2.

LOWER LIMB, ABDOMEN AND PELVIS

Contents

Preface to the Eighth Edition vii

Preface to the First Edition (excerpts) viii
Index of Competencies xxv

Section 1 LOWER LIMB

1. Introduction 3 Clinical Anatomy 36

Navicular Bone 36
Development of Lower Limb 3 Ossification 37
Molecular Regulation of Limb Development 4 Cuneiform Bones 37
Parts of the Lower Limb 4 Medial Cuneiform 38
Related Terms 4 Intermediate Cuneiform 38
Frequently Asked Questions 6 Lateral Cuneiform 39
Viva Voce 6 Ossification 39
Cuboid 39
2. Bones 7 Ossification 39
Metatarsus 39
Introduction 7 Ossification 40
Hip Bone 7 Phalanges 40
Ilium 7 Ossification 41
Pubis 9 Clinical Anatomy 41
Ischium 12 Sesamoid Bones 41
Acetabulum 14 Mnemonics 41
Obturator Foramen 14 Facts to Remember 42
Ossification 14 Clinicoanatomical Problem 42
Clinical Anatomy 15 Further Reading 42
Femur 15 Frequently Asked Questions 43
Ossification 20 Multiple Choice Questions 43
Clinical Anatomy 21 Viva Voce 43
Patella 22
Ossification 23 3. Front of Thigh 45
Clinical Anatomy 23
Tibia 23 Introduction 45
Ossification 28 Surface Landmarks 45
Clinical Anatomy 28 Skin and Superficial Fascia 46
Fibula 28 Superficial Fascia 46
Ossification 32 Cutaneous Nerves 46
Clinical Anatomy 32 Cutaneous Arteries 47
Bones of the Foot 32 Great or Long Saphenous Vein 47
Tarsus/Tarsals 32 Superficial Inguinal Lymph Nodes 48
Talus 32 Subcutaneous Bursae 48
Ossification 34 Dissection 48
Clinical Anatomy 34 Clinical Anatomy 49
Calcaneus or Calcaneum 34 Deep Fascia 49
Ossification 36 Deep Fascia/Fascia Lata 49
xii HUMAN ANATOMY—LOWER LIMB, ABDOMEN AND PELVIS

Dissection 50 Structures Deep to the Gluteus Medius 79

Clinical Anatomy 50 Structures Deep to the Gluteus Minimus 80
Femoral Triangle 51 Dissection 80
Boundaries 51 Clinical Anatomy 81
Contents 51 Sacrotuberous and Sacrospinous Ligaments 82
Femoral Sheath 53 Nerves of the Gluteal Region 82
Femoral Canal 53 Superior Gluteal Nerve 82
Clinical Anatomy 54 Inferior Gluteal Nerve 82
Femoral Artery 55 Sciatic Nerve 83
Clinical Anatomy 57 Clinical Anatomy 83
Femoral Vein 58 Posterior Cutaneous Nerve of the Thigh 83
Femoral Nerve 58 Nerve to Quadratus Femoris 83
Branches and Distribution 58 Pudendal Nerve 83
Clinical Anatomy 59 Nerve to the Obturator Internus 84
Muscles of the Front of the Thigh 59 Perforating Cutaneous Nerve 84
Iliacus and Psoas Major 60 Arteries of Gluteal Region 84
Clinical Anatomy 60 Superior Gluteal Artery 84
Adductor/Hunter’s/Subsartorial Canal 62 Inferior Gluteal Artery 84
Dissection 64 Internal Pudendal Artery 84
Facts to Remember 64 Trochanteric Anastomoses 84
Clinicoanatomical Problem 64 Cruciate Anastomoses 84
Further Reading 64 Structures Passing through the Greater
Frequently Asked Questions 64 Sciatic Foramen (Gateway of Gluteal
Multiple Choice Questions 64 Region) 85
Viva Voce 65 Structures Passing through the Lesser
Sciatic Foramen 85
Facts to Remember 85
4. Medial Side of Thigh 66
Clinicoanatomical Problem 85
Introduction 66 Further Reading 85
Adductor Compartment 66 Frequently Asked Questions 86
Boundaries 66 Multiple Choice Questions 86
Dissection 66 Viva Voce 86
Muscles of Adductor Compartment of Thigh 67
Relations of Adductor Longus 67 6. Popliteal Fossa 87
Obturator Nerve 68
Clinical Anatomy 69 Introduction 87
Accessory Obturator Nerve 70 Surface Landmarks 87
Obturator Artery 70 Dissection 87
Medial Circumflex Femoral Artery 70 Location 87
Clinical Anatomy 71 Boundaries 87
Facts to Remember 72 Contents 89
Clinicoanatomical Problem 72 Popliteal Artery 89
Further Reading 72 Clinical Anatomy 91
Frequently Asked Questions 72 Popliteal Vein 91
Multiple Choice Questions 72 Tibial Nerve in Popliteal Fossa 91
Viva Voce 73 Clinical Anatomy 92
Common Peroneal Nerve 92
Posterior Cutaneous Nerve of Thigh 92
5. Gluteal Region 74 Genicular Branch of Obturator Nerve 92
Introduction 74 Popliteal Lymph Nodes 92
Surface Landmarks 74 Clinical Anatomy 93
Superficial and Deep Fascia 75 Anastomoses Around the Knee Joint 93
Superficial Fascia 75 Mnemonics 94
Cutaneous Nerves 75 Facts to Remember 94
Cutaneous Vessels and Lymphatics 75 Clinicoanatomical Problem 94
Deep Fascia 75 Further Reading 94
Dissection 75 Frequently Asked Questions 95
Muscles of Gluteal Region 75 Multiple Choice Questions 95
Structures under Cover of Gluteus Maximus 76 Viva Voce 95
 CONTENTS xiii

7. Back of Thigh 96 Frequently Asked Questions 121

Multiple Choice Questions 121
Introduction 96 Viva Voce 121
Muscles and Nerves 96
Muscles of the Back of Thigh 96 9. Back of Leg 123
Dissection 96
Clinical Anatomy 96 Introduction 123
Sciatic Nerve 99 Superficial Fascia 123
Clinical Anatomy 100 Small or Short Saphenous Vein 123
Arteries of the Back of Thigh 102 Great or Long Saphenous Vein 123
Anastomoses on the Back of Thigh 102 Cutaneous Nerves 123
Facts to Remember 102 Dissection 124
Clinicoanatomical Problem 103 Clinical Anatomy 124
Further Reading 103 Deep Fascia 124
Frequently Asked Questions 104 Boundaries and Subdivisions 124
Multiple Choice Questions 104 Flexor Retinaculum 125
Viva Voce 104 Dissection 125
Clinical Anatomy 126
8. Front of Leg with Dorsum of Foot; Muscles 126
Superficial Muscles 126
Lateral and Medial Sides of Leg 105
Deep Muscles 128
Introduction 105 Dissection 129
Surface Landmarks 105 Clinical Anatomy 130
Superficial Fascia 107 Posterior Tibial Artery 130
Superficial Veins 107 Peroneal Artery 131
Cutaneous Nerves 107 Tibial Nerve 132
Dissection 108 Clinical Anatomy 132
Clinical Anatomy 108 Mnemonics 133
Deep Fascia 108 Facts to Remember 133
Superior Extensor Retinaculum 109 Clinicoanatomical Problem 133
Inferior Extensor Retinaculum 109 Further Reading 133
Dissection 110 Frequently Asked Questions 134
Clinical Anatomy 110 Multiple Choice Questions 134
Muscles of Front of Leg 110 Viva Voce 134
Muscles of Anterior Compartment of the Leg 112
Anterior Tibial Artery 113 10. Sole of Foot 135
Deep Peroneal Nerve 114
Dissection 115 Introduction 135
Clinical Anatomy 115 Skin 135
Dorsum of Foot 115 Dissection 136
Dorsalis Pedis Artery (Dorsal Artery of Fasciae 136
the Foot) 115 Superficial Fascia 136
Dissection 116 Dissection 136
Clinical Anatomy 116 Deep Fascia 136
Fascia and Muscles of Lateral Side of the Leg 116 Plantar Aponeurosis 136
Peroneal Retinacula 116 Deep Transverse Metatarsal Ligaments 137
Dissection 117 Fibrous Flexor Sheaths 137
Clinical Anatomy 117 Clinical Anatomy 137
Peroneal Muscles 117 Muscles of Sole 137
Clinical Anatomy 117 Muscles and Tendons of the First and Second
Superficial Peroneal Nerve 117 Layers 139
Dissection 119 Dissection 139
Clinical Anatomy 119 Muscles and Tendons of Third and Fourth
Medial Side of the Leg 119 Layers 141
Dissection 120 Dissection 141
Clinical Anatomy 120 Plantar Vessels and Nerves 143
Mnemonics 120 Medial Plantar Nerve 144
Facts to Remember 120 Lateral Plantar Nerve 144
Clinicoanatomical Problem 120 Dissection 144
Further Reading 120 Clinical Anatomy 144
xiv HUMAN ANATOMY—LOWER LIMB, ABDOMEN AND PELVIS

Medial Plantar Artery 144 Ligaments 167

Lateral Plantar Artery 144 Dissection 172
Plantar Arch 145 Synovial Membrane 172
Clinical Anatomy 145 Bursae around the Knee 172
Facts to Remember 146 Relations of Knee Joint 172
Clinicoanatomical Problem 146 Blood Supply 172
Further Reading 146 Nerve Supply 172
Frequently Asked Questions 147 Dissection 172
Multiple Choice Questions 147 Movements at the Knee Joint 173
Viva Voce 147 Locking and Unlocking of the Knee Joint 173
Dissection 174
Clinical Anatomy 174
11. Venous and Lymphatic Drainage;
Ankle Joint 175
Segmental and Sympathetic Innervation; Ligaments 177
and Comparison of Lower and Upper Relations of the Ankle Joint 177
Limbs 148 Movements 177
Blood Supply 178
Introduction 148 Nerve Supply 178
Venous Drainage 148 Dissection 178
Factors Helping Venous Return 148 Clinical Anatomy 178
Veins of Lower Limb 148 Tibiofibular Joints 179
Long Saphenous Vein 149 Superior Tibiofibular Joint 179
Small or Short Saphenous Vein 150 Middle Tibiofibular Joint 179
Perforating Veins 150 Inferior Tibiofibular Joint 179
Clinical Anatomy 151 Dissection 179
Lymphatic Drainage 152 Clinical Anatomy 180
Classification 152 Joints of the Foot 180
Superficial Inguinal Lymph Nodes 152 Talocalcanean Joint 180
Deep Inguinal Lymph Nodes 153 Movements 180
Superficial Lymphatics 153 Talocalcaneonavicular Joint 180
Deep Lymphatics 153 Movements 181
Clinical Anatomy 154 Calcaneocuboid Joint 181
Segmental Innervation 154 Transverse Tarsal or Midtarsal Joint 182
Dermatomes 154 Inversion and Eversion of the Foot 182
Myotomes 155 Joints Taking Part 182
Clinical Anatomy 155 Muscles Producing Movements 182
Sympathetic Innervation 156 Dissection 183
Comparison of Lower and Upper Limbs 157 Smaller Joints of Forefoot 183
Mnemonics 159 Joint Cavities of Foot 183
Facts to Remember 159 Metatarsophalangeal and Interphalangeal
Clinicoanatomical Problem 159 Joints 183
Further Reading 160 Dissection 183
Frequently Asked Questions 160 Gait/Walking 184
Multiple Choice Questions 160 Clinical Anatomy 184
Viva Voce 161 Mnemonics of Locking and Unlocking 185
Facts to Remember 186
12. Joints of Lower Limb 162 Clinicoanatomical Problems 186
Further Reading 186
Introduction 162 Frequently Asked Questions 187
Hip Joint 162 Multiple Choice Questions 187
Type 162 Viva Voce 188
Ligaments 162
Relations of the Hip Joint 164 13. Arches of Foot 189
Blood Supply 165
Nerve Supply 165 Introduction 189
Movements 165 Formation or Structure of Arches 189
Dissection 165 Medial Longitudinal Arch 189
Clinical Anatomy 166 Lateral Longitudinal Arch 190
Knee Joint 167 Anterior Transverse Arch 190
Type 167 Posterior Transverse Arch 190
 CONTENTS xv

Factors Responsible for Maintenance of Deep Peroneal Nerve 200

Arches 190 Superficial Peroneal Nerve 200
Functions of Arches 191 Medial Plantar Nerve 200
Summary 191 Lateral Plantar Nerve 200
Comparison of Medial and Lateral Longitudinal Miscellaneous Structures 201
Arches 192 Saphenous Opening 201
Clinical Anatomy 193 Femoral Ring 201
Facts to Remember 194 Superior Extensor Retinaculum 201
Clinicoanatomical Problem 194 Inferior Extensor Retinaculum 201
Frequently Asked Questions 195 Flexor Retinaculum 201
Multiple Choice Questions 195 Radiological Anatomy 201
Viva Voce 195 Hip 202
Knee 202
14. Surface and Radiological Foot 203
Further Reading 203
Anatomy 196
Palpable Parts of the Bones 196 Appendix 1: Nerves, Arteries and
Surface Marking 197 Clinical Terms 204
Arteries 197
Femoral Artery 197 Nerves of Lower Limb 204
Profunda Femoris Artery 197 Femoral Nerve 204
Popliteal Artery 197 Obturator Nerve 204
Superior Gluteal Artery 197 Accessory Obturator Nerve 205
Inferior Gluteal Artery 197 Superior Gluteal Nerve 205
Anterior Tibial Artery 198 Inferior Gluteal Nerve 205
Posterior Tibial Artery 198 Nerve to Quadratus Femoris 205
Dorsalis Pedis Artery 198 Nerve to Obturator Internus 206
Medial Plantar Artery 198 Sciatic Nerve 206
Lateral Plantar Artery 198 Tibial Nerve 207
Plantar Arch 199 Common Peroneal Nerve 207
Veins 199 Deep Peroneal Nerve 207
Femoral Vein 199 Superficial Peroneal Nerve 208
Great Saphenous Vein 199 Plantar Nerves 209
Small Saphenous Vein 199 Arteries of Lower Limb 211
Nerves 199 Clinical Anatomy 212
Femoral Nerve 199 Clinical Terms 213
Sciatic Nerve 199 Multiple Choice Questions 214
Tibial Nerve 200 Spots on Lower Limb 215
Common Peroneal Nerve 200 Answers: Spots on Lower Limb 216

Section 2 ABDOMEN and PELVIS

Ossification 227
15. Introduction and Osteology 219
Bony Pelvis 227
Introduction to Abdomen 219 Sex Differences in the Pelvis 229
Osteology 219 Anatomical Position of the Pelvis 229
Lumbar Vertebrae 219 Intervertebral Joints 230
Ossification 222 Intervertebral Disc 230
Clinical Anatomy 222 Mnemonics 231
The Sacrum/Vertebra Magnum 224
Facts to Remember 231
Sacral Canal 226
Clinicoanatomical Problem 231
Attachments on the Sacrum 226
Relations of the Sacrum 226 Further Reading 231
Sex Differences 226 Frequently Asked Questions 232
Ossification 227 Multiple Choice Questions 232
Coccyx 227 Viva Voce 232
xvi HUMAN ANATOMY—LOWER LIMB, ABDOMEN AND PELVIS

16. Anterior Abdominal Wall 233 Scrotum 260

Clinical Anatomy 261
Surface Landmarks 233 Testis 261
Skin and Superficial Fascia 234 External Features 262
Dissection 234 Arterial Supply 264
Umbilicus 235 Histology of Seminiferous Tubule 264
Clinical Anatomy 236 Clinical Anatomy 264
Superficial Fascia 237 Epididymis 266
Clinical Anatomy 237 Clinical Anatomy 266
Cutaneous Nerves 237 Histology 266
Cutaneous Arteries 238 Development of Male Reproductive System 266
Cutaneous Veins 238 Descent of the Testis 266
Clinical Anatomy 239 Ducts 267
Muscles of the Anterolateral Abdominal Wall 239 External Genitalia 267
External Oblique Muscle 239 Molecular Regulation 268
Internal Oblique Muscle 240 Facts to Remember 268
Dissection 240 Clinicoanatomical Problem 268
Transversus Abdominis Muscle 241 Further Reading 268
Dissection 241 Frequently Asked Questions 269
Rectus Abdominis Muscle 241 Multiple Choice Questions 269
Actions of the Main Muscles of the Viva Voce 269
Anterior Abdominal Wall 242
Inguinal Ligament 242 18. Abdominal Cavity and Peritoneum 270
Conjoint Tendon or Falx Inguinalis 243
Cremaster Muscle 243 Introduction 270
Pyramidalis 243 Nine Regions of Abdomen 270
Dissection 243 Peritoneum 271
Clinical Anatomy 244 Functions of Peritoneum 272
Deep Nerves 244 Clinical Anatomy 273
Deep Arteries 244 Peritoneal Folds 273
Rectus Sheath 246 Greater Omentum 274
New Concepts of Rectus Sheath 247 Dissection 275
Fascia Transversalis 248 Lesser Omentum 276
Dissection 248 Mesentery 276
Inguinal Canal 249 Mesoappendix 277
Definition 249 Dissection 277
Boundaries 249 Transverse Mesocolon 278
Structures Passing through the Inguinal Canal 250 Dissection 278
Constituents of the Spermatic Cord 250 Sigmoid Mesocolon 278
Mechanism of Inguinal Canal 251 Dissection 279
Development of Inguinal Canal 251 Reflection of Peritoneum 279
Dissection 251 Peritonial Cavity 279
Clinical Anatomy 252 Vertical Tracing/Sagittal Tracing 279
Mnemonics 254 Horizontal Tracing above Transverse Colon 280
Facts to Remember 255 Horizontal Tracing below the Level of the
Clinicoanatomical Problem 255 Transverse Colon 281
Further Reading 255 Horizontal Tracing of Peritoneum in the
Frequently Asked Questions 255 Lesser Pelvis/True Pelvis (Male) 282
Multiple Choice Questions 256 Horizontal Tracing of Peritoneum in the
Viva Voce 256 Lesser Pelvis/True Pelvis (Female) 282
Epiploic Foramen/Omental Foramen/
17. Male External Genital Organs 257 Foramen of Winslow 282
Lesser Sac or Omental Bursa 282
Introduction 257 Clinical Anatomy 283
Dissection 257 Special Regions of the Peritoneal Cavity 284
External Genital Organs 257 Supracolic Compartment/Subphrenic
Penis 257 Spaces 285
Root of Penis 257 Hepatorenal Pouch (Morrison’s Pouch) 285
Body of Penis and its Histology 258 Infracolic Compartments 285
Clinical Anatomy 260 Paracolic Gutters 285
 CONTENTS xvii

Rectouterine Pouch (Pouch of Douglas) 285 Dissection 311

Clinical Anatomy 286 Clinical Anatomy 311
Peritoneal Fossae (Recesses) 287 Large Intestine 312
Clinical Anatomy 288 Dissection 314
Development of Gut and its Folds 288 Clinical Anatomy 314
Facts to Remember 288 Caecum 314
Clinicoanatomical Problem 288 Dissection 316
Further Reading 289 Clinical Anatomy 316
Frequently Asked Questions 289 Vermiform Appendix 316
Multiple Choice Questions 289 Histology 318
Viva Voce 290 Clinical Anatomy 318
Ascending Colon 319
19. Abdominal Part of Oesophagus and Right Colic Flexure (Hepatic Flexure) 319
Transverse Colon 319
Stomach 291 Left Colic Flexure (Splenic Flexure) 319
Introduction 291 Descending Colon 319
Dissection 291 Sigmoid Colon (Pelvic Colon) 320
Abdominal Part of Oesophagus 291 Histology of Colon 320
Histology 292 Development of Intestines 320
Clinical Anatomy 292 Mnemonics 321
Stomach 294 Facts to Remember 321
Location 294 Clinicoanatomical Problem 321
External Features 294 Further Reading 321
Relations of Stomach 295 Frequently Asked Questions 322
Blood Supply 295 Multiple Choice Questions 322
Lymphatic Drainage 295 Viva Voce 322
Nerve Supply 297
Interior of Stomach 297 21. Large Blood Vessels of the Gut 323
Functions of Stomach 298
Dissection 298 Introduction 323
Clinical Anatomy 298 Blood Vessels 323
Histology of Stomach 299 Coeliac Trunk 323
Development 300 Origin and Length 323
Molecular Regulation of Gut Tube Branches 324
Development 300 Superior Mesenteric Artery 325
Mnemonics 300 Origin, Course and Termination 326
Facts to Remember 300 Branches 326
Clinicoanatomical Problem 301 Superior Mesenteric Vein 328
Further Reading 301 Dissection 328
Frequently Asked Questions 301 Clinical Anatomy 328
Multiple Choice Questions 301 Inferior Mesenteric Artery 328
Viva Voce 302 Branches 329
Inferior Mesenteric Vein 329
Clinical Anatomy 329
20. Small and Large Intestines 303 Marginal Artery of Drummond 329
Introduction 303 Portal Vein 330
Small Intestine 303 Branches 331
Relevant Features 303 Tributaries 331
Large Surface Area 303 Portosystemic Communications
Duodenum 305 (Portocaval Anastomoses) 331
Dissection 305 Clinical Anatomy 331
Peritoneal Relations 306 Development 334
Suspensory Muscle of Duodenum or Facts to Remember 334
Ligament of Treitz 308 Clinicoanatomical Problem 334
Histology 309 Further Reading 334
Clinical Anatomy 309 Frequently Asked Questions 335
Jejunum and Ileum 310 Multiple Choice Questions 335
Histology 311 Viva Voce 335
Meckel’s Diverticulum (Diverticulum Ilei) 311
xviii HUMAN ANATOMY—LOWER LIMB, ABDOMEN AND PELVIS

22. Extrahepatic Biliary Apparatus 336 Hepatic Segments 359

Dissection 360
Introduction 336 Clinical Anatomy 360
Right and Left Hepatic Ducts 336 Histology 361
Common Hepatic Duct 336 Development 362
Gallbladder 336 Molecular Regulation of Liver Formation 362
Cystic Duct 338 Mnemonics 362
Bile Duct 338 Facts to Remember 362
Sphincters Related to the Bile and Clinicoanatomical Problem 363
Pancreatic Ducts 339 Further Reading 363
Vascular and Nerve Supply 339 Frequently Asked Questions 363
Dissection 340 Multiple Choice Questions 363
Clinical Anatomy 340 Viva Voce 364
Histology of Gallbladder 341
Development 342
24. Kidney and Ureter 365
Facts to Remember 342
Clinicoanatomical Problems 342 Kidney 365
Further Reading 342 External Features 365
Frequently Asked Questions 343 Hilum 366
Multiple Choice Questions 343 Relations of the Kidneys 366
Viva Voce 343 Capsules or Coverings of Kidney 366
Structure 368
23. Spleen, Pancreas and Liver 344 Blood Supply of Kidney 370
Lymphatic Drainage 370
Introduction 344 Nerve Supply 370
Spleen 344 Exposure of the Kidney from Behind 370
Dissection 344 Histology 371
External Features 345 Dissection 371
Relations 345 Clinical Anatomy 372
Arterial Supply 346 Ureter 374
Venous Drainage 347 Dimensions 375
Lymphatic Drainage 347 Normal Constrictions 375
Clinical Anatomy 347 Relations 375
Histology 349 Abdominal Part of Ureter 375
Development 349 Pelvic Part of Ureter 376
Pancreas 349 Intravesical Part 377
Head of the Pancreas 349 Blood Supply 377
Body of the Pancreas 351 Nerve Supply 378
Tail of the Pancreas 352 Histology 378
Ducts of the Pancreas 352 Clinical Anatomy 378
Arterial Supply 353 Development of Kidney and Ureter 378
Venous Drainage 353 Anomalies of the Kidney and Ureter 380
Lymphatic Drainage 353 Molecular Regulation of Kidney
Nerve Supply 353 Development 380
Functions 353 Mnemonics 380
Dissection 353 Facts to Remember 380
Clinical Anatomy 354 Clinicoanatomical Problem 380
Histology 354 Further Reading 380
Development 354 Frequently Asked Questions 381
Molecular Regulation of Development of Multiple Choice Questions 381
Pancreas 355 Viva Voce 381
Liver 355
External Features 355 25. Suprarenal Gland and
Five Surfaces 356 Chromaffin System 382
One Prominent Border 356
Visceral Relations 357 Suprarenal Gland 382
Arterial Supply 358 Right Suprarenal Gland 382
Venous Drainage 358 Left Suprarenal Gland 383
Lymphatic Drainage 359 Structure and Function 383
Nerve Supply 359 Arterial Supply 384
 CONTENTS xix

Venous Drainage 384 Inferior Hypogastric Plexuses 405

Lymphatic Drainage 384 Clinical Anatomy 405
Nerve Supply 384 Layers of the Abdomen 406
Clinical Anatomy 384 Mnemonics 407
Histology 385 Facts to Remember 407
Development 385 Clinicoanatomical Problem 407
Molecular Regulation 385 Further Reading 407
Dissection 385 Frequently Asked Questions 408
Chromaffin System 385 Multiple Choice Questions 408
Facts to Remember 386 Viva Voce 408
Clinicoanatomical Problem 386
Further Reading 386 28. Perineum 409
Frequently Asked Questions 387
Multiple Choice Questions 387 Introduction 409
Viva Voce 387 Superficial Boundaries 409
Deep Boundaries of the Perineum 409
26. Diaphragm 388 Divisions of the Perineum 410
Anal Region 410
Introduction 388 Perineal Body 410
Gross Anatomy 388 External Anal Sphincter 410
Openings in the Diaphragm 390 Ischioanal Fossa 411
Relations 390 Spaces and Canals of the Fossa 412
Nerve Supply 390 Contents of Ischioanal Fossa 413
Actions 391 Dissection 413
Dissection 391 Clinical Anatomy 413
Clinical Anatomy 391 Male Perineum 414
Development 392 Male External Genital Organs 414
Mnemonics 392 Male Urogenital Region 414
Facts to Remember 393 Dissection 414
Clinicoanatomical Problem 393 Clinical Anatomy 414
Further Reading 393 Superficial Perineal Sapce 415
Frequently Asked Questions 393 Deep Perineal Space 415
Multiple Choice Questions 393 Boundaries 415
Viva Voce 394 Deep Transversus Perinei 416
Distal Urethral Sphincter Mechanism 416
27. Posterior Abdominal Wall 395 Perineal Membrane 417
Clinical Anatomy 419
Introduction 395 Female Perineum 419
Blood Vessels, Muscles and Nerves 395 Female External Genital Organs/Pudendum/
Abdominal Aorta 395 Vulva 419
Relations 395 Female Urogenital Region 420
Branches 395 Clinical Anatomy 421
Common Iliac Arteries 397 Superficial Perineal Space 421
Inferior Vena Cava 397 Deep Perineal Space 422
Tributaries 397 Boundaries 422
Clinical Anatomy 398 Contents 422
Abdominal Parts of Azygos and Hemiazygos Urethral Sphincter Mechanism 422
Veins 398 Actions 422
Lymph Nodes of Posterior Abdominal Wall 399 Nerve Supply 422
Cisterna Chyli 399 Compressor Urethrae 422
Muscles of the Posterior Abdominal Wall 399 Sphincter Urethrovaginalis 422
Dissection 399 Actions 422
Clinical Anatomy 401 Pudendal Canal 423
Thoracolumbar Fascia (Lumbar Fascia) 401 Perineal Membrane 422
Nerves of the Posterior Abdominal Wall 402 Pudendal Nerve 423
Abdominal Part of the Autonomic Nervous Sytem 403 Clinical Anatomy 424
Lumbar Sympathetic Chain 403 Internal Pudendal Artery 424
Coeliac Ganglia and Coeliac Plexus 403 Internal Pudendal Vein 426
Superior Hypogastric Plexus (Presacral Histology of Body of Penis/Clitoris 426
Nerve) 404 Facts to Remember 426
xx HUMAN ANATOMY—LOWER LIMB, ABDOMEN AND PELVIS

Clinicoanatomical Problem 426 31. Female Reproductive Organs 445

Further Reading 426
Frequently Asked Questions 427 Introduction 445
Multiple Choice Questions 427 Internal Genital Organs 445
Viva Voce 427 Ovaries 445
External Features 446
29. Preliminary Consideration of Relations 446
Arterial Supply 447
Boundaries and Contents of Pelvis 428 Venous Drainage 447
Introduction 428 Histology 447
Lesser Pelvis 428 Clinical Anatomy 448
Muscles 429 Dissection 448
Pelvic Inlet (Superior Aperture of Pelvis) 429 Uterine Tubes 448
Pelvic Outlet (Inferior Aperture of Pelvis) 429 Course and Relations 448
Clinical Anatomy 430 Blood Supply 449
Pelvic Floor 430 Lymphatic Drainage 449
Clinical Anatomy 430 Nerve Supply 449
Pelvic Cavity 431 Histology 449
Contents 431 Clinical Anatomy 449
Structures Crossing the Pelvic Inlet/ Uterus 450
Brim of the Pelvis 431 Size and Shape 451
Facts to Remember 431 Normal Position and Angulation 451
Clinicoanatomical Problem 431 Parts of Uterus 452
Cervix of Uterus 452
Further Reading 432
Ligaments of Uterus 453
Frequently Asked Questions 433
Arterial Supply 453
Multiple Choice Questions 433
Venous Drainage 454
Viva Voce 433
Lymphatic Drainage 454
Nerve Supply 454
30. Urinary Bladder and Urethra 434 Age and Reproductive Changes 454
Introduction 434 Supports of the Uterus 454
Role of Individual Supports 455
Urinary Bladder 434
Histology 456
External Features 434
Clinical Anatomy 457
Relations 435
Vagina 457
Ligaments of the Bladder 435
Extent and Situation 458
Interior of the Bladder 436
Fornices of Vagina 458
Arterial Supply 436
Relations 458
Venous Drainage 436
Arterial Supply 458
Lymphatic Drainage 437
Venous Drainage 459
Nerve Supply 437
Lymphatic Drainage 459
Histology of Urinary Bladder 437
Nerve Supply 459
Dissection 437 Ureter in Female Pelvis 459
Clinical Anatomy 437 Histology 459
Urethra 438 Clinical Anatomy 460
Male Urethra 438 Development 460
Posterior Part 439 Molecular Regulation 462
Anterior Part 440 Mnemonics 462
Clinical Anatomy 441 Facts to Remember 462
Female Urethra 441 Clinicoanatomical Problem 462
Walls of Urethra 441 Further Reading 463
Micturition 442 Frequently Asked Questions 463
Clinical Anatomy 442 Multiple Choice Questions 463
Development of Urinary Bladder and Urethra 442 Viva Voce 464
Facts to Remember 443
Clinicoanatomical Problem 443
Further Reading 443
32. Male Internal Genital Organs 465
Frequently Asked Questions 444 Introduction 465
Multiple Choice Questions 444 Dissection 465
Viva Voce 444 Ductus Deferens 465
 CONTENTS xxi

Course and Relations 465 Development 485

Arterial Supply 466 Facts to Remember 485
Venous Drainage 466 Clinicoanatomical Problem 486
Histology 467 Further Reading 486
Development 467 Frequently Asked Questions 487
Clinical Anatomy 467 Multiple Choice Questions 487
Seminal Vesicles 467 Viva Voce 487
Ejaculatory Duct 467
Prostate 467 34. Walls of Pelvis 488
Situation 468
Gross Features 468 Introduction 488
Zones of the Prostate 468 Vessels of the Pelvis 488
Capsules and Ligaments of Prostate 469 Internal Iliac Artery 488
Structures within the Prostate 469 Course 488
Structural Zones of the Prostate 470 Relations 488
Blood Supply 470 Branches 488
Lymphatic Drainage 470 Branches of Anterior Division 488
Nerve Supply 470 Branches of Posterior Division 490
Age Changes in Prostate 470 Internal Iliac Vein 490
Histology 471 Lymph Nodes of the Pelvis 491
Development 471 Dissection 491
Clinical Anatomy 471 Nerves of the Pelvis 491
Lumbosacral Plexus 491
Vertebral System of Veins/Batson’s Plexus 472
Branches from Dorsal Divisions 491
Communications and Implications 472
Branches from Ventral Division 492
Facts to Remember 472
Coccygeal Plexus 492
Clinicoanatomical Problems 472
Clinical Anatomy 492
Further Reading 473
Pelvic Autonomic Nerves 492
Frequently Asked Questions 474
Pelvic Sympathetic System 492
Multiple Choice Questions 474
Pelvic Splanchnic Nerves 492
Viva Voce 474 Dissection 492
Pelvic Fascia 493
33. Rectum and Anal Canal 475 Pelvic Muscles 493
Levator Ani 494
Introduction 475 Pubococcygeus Part 494
Rectum 475 Iliococcygeus Part 494
Situation 475 Ischiococcygeus Part 494
Dimensions 475 Nerve Supply 494
Relations 476 Actions of the Levator Ani and Coccygeus 495
Mucosal Folds 476 Relations of the Levator Ani 495
Arterial Supply 477 Dissection 495
Venous Drainage 478 Clinical Anatomy 495
Lymphatic Drainage 478 Joints of Pelvis 495
Nerve Supply 479 Lumbosacral Joints 495
Supports of Rectum 479 Sacrococcygeal and Intercoccygeal Joints 496
Dissection 479 Sacroiliac Joint 496
Clinical Anatomy 480 Ligaments 496
Anal Canal 481 Factors Providing Stability 498
Length, Extent and Direction 481 Blood Supply 498
Relations of the Anal Canal 481 Nerve Supply 498
Interior of the Anal Canal 481 Movements 498
Musculature of the Anal Canal 482 Pubic Symphysis 498
Anorectal Ring 482 Mechanism of Pelvis 498
Surgical Spaces Related to the Anal Canal 483 Dissection 498
Arterial Supply 483 Clinical Anatomy 499
Venous Drainage 483 Facts to Remember 499
Lymphatic Drainage 483 Clinicoanatomical Problem 499
Nerve Supply 484 Further Reading 499
Dissection 484 Frequently Asked Questions 500
Clinical Anatomy 484 Multiple Choice Questions 500
Histology 485 Viva Voce 500
xxii HUMAN ANATOMY—LOWER LIMB, ABDOMEN AND PELVIS

35. Surface Marking of Abdomen and Alimentary Canal (Barium Studies) 507
Barium Meal Examination 507
Pelvis 501
Barium Enema 508
Planes and Regions of the Abdomen 501 Pyelography 508
Surface Marking 501 Excretory (Intravenous or Descending)
Viscera 501 Pyelography 508
Spleen 501 Retrograde (Instrumental or Ascending)
Stomach 501 Pyelography 509
Duodenum 502 Biliary Apparatus (Ultrasonography) 509
Caecum 502 Hysterosalpingography 510
Ileocaecal Orifice or Valve 502 Further Reading 510
Appendix 502
Ascending Colon 502
Transverse Colon 503 Appendix 2: Nerves, Arteries and
Descending Colon 503 Clinical Terms 511
Rectum and Anal Canal 503
Liver 503 Nerves of Abdomen 511
Gallbladder 503 Lower Intercostal Nerves 511
Bile Duct 503 Upper Lumbar Nerves 511
Pancreas 503 Lumbar Plexus 511
Kidney 503 Sacral Plexus 512
Ureter 504 Pudendal Nerve 512
Vessels 504 Abdominal Part of Sympathetic Trunk 512
Abdominal Aorta 504 Aortic Plexus 512
Common Iliac Artery 504 Pelvic Part of Sympathetic Trunk 512
External Iliac Artery 504 Collateral or Prevertebral Ganglia and
Coeliac Trunk and its Branches 504 Plexuses 513
Superior Mesenteric Artery 504 Coeliac Plexus 513
Inferior Mesenteric Artery 505
Superior Hypogastric Plexus 513
Inferior Vena Cava 505
Autonomic Nerve Supply of Various Organs 513
Portal Vein 505
Miscellaneous 505 Gastrointestinal Tract 513
Inguinal Canal 505 Genitourinary Tract 514
Root of Mesentery 505 Clinical Anatomy 515
Further Reading 505 Arteries of Abdomen and Pelvis 515
Clinical Terms 518
Multiple Choice Questions 521
36. Radiological and Imaging
Spots on Abdomen and Pelvis 523
Procedures 506
Answers: Spots on Abdomen and Pelvis 524
Introduction 506
Plain Skiagram of Abdomen 506 Index 525