!

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Illustrated by NCKU MED106 

CONTENTS!
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Skeletal system ……………………………………………!1!
Muscular system ……………………………..….………!12!
Vascular system …………………………………………!29!
Nervous system …………………………………………! 42!
Gastrointestinal system ……………………………….! 66!
Urinary system …………………………………………..! 80!
Reproductive system …………………………………..! 86!
Respiratory system …………………………………….! 92!
Lymphatic system ………………..…………………….! 99!
Heart ………………………………………………..……!104!
Blood ……………………………………………………..!110!
Endocrine system ………………..……………….……!112!
Skin ……………………………………………………….!116
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E-mail: puddingyd@gmail.com

 !
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SKELETAL SYSTEM!
1-1 ~ 2-2


1
 Skeletal system

GENERAL
GENERAL

mediastinum

Thorax

diaphragm

Abdomen sacral promontory

arcuate line

pelvic brim iliopectineal line

pubic crest
true pelvis pubic symphysis
pelvic diaphragm
(levator ani m., coccygeus m.)
Perineum

SURFACE LANDMARK
SURFACE LANDMARK
hyoid bone
C3 larynx
jugular notch
esophagus
T3 trachea (C6-T10)
2 carina
sternal angle 3 T4
4 nipple
scapula
(T2-T7) 5 cardiac apex
6
xyphoid
T9-T10 liver stomach
process

7 pancreas
transpyloric line L1-L2
cisterna L3 IVC AA
chyli (L2)
kidney transv. spleen
colon
iliac crest (T12-L3)
L4
iliac tubercle
L5
ASIS
S2

2
 Skeletal system

CRANIAL BONE
CRANIAL BONE

ant. pterion
mid. meningeal a.
frontanelle
(18 ) coronal suture
sagittal suture
squamous suture
lamboid suture

post.
frontanelle asterion
(3 )

0101 01:15:00 14-10

TEMPORAL BONE
TEMPORAL BONE

岩狀狀部（內耳）
petrous part
zygomatic (int. ear)
arch squamous part
ZYGOMA
tympanic part ⿎鼓室部
(ext. ear, mid. ear, E-tube)
TMJ
mastoid part
乳突部

lat. ligament of TMJ

ramus
MANDIBLE condylar process 果狀狀突
下頷骨

body coronoid process 冠狀狀突

styloid process (stylomastoid f. : 腦神經 7)

第七第八都經過內聽孔，第八管內耳不出來來，第七從莖乳突孔鑽出

3
 Skeletal system
0101 1:10:00 14-15
CRANIAL BASE
CRANIAL BASE foramen cecum
greater petrosal n.
ant. ethmoidal foramen
額骨 ant. ethmoidal a., v., n.
post. ethmoidal foramen
cribiform plate
⽔水平板（有嗅神經孔） post. ethmoidal a., v., n.
CN I
視神經孔（2）optic canal P
CN II F
sup. orbital fissure T O
框上裂（3.4.5-1.6） CN III, IV, V1, VI
sup. ophthalmic v. 顳骨
圓孔（5-2） foramen rotundum
cerebellum
CN V2
後顱窩有⼩小腦半球
卵卵圓孔（5-3、⼩小岩）foramen ovale
CN V3
lesser petrosal n. foramen lacerum 破裂
棘 foramen spinosum greater petrosal n.
mid. meningeal a.
carotid canal 動
meningeal branch of CN V3
int. carotid a.
枕骨⼤大孔 foramen magnum int. acoustic meatus 聽（7.8）
medulla oblongata CN VII, VIII
vertebral a. jugular foramen 靜（9.10.11）
枕骨
spinal a. CN IX, X, XI
spinal branch of CN XI int. jugular v.
hypoglossal canal
CN XII 舌下神經孔

PARANASAL
PARANASAL SINUS SINUS



frontal sinus

sphenoid sinus

ethmoid sinus
(ant., mid., post.)

maxillary sinus

4
 Skeletal system

PALATE 顎骨
PALATE 初級顎

incisive fossa
nasopalatine n.
（5-2 分⽀支）

MAXILLA
hard
palate
greater palatine foramen
PALATINE greater palatine a., v., n.
BONE
lesser palatine foramen
lesser palatine a., v., n.
soft
palate

0101 01:49 14-12

NASAL SEPTUM
NASAL SEPTUM
雞冠
⽔水平板（嗅神經孔）
cribiform
plate

ethmoid
simus ethmoid

septal
cartilage

vomer
上中⿐鼻甲是篩骨ㄉ
下⿐鼻甲獨立

5
 Skeletal system
0101 01:41:00

ORBIT 


ORBIT supraorbital foramen

CN V1

infraorbital foramen
CN V2 匡下孔（匡下神經 5-2 分⽀支）

mental foramen
CN V3

common tendinous ring

CN II, III, V1 (nasociliary branch), VI
ophthalmic a.
F
optic canal
CN II, ophthalmic a.
框上裂（蝶骨⼤大⼩小翼之間）sup. orbital fissure
CN III, IV, V1, VI
sup. ophthalmic v. Z S S E L M
inf. orbital fissure
CN V2 M P
inf. ophthalmic v.

Z M

maxilla （上頷骨）

PTERYGOPALATINE FOSSA
PTERYGOPALATINE FOSSA
七孔六腔
orbit
mid. cranial
眼睛
in

fossa
f. o

du
um
rb
tai

t
ro

l
l fi

a 顱
an
en

PALATINE
ss

dc
m
ur

oi
ra

ryg
e

sphenopalatine
fo

foramen pte
⿐鼻
MAXILLA SPHENOID
pharyngeal canal
al
an
ec

pterygomaxillary fissure
in
lat
pa

⼝口
pharynx

咽咽

6
 Skeletal system

VERTEBRA intervertebral disc

C1-C2, S-Co vertebral a.
VERTEBRA
椎⽔水平進針（L4）
lumbar puncture 從薦
L spine

T spine

C spine

c1~c6 有橫突孔 supraspinous lig. 棘上韌帶

（椎動脈）
interspinous lig.
2nd curvature
7 C (3 months) ligamentum flavum 黃韌帶

12 T 1st curvature post. longitudinal lig.

ant. longitudinal lig.
2nd curvature
5 L (12 months)

5 1 S 1st curvature
26個椎孔形成椎管（脊髓） bifurcated spinous process (C spine)
vertebral
5 1 Co foramen
spinous process

lamina

transverse process
tubercle

pedicle

body
head



7
 Skeletal system

UPPER EXTREMITY rotator cuff

UPPER EXTREMITY subscapularis m. subscapular n. int. rotation
肩胛三區 supraspinatus m. abduction
suprascapular n.
infraspinatus m.
ext. rotation
teres minor m. axillary n.

glenoid
head
SCAPULA
anatomical neck
⼤大結節
greater tubercle lesser tubercle
(insertion of (insertion of subscapularis m.)
supraspinatus m., 肩胛下、＊⼤大園、＊闊背
infraspinatus m., surgical neck
teres minor m.)
棘上、棘下、⼩小圓、＊胸⼤大 intertuberous sulcus
(tendon of biceps brachii, long head)
結節間溝：肱⼆二頭ㄉ長頭韌帶

deltoid tuberosity radial groove

三⾓角肌粗隆隆（三⾓角肌附著）
橈神經溝（橈神經、深肱動脈）
後
HUMERUS

側
radia

ulnar n.
l n.

HUMERUS
lat. epicondyle med. epicondyle

radial fossa coronoid fossa

olecranon
capitulum fossa 鷹嘴窩

olecranon
trochlea 鷹嘴突

橈骨切雞（以凸ㄉ取名）radial notch trochlear

of ulna coronoid
process notch
ULNA

interosseous ant. post.

membrane
RADIUS

ULNA

(lat. view)

ulnar notch styloid process (莖狀狀突)

of radius
腕關節（⾈舟⽉月） wrist joint Bennett fracture: base of 1st metacarpal bone
boxer fracture: neck of 5th metacarpal bone

deep transverse metacarpal ligment （綁2~5掌骨）

cf.腳趾（metatarsal）：綁1~5
8
 Skeletal system

THORACIC CAGE
THORACIC CAGE
T2
coracoclavicular lig. 前斜⾓角肌
ant. scalene m.
conoid lig. T2
trapezoid lig. cla
v icle
T3 1 subclavian a.
T2 acromion
T4 subclavian v.
coracoid process suprascapular 2
T3 glenoid cavity notch
(subscapular n.) 3
spine V
A
肩胛脊根T3 4 N

coracoid 喙狀狀 scapula

coronoid 冠狀狀 5
conoid 錐狀狀 6
7
T7 T10
8

・ 9 false ribs

10
・
11
float ribs
12

PELVIS
PELVIS
iliac crest
L4
iliac tubercle L5
IM injection

ILIUM
ASIS sup. gluteal a./n.
ILIAC CREST髂脊 S2 piriformis m.
S4
greater sciatic notch inf. gluteal a./n.
sacrospinous lig. pudendal n.
sacrotuberous lig. int. pudendal a.
sciatic n.
ischial spine
lesser sciatic notch pudendal n.
ischial tuberosity int. pudendal a.
ISCHIUM
obturator canal
(obturator n., a., v.)

PUBIS

ilium：髂骨
ileum：迴腸

9
 Skeletal system

THIGH AND LEG

THIGH AND LEG
AIIS
iliofemoral lig. acetabulum
greater trochanter
gluteus medius m. head blood supply:
gluteus minimus m. acetabular branch of obturator a.
sup./inf. gemellus m.
obturator internus m. anatomical neck
piriformis m.

trochanteric fossa 125° lesser trochanter

obturator externus insertion of iliopsoas m.
intertrochanteric surgical neck
line (ant.)/ crest (post.)

linea aspera
lat. lip (biceps femoris m., short head)
med. lip (adductor m.)

patella
FEMUR

fibular collateral lig. tibia collateral lig.

FEMUR
lat. condyle of femur med. condyle
of femur
lat. meniscus med. meniscus
ACL PCL
lat. condyle of tibia med. condyle
of tibia
TIBIA

ant. post.
tibia tuberosity (lat. view)
patellar lig. (quadriceps tendon)
FIBULA

TIBIA

・
・

lat. malleolus med. malleolus

TALUS

10
 Skeletal system

ANKLE AND FOOT

ANKLE AND FOOT

ankle joint
AVN Achilles tendon
soleus m.
gastrocnemius m.
plantaris m.

talus
oid
cub
navicular

ph calcaneus
s
ala tarsu
ng m et a eiform
e cun
s

11
 !

MUSCULAR SYSTEM!
2-2 ~ 3-3


12
 Muscular system

FACIAL EXPRESSION MUSCLE

FACIAL EXPRESSION MUSCLE

EXTRAOCULAR
EXTRAOCULAR MUSCLE
MUSCLE

・
・

13
 Muscular system

MUSTICATION MUSCLE

TONGUE MUSCLE

hyoid bone

14
 Muscular system

PHARYNGEAL MUSCLE

・
・

pterygoid hamulus

15
 Muscular system



INTRINSIC MUSCLE OF LARYNX

・
・

16
 Muscular system

SUPRAHYOID AND INFRAHYOID MUSCLE

digastric m., ant. belly

stylohyoid m. mylohyoid m.

digastric m., geniohyoid m.

post. belly
(to mastoid notch of hyoid bone
temporal bone)

thyrohyoid m.

thyroid
omohyoid m. cartilage

sterothyroid m.
sternohyoid m.
scapula sternum

17
 Muscular system

NECK TRIANGLE 


SUBOCCIPITAL TRIANGLE

18
 Muscular system

SCALENE
SCALENEMUSCLE
MUSCLE



!DIAPHRAGM
DIAPHRAGM
・

sympathetic trunk

19
 Muscular system

ABDOMINAL MUSCLE
・

・
・

20
 Muscular system

BACK MUSCLE

21
 Muscular system

PELVIC MUSCLE -1

22
 Muscular system

PELVIC MUSCLE -2

23
 Muscular system

UPPER EXTREMITY
UPPER EXTREMITYMUSCLE
MUSCLE-1
(musculocutaneous n.)
ARM (ant.) caracobrachialis
(shoulder flexion)
musculocutaneous n. brachialis
(elbow flexion)
radial n.
ulnar n. biceps brachii
(shoulder, elbow flexion)
median n.
(radial n.)
triceps brachii
(long, med., lat.)
(radial n.
(post.)
FOREARM
(median n.)
(ulnar n.)
palmaris longus
flexor carpi ulnaris (ant.)
flexor carpi radialis
(median n.) pronator teres
flexor digitorum
superficialis (radial n.)
pronator quadratus brachioradialis
(elbow flexion) (lat.)
(radial n.) supinator extensor carpi
radialis longus

・extensor m.
extensor carpi radialis brevis
extensor digitorum
lat. epicondyle
extensor digiti minimi
(post.) extensor carpi ulnaris
・flexor m. anconeus
med. epicondyle

HAND MUSCLE
・thenar (median n.) and hypothenar (ulnar n.) muscle:
opponens/abductor/flexor pollicis/digiti minimi m.
・lumbrical m. (1,2: median n.; 3,4: ulnar n.): MP flexion, IP extension
・interosseous m. (ulnar n.): abd. (dorsal); add. (palmar)

24
 Muscular system

UPPER EXTREMITY MUSCLE -2 


UPPER EXTREMITY MUSCLE-2

(Rt. side, post. view)
subscapularis/
teres minor
TRIANGULAR SPACE
circumflex scapular a.

HUMERUS
teres major

triceps,
long head
QUADRANGULAR SPACE
post. circumflex humeral a.
axillary n.

TRIANGULAR INTERVAL
profunda brachii a.
radial n.
brachiatendon

CUBITAL FOSSA
medianl a.
n.
bicepsn.
radial

(lat.) (med.)

brachioradialis pronator teres

floor:
supinator m., brachialis m.

CARPAL TUNNEL
・outside: palmaris longus, ulnar n./a./v.
・inside:
superf.: flexor digitorum superf., median n.
deep: flexor digitorum profundus, flexor pollicis longus

25
 Muscular system

LOWER EXTREMITY MUSCLE -1 


LOWER EXTREMITY MUSCLE-1
HIP
flexor: iliopsoas, sartorius, rectus femoris
extensor: gluteus maximus (sup. gluteal n.),
hamstrings m. (biceps, semimembranosus, semitendinosus)
abductor: gluteus medius, minimus (inf. gluteal n.), tensor fascia lata
adductor: gracilis ( ), adductor magnus, longus, brevis, (obturator n.)
・ gluteus medius
・ ：gluteus medius
femoral n.
THIGH quadratus femoris
(knee extension)
obturator n.
sartorius
adductor m.
magnus, longus, brevis
gracilis
(hip add., knee flexion) biceps femoris
semitendinosus
semimembranosus
・hamstring part of add. magnus tibial n.
is innervated by tibial n.
・biceps, short head is innervated
・unlock the knee: popliteal m. by common fibular n.

LEG
fibularis tertius deep fibular n.
extensor digitorum
and hallucis
superf. fibular n.
tibialis ant. fibularis longus

flexor digitorum fibularis brevis

and hallucis
tibialis post.
plantaris
soleus tibial n.
gastrocnemius

・COMPARTMENT SYNDROME

: 5P (pain, pale, pulseless, paresthesia, paralysis)

26
 Muscular system

LOWER EXTREMITYMUSCLE
LOWER EXTREMITY MUSCLE -2
FEMORAL TRIANGLE

floor: add. longus, pectineus, iliopsoas

roof: fascia lata superf. circumflex

fe o ra n .
iliac v.

fe mo ora as m
(ly mo ral l a. .
o
fe ops

l
inguinal lig. superf. epigastric v.

l
na
m ral v.
ili
m

iliotibial tract
ph ca
fe
m

)
muscular
compartment superf. ext.
adductor longus,
pudendal v.
vascular
compartment med. border saphenous
(post.)
opening
sartorius m.
add. longus fascia lata
vastus sartorius great saphenous v.
medialis
ADDUCTOR CANAL:
(ant.) femoral a./v., saphenous n. (branch of femoral n.)
nerve to vastus medialis (branch of femoral n.)

POPLITEAL FOSSA ANKLE JOINT

extensor digitorum and
semimembranosus

hallucis longus
semitendinosus

tibialis ant. post. tibial a.

biceps femoris

fibularis tertius
tibial n.

ant. tibial a. flexor digitorum and

deep fibular n. hallucis longus
tibialis post.
sup./inf. extensor
popliteal a. retinaculum

poploteal v.
tibial n. flexor
aris

retinaculum
plant

common
gastrocnemius

gastrocnemius

fibular n.
med. malleolus
floor:
popliteus m. inversion: tibialis ant., post., extensor hallucis longus
eversion: fibularis longus, brevis, tertius

27
 Muscular system

NECK FASCIA
NECK FASCIA
INVESTING LAYER thyroid cartilage
SCM, trapezius, parotid gl.,
sunmandibular gl. SCM
T
PRETRACHEAL LAYER E carotid sheath
thyroid gl., parathyroid gl. (CN XI, IJV, CCA
deep cervical LN)

PREVERTEBRAL LAYER
sympathetic trunk
axillary sheath
RETROPHARYNGEAL
SPACE

AXILLA
AXILLA
apex: clavicle, scapula, 1st rib
pula
post.: sca 1st rib
subscapularis,
teres major, clavicle lat.:
latissimus dorsi biceps brachii
coracobrachialis

med.:
serratus ant.

floor: ant.:
pectoralis major, latissimus dorsi superf: pectoralis major
deep: subclavius, pectoralis minor
・axillary sheath: axillary a., v., brachial plexus

28
 !

VASCULAR SYSTEM!
3-3 ~ 3-4!
9-3 ~ 9-4


29
 Vascular system

GENERAL
GENERAL
carotid sinus (baroreceptor)

brachiocephalic carotid body (chemoreceptor)

trunk
common carotid a.
subclavian a.
arch of aorta
T4
ascending bronchial a.
esophageal a. (mid. 1/3)
aorta thoracic pericardial a.
descending post. intercostal a. (3rd-11th)
coronary a. aorta subcostal a.
LV sup. phrenic a.

diaphragm
celiac trunk
SMA
IMA
inf. phrenic a. sup. suprarenal a.
abdominal mid. suprarenal a. supply
descending adrenal gl.
aorta renal a. inf. suprarenal a.
testicular/ovarian a.

L4

common iliac a.

int. iliac a. ext. iliac a.

inguinal lig.

inf. epigastric a.
femoral a.

30
 Vascular system

COMMON
COMMONCAROTID
CAROTIDARTERY
A. MAXILLARY
MAXILLARYARTERY
A.
mid. cerebral a.
ant. cerebral a. mid. meningeal a.

ophthalmic a. ICA
post. auricular a. infraorbital a.
superf. temporal a. maxillary a.

maxillary a. occipital a. ant. sup. alveolar a.

facial a. descending
ascending post. sup. alveolar a. palatine a.
lingual a. pharyngeal a. inf. alveolar a.

ECA
sup. thyroid a.
common
carotid a. 


VERTEBRAL
VERTEBRALARTERY
A. CIRCLE
CIRCLEOF WILLIS
OF WILLIS
ACA
A. com

MCA
post. cerebral a.

ICA P. com
sup. cerebellar a.

ant. inf. cerebellar a. PCA basilar a.

pontine branch
merge into basilar a. vertebral a.
post. inf. cerebellar a.

vertebral a.
ant./post. spinal a.

subclavian a.

31
 Vascular system

ARTERY OF UPPER LIMB

ARTERY OF UPPER LIMB
vertebral a.
rib 1
teres major m. clavicle
y a.
illar subclavian a.
x
int. thoracic a.

a
ant. intercostal a.
profundus brachii a.

l a.
radial n.)

hia
brac
musculophrenic a.

ia l a. lat. thoracic a.
d
ra ra long thoracic n.) pericardiacophrenic a.
.

n a
ul

sup. epigastric a.

a.
ial
d
ra

.
a ra
uln
common palmar
metacarpal a.
deep plamar arch
(from radial a.)
superf. palmar arch
(from ulnar a.)
common palmar digital a.

proper palmar digital a.

VEIN
cephalic v. (on radial side)

median cubital v. drain into axillary a.

basilic v. (on ulnar side)

32
 Vascular system

CELIAC TRUNK, SMA, IMA

CELIAC TRUNK, SMA, IMA
celiac trunk
common hepatic a.
left gastric
left hepatic a.
short gastric
right hepatic a.
splenic a.
cystic a.
pancreatic branch
proper hepatic a.
left gastro-omental a.
right gastric a.
right gastro-omental a.
gastroduodenal a.
sup. pancreaticoduodenal a.

SMA
inf. pancreatocoduodenal a.

mid. colic a.

right colic a. branch to jejunum

branch left colic a.

to ileum IMA

ileocecal a.
sigmoid branch

sup. rectal a.

33
 Vascular system

INTERNAL
INTERNALILIAC
ILIACA.ARTERY



int. iliac a.

ant. post.
branch branch
obturator a.
umbilical a.
sup. gluteal a.
sup. vesicle a.
int. pudendal a. iliolumbar a.

inf. vesicle a. lat. sacral a.

vaginal a.
uterine a.
mid. rectal a.
inf. gluteal a.

IMA

int. iliac a.

sup. rectal a.

mid. rectal a. int. pudendal a.

inf. rectal a.

34
 Vascular system

ARTERYOFOF
ARTERY LOWER
LOWER LIMBEXTREMITY 


superf. circumflex iliac a.

ext. iliac a.
superf. epigastric a.

superf. ext. pudendal a.

saphenous
deep ext. pudendal a
opening
femoral a.
profunda femoris a.

popliteal a.

post. tibial a.
ant. tibial a.

fibular a.

sup./inf. extensor
retinaculum

dorsalis pedis
flexor
retinaculum
med. plantar a.
lat. plantar a.
VEIN
great saphenous v. (med. side) femoral v.
small saphenous v. (lat. side) popliteal v.

35
 Vascular system

PORTALSYSTEM
PORTAL SYSTEM 


lesser
omentum

portal v.

portal v. starts at
the neck of pancreas
(L1-L2) splenic v.

SMV

PORTAL-SYSTEMIC ANASTOMOSIS

esophageal v.
(to azygos v.)

Lt. gastric v.

Rt. gastric v.
cystic v.

paraumbilical v.

SMV IMV

sup./inf.
epigastric v.
(to int. thoracic v.)
sup. rectal v.

mid./inf. rectal v.
(to int. iliac v.)

36
 Vascular system

CRANIAL SINUS
CRANIAL SINUS

cerebral falx

tentorium

cerebellar falx

sup. sagittal sinus

confluence sinus
sup. cerebral v.
transverse sinus

inf. cerebral v. occipital sinus

straight sinus

inf. sagittal sinus

cerebellar v.
sup. petrosal sinus

cavernous sinus
(ICA, CN VI )

ophthalmic v. sigmoid sinus

inf. petrosal sinus

int. jugular v.

37
 Vascular system

JUGULAR
JUGULAR V.VEIN post. auricular v.



IJV retromandibular v.
ant. jugular v. EJV

transv. cervical v.
suprascapular v.

subclavian v.

brachiocephalic v.

SVC

AZYGOS SYSTEM
AZYGOS SYSTEM ·azygos v. passes through aortic hiatus of diaphragm
·bronchial v. and esophageal v. drain into azygos system

1 1
2
2 3
3 4

4
8
accessary hemiazygos v.
azygos v.
hemiazygos v.
9

11 11

subcostal v. subcostal v.

ascending lumbar v. ascending lumbar v.

38
 Vascular system

IVC
IVC

IVC

adrenal gl.

Rt. suprarenal v. Lt. suprarenal v.

kidney

Rt. ovarian/testicular v. Lt. ovarian/testicular v.

ovary/testis

39
 Vascular system

FETAL CIRCULATION
FETAL CIRCULATION ductus arteriosus

LA LV
oval foramen
RA RV

chorionic
hepatic v.
membrane

endometrium IVC descending

umbilical v. aorta
placenta

ductus
venosus

umbilical a.

40
 Vascular system

BLOOD VESSELS
BLOOD VESSEL 


tunica adventitia
type I collagen
ext. elastic lamina
tunica media
elastic fiber
smooth muscle
int. elastic lamina
ext. elastic lamina

tunica intima
endothelial cell endothelial cell
subendothelial layer
int. elastic lamina

vasa vasorum

pericyte:
at capillary, postcapillary venule
function: regeneration (endothelium, connective tissue), contraction

elastic (large) artery: conduction

no ext. elastic lamina
muscular (medium) artery: distribution
prominent int. and ext. elastic lamina
arteriole: flow control
vein: storage of blood

vein in head and neck, SVC, hepatic portal v. have no valve

CAPILLARY
continuous capillary:
tight junction
tight junction
lots of pinocytotic vesicle (transcellular pathway)
continuous basal lamina

fenestration
fenestrated capillary:
fenestration with diaphragm
continuous basal lamina

sinusoid capillary:
fenestration without diaphragm
incontinuous basal lamina

fenestration

41
 !

NERVOUS SYSTEM!
4-1 ~ 5-4!
11-1 ~ 11-3


42
 Nervous system

GENERAL CNS

cerebrum

diencephalon

midbrain

cerebellum pons cerebellum

medulla
oblongata

spinal
cord

43
 Nervous system

MENINGES
MENINGES AND SCALP
Skin
dura mater
Connective tissue
periosteal layer
Aponeurosis sinus
Loose CT meningeal layer
Periosteum ・sensory: CN V, X, C1-3

ACA, MCA, PCA

CSF
arachnoid mater
EDH pia mater
(mid. meningeal a.)
SDH
(sup. cerebral v.) falx cerebri
SAH dura
(cortical v.) tentorium
falx cerebelli

denticulate lig.

L1-2

S2
filum terminale
Coccyx

44
 Nervous system

CSF AND CHOROID PLEXUS

CSF AND CHOROID PLEXUS
arachnoid granulation
CSF: (CSF sup. saggital sinus)

ependymal cells

choroid plexus
blood vessels
pia mater
ependymal cells

choroid
lat. ventricle plexus
Monro foramen chiasmatic
cistern
3rd ventricle sup. cistern
cerebral aqueduct cerebropontine
cistern
4th ventricle
Luschka
pontine
foramen cistern cisterna
magna
Magendie
central canal
foramen

45
 Nervous system

CEREBRUM
CEREBRUM

central sulcus PARIETAL

OCCIPITAL
FRONTAL
calcarine
TEMPORAL fissure
lat. fissure
ACA: medial side of F, T, P lobe
MCA: lateral side of F, T, P lobe
PCA: O lobe

la
longitudinal fissure lecular yer
mo
granular laye
ext. r
. pyramidal layer
ext
granular layer
int.
transverse t. pyramidal laye
fissure in r
ltiform laye
mu r

ATYPICAL CORTEX:
primary sensory cortex (3, 1, 2):
granular type (no ext./int. pyramidal layer)
primary motor cortex (4, 6, 8):
agranular type (no ext./int. granular layer)
hippocampus:
agranular type (no ext./int. granular layer)

46
 Nervous system

CEREBRAL FUNCTIONAL AREA

CEREBRAL FUNCTIONAL AREA
・
primary motor area somatosensory

premotor cortex
2 angular gyrus
frontal eye field 1 39
3
4
6 arcuate
8 primary visual
43 fasciculus 19 18 17 cortex

41 visual association
44 area
42
45
22
Broca area gastatory cortex

Wernicke area
auditory area
olfactory area
・

knee

47
 Nervous system

CEREBRAL
CEREBRAL FASCICULUS
FASCICULUS

projection fiber commisural fiber

corpus callosum
int. capsule (F, P lobe)

corona fornix
ant. commisure
radiata (T lobe, olfactory area)
lamina
terminalis

association fiber

cingulum

sup. longitudinal fasciculus

uncinate fasciculus
inf. longitudinal fasciculus

48
 Nervous system

BASAL GANGLIA
BASAL GANGLIA
caudate nucleus
corpus striatum
thalamus
lentiform nucleus striatum
lentiform nucleus
globus pallidus putamen caudate nucleus
amydala

Glu
(+)

Glu
ACh
(+)
P GABA
(-)
int. capsule:
C
ant. limb
(-)
dopamine G
P G genu (+) GABA
Glu
post. limb ventrolateral nu.
Th (-) Th ventroanterior nu.

subTh
claustrum
ext. capsule
sub.
nigra

49
 Nervous system

LIMBICSYSTEM
LIMBIC SYSTEM emotion, learning, memory, motivation, olfaction

2. limbic lobe

cingulate gyrus

1. hippocampal formation:
septal area denticulate gyrus
hippocampal gyrus
subiculum

3. amygdala
parahippocampal gyrus

4. thalamus (ant. nucleus)

5. hypothalamus (mammillary body)

Papez circuit

te gyrus
ingula
c
corpus callosum

fornix
stria terminalis
mammillothalamic
tract
lamina terminalis
rus
gy
al
mp
ca
po

p
hi
p a ra

50
 Nervous system

DIENCEPHALON
DIENCEPHALON THALAMUS:

epithalamus
thalamus
subthalamus
hypothalamus

massa intermedialis
(interthalamic adhesion)

HYPOTHALAMUS
HYPOTHALAMUS
ventromedial nu.
( )
arcuate nu.
(secrete GHRH)
paraventricular nu.
(secrete oxytocin)
ant. hypothalamic nu. post. hypothalamic nu.
( ) ( )
suprachiasmatic nu.
( ) mammillary body
supraoptic nu.
(secrete ADH)

51
 Nervous system

MIDBRAIN
MIDBRAIN
cerebral peduncle

crus cerebri

substantia nigra

red nucleus

periaqueductal gray tegmentum

cerebral aqueduct

tectum colliculus
sup. colliculus: visual processing
inf. colliculus: auditory processing

MEDULLA
MEDULLA OBLONGATA
OBLONGATA
arcuate nu.

pyramid
(corticospinal tract )

4th ventricle
olivary nu.

nu. cuneate
(upper limb)

nu. gracilis
(lower limb)

52
 Nervous system

SOMATOSENSORY
SOMATOSENSORY PATHWAY
PATHWAY

corona radiata

VPL of int. capsule

thalamus
VPL VPL

med. lemniscus

int. arcuate fibers spinal spinal

lemniscus lemniscus
nu. gracilis/cuneatus

dorsal root fasciculus ant. lat.

ganglion gracilis/cuneatus spinothalamic spinothalamic
tract tract

CORTICOSPINAL
CORTICOSPINAL TRACT
TRACT 


corona radiata

int. capsule

cerebral
peduncle

pyramid
pyramidal decussation

lat. CST (85%)

ant. CST (15%)

53
 Nervous system

AUDITORY PATHWAY
AUDITORY PATHWAY

41
primary auditory
cortex

med. geniculate nu.

inf. colliculus

sup. olivary nu.

dorsal cochlear nu. trapezoid body

spiral ganglion
ventral cochlear nu.
cochlea

54
 Nervous system

EAR
EAR
MID EAR COCHLEA
(ant.) E-tube

tensor tympani m. scala vestibuli

CN V3 (perilymph)

malleus incus stapes scala media

(lat.) (med.) (endolymph)
ext. ear int. ear

scala tympani
stapedius m. (perilymph)
CN VII

(post.)

INTERNAL EAR
bony labyrinth membrane labyrinth

semicircular canal semicircular duct

vestibula saccule, utricle
cochlea cochlea duct

55
 Nervous system

ROOF
ROOF OF
OF FOURTH VENTRICLE

sup. and inf.

colliculus (ant.)

locus ceruleus
sulcus limitans
dorsal median sulcus facial nu.
facial colliculus
abducen nu.
vestibular area
stria medullaris
vestibular nu.
hypoglossal trigone
vagal trigone 4th ventricle

CEREBELLUM
CEREBELLUM

hemisphere vermis

primary fissure

horizontal fissure

T U T
N uvulonodular fissure
F F (posterolateral fissure)
T: tonsil
U: uvula
N: nodulus
F: flocculus

56
 Nervous system

CEREBELLAR PATHWAY
CEREBELLAR PATHWAY
basket cell
stellate cell

Purkinje cell

granule cell
climbing fiber

mossy fiber
other fibers
inf. olivary nu.

deep nuclei

interposed nu.

fastigii
globose nu.
emboliform nu.
dentate nu.

Input from cortex Input from spinal cord Output

cerebral cortex thalamus
red nu.

sup.

pontine nu.
mid.
reticular nu.
olivary nu.
inf.
arcuate nu. cerebellar peduncle

vestibular nu.
post. reticular nu.
spinocerebellar tract
ant. spinocerebellar tract

57
 Nervous system

SPINALCORD
SPINAL CORD
post. column

I
III
II dorsal horn
IV
V
VI
lat. column X intermediate horn
VII

IX
ventral horn
VIII

ant. column

Ascending pathway Rexed lamina

Descending pathway

58
 Nervous system

AUTONOMIC
AUTONOMIC NERVE SYSTEM

sympathetic
parasympathetic

ciliary gg.
III
CN short ciliary n. sphincter pupillae
E-W nu. ciliary m.
VII
pterygopalatine gg.
CN greater petrosal n.
lacrimal nu. lacrimal gl.
VII
CNchorda tympani submandibular gg. submandibular gl.
sup. salivary nu.
submental gl.
IX lesser petrosal n. otic gg.
CN
inf. salivary nu. parotid gl.
X
CN vagus n. terminal gg.
dorsal nu.
viscera (~midgut)
T5
greater splan celiac gg.
T6 chnic n.
T7 hindgut
T8
T9
sup. mesenteric gg.
T10 lesser splanchnic n.
midgut
T11
renal gg.
least splanchnic n.
T12 kidney

inf mesenteric gg.

L1
L2 hindgut
L3
sup. hypogastric gg.
pelvic viscera

S2 pelvic splanchnic n. inf. hypogastric gg.

S3 viscera (hindgut~)
S4

59
 Nervous system

TRIGEMINAL DERMATOME
TRIGEMINAL DERMATOME 


V1

V2

V3

SYMPATHETIC
SYMPATHETIC SPINAL PATHWAY
PATHWAY
dorsal root gg.
(dorsal)

root branch

(ventral) gray

white
. n. communicating
l gg spla
nchnic ramus
tebra g.
ver lg
p re te bra
ver
para

viscera viscera sensory

from viscera

60
 Nervous system

SPINAL NERVE
SPINAL NERVE
dorsal root gg.
(dorsal)

root branch somatic sensory

somatic motor
of post. wall

(ventral) gray

white
communicating
ramus
visceral motor
visceral sensory

somatic sensory
spinal plexus: somatic motor
of ant. wall and
cervical plexus: C1-C4 extremities
brachial plexus: C5-C8, T1
lumbar plexus: T12, L1-4
sacral plexus: L4-5, S1-3
coccygeal plexus: S4-5, Co1

dermatome: myotome:
nipple: T5 deltoid (abduction): C5
umbilicus: T10 biceps brachii (flexion): C6
inguinal lig.: T12 triceps brachii (extension): C7

61
 Nervous system

CERVICAL
CERVICAL PLEXUS 


phrenic n. (from C3-5)

ant. scalene m.
R2
R1

subclavian a.

subclavian v.

CN XII
mandible
C1

C2
geniohyoid m.

C3 hyoid bone
descending
cervical n.
thyrohyoid m.

ansa cervicalis thyroid

(C1-C3) cartilage

omohyoid m. sternohyoid m. sterothyroid m.

scapula sternum

62
 Nervous system

BRACHIAL
BRACHIAL PLEXUS
PLEXUS subscapular n.
(subscapular m.)
dorsal scapular n. thoracodorsal n.
(levator scapulae m., rhomboid m.) (latissimus dorsi)

root trunk division cord branch

suprascapular n.
C5 (supra-/infraspinatus m.) axillary n.
ant.
upper post.
post. radial n.
C6

ant. musculocutaneous n.
C7 mid. lat.
post.
median n.
C8
ant.
lower med.
post. ulnar n.
T1
lat. pectoral n. (pec. maj.)
long thoracic n. (ant. sarratus m.)
(along with lat. thoracic a.)
med. pectoral n. (pec. maj. and min.)

(Rt. side, post. view)

subscapularis/
teres minor

TRIANGULAR SPACE
circumflex scapular a. axillary n.
teres major

triceps,

QUADRANGULAR SPACE
long head HUMERUS
post. circumflex humeral a.
axillary n.

radial groove
(between med. and lat. head
TRIANGULAR INTERVAL of triceps brachii)
profunda brachii a.
radial n.
ulnar n. radial n.

63
 Nervous system

LUMBAR PLEXUS
LUMBAR PLEXUS
femoral n. (L2-4): ant. compartment of thigh muscle
( saphenous n. great saphenous v.)
obturator n. (L2-4): med. compartment of thigh muscle (adductor muscle)
iliohypogastric n. (T12-L1): inguinal area
ilioinguinal n. (T12-L1): scrotum/labia majora
genitofemoral n. (L1-2): cremaster reflex

SACRAL PLEXUS
SACRAL PLEXUS
sciatic n. (L4-S3)
tibial n.: post. compartment of thigh and leg, plantar foot
( sural n. small saphenous v.)
common fibular n.: ant., lat. compartment of leg, dorsal foot
pudendal n. (S2-4)
scrotal/labial n. (within superf. perineal pouch)
perineal n.
(ext. urethral sphincter, ext. genitalia) dorsal n. of penis/clitoris (within deep perineal pouch)

inf. rectal n. (within ischioanal fossa)

(ext. anal sphincter, levator ani)
sup. gluteal n.: gluteus medius/minimus m., tensor fascia lata
inf. gluteal n.: gluteus maximus m.
nerve to obturator internus: obturator internus m., sup. gemellus m.

64
 Nervous system

EYE non-keratinized stratified squamous epi.

Bowman membrane
cornea stroma
Descemet membrane
corneal endothelium
ciliary m.
epithelium
ciliary body iris stroma
lens muscle
canal of Schlemn (type IV collagen) dilator/sphinctor

sclera
choroid
retina
blood supply:
optic disc central retinal a.
(blind spot) short ciliary a.
fovea

optic n.

RETINA optic n.
inner limiting membrane
optic fiber layer

G ganglion layer

inner plexiform layer

M
A B H inner nuclear layer

outer plexiform layer

R outer nuclear layer

& outer limiting membrane
C photosensitivity layer
pigment layer
M: Muller cell R & C: rods and cones
A: amacrine cell H: horizontal cell
B: bipolar cell G: ganglion cell

65
 !

GASTROINTESTINAL
SYSTEM!
6-1 ~ 7-1


66
 GI system

HISTOLOGY
HISTOLOGY

MUCOSA:
muscularis mucosae
lamina propria
epithelium
SUBMUCOSA
MUSCLE LAYER:
circular muscle
longitudinal muscle
SEROSA

67
 GI system

PERITONEUM
PERITONEUM

falciform lig.

lesser sac
lesser omentum
omental foramen
parietal layer (foramen of Winslow)

visceral layer

mesocolon
greater omentum
mesentery of
small intestine

greater sac

68
 GI system

FAUCES
FAUCES

palatopharynheal arch
uvula palatoglossal arch

palatine tonsil

PALATE
PALATE
hard palate: innervated by greater palatine n. (V2), nasopalatine n. (V2)
soft palate: innervated by lesser palatine n. (V2), glossopharyngeal n. (CN IX)

TONGUE
TONGUE
apex

median
filiform papilla sulcus
(no taste bud)
fungiform papilla body
(5 taste bud)
circumvallate papilla inal
(100 taste bud) termcus
sul
lingual tonsil
root

foramen cecum
( thyroid gland

69
 GI system

TEETH
TEETH
enamal (
from ameloblast (ectoderm)
crown
dentin (
neck from odontoblast (mesoderm)
cementum (
from cementoblast (mesoderm)
periodontal lig.
root

root canal

incisor canine premolar molar

central lateral

70
 GI system

SALIVARY
SALIVARYGLAND
GLAND

supply innervation type major duct

Stenson duct
parotid gl. 25% ECA CN IX serous ( upper 2nd molar )
Wharton duct
submandibular gl. 70% facial a. CN VII mix (serous
) ( sublingual caruncle )

submental gl. 5% lingual a. CN VII mucous Rivinus duct

( )

major duct

striated duct
( + +
) interlobular duct

intercalated duct
( - -)

myoepithelium
glandualar epithelium

lobule

71
 GI system

ESOPHAGUS
ESOPHAGUS

(15mm) C6 inf. thyroid a., v.

5 cm

thoracic aorta
bronchial a.
(16mm) T4
20 cm azygos v.
hemiazygos v.
accessory hemiazygos v.
(17mm) T10
left gastric a., v.
2 cm inf. phrenic a., v.

72
 GI system

STOMACH
STOMACH mucosa barrier
aspirin
PGE2
NSAIDs
1. tight junction
2. mucosa membrane (mucin, HCO3- )
surface
cardia (T10) mucous cell
fundus
gastric pit
curvature

body
gland
lessser
pylorus (L1) chief cell mucous cell
antrum u re mucosa
at
rv G cell parietal cell
cu
gr e ate r submucosa
most common site of muscle layer
peptic ulcer, gastric cancer
serosa

mucous cell (all portion):

secrete mucin
LYMPH NODE chief cell (fundus, body):
secrete pepsinogen, lipase
9 (basophilic)
parietal cell (fundus, body):
8 secrete HCl, intrinsic factor
1 2 10
7 (eosinophilic)
11 (ACh, histamine, gastrin
HCl )
5 3 G cell (antrum):
secrete gastrin
12
6 4 function of HCl:
1. activate pepsinogen
2. kill bacteria
PARASYMPATHETIC INNERVATION 3. Fe 3+ ---> Fe 2+

post. vagus trunk B12 Fe

Vagotomy:
ant. vagus trunk truncal:

celiac branch
post. Laterjet selective:
ant. Laterjet
hepatic branch
highly selective:
crow’s foot



73
 GI system

LIVER
LIVER
(ant.)
falciform lig. gallbladder round lig.
(umbilical v. )
triangular lig.
quadrate
lobe

bare area coronary lig.

right lobe left lobe
caudate porta
lobe hepatis

IVC ligamentum venosum

Cantlie line (ductus venosus )
(post.)
to IVC

Rt./mid./Lt. hepatic v.

post. m
ed la
t.
.
7 ant.

8
1 2
6

5
4 3
GB

right lobe left lobe

Classic lobule Portal lobule Acinar lobule

central v.
portal area

3 2 112 3

Ito cell ( 、Vit. A； fibroblast， cirrhosis)

hepatocyte
canaliculus
endothelial
cell space of Disse
Kupffer cell sinusoid

74
 GI system

BILE
BILE AND PANCREATIC DUCT
AND PANCREATIC DUCT

canaliculus

interlobular Rt./Lt/ hepatic duct

duct
gle
rian
ot t
Cal cystic a.
common hepatic duct

neck
body cystic duct

fundus

common bile duct

CCK

I cell

major pancreatic duct

sphincter of Oddi
minor pancreatic duct

2nd portion
of duodenum ampulla of Vater

75
 GI system

PANCREAS
PANCREAS celiac trunk

sup. pancreaticoduodenal a. gastroduodenal a. common hepatic a.

islet of Langerhans
2
β cell > α cell > δ cell
G cell (gastrin), δ1 cell (VIP),
EC cell (substance P, serotonin)
4
3

inf. pancreaticoduodenal a. SMA

Histology
secretin (S cell)
CCK (I cell) major duct

intralobular duct
( interlobular duct
( )

(+)
intercalated duct (+)
( )

glandualar epithelium
(serous gland; )

centroacinar cell

76
 GI system

SMALL INTESTINE
INTESTINE
common portal
bile duct vein

splenic v.

25 cm Treitz lig. (border of upper/lower GI)

SMA SMV 100 jejunum

cm

150 ileum
cm

ileocecal valve

antigen
villi
HCO3-

M cell

MUCOSA

Lieberkühn
gland
(whole small intestine)

Paneth cell
SUBMUCOSA
Brunner gland
Peyer patch (duodenum only)

MUSCLE LAYER

77
 GI system

LARGEINTESTINE
LARGE INTESTINE
SM
V
IMV
sup. mesenteric inf. mesenteric
plexus plexus
vagus n. inf. hypogastric
plexus
SMA IMA
splenic flexure
transverse colon
hepatic flexure 38 cm

descending colon
25 cm

ascending colon
13 cm tenia
haustra
sigmoid colon
25 cm

cecum
6 cm S3
with sup. rectal a. IMA
peritoneum
mid rectal a. int. iliac a.
without inf. rectal a. int.
peritoneum pudendal a.
Co
rectum: no tenia, haustra,
13 cm

RECTUM
inf mesenteric gg.
sympathetic system
L1-L2 Auerbach or
Meissner
plexus

sup. hypogastric gg.

hypogastric n.
parasympathetic system
S2-S4
pelvic splanchnic n.
inf. hypogastric gg.

hypogastric plexus

78
 GI system

ANAL
ANAL CANAL
CANAL

sup. rectal a. IMA

mid rectal a. int. iliac a.

RECTUM

inf. rectal a. int.

pudendal a.
hypogastric plexus
(visceral)
anorectal ring
(puborectalis, int. sphincter, ext. sphincter)

endoderm simple columnar epi. (mucosa)

dentate
ANAL CANAL line
ectoderm stratified squamous epi (skin)
inf. rectal n. (somatic)

79
 !

URINARY SYSTEM!
7-1 ~ 7-3


80
 Urinary system

GENERAL
GENERAL

LIVER
T12

L1

L3

pararenal fat
renal fascia
kidney perirenal fat
capsule

peritoneum
extraperitoneal fat
transversalis fascia

81
 Urinary system

KIDNEY
KIDNEY ob
e

l
al
ren
renal column minor calyx (8-12)
(cortical tissue) major calyx (2-3)
renal pyramid pelvis (1)

sinus

medulla

cortex
interlobular a. aff./glomerulus/
eff. arteriole

arcuate a. renal a.:

renal a. Rt. > Lt.
renal v.:
interlobar a. Lt. > Rt.

vasa recta IVC aorta

(capillary)

afferent efferent
arteriole arteriole

mesangial glomerulus (simple squamous epi.)

cell Bowman capsule (simple squamous epi.)
podocyte
distal
convoluted
tubule
proximal
convoluted
tubule
(simple cuboidal epi.)
collecting (with microvilli, or brush border)
tubule

collecting loop of
duct Henle
(simple (simple
cuboidal epi.) cuboidal
epi.)

renal pyramid

82
 Urinary system

PROXIMAL AND
PROXIMAL AND DISTAL
DISTAL TUBULE
TUBULE 


Proximal tubule

basal striation

2 K+ 3 Na+
Na+ glucose ATP

ADP brush border

(microvilli)

Distal tubule

principal cell
Na+
2 K+ 3 Na+
ATP

ADP
K+

intercalated cell

ATP
H+

ADP

83
 Urinary system

URETER
URETER AND BLADDER

umbilicus
renal a.

urachus
( median
15 cm umbilical fold)
(abdominal)
a.
ar
ul
tic
s
te

apex
10 cm
(pelvic)

uterine a. BLADDER
ductus deferens

base (trigone): inf., post. wall

neck detrusor m.
int. sphincter ANS (hypogastric plexus)
urogenital
diaphragm
ext. sphincter (perineal branch of pudendal n.)

84
 Urinary system

URETHRA
URETHRA

urethra
ejaculatory duct
BLADDER
mid.
lat. view
ant.
post.

prostatic urethra
transitional epi.
3 cm

membranous urethra
stratified columnar epi. prostate
2 cm
penile urethra bulbourethral gl.
15 cm Littre gl. urethra
(mucous)
pseudostratified epi. prostatic gl.
(prox. part)

stratified squamous epi.

(distal part)

seminal colliculus

prostatic utricle
(= vagina in female)
ejaculatory duct

prostatic gland
prostatic
sinus
urethral
crest

85
 !

REPRODUCTIVE !
SYSTEM!
7-3 ~ 7-4 (male)!
10-1 ~ 10-2 (female)!
11-3 (female)!
!
!

86
 Reproductive system
testicular a.
MALE REPRODUCTIVE TRACT blood supply mid. rectal a.
MALE REPRODUCTIVE TRACT ductus deferens
inf. vesicle a.

(pseudostratified epi. with stereocilia)

(thich smooth muscle layer: )
( bladder )

seminal vesicle
(pseudostratified epi.)
(smooth muscle layer: )

ejaculatory duct
(pseudostratified epi.)
(lat. to ductus (no muscle layer)
deferens)
epididymis prostatic part
(pseudostratified epi.) (transitional epi.)
(with stereocilia)
membranous part
(stratified columnar epi.)
prox. penile part
(pseudostratified epi.)

distal penile part

(stratified squamous epi.)

fallopian tube in female

ductuli efferentes
(simple columnar epi.)
(with flagella)

epididymis
rete testis (pseudostratified epi.)
(simple cuboidal epi.)
(with stereocilia)

tubuli recti
(Sertoli cell)

convoluted
seminiferous duct
(Sertoli cell + germ cell)

SPERM
head
mid. piece principal piece end piece

mitochondria tail: form flaggella

acrosome (golgi complex; with hyaluronidase, proteinase)



87
 Reproductive system

TESTIS
TESTIS

peritoneum
transversalis fascia
transveralis abdominis m.
int. oblique m.
ext. oblique m.

genitofemoral n.
ant. scrotal n. (from ilioinguinal n.)
SCROTUM sensory innervation
post. scrotal n.
post. femoral cutaneous n.

tunica vaginalis
int. spermatic fascia
mid. spermatic fascia (cremaster m.)
ext. spermatic fascia

int.: membranous layer (extended from Scarpa fascia)

dartos fascia
ext.: smooth muscle layer (extended from Camper fascia)

germ cell
germ cell

Sertoli-Sertoli Sertoli cell:

junctional complex endocrine:
(tight junction)
activin (activate FSH),
(form blood-testis barrier)
inhibin (inactivate FSH),
Mullerian duct inhibiting factor
n
ge ne testosterone estrogen
tro te
ro exocrine: testicular fluid
es o s
st phagocytosis of residual body
te e produce androgen-binding protein
on
ter
s
s to
te Leydig cell:
Reinke crystal
produce testosterone

lobule
tunica albuginea
(testis, ovary, penis)

88
 Reproductive system

PROSTATE
PROSTATE

transitional zone
base
ejaculatory
mid. duct central zone
ant.
post.
(ant.) (post.) peripheral
zone
apex

blood supply:
inf. vesicle a. int. iliac a.
mid. rectal a.
int. pudendal a.
ant. view lat. view

PENIS AND
AND CLITORIS
CLITORIS
PENIS CLITORIS
root
bulb of penis

crura of penis body

body
glans
corpora cavernosa crura

(covered by tunica albuginea) root

corpus spongiosum vestibular bulb

prostatic utricle vagina

prostate paraurethral gl.
bulbourethral body Bartholin gl.

erection: parasympathetic stimulation

ejaculation: sympathetic stimulation
emission: contraction of seminal vesicle and ductus deferens
ejaculation: contraction of bulbospongiosus m. and deep transv. perineal m.

89
 Reproductive system

FEMALEREPRODUCTIVE
FEMALE REPRODUCTIVETRACT
TRACT
ciliated cell estrogen
Fallopian tube (simple columnar epi.)
non-ciliated cell progesterone
intramural
isthmus
vagus n.
ampulla
uterus (simple columnar epi.)
infundibulum fundus
ovary
(simple cuboidal epi.)
body
suspensory lig.
(ovarian a., v.)
mesoovarium
cervix
ovarian lig. (ext. os
stratified squamous epi.)
broad lig.
(peritoneum)
vagina
cardinal lig. (stratified squamous epi.)
(uterine a.,v.) (muscle layer:

round lig.

functional layer
inguinal canal
basal layer

anteversion muscle layer

( )
anteflexion serosa

uterine a.
spiral a.
straight a.
radial a.
arcuate a.

clitoris

urethra

vagina

Douglas pouch Batholin gl.

sacrocervical lig. labia minora

90
 Reproductive system

OVARY
OVARY
n polar body

2n
n polar body
polar body
2n 2n
n polar body
oogonia primary oocyte 2n

secondary oocyte n ovum

cumulus theca externa

oophorus
theca interna
granulosa cell basement membrane
FSH Call-Exner body
granulosa cell
zona pellucida atrum
primordial primary
follicle follicle corona
radiata secondary follicle
(Graafian follicle)

corpus albicans corpus luteum

91
 !

RESPIRATORY SYSTEM!
8-1 ~ 8-2


92
 Respiratory system
olfactory segment
NOSE
NOSE (pseudostratified epi.)

respiratory segment
(pseudostratified epi.)

vestibule
(stratified squamous epi.)

cribiform
plate
ethmoid

septal
cartilage

vomer

Innervation Blood supply

olfactory n.
ethmoidal a. sphenopalatine a.
sphenopalatine n. (from ophthalmic a.) (from maxillary a.)
(V2)
sup. labial a.
(from facial a.)
ethmoidal n.
(V1) (anastomosis of sup labial a.
and sphenopalatine a.)

supreme nasal meatus sphenoid sinus

sup. concha
ethmoid sup. nasal meatus post. ethmoidal sinus
bone
mid. concha ant./mid. ethmoidal sinus
mid. nasal meatus maxillary sinus
frontal sinus
inf. concha
(independent bone) nasolacrimal duct
inf. nasal meatus

93
 Respiratory system

NASAL
NASALMEATUS
MEATUS

lacrimal gl.
lacrimal sac
frontal sinus

sphenoid sinus
ant.
ethmoid sinus mid. nasolacrimal
post. duct

maxillary sinus

!
PHARYNX



PHARYNX ub
e mid.
ear
E-t

pharyngeal tonsil

nasopharynx
CN V2 (pseudostratified epi.)

hard palate

oropharynx
lingual tonsil
CN IX (stratified squamous epi.)
palatine tonsil

id
hyo
CN X laryngopharynx
C4 (stratified squamous epi.)

C6

94
 Respiratory system

LARYNX C4
LARYNX vestibule
vestibular fold
intermediate
int. branch of laryngeal cavity
sup. laryngeal n.
vocal fold
recurrent
laryngeal n. rima glottidis
C6

int. branch of sup. laryngeal a.

sup. laryngeal n. (from sup. thyroid a.)

hyoid bone

epiglottis

corniculate

arytenoid

thyroid

cricoid

(ant. view) (lat. view) recurrent

laryngeal n.

95
 Respiratory system

BRONCHIALTREE
BRONCHIAL TREE
C6

T4-5
o
1 main bronchus

2o lobar bronchus e
n zon
tio
o o
30 45
2o on duc
c
3o segmental
bronchus
16o
terminal
bronchiole e
zon
or y
p irat
respiratory res
bronchiole

alveolar duct

alveolar sac
alveolus

lobule
(functional unit)

alveolus
Kohn pore type II cell (secrete surfactant; 20-24 weeks)
(cuboidal cell with lamellar body)
type I cell (squamous cell)

basement membrane alveolar septum

(blood-air barrier)
endothelium
dust cell

surfactant: 90% lecithin; 8% protein; 2% carbohydrate

96
 Respiratory system

LUNG
LUNG
apex
rib 1

the lower border of

sup. lung pleura

3
midclavicular 6 8
3 sup.
sup. division midaxillary 8 10

sup. paravertebral 10 12
mid. inf. division
2 (lingula) (rib)
2
inf.
5 inf.
4

base

Recess costomediastinal recess

heart

costodiaphragmatic recess

Blood supply
conduction zone: bronchial a. pulmonary a.
respiratory zone: pulmonary a.
bronchial a.
v.
y
ar
on
lm

.
lv
pu

ia
ch

pulmonary v.
on
br

Rt. hilum Lt. hilum

bronchus pulmonary a.
pulmonary a. bronchus
pulmonary v. pulmonary v.

・phrenic n. hilum vagus n. hilum

97
 Respiratory system

HISTOLOGY
HISTOLOGY
pseudostratified epi.
with cilia, goblet cell simple columnar to cuboidal epi.
cartilage, mucous gland smooth m., elastic fiber
Clara cell (with microvilli)

elastic fiber,
reticular fiber

le
onchio
br
terminal

le
ronchio
b
respiratory

Clara cell:
at terminal and respiratory bronchiole
secrete surface-active agent
(lipoprotein)

98
 !

LYMPHATIC SYSTEM!
8-2 ~ 8-3!
!

99
 Lymphatic system

LYMPHATIC VESSELS
LYMPHATIC VESSELS CNS, cartilage, bone, epithelium

cervical trunk

subclavian trunk

bronchomediastinal
trunk thoracic duct

right lymphatic duct

intestinal trunk

cisterna chyli (L1-L2)

lumbar trunk

100
 Lymphatic system

LYMPH NODE
LYMPH NODE

postcapillary venule:

outer cortex
afferent lymphatic vessels
paracortex

B B medulla
B B B
subcapsular sinus B T T T
T T T
trabecular sinus
T efferent
lymphatic vessels

medullary sinus
trabecula medullary cord
capsule

Lymphatic drainage:
para-aortic (lumbar) LN: adrenal gl., kidney, ureter, testis/ovary, Fallopian tube, uterus
celiac LN: (following corresponding artery)
sup. mesenteric LN: (following corresponding artery)
inf. mesenteric LN: (following corresponding artery, including upper rectum, upper anal canal)
int. iliac LN: prostate, cervix, lower rectum
ext. iliac LN: bladder, upper vagina
superf. inguinal LN: lower anal canal, lower vagina, urethra, penis/clitoris, scrotum/labia majora

101
 Lymphatic system

TONSIL
TONSIL

epithelium
pharyngeal: pseudostratified epi.
palatine: stratified squamous epi.
lingual: stratified squamous epi.

capsule
efferent lymphatic duct

blood supply of palatine tonsil:

major: tonsilar a. (from facial a.)
minor: dorsal lingual a., ascending palatine a.,
ascending pharyngeal a., descending pharyngeal a.

SPLEEN
SPLEEN

central a.
trabecular a.

lymph nodule
(Malpighian corpuscle) sinusoid
(B-lymphocyte)
splenic cord
splenic a. (Billroth cord)
splenic v.
efferent lymphatic vessels periarterial
penicillar arteriole lymphatic sheath (PALS)
sheathed capillary (T-lymphocyte)

pulp vein
trabecular a./v.

no afferent lymphatic vessels

major ligament:
splenorenal lig.: splenic a./v.
splenogastric lig.: short gastric a./v.,
left gastro-omental a./v.



102
 Lymphatic system

THYMUS
THYMUS
lobule

cortex
(T-lymphocyte )
medulla
(epi. reticular cell )

Hassall body

cell type:
T-lymphocyte (from mesoderm)
epithelial reticular cell (from endoderm)

no B lymphocyte, lymphoid follicle, afferent lymphatic vessels

T
endothelium
T T T basement membrane
T T macrophage blood-thymus barrier
T T T T basement membrane
T T epithelial reticular cell
T T

103
 !

HEART!
8-3 ~ 8-4


104
 Heart

SURFACE PROJECTION
SURFACE PROJECTION costal surface (ant.): RV
diaphragmatic surface (inf.): LV

base (post. surface; LA)

2
pulmonary valve
3 LA
aortic valve
mitral valve
4 RA LV
tricuspid valve
RV
5
apex (LV)

105
 Heart

STRUCTURE
STRUCTURE
fibrous pericardium
parietal
serous pericardium
visceral
(epicardium)

myocardium
endocardium
valve

Reflection

aorta
PA

SVC transverse sinus

R L LA ( )

R L
RA oblique sinus

LV

IVC RV

106
 Heart

CHAMBER
CHAMBER

terminal crest
RA LA auricle
pectinate muscle

fibrous ring

mitral valve

moderator papillary muscle

band
trabeculae carneae

chordae tendinea

RA LA
3 mmHg 8 mmHg

RV LA
25 mmHg 120 mmHg

107
 Heart

VALVE
VALVE

4-6 cm2
tricuspid valve mitral valve

P P
S
A A

P
aortic valve
R L
2
2.5-3.5 cm
R L pulmonary valve
A

108
 Heart

Coronary artery
CORONARY ARTERYandAND
cardiac vein VEIN
CARDIAC

atrial branch
of RCA LCA
circumflex branch of LCA
RC A

post. interventricular Lt. marginal branch

branch
Rt. marginal branch diagonal branch

Lt. ant. descending branch (LAD)

(ant. interventricular branch)

coronary sinus

Rt. marginal branch ant. interventricular branch (LAD)

small cardiac v. great cardiac v.
post. interventricular branch
mid. cardiac v.

109
 !

BLOOD!
9-1 ~ 9-2


110
 Blood
Stem
BLOOD cell

myeloid lymphoid

CFU-E CFU-GM CFU-M T cell B cell NK cell

proerythroblast myeloblast monoblast megakaryoblast TH1 cell

TH2 cell
TC cell
basophilic promyelocyte promonocyte promegakaryocyte TS cell
erythroblast (azurophilic
(polyribosome) granule)

polychromatophilic myelocyte monocyte megakaryocyte

erythroblast (specific granule)
( mitosis； Hb)

orthochromatophilic metamyelocyte macrophage thrombocyte

erythroblast (platelet)
( )
neutrophil (65%)

reticulocyte basophil granulocyte basophil (1%)

( ) eosinophil
neutrophil eosinophil (3%)
WBC
erythrocyte monocyte (6%)
agranulocyte
lymphocyte (25%)

2+



111
 !

ENDOCRINE SYSTEM!
9-2


112
 Endocrine system

PITUITARY GLAND

GHRH GH
SS GH , TSH
TRH TSH , PRL
GnRH FSH , LH
CRH ACTH
PIF PRL , TSH , LH
(dopamine)

median
eminence
infundibulum
pars tuberalis
stem
hypophyseal portal v.

35% Herring body

acidophil
(GH, PRL) pars nervosa
15%
basophil ADH
(TSH, FSH, LH,
ACTH, LPH) 50%

chromophobe
oxytocin
POMC
pars distalis (endorphin, MSH)
pars intermedia
Ranthke pouch

ADENOHYPOPHYSIS NEUROHYPOPHYSIS

POMC (pro-opiomelanocortin)
1 134

pars distalis
1 ACTH 39 42 LPH 134

pars intermedia
1 13 104 134
MSH β-endorphin

113
 Endocrine system

THYROID AND PARATHYROID GLAND

Ca P
sup. thyroid a.
PTH (from ext. carotid a.)
calcitonin
Vit. D3

follicular cell
(secrete T3, T4) parathyroid
(from endoderm) gland

isthmus

inf. thyroid a.
(from thyrocervical trunk)
(from subclavian a.)

parathyroid gland:
embrology:
sup.: from 4th pharyngeal pouch
inf.: from 3rd pharyngeal pouch
cell trpe:
parafollicular cell (C cell) chief cell: secrete parathyroid hormone
(secrete calcitonin)
(from ectoderm)
oxyphil cell

114
 Endocrine system

ADRENAL GLAND

kidney

medulla (chromaffin cell)

secrete norepinephrine (20%), epinephrine (80%)

zona reticularis
secrete androgen

zona fasciculata
secrete cortisol ( )

zona glomerulosa
secrete aldosterone ( )

Blood supply:
sup. suprarenal a. (from inf. phrenic a.)
mid. suprarenal a. (from abdominal aorta)
inf. suprarenal a. (from renal a.)

115
 !

SKIN!
9-3


116
 Skin

SKIN

stratum corneum
epidermis (no vessel)
(from ectoderm) stratum lucidum ( )
stratum granulosum
sal lamin
Langerhan cell stratum spinosum

ba

a
Merkel cell
stratum basale (stem cell)
melanocyte

papillary dermis (vessel +++)

arrector pili m.
reticular dermis (vessel +)
(sebaceous gl., sweat gl., arrector pili m.)

(from mesoderm)
hair follicle

117