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Expose the slips of diaphragm arising from the internal surfaces of the remaining costal cartilages and identify the intercostal vessels and nerves entering the abdominal wall between them menstrual flooding fosamax 35 mg buy mastercard. Section 2 Abdomen and Pelvis 1 the diaphragm is the principal muscle of inspiration. On contraction, the diaphragm descends increasing the vertical diameter of the thorax. Thus before sneezing, coughing, laughing, crying, vomiting, micturition, defaecation, or parturition, a deep inspiration takes place. This is followed by closure of the glottis and powerful contraction of the trunk muscles. On lying down, the pressure exerted by the abdominal viscera pushes the diaphragm upwards. While standing, the muscles in the abdominal wall contract, increasing the intra-abdominal pressure. Because of these factors, the level of the diaphragm is highest in the supine position, lowest while sitting, and intermediate while standing. Retrosternal hernia: It occurs through the space between the xiphoid and costal origins of the diaphragm, or foramen of Morgagni, or space of Larrey. It is more common on the right side and lies between the pericardium and the right pleura. Posterolateral hernia: this is by far the commonest type of congenital diaphragmatic hernia. It occurs through the pleuroperitoneal hiatus or foramen of Bochdalek situated at the periphery of the diaphragm in the region of attachments to the 10th and 11th ribs. Posterior hernia: this is due to failure of development of the posterior part of the diaphragm. Central hernia: It is rare, left-sided and is supposed to be the result of rupture of the foetal membranous diaphragm in the region of the left dome. It is due to weakness of the phrenicooesophageal membrane which is formed by the reflection of diaphragmatic fascia to the lower end of the oesophagus. In this way, the valvular mechanism at the cardio-oesophageal junction is disturbed causing reflux of gastric contents into the oesophagus. Hiatal Congenital hiatal rolling hernia Acquired hiatal sliding hernia (commonest). The rolling type is usually congenital while the sliding type is usually acquired. It occurs due to weakness of phrenicooesophageal membrane, which is formed by the reflection of diaphragmatic fascia to the lower end of oesophagus. In this way, the valvular mechanism at the cardio-oesophageal junction is disturbed, causing reflux of gastric contents up to the oesophagus. An article that describes the normal mechanism that prevents reflux of gastric contents into the oesophagus, including the resting tone of the lower oesophageal sphincter, the mechanical effect of the crural sling, and the specialized anatomy of the proximal stomach.
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Bailey & Love · Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy · Bailey & Love Chapter Bailey & Love · Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy 14 the wrist and hand · · · · the bones of the hand 5 menstrual cycles in 2 months cheap fosamax 70 mg overnight delivery. The square flexor retinaculum is attached to the scaphoid, trapezium, pisiform and hamate. All its points of attachment are palpable, as is the scaphoid in the anatomical snuffbox. The 1 metacarpal is the shortest, strongest and most mobile; its axis is rotated to lie almost at a right angle to that of the other metacarpals. The proximal phalanges have cupped surfaces for proximal articulation with the metacarpals; the heads of the proximal and middle phalanges have paired articular condyles and the distal phalanges taper distally. The phalanges give attachment to the long flexors and extensors of the fingers and thumb and to all the small muscles of the hand, apart from the opponens muscles. The capsule, attached to the articular margins, is thickened by medial and lateral collateral ligaments. The triangular articular disc is intracapsular, its apex being attached to the base of the ulnar styloid and its base to the lower end of the radius. Only if the disc is perforated does the wrist joint communicate with the distal radioulnar joint. The intercarpal joints are synovial joints; the extensive composite joint between the proximal and distal row of carpal bones is known as the midcarpal joint, and it is here that most of the flexion and abduction of the wrist occurs. The stability of the joints is dependent on ligaments: palmar, dorsal and interosseous. Flexion (flexor carpi radialis and ulnaris aided by the long digital flexors) is greater than extension (extensor carpi ulnaris and radialis longus and bre- vis assisted by the long digital extensors). Adduction (extensor and flexor carpi ulnaris) is greater than abduction (flexor carpi radialis and extensor carpi radialis longus and brevis). Proximal to this the radial artery can be readily palpated as it lies on the radius. Medial to this are the tendons of flexor carpi radialis and palmaris longus, and under the latter the median nerve crosses the joint deep to the retinaculum. Lying centrally on a deeper plane are the tendons of flexor digitorum superficialis and profundus and flexor pollicis longus. The shape of the articular surfaces ensures that flexion is always accompanied by medial rotation, and extension by lateral rotation. One of the most specific thumb movements is that of opposition, in which the tip of the thumb is brought into contact with the tips of the fingers. It requires a combination of flexion, medial rotation and adduction of the thumb, and is very much a human attribute: the carpometacarpal joints of the fingers are synovial plane joints. The second and third are less mobile than the fourth and fifth, and all are less mobile than that of the thumb; the metacarpal heads articulate with the cupped bases of the proximal phalanges.
There is an elevation called verumontanum (colliculus seminalis) at about middle of urethral crest womens health 30 day meal plan generic fosamax 70 mg otc. Prostatic utricle It is a cul-de-sac, 6 mm long, which runs upwards and backwards in the substance of prostate behind its median lobe. It develops from paramesonephric ducts or urogenital sinus and is thought to be homologous with the vagina of female. Lowermost part of prostatic urethra is fixed by puboprostatic ligaments and is, therefore, immobile. Membranous Part floor with heterogenous mixture of slow and fast twitch type of larger diameter. So slow twitch fibres of sphincter are capable of sustained contraction over long period of time and contribute to tone that closes the urethra and maintains urinary continence. Pubourethral part of levator ani, important to resist surges of intra-abdominal pressure (on coughing or exercise). Descends with a slight ventral concavity from the prostate to bulb of penis, passing through the perineal membrane. Muscle coat consists of relatively thin layer of bundles of smooth muscle, which are continuous proximally with those of prostatic urethra and a prominent outer layer of the circularly oriented striated muscle fibres (rhabdosphincter) which form external urethral sphincter. External sphincter represents points of highest transurethral pressure in the normal, and contracted states. Intrinsic striated muscle is made of fibres of very small diameter, devoid of muscle spindles, physiologically being slow twitch type, unlike pelvic Anterior or spongiosus part lies in corpus spongiosum and is 16 cm long when penis is flaccid. Part of anterior urethra which is surrounded by bulbospongiosus is called bulbar urethra and is wide part of urethra. It is narrow and slit-like when empty and has diameter of 6 mm when passing urine. External urethral orifice is the narrowest part of urethra and is a sagittal slit, 6 mm long, bounded on each side by a small labium. Epithelium of urethra, particularly in bulbar and distal penile segments, presents orifice of numerous small glands and follicles situated in the submucous tissue called urethral glands. It contains a number of small pit-like recesses, or lacunae of varying size whose orifices are directed forwards. One lacuna larger than the rest is lacuna magna which is situated on the roof of navicular fossa. Arteries Section 1 Urethral artery arises from internal pudendal artery just below perineal membrane and travels through corpus spongiosum to reach glans penis. Veins 2 Anterior urethra dorsal vein of penis internal pudendal vein which drains into prostatic venous plexusinternal iliac veins. Lymphatic Drainage Each paraurethral duct runs down in the submucous tissue and ends in a small aperture on the lateral margins of external urethral orifice. Veins Prostatic plexus supplies the smooth muscle of prostate and prostatic urethra.
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Enzo, 30 years: Cerebellopontine angle syndrome: the anatomical structures located in cerebellopontine angle are choroid plexus of 4th ventricle, 7th and 8th nerves.
Lee, 32 years: The fat in the perianal space is tightly arranged in small loculi formed by complete septa.
Vigo, 34 years: Brownian motion is independent of the suspending medium, and although an increase in the viscosity does slow down the motion, the amplitude of the movements is unaltered.
Aldo, 59 years: Extension of the wrist is maintained because extensor carpi radialis is supplied by a branch of the radial nerve that arises above the elbow.
Kurt, 49 years: It is formed by the frontal bone, the cribriform plate of the ethmoid and the sphenoid.
Jarock, 38 years: Its anterior surface is covered with peritoneum, except in the median plane, where it is crossed by the superior mesenteric vessels and by the root of the mesentery.
Daryl, 51 years: As it runs through the carotid canal it passes over the cartilage-filled foramen lacerum.