His areas of interest include biomedical tography, crafting illustration programs, anddeveloping instructional technology learningsystems He chaired the Midwest Regional Hu-man Anatomy and Physiology Conference and
pho-is also a national and regional presenter at theLeague for Innovation Conferences on Infor-mation Technology for Colleges and Universi-ties and at Human Anatomy and PhysiologySociety meetings
of the “unofficial teachers of the year.” Dr.Tallitsch is a member of the American Physi-ological Society, American Association ofAnatomists, American Association of Clini-cal Anatomists, AsiaNetwork, and the Hu-man Anatomy and Physiology Society Inaddition to his teaching responsibilities atAugustana College, Dr Tallitsch has served
as a visiting faculty member at the BeijingUniversity of Chinese Medicine and Pharma-cology (Beijing, PRC), the Foreign LanguagesFaculty at Central China Normal University(Wuhan, PRC), and in the Biology Depart-ment at Central China Normal University(Wuhan, PRC)
iii
Trang 5William C Ober
Art Coordinator and Illustrator
Dr William C Ober received his
undergrad-uate degree from Washington and Lee
Uni-versity and his M.D from the UniUni-versity of
Virginia While in medical school, he also
studied in the Department of Art as Applied
to Medicine at Johns Hopkins University
Af-ter graduation, Dr Ober completed a
resi-dency in Family Practice and later was on the
faculty at the University of Virginia in the
Department of Family Medicine He is
cur-rently a Visiting Professor of Biology at
Washington and Lee University and is part of
the Core Faculty at Shoals Marine
Labora-tory, where he teaches Biological Illustration
every summer The textbooks illustrated by
Medical & Scientific Illustration have won
numerous design and illustration awards
Claire W Garrison
Illustrator
Claire W Garrison, R.N., B.A., practiced
pe-diatric and obstetric nursing before turning
to medical illustration as a full-time career
She returned to school at Mary Baldwin
Col-lege where she received her degree with
dis-tinction in studio art Following a five-year
apprenticeship, she has worked as Dr Ober’s
partner in Medical & Scientific Illustration
since 1986 She is on the Core Faculty at
Shoals Marine Laboratory and co-teaches the
Biological Illustration course
Kathleen Welch
Clinical Consultant
Dr Welch received her M.D from the sity of Washington in Seattle and did her resi-dency at the University of North Carolina inChapel Hill For two years she served as Direc-tor of Maternal and Child Health at the LBJTropical Medical Center in American Samoaand subsequently was a member of the De-partment of Family Practice at the Kaiser Per-manente Clinic in Lahaina, Hawaii She hasbeen in private practice since 1987 Dr Welch
Univer-is a Fellow of the American Academy of ily Practice and a member of the Hawaii Med-ical Association and the Human Anatomy andPhysiology Society
Trang 6Welcome to the Seventh Edition of Human Anatomy!
v
THROUGH SEVEN EDITIONS, the authors and illustrators have continued to build on this text’s hallmark qualities: its distinctive atlas-style format and its unsurpassed visual presentation of anatomy and anatomical concepts Our approach for this text has been to provide a seamless learning system with closely integrated art and text The illustrations do more than provide occasional support for the narrative; they are partners with the text in conveying information and helping students understand structures and relationships in a way that distinguishes this human anatomy textbook from all others.
New to the Seventh Edition
In approaching this Seventh Edition, we paid particular attention to the most difficult topics in human anatomy and to areas identified by students and reviewers Our primary goal was to build upon the strengths of the previous edition while addressing the changing needs of today’s students The changes described below are intended to enhance student learning and increase student engagement.
• A more visual and dynamic presentation of clinical information Select Clinical Notes
covering key clinical topics now feature new, dramatic layouts that integrate
illustrations, photos, and text in a way that makes reading
easy and science relevant
(see pp 108–109, 127,
132–133) Clinical Cases,
which appear at the end of
each body system section, now
include patient photos and
diagnostic images (see
pp 110–111, 501–502, 602–604).
Every Clinical Case begins with a
photo of the patient and his/her
background information, making
the case personal and real to the
students Diagnostic images (photos,
x-rays, and MRI scans) also appear
within the narrative.
• Over 65 new and visually stunning
histology photomicrographs These
photomicrographs appear in chapters 3, 4,
5, 13, 19–21, and 23–27 The slides
prepared for these photos match the types
Trang 7of slides that beginning students will encounter in the anatomy
lab.
• New spiral scans Using the most up-to-date imaging technique
available, these spiral scans (see Figures 8.16 and 22.16) provide
students with unparallelled views of anatomical structures and
introduce them to a new imaging technique that is increasingly
used in clinical settings These spiral scan images have been
pro-vided by Fovia, Inc., and by TeraRecon, Inc.
• Improved presentation of figures Figure legends now appear
consistently above figures, and the detailed figure captions that
describe parts within figures now appear within the figures.
This new figure presentation style guides students through
multi-part figures and compels them to read the part captions
as they view each part of a figure The result is easier reading
and improved understanding of figures.
• A reorganized and streamlined presentation of the nervous
system chapters (Chapters 13–18) These chapters have been
reorganized to take a “bottom up” rather than a “top down”
ap-proach to make the nervous system easier for instructors to
present and students to understand Specifically, the discussion
of the spinal cord started in Chapter 14 (The Nervous System:
The Spinal Cord and Spinal Nerves) now continues in Chapter
15 (The Nervous System: Sensory and Motor Tracts of the
Spinal Cord) so that sensory and motor tracts of the spinal cord
are covered before the brain and cranial nerves in Chapter 16
(The Nervous System: The Brain and Cranial Nerves)
Addi-tionally, Chapter 16 also presents the brain and cranial nerve
in-formation in a “bottom up” sequence, starting with the brain
stem and ending with the cerebrum.
• New “Hot Topics: What’s New in Anatomy” highlight
cur-rent research These brief boxes introduce students to new
peer-reviewed anatomical research findings that have been published within the past two years This feature appears in chapters 2–5, 10, 13, 19, 21, and 23–28.
• Increased focus on learning methodology Each chapter now
opens with concrete Student Learning Outcomes instead of learning objectives.
In addition, approximately 85 percent of the figures in this edition are either new or have been revised Some figures were updated for increased visual appeal to students (see Figures 1.1, 4.1, and 4.12) In many figures, areas of detail have been revised
to improve clarity All bone photos in chapters 6 and 7 received a new silhouette treatment that results in a cleaner, more
contemporary look and makes bone markings easier to see The presentation of boxes and banners has been improved to better organize many figures (see Figures 9.11, 26.6, and 23.7) The overlay of illustrations on surface anatomy photos has been continued in this edition to provide students with a better understanding of where structures are located within the human body The information derived from superficial and deep
dissections is more easily understood as a result of a new heading style that has been continued in many of the figures (see Figure 23.14b).
The following section provides a detailed description of this edition’s chapter-by-chapter revisions.
Trang 8Specific chapter-by-chapter revisions, with select examples, include:
Foundations: An Introduction to Anatomy
Anatomica (TA)
Foundations: The Cell
Histologica (TH)
student learning
Foundations: Tissues and Early Embryology
student learning
histolog-ical research
The Integumentary System
material was revised for easier comprehension
The Skeletal System: Osseous Tissue and Skeletal
Structure
the existing material was revised for easier reading and comprehension
cur-rent histological terminology and research
The Skeletal System: Axial Division
match current anatomical terminology and research
dis-cussions of the vertebral regions
The Skeletal System: Appendicular Division
dis-cussions of the clavicle, scapula, humerus, pelvic girdle, patella, tibia, and thearches of the foot
The Skeletal System: Articulations
comprehension
The Muscular System: Skeletal Muscle Tissue and Muscle Organization
stu-dent comprehension and learning
The Muscular System: Axial Musculature
Perineum and the Pelvic Diaphragm” have been updated and clarified
The Muscular System: Appendicular Musculature
was added to this chapter in the Sixth Edition and has been revised for thisSeventh Edition This section helps students work through the process ofunderstanding the actions of skeletal muscles at a joint This section also ex-plains the concept of the action line of a muscle, and how students, once theyhave determined the action line, may apply three simple rules in order to de-termine the action of a muscle at that joint
Surface Anatomy and Cross-Sectional Anatomy
The Nervous System: Neural Tissue
were updated in order to match current research findings in the field
The Nervous System: The Spinal Cord and Spinal Nerves
with particular emphasis on the revision of the section on “Organization ofthe Gray Matter.”
stu-dent learning and comprehension
14
13 12
11 10
9 8
Chapter-by-Chapter Revisions
Trang 9• The sections on “The Brachial Plexus” and “The Lumbar and Sacral Plexuses”
were rewritten to make them easier to understand
The Nervous System: Sensory and Motor Tracts of the
Spinal Cord
signifi-cantly revised
them easier to understand
Higher-Order Functions has been deleted
The Nervous System: The Brain and Cranial Nerves
The Nervous System: Autonomic Division
them easier to understand
The Nervous System: General and Special Senses
them easier to understand
The Endocrine System
them easier to understand
The Cardiovascular System: Blood
findings in the field
The Cardiovascular System: The Heart
rewritten in order to reflect new research findings in the field and to make
them easier to understand
The Cardiovascular System: Vessels and Circulation
findings in the field
them easier to understand
The Lymphoid System
findings in the field
them easier to understand
The Respiratory System
respiratory system
them easier to understand
The Digestive System
various organs of the digestive system
them easier to understand
The Urinary System
various organs of the urinary system
them easier to understand
The Reproductive System
various organs of the male and female reproductive systems
them easier to understand
The Reproductive System: Embryology and Human Development
28 27 26 25 24 23
Trang 10The creative talents brought to this project by our artist team, William Ober,
M.D., Claire Garrison, R.N., and Anita Impagliazzo, M.F.A., are inspiring and
valuable beyond expression Bill, Claire, and Anita worked intimately and
tire-lessly with us, imparting a unity of vision to the book while making each
illus-tration clear and beautiful Their superb art program is greatly enhanced by the
incomparable bone and cadaver photographs of Ralph T Hutchings, formerly
of The Royal College of Surgeons of England In addition, Dr Pietro Motta,
Pro-fessor of Anatomy, University of Roma, La Sapienza, provided several superb
SEM images for use in the text We also gratefully acknowledge Shay Kilby, Ken
Fineman, and Steve Sandy of Fovia, Inc., and Donna Wefers and Cormac
Dono-van of TeraRecon, Inc., for creating and providing the 3-D spiral scans that
ap-pear in this edition
We are deeply indebted to Jim Gibson of Graphic Design Associates for his
wonderful work and suggestions in the design aspect of the Seventh Edition of
Human Anatomy Jim provided new insight into the design concept, and most
of the design changes and innovations in this edition of Human Anatomy reflect
Jim’s expertise
We would like to acknowledge the many users and reviewers whose advice,
comments, and collective wisdom helped shape this text into its final form
Their passion for the subject, their concern for accuracy and method of
presen-tation, and their experience with students of widely varying abilities and
back-grounds have made the revision process interesting and educating
Reviewers
Lori Anderson, Ridgewater College
Tamatha R Barbeau, Francis Marion University
Steven Bassett, Southeast Community College
Martha L Dixon, Diablo Valley College
Cynthia A Herbrandson, Kellogg Community College
Judy Jiang, Triton College
Kelly Johnson, University of Kansas
Michael G Koot, Michigan State University
George H Lauster, Pulaski Technical College
Robert G MacBride, Delaware State University
Les MacKenzie, Queen’s University
Christopher McNair, Hardin-Simmons University
Qian F Moss, Des Moines Area Community College
Tim R Mullican, Dakota Wesleyan University
John Steiner, College of Alameda
Lucia J Tranel, Saint Louis College of Pharmacy
Maureen Tubbiola, Saint Cloud State University
Jacqueline Van Hoomissen, University of Portland
Michael Yard, Indiana University-Purdue University at Indianapolis
Scott Zimmerman, Missouri State University
John M Zook, Ohio University
We are also indebted to the Pearson Benjamin Cummings staff, whose effortswere vital to the creation of this edition A special note of thanks and apprecia-tion goes to the editorial staff at Benjamin Cummings, especially Leslie Berri-man, Executive Editor, for her dedication to the success of this project, andKatie Seibel, Associate Editor, for her management of the text and its supple-ments Thanks also to Barbara Yien, Editorial Development Manager, andNicole McFadden, Editorial Assistant We express thanks to Aimee Pavy, MediaProducer, and Sarah Young-Dualan, Senior Media Producer, for their work onthe media programs that support Human Anatomy, especially Mastering A & P™and Practice Anatomy Lab™ (PAL™) Thanks also to Caroline Ayres, ProductionSupervisor, for her steady hand managing this complex text; and Debbie Cogan,Norine Strang, Holly Smith, Maureen Spuhler, and Donna Kalal for their roles
in the production of the text
We are very grateful to Paul Corey, President, and Frank Ruggirello, rial Director, for their continued enthusiasm and support of this project We ap-preciate the contributions of Derek Perrigo, Marketing Manager, who keeps hisfinger on the pulse of the market and helps us meet the needs of our customers,and the remarkable and tireless Pearson Science sales reps
Edito-We are also grateful that the contributions of all of the aforementioned ple have led to this text receiving the following awards: The Association of Med-ical Illustrators Award, The Text and Academic Authors Award, the New YorkInternational Book Fair Award, the 35th Annual Bookbuilders West Award, andthe 2010 Text and Academic Authors Association “Texty” Textbook ExcellenceAward
peo-We would also like to thank Steven Bassett of Southeast Community lege; Kelly Johnson of University of Kansas; Jason LaPres of North Harris Col-lege; Agnes Yard of University of Indianopolis; and Michael Yard of IndianaUniversity-Purdue University at Indianapolis for their work on the media andprint supplements for this edition
Col-Finally, we would like to thank our families for their love and support ing the revision process We could not have accomplished this without the help
dur-of our wives—Kitty, Judy, and Mary—and the patience dur-of our children—P.K.,Molly, Kelly, Patrick, Katie, Ryan, Molly, and Steven
No three people could expect to produce a flawless textbook of this scopeand complexity Any errors or oversights are strictly our own rather than those
of the reviewers, artists, or editors In an effort to improve future editions, weask that readers with pertinent information, suggestions, or comments con-cerning the organization or content of this textbook send their remarks toRobert Tallitsch directly, by the e-mail address below, or care of Publisher, Ap-plied Sciences, Pearson Benjamin Cummings, 1301 Sansome Street, San Fran-cisco, CA 94111
Frederic H Martini, Haiku, HI Michael J Timmons, Orland Park, IL Robert B Tallitsch, Rock Island, IL
(RobertTallitsch@augustana.edu)
ix
Trang 11Step-by-Step Figuresbreak down complex
processes into numbered step-by-step illustrations that
coordinate with narrative descriptions
Atlas-Quality Photographs
NEW! Spiral CT Scans with 3D Volume Rendering,the most up-to-date imaging available,provide students with unparalleledvisualization of anatomical structures
x
NEW! Silhouetted treatment of bones
results in a cleaner, morecontemporary look
Side-by-Side Figures showmultiple views of the same structure ortissue, allowing students to compare anillustrator’s rendering with a photo of theactual structure or tissue as it would beseen in a laboratory or operating room
Trang 12NEW! Over 65 visually stunning histology photomicrographs,often with paired art, match thetypes of slides that student will encounter in their anatomy lab.
views from whole organs or other
structures down to their smaller parts
Illustration-over-Photo Figures
bring depth, dimensionality, and visual interest to the page and show that theillustrated structures are proportional in size to the human body
xi
Trang 13Tibia with inadequate calcium deposition and resultant bone deformity
C L I N I C A L N O T E
Congenital Disorders of the Skeleton
Gigantism
Excessive growth resulting
in gigantism occurs if there
hormone before puberty.
Pituitary Dwarfism
Inadequate production of
growth hormone before
pu-pituitary dwarfism People
with this condition are very
plastic dwarfs (discussed
below), their proportions
are normal.
Achondroplasia
Achondroplasia ( ) also results from abnormal
epiphyseal activity The child’s epiphyseal cartilages grow unusually
slowly, and the adult has short, stocky limbs Although other skeletal
abnormalities occur, the trunk is normal in size, and sexual and mental
development remain unaffected An adult with achondroplasia is known as an achondroplastic
re-50 percent will be affected to some degree, and 25 percent will inherit two abnormal genes, leading to severe abnormalities and early death.
Marfan’s Syndrome
Marfan’s syndrome is also
tive tissue structure tremely long and slender limbs, the most obvious physical indication of this disorder, result from exces- sive cartilage formation at the epiphyseal cartilages An abnormality of a gene on chromosome 15 that affects the protein fibrillin is responsible The skeletal effects are striking, but associated arterial wall weaknesses are more dangerous.
Ex-Osteomalacia
In osteomalacia ( ; malakia, softness) the size of the skeletal elements does not change, but their mineral content de- creases, softening the bones The osteoblasts work hard, but the matrix doesn’t accumulate enough
calcium salts This condition,
called rickets, occurs in
adults or children whose diet contains inadequate levels of calcium or vitamin D3.
os-te 䊏 -o 䊏 -ma-LA 䊏
-she 䊏 -uh
xii
their relation to normal function.
C L I N I C A L N O T E
Shoulder Injuries
WHEN A HEAD-ON CHARGEleads to a collision,
such as a block (in football) or check (in hockey), the
shoulder usually lies in the impact zone The clavicle provides the
only fixed support for the pectoral girdle, and it cannot resist large
forces Because the inferior surface of the shoulder capsule is
poorly reinforced, a dislocation caused by an impact or violent
muscle contraction most often occurs at this site Such a
disloca-tion can tear the inferior capsular wall and the glenoid labrum.
The healing process often leaves a weakness and inherent
instabil-ity of the joint that increases the chances for future dislocations.
C L I N I C A L N O T EBell’s Palsy
BELL’S PALSYresults from an inflammation of the facial nerve that is probably related to viral infection.
Involvement of the facial nerve (N VII) can be deduced from symptoms of paralysis of facial muscles on the affected side and loss of taste sensations from the anterior two-thirds of the tongue The individual does not show prominent sensory deficits, and the condition is usually painless In most cases, Bell’s palsy “cures itself ” after a few weeks or months, but this process can be accelerated by early treatment with corticos- teroids and antiviral drugs.
C L I N I C A L N O T E
Fractures and Their Repair
Bone fragments
Fracture hematoma
Dead bone
Periosteum Spongy bone of external callus
Repair
of a fracture
Types of Fractures
Fractures are named according to their external appearance, their location, and the nature of the crack or break in the bone.
Important types of fractures are illustrated here by representative x-rays The broadest general categories are closed fractures and open fractures Closed, or simple, fractures are completely internal They can be seen only on x-rays, because they do not involve a break in the skin Open,
or compound, fractures project through the skin These fractures, which are obvious on inspection, are more dangerous than closed fractures, due to the possibility of infection or uncontrolled bleeding
Many fractures fall into more than one category, because the terms overlap.
Displaced fractures produce
new and abnormal bone arrangements; nondisplaced fractures retain the normal alignment of the bones or fragments.
Transverse fractures, such as
this fracture of the ulna, break a bone shaft across its long axis.
Spiral fractures, such as
this fracture of the tibia, are produced by twisting stresses that spread along the length of the bone.
Compression fractures
occur in vertebrae subjected
to extreme stresses, such forces that arise when you land on your sacrum in
1 An internal callus forms as
unites the inner edges, and an bone stabilizes the outer edges.
2
Comminuted fractures, such as
this fracture of the femur, shatter the affected area into a multitude
of bony fragments.
Epiphyseal fractures, such as this fracture
of the femur, tend to occur where the bone matrix is undergoing calcification and chondrocytes are dying A clean transverse fracture along this line generally heals well
the epiphysis and the epiphyseal cartilage can permanently stop growth at this site.
In a greenstick fracture, such
as this fracture of the radius, only one side of the shaft is broken, and the other is bent
occurs in children, whose long bones have yet to ossify fully.
A Colles fracture, a break
in the distal portion of the radius, is typically the result of reaching out to cushion a fall.
A Pott fracture occurs at
the ankle and affects both bones of the leg.
Colles fracture
eenstick fractur
Comminuted fracture
Epiphyseal fracture
Pott fractur
Internal callus External callus
External callus
The cartilage of the external callus has been replaced by bone, and struts of spongy bone now unite the broken ends Fragments of dead bone and the areas of bone closest to the break have been removed and replaced.
3 A swelling initially marks the location of the fracture
Over time, this region will be remodeled, and little evidence of the fracture will remain.
Trang 143 What are the anatomical characteristics of the hip joint?
4 The patient’s lower limb is externally rotated and she is unable
to lift her right heel from the stretcher Would this condition be the result of axial or appendicular muscles? What specific mus- cles would be involved in the external rotation of the hip? What muscles would be involved in flexion of the hip?
Analysis and Interpretation
1 The anatomical characteristics of the bones of the lower limb may be found in Chapter 7 ∞ pp 199–206
2 The following anatomical landmarks are mentioned in this problem:
4 The muscles involved in the positioning of your grandmother’s lower limb would all be appendicular muscles The muscles in- volved in externally (laterally) rotating the hip and flexing the hip may be found in Table 11.6 on p 310.
Diagnosis
Your grandmother is 75 years old, and her skeleton is undergoing several anatomical changes as a result of the aging process.
∞ pp 129–130Your grandmother has a displaced, subcapital fracture
of the femur The angle between the head and neck of the femur is decreased, and the neck and shaft are externally rotated The pelvic bones and femur have a high probability of marked osteoporosis.
∞ p 130This condition increases the likelihood of fractures in elderly individuals, and also lengthens the time required for the repair of a fracture ∞ pp 129–133
The position of your grandmother’s lower limb is due to ening of the external rotators (piriformis, superior and inferior gemelli, and obturator externus muscles) ∞ pp 308–311Her right lower limb is shorter than the left due to (a) the fracture of the hip and (b) contraction of the hip flexors and extensors (Table 11.6,
tight-p 310) Her hip will probably require surgery Although there are
several procedures that might be used, moval of the head of the femur (∞ pp 199–202) and replacement with a prosthesis is a common procedure The chosen prosthesis would replace the head
re-of the femur and would also possess a long stem that would be inserted into the medullary cavity of the bone and ex- tended almost halfway down the femoral shaft to anchor the head into place
(Figure 11.24) The stem of the prosthesis would be designed with holes through it, and bits of spongy bone (∞ pp 118–120) would be inserted into the holes to serve
as bone grafts Another procedure monly followed is cementing the prosthe- sis into place, which might be more likely for your grandmother considering her ad- vanced age and reduced level of activity.
X-ray of an individual with
a surgically implanted hip prosthesis
Acetabular shell Polyethylene
liner
Femoral head Neck Stem
Unassembled total hip
Assembled total hip Figure 11.24 X-Ray of the Hip After Surgery
xiii
Each Clinical Case:
• Includes helpful patient photos anddiagnostic images
• Describes the patient’s symptoms
• Reveals the results of physicalexaminations and lab work
• Isolates key points to consider
• Offers an analysis and interpretation
of the key points with references torelevant pages and figures in thepreceding chapters
• Provides a diagnosis
FPO
Evelyn - 75 years old
C L I N I C A L C A S E The Muscular System
Grandma’s Hip
You stop to see your 75-year-old grandmother during your weekly
visit to her apartment to set out her medications for the coming week.
As you enter her apartment, you find her lying on her back in severe
pain She is confused and does not recognize you when you enter the
room In addition, she is unable to tell you how she came to be lying
on the floor.
You try to help her up off the floor, but she immediately
com-plains of significant pain in the groin area You dial 911 and an
ambu-lance arrives As the paramedics make their initial assessment and
transfer her to the gurney, they note that the right lower limb is
later-ally rotated and noticeably shorter than her left lower limb An
attend-ing resident does the initial assessment upon admission to the ER.
Initial Examination and Laboratory Results
The resident does the initial assessment of your grandmother and the
following is noted:
• The right lower limb is noticeably shorter than the left.
• The right thigh is externally rotated, and the patient is unable to
change the limb’s position without considerable pain.
• On palpation, the groin region is tender, but there is no obvious
swelling.
• Passive movement of the hip causes extreme pain, especially
upon external and internal rotation.
• White Blood Cell count (WBC) is 20,000/mm 3
• Hemoglobin (Hgb) is 9.8 g/dl.
• Although confused, your grandmother repeatedly states that she
was lying on the floor of her apartment for a long time prior to
being found.
The resident is concerned that the time lag between the injury
and being discovered and transported to the hospital may have
caused complications As a result, he is not sure about how treatment
should proceed He administers a painkiller to make your
grand-mother more comfortable and then pages the orthopedic surgeon on
call for a consult.
The attending orthopedic surgeon arrives and immediately
sug-gests intravenous fluid replacement to alleviate the dehydration
Follow-up Examination
Upon examination the orthopedic surgeon notes the following:
• The patient appears to be in a rather poor nutritional state.
• Initially she seemed to be mentally confused, but I.V fluid and electrolyte replacement caused a significant improvement in her condition.
• The right lower limb is externally rotated and the patient is able to lift her right heel from the stretcher.
un-• The right lower limb is shorter, which is confirmed by measuring the distance between the anterior, superior iliac spine and the distal tip
of the medial malleolus of the tibia, and comparing the results with those of the left lower limb (after passive rotation by the surgeon).
• The greater trochanter on the right side also appears to be higher and more prominent than that of the left side.
• Palpation yields tenderness in the femoral triangle on the rior surface of the hip joint.
ante-Points to Consider
As you examine the information presented above, review the material covered in Chapters 5 through 11, and determine what anatomical information will enable you to sort through the information given to you about your grandmother and her
particular problems
Find the Clinical Cases at the end of every body system.
Trang 15students 24/7 access to the most widely used lab specimens, including human cadaver, anatomical models, histology, cat, and fetal pig PAL 3.0 retains all of the key advantages of version 2.0, including ease-of-use, built-in audio pronunciations, rotatable bones, and simulated fill-in-the-blank lab practical exams.
NEW! Carefully prepared dissections shownerves, blood vessels, and arteries across body systems
NEW! Layering sliderallows students topeel back layers of the human cadaver and viewand explore hundreds of brand-new dissectionsespecially commissioned for 3.0
NEW! Photo galleryallowsstudents to quickly see thumbnails
of images for a particular region or sub-region
PAL 3.0 is available in the Study Area of MasteringA&P™ (www.masteringaandp.com).
Trang 16PAL 3.0 also includes:
• NEW! Question randomization feature gives students more
opportunities for practice and self-assessment Each time the studentretakes a quiz or lab practical, a new set of questions is generated
• NEW! Hundreds of new images and views are included, especially
in the Human Cadaver, Anatomical Models, and Histology modules
• NEW! Turn-off highlight feature in quizzes and lab practicals gives
students the option to see a structure without the highlight overlay
Trang 17Get your students ready for your course.
Get Ready for A&P allows you to assign tutorials and
assessments on topics students should have learned prior
to their anatomy course:
Assign art from the textbook.
Assign and assess figures from the textbook
xvi
Trang 18helpful wrong-answer feedback and hints
Give students 24/7 lab practice.
Practice Anatomy Lab™ (PAL™) 3.0 is a tool that
helps students study for their lab practicals
outside of the lab To learn more about version
3.0, see pages xiv-xv
Identify struggling students before it’s too late.
MasteringA&P has a color-coded gradebook thathelps you identify vulnerable students at a glance
Assignments in MasteringA&P are automaticallygraded, and grades can be easily exported tocourse management systems or spreadsheets
Go to www.masteringaandp.com to watch the demo movie.
Trang 19Students can access their textbook wherever and wheneverthey are online eText pages look exactly like the printed textyet offer additional functionality Students can:
• Create notes
• Highlight text in different colors
• Create bookmarks
• Zoom in and out
• View in single-page or two-page view
• Click hyperlinked words and phrases to view definitions
• Link directly to relevant animations
• Search quickly and easily for specific content
xviii
Get Ready for A&P
Students can access the Get Ready for
A&P eText, activities, and diagnostic
tests for these important topics:
from within the eText
Easily access definitions
of key words
Highlight text
and make notes
ready for tests with its simple three-step approach Students can:
and interactive tutorials.
STUDY AREA
Trang 20in human anatomy:
• Origins, Insertions, Actions, Innervations
• Group Muscle Actions & Joints
Practice Anatomy Lab™ (PAL™) 3.0
Practice Anatomy Lab (PAL) 3.0 is a virtual
anatomy study and practice tool that gives students24/7 access to the most widely used lab specimens,including the human cadaver, anatomical models,histology, cat, and fetal pig
PAL 3.0 retains all of the key advantages of 2.0,including ease-of-use, built-in audio pronunciations,rotatable bones, and simulated fill-in-the-blank labpractical exams New features includes layering ofhuman cadaver dissections, quiz questionrandomization, multiple views of same histologytissue slide at varying magnifications, hundreds ofnew images, plus much more To learn more aboutversion 3.0, see pages xiv–xv
Trang 21Instructor Resource DVD (IRDVD)
978-0-321-73592-8 • 0-321-73592-7
This IRDVD offers a wealth of instructor media resources, including presentation art, lecture outlines, test
items, and answer keys—all in one convenient location The IRDVD includes:
•Textbook images in JPEG format (in two
versions—one with labels and one without)
• Customizable textbook images embedded in
PowerPoint slides (in three versions—one with
editable labels, one without labels, and one with
step-edit art)
• Customizable PowerPoint lecture outlines,
including figures and tables from the book and
links to the A&P Flix
• A&P Flix™ 3-D movie-quality animations on tough
topics
• PRS-enabled Active Lecture Clicker Questions
• PRS-enabled Quiz Show Clicker Questions
• Martini’s Atlas of the Human Body images
• MRI/CT scans
• Histology slides
• Muscle Origins and Insertions images
• PDF files of Transparency Acetate masters
• The Test Bank in TestGen® format and MicrosoftWord® format
• The Instructor’s Manual in Microsoft Word® format
eText with Whiteboard Mode
The Human Anatomy, Seventh Edition, eText comes with Whiteboard Mode, allowinginstructors to use the eText for dynamic classroom presentations Instructors can show one-page or two-page views from the book, zoom in or out to focus on select topics, and use the Whiteboard Mode to point to structures, circle parts of a process, trace pathways, and customize their presentations
Instructors can also add notes to guide students, upload documents, and share their enhanced eText with the whole class
custom-practice anatomy lab
VERSON 3.0
Instructor’s Manual
by Kelly Johnson
978-0-321-73591-1 • 0-321-73591-9This useful resource includes a wealth ofmaterials to help instructors organize theirlectures, such as lecture ideas, analogies,common student misconceptions/problems,and vocabulary aids
Printed Test Bank
by Jason LaPres
978-0-321-73584-3 • 0-321-73584-6
A test bank of more than 3,000 questions tied tothe Learning Outcomes in each chapter helpsinstructors design a variety of tests and quizzes
The test bank includes text-based and art-basedquestions This supplement is the print version
of the TestGen that is on the IRDVD
Instructor’s Visual Guide
978-0-321-73201-9 • 0-321-73201-4This handy resource is a printed andbound collection of thumbnails of the artand media on the IRDVD (See above.)With this take-anywhere supplement,instructors can plan their lectures whenaway from their computers
Practice Anatomy Lab™ 3.0 (PAL™ 3.0) IRDVD
978-0-321-74963-5 • 0-321-74963-4This IRDVD includes everything instructorsneed to present and assess PAL in lecture andlab It includes images in PowerPoint® andJPEG formats, links to animations, and a testbank of 4,000 lab practical and quiz questions
Transparency Acetates
978-0-321-73590-4 • 0-321-73590-0
All figures and tables from the text are included in this printed supplement
Complex figures are broken out for readable projected display
CourseCompass™/ Blackboard
Pre-loaded book-specific content and test item files accompanying thetext are available in several course management formats
See pages xvi-xvii for MasteringA&P.
Instructor Resource DVD with Test Bank for
Trang 22Martini’s Atlas of the Human Body
by Frederic H Martini
The Atlas offers an abundantcollection of anatomyphotographs, radiology scans,and embryology summaries,helping students visualizestructures and become familiarwith the types of images seen
in a clinical setting
A&P Applications Manual
By Frederic H Martini and Kathleen Welch
This manual containsextensive discussions onclinical topics and disorders tohelp students apply theconcepts of anatomy andphysiology to daily life andtheir future health professions
Get Ready for A&P
by Lori K Garrett
This book and onlinecomponent were created tohelp students be betterprepared for their course
Features include pre-tests,guided explanations followed
by interactive quizzes andexercises, and end-of-chaptercumulative tests Also available
in the Study Area ofwww.masteringaandp.com
Practice Anatomy Lab™ (PAL)™ 3.0 DVD
PAL 3.0 is an indispensable virtualanatomy study and practice toolthat gives students 24/7 access tothe most widely used lab
specimens including humancadavers, anatomical models,histology, cat, and fetal pig
eText
Students can access their textbook wherever and
whenever they are online eText pages look exactly like the
printed text yet offer additional functionality Students can:
• Create notes
• Highlight text in different colors
• Create bookmarks
• Zoom in and out
• View in single-page or two-page view
• Click hyperlinked words and phrases to view definitions
• Link directly to relevant animations
• Search quickly and easily for specific content
Option for Your Lab Laboratory Manual for Human Anatomy with Cat Dissections
By Michael G Wood
© 2009, 512 pagesThis full-color laboratory manualcombines illustrations (modified, asneeded) and photos from HumanAnatomy with Michael G Wood’s easy-to-follow writing style and studentfocused features, making it the mostlearner-centered Human Anatomylaboratory manual available
See pages xviii–xix for the MasteringA&P Study Area.
practice anatomy lab Ace Your Lab Practical
VERSON 3.0
Trang 23An Introduction to Organ Systems 7
The Language of Anatomy 14
Intercellular Attachment 45 The Cell Life Cycle 46
53
Trang 24Neural Tissue 78
Tissues, Nutrition, and Aging 80
Embryology Summaries
Clinical Notes
Clinical Terms 86
4 The Integumentary System
Integumentary Structure and Function 92
The Subcutaneous Layer 98
5 The Skeletal System:
Osseous Tissue and Skeletal Structure
Structure of Bone 116
Structural Differences between Compact and Spongy
Functional Differences between Compact and Spongy
Bone Development and Growth 122
Bone Maintenance, Remodeling, and Repair 129
115
Trang 258 The Skeletal System:
Articulations
Classification of Joints 212
211
Anatomy of Skeletal Elements 131
Integration with Other Systems 136
Clinical Notes
Clinical Terms 136
6 The Skeletal System:
Axial Division
The Skull and Associated Bones 141
The Skulls of Infants, Children, and Adults 164 The Vertebral Column 164
The Pectoral Girdle and Upper Limb 182
The Pelvic Girdle and Lower Limb 192
Individual Variation in the Skeletal System 206
Trang 26Clinical Case
Clinical Terms 239
9 The Muscular System:
Skeletal Muscle Tissue and Muscle Organization
Functions of Skeletal Muscle 244 Anatomy of Skeletal Muscles 244
Muscle Contraction 251
Motor Units and Muscle Control 254
Types of Skeletal Muscle Fibers 255
The Organization of Skeletal Muscle Fibers 257
Levers and Pulleys: A Systems Design for Movement 261
Articular Form and Function 215
Aging and Articulations 237
Bones and Muscles 237
Clinical Notes
Trang 2713 The Nervous System:
Fascia, Muscle Layers, and Compartments 324
and Cross-Sectional Anatomy
A Regional Approach to Surface Anatomy 334
Cross-Sectional Anatomy 342
333
10 The Muscular System:
Axial Musculature
The Axial Musculature 268
The Intermediate Layer of the Intrinsic Back
Muscles of the Pelvic Girdle and Lower Limbs 308
290
Trang 2814 The Nervous System:
The Spinal Cord and Spinal Nerves
Gross Anatomy of the Spinal Cord 368
Spinal Meninges 368
Sectional Anatomy of the Spinal Cord 373
Spinal Nerves 375
Clinical Terms 389
367
15 The Nervous System: Sensory and
Motor Tracts of the Spinal Cord
Sensory and Motor Tracts 393
Levels of Somatic Motor Control 401
Clinical Note
Clinical Terms 403
392
16 The Nervous System:
The Brain and Cranial Nerves
An Introduction to the Organization of the Brain 406
Protection and Support of the Brain 408
The Medulla Oblongata 415 The Pons 416
The Mesencephalon 417 The Diencephalon 418
Neuron Organization and Processing 361
Anatomical Organization of the Nervous System 362
Clinical Notes
Clinical Terms 362
Trang 29The Hypothalamus 420
The Cerebellum 424 The Cerebrum 426
The Cranial Nerves 436
A Summary of Cranial Nerve Branches and
17 The Nervous System:
Autonomic Nervous System
A Comparison of the Somatic and Autonomic Nervous Systems 452
The Sympathetic Division 453
Sympathetic Activation and Neurotransmitter
The Parasympathetic Division 460
Organization and Anatomy of the Parasympathetic
Parasympathetic Activation and Neurotransmitter
Relationships between the Sympathetic and Parasympathetic Divisions 463
A Comparison of the Sympathetic and Parasympathetic
Clinical Notes
Urinary Bladder Dysfunction following Spinal Cord
Clinical Terms 467
451
Trang 3018 The Nervous System:
General and Special Senses
Receptors 471
Equilibrium and Hearing 479
19 The Endocrine System
An Overview of the Endocrine System 507
The Pituitary Gland 508
The Thyroid Gland 512
The Parathyroid Glands 514 The Thymus 514
The Suprarenal Glands 514
Endocrine Functions of the Kidneys and Heart 517 The Pancreas and Other Endocrine Tissues of the Digestive System 517
Trang 31Structure of the Heart Wall 550
Orientation and Superficial Anatomy of the Heart 552 Internal Anatomy and Organization of the Heart 554
22 The Cardiovascular System:
Vessels and Circulation
Histological Organization of Blood Vessels 571
Blood Vessel Distribution 578
Structural Differences between the Left and Right
The Cardiac Cycle 561
Clinical Notes
Cardiac Arrhythmias, Artificial Pacemakers, and Myocardial
Clinical Terms 566
Trang 32An Overview of the Lymphoid System 608
Structure of Lymphatic Vessels 609
Aging and the Lymphoid System 625
Clinical Notes
24 The Respiratory System
An Overview of the Respiratory System 630
The Upper Respiratory System 632
The Pleural Cavities and Pleural Membranes 646 Respiratory Muscles and Pulmonary Ventilation 649
Aging and the Respiratory System 651
Clinical Notes
629
Trang 3326 The Urinary System
The Kidneys 696
An Introduction to the Structure and Function of the
The Large Intestine 679
Accessory Glandular Digestive Organs 682
Aging and the Digestive System 689
Clinical Notes
Clinical Case
Clinical Terms 691
25 The Digestive System
An Overview of the Digestive System 658
The Oral Cavity 664
The Small Intestine 676
657
Trang 3427 The Reproductive System
Organization of the Reproductive System 717
Anatomy of the Male Reproductive System 717
Anatomy of the Female Reproductive System 729
716
Structures for Urine Transport, Storage, and
Elimination 706
Aging and the Urinary System 710
Clinical Notes
Clinical Case
Clinical Terms 713
Development of the Mammary Glands during
Aging and the Reproductive System 743
Prenatal Development 751
Labor and Delivery 762
749
Trang 35Clinical Notes
The Neonatal Period 765
Embryology Summaries
Trang 367 An Introduction to Organ Systems
An Introduction to Anatomy
Student Learning Outcomes
After completing this chapter, you should
be able to do the following:
1 Describe the reasons for studying anatomy and the relationships between structure and function.
2 Define the limits of microscopic anatomy and briefly describe cytology and histology.
3 Summarize various ways to approach gross anatomy.
4 Define and contrast the various specialties of anatomy.
5 Identify the major levels of organization in living organisms.
6 Summarize the basic life functions of
an organism.
7 Identify the organ systems of the human body and contrast their major functions.
8 Utilizing anatomical terminology, describe body sections, body regions, relative positions, and the anatomical position.
9 Identify the major body cavities and describe their functions.
Trang 37WE ARE ALL anatomists in our daily lives, if not in the classroom For
exam-ple, we rely on our memories of specific anatomical features to identify our
friends and family, and we watch for subtle changes in body movement or
po-sition that give clues to what others are thinking or feeling To be precise,
anatomy is the study of external and internal structures and the physical
rela-tionships between body parts But in practical terms, anatomy is the careful
observation of the human body Anatomical information provides clues about
probable functions Physiology is the study of function, and physiological
mechanisms can be explained only in terms of the underlying anatomy All
specific physiological functions are performed by specific anatomical structures
For instance, filtering, warming, and humidifying inspired air are functions of
the nasal cavity The shapes of the bones projecting into the nasal cavity cause
turbulence in the inhaled air, making it swirl against the moist lining This
contact warms and humidifies the air, and any suspended particles stick to the
moist surfaces In this way, the air is conditioned and filtered before it reaches
the lungs
The link between structure and function is always present, but not always
understood For example, the superficial anatomy of the heart was clearly
de-scribed in the 15th century, but almost 200 years passed before the pumping
ac-tion of the heart was demonstrated On the other hand, many important cell
functions were recognized decades before the electron microscope revealed the
anatomical basis for those functions
This text will discuss the anatomical structures and functions that make
hu-man life possible The goals are to help you develop a three-dimensional
under-standing of anatomical relationships as well as prepare you for more advanced
courses in anatomy, physiology, and related subjects, and to help you make
in-formed decisions about your personal health
Microscopic anatomy considers structures that cannot be seen without
magni-fication The boundaries of microscopic anatomy, or fine anatomy, are
shows details that barely escape the naked eye, while an electron microscope
demonstrates structural details that are less than one-millionth as large As we
proceed through the text, we will be considering details at all levels, from
macroscopic to microscopic
Microscopic anatomy can be subdivided into specialties that consider
ana-lyzes the internal structure of cells, the smallest units of life Living cells are
composed of complex chemicals in various combinations, and our lives
de-pend on the chemical processes occurring in the trillions of cells that form
our body
tissues, groups of specialized cells and cell products that work together to
per-form specific functions The cells in the human body can be assigned to four
ba-sic tissue types, and these tissues are the focus of Chapter 3
Tissues in combination form organs such as the heart, kidney, liver, and
brain Organs are anatomical units that have multiple functions Many tissues
and most organs are examined easily without a microscope, and at this point we
cross the boundary from microscopic anatomy into gross anatomy
Gross anatomy, or macroscopic anatomy, considers relatively large structures
and features visible to the unaided eye There are many ways to approach grossanatomy:
su-perficial anatomical markings
a specific area of the body, such as the head, neck, or trunk Advancedcourses in anatomy often stress a regional approach because it empha-sizes the spatial relationships among structures
the skeletal or muscular systems Organ systems are groups of organs thatfunction together to produce coordinated effects For example, the heart,blood, and blood vessels form the cardiovascular system, which distributesoxygen and nutrients throughout the body There are 11 organ systems inthe human body, and they will be introduced later in the chapter Introduc-tory texts in anatomy, including this one, use a systemic approach because
it provides a framework for organizing information about important tural and functional patterns
Other anatomical specialties will be encountered in this text
the period between conception and physical maturity Because it considersanatomical structures over such a broad range of sizes (from a single cell to
an adult human), developmental anatomy involves the study of both croscopic and gross anatomy Developmental anatomy is important inmedicine because many structural abnormalities can result from errorsthat occur during development The most extensive structural changes oc-
mi-cur during the first two months of development Embryology
types of animals Observed similarities may reflect evolutionary ships Humans, lizards, and sharks are all called vertebrates because theyshare a combination of anatomical features that is not found in any othergroup of animals All vertebrates have a spinal column composed of indi-
techniques of gross, microscopic, and developmental anatomy tion on developmental anatomy has demonstrated that related animals typ-
Several other gross anatomical specialties are important in medicaldiagnosis
recog-nizable pathological changes during illness
procedures
em-bre䊏
-OL-o䊏
-je䊏
Trang 38Approximate Magnification (Reduction) Factor
From actual to artwork on this page
Unaided human eye
Compound light microscope
Scanning electron microscope
Transmission electron microscope
Fingertip (width) Large pr
millimeters (mm) micrometers (μm) nanometers (nm)
method of study and the degree of magnification.
Trang 39Vertebrate
Body Plan
Digestive tract
Somites
segmental blocks forming muscles, vertebrae, etc.
Vertebrae
surround spinal cord
in spinal cavity
Vertebrae
Vertebrae Somites
Limb bud
Limb buds
Muscular tail
extends beyond exit of digestive tract
Braincase
of cartilage or
bone surrounds
the brain
Pharyngeal (gill) arches
may persist or be modified
to form other structures
in adult
Ventral body cavity
contains thoracic and abdominopelvic organs All vertebrates share a basic pattern of
anatomical organization that differs
from that of other animals.
The similarities between vertebrates are most apparent when comparing embryos at comparable stages of development.
The similarities are less obvious when comparing adult vertebrates.
a
Figure 1.2 Comparative Anatomy Humans are classified as
vertebrates, a group that also includes animals as different in appearance
as fish, chickens, and cats.
Disease, Pathology, and Diagnosis
THE FORMAL NAME FOR THE STUDY OF DISEASE is pathology
Dif-ferent diseases typically produce similar signs, the physical
manifesta-tion of a disease, and symptoms, the patient’s percepmanifesta-tion of a change
in normal body function For example, a person whose lips are paler
than normal and who complains of a lack of energy and
breathless-ness might have (1) respiratory problems that prevent normal oxygen
transfer to the blood (as in emphysema); (2) cardiovascular problems
that interfere with normal blood circulation to all parts of the body
(heart failure); or (3) an inability to transport adequate amounts of
oxygen in the blood, due to blood loss or problems with blood
forma-tion In such cases, doctors must ask questions and lect information to determine the source of the problem The patient’shistory and physical exam may be enough for a diagnosis in manycases, but laboratory testing and imaging studies such as x-rays areoften needed
col-A diagnosis is a decision about the nature of an illness The
diag-nostic procedure is often a process of elimination, in which several tential causes are evaluated and the most likely one is selected Thisbrings us to a key concept: All diagnostic procedures presuppose an un-derstanding of the normal structure and function of the human body
po-C L I N I po-C A L N O T E
Trang 40Concept Check See the blue ANSWERS tab at the back of the book.
systemic anatomy?
Levels of Organization[Figures 1.3 • 1.4]
Our study of the human body will begin with an overview of cellular anatomy
and then proceed to the anatomy, both gross and microscopic, of each organ
sys-tem When considering events from the microscopic to macroscopic scales, we
are examining several interdependent levels of organization
We begin at the chemical or molecular level of organization The human body
consists of more than a dozen different elements, but four of them (hydrogen,
oxygen, carbon, and nitrogen) account for more than 99 percent of the total
three-dimensional compounds with distinctive properties The major classes of
Figure 1.4presents an example of the relationships between the
chemi-cal level and higher levels of organization The cellular level of organization
includes cells, the smallest living units in the body Cells contain internal
structures called organelles Cells and their organelles are made up of
com-plex chemicals Cell structure and the function of the major organelles found
interac-tions produce complex proteins within a muscle cell in the heart Muscle cells
are unusual because they can contract powerfully, shortening along their
longitudinal axis
Heart muscle cells are connected to form a distinctive muscle tissue, an
ex-ample of the tissue level of organization Layers of muscle tissue form the bulk of
the wall of the heart, a hollow, three-dimensional organ We are now at the organ
level of organization
Normal functioning of the heart depends on interrelated events at the
chemical, cellular, tissue, and organ levels of organization Coordinated
contrac-tions in the adjacent muscle cells of cardiac muscle tissue produce a heartbeat
When that beat occurs, the internal anatomy of the organ enables it to function
as a pump Each time it contracts, the heart pushes blood into the circulatory
tem, a network of blood vessels Together the heart, blood, and circulatory
sys-tem form an organ syssys-tem, the cardiovascular syssys-tem (CVS)
Each level of organization is totally dependent on the others For example,
damage at the cellular, tissue, or organ level may affect the entire system Thus,
a chemical change in heart muscle cells may cause abnormal contractions oreven stop the heartbeat Physical damage to the muscle tissue, as in a chestwound, can make the heart ineffective even when most of the heart muscle cellsare intact and uninjured An inherited abnormality in heart structure can make
it an ineffective pump, although the muscle cells and muscle tissue are perfectlynormal
Finally, it should be noted that something that affects the system will mately affect all of its components For example, the heart may not be able topump blood effectively after a massive blood loss due to damage of a majorblood vessel somewhere in the body If the heart cannot pump and blood can-not flow, oxygen and nutrients cannot be distributed In a very short time, thetissue begins to break down as heart muscle cells die from oxygen and nutrientstarvation
ulti-Of course, the changes that occur when the heart is not pumping effectivelywill not be restricted to the cardiovascular system; all of the cells, tissues, andorgans in the body will be damaged This observation brings us to another,higher level of organization, that of the organism; in this case a human being.This level reflects the interactions among organ systems All are vital; every sys-tem must be working properly and in harmony with every other system, or sur-vival will be impossible When those systems are functioning normally, thecharacteristics of the internal environment will be relatively stable at all levels
Elemental composition of the body.
Trace elements include silicon, fluorine, copper, manganese, zinc, selenium, cobalt, molybdenum, cadmium, chromium, tin, aluminum, and boron.
Molecular composition of the body
Water – 66%
Proteins 20% Lipids
10%
Carbohydrates 3%
Hydrogen 62%
Oxygen 26%
OTHER ELEMENTS Calcium
Phosphorus Potassium Sodium Sulfur Chlorine Magnesium Iron Iodine Trace elements
Carbon 10%
are visualized by x-rays, ultrasound scans, or other specialized procedures
performed on an intact body
as new advances in radiographic anatomy, such as CT (computerized
tomog-raphy) and spiral scans, have emerged