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Copyright, ii
About the Authors, iii
Preface, v
Acknowledgments, xv
Reviewers, xvi
1. The Human Body: An Orientation, 1
An Overview of Anatomy, 2
Anatomical Terminology, 2
Branches of Anatomy, 2
Gross Anatomy, 2
Microscopic Anatomy, 2
Other Branches of Anatomy, 2
The Hierarchy of Structural Organization, 3
Scale: Length, Volume, and Weight, 6
Gross Anatomy: An Introduction, 6
The Anatomical Position, 6
Directional and Regional Terms, 7
Body Planes and Sections, 7
Anatomical Variability, 10
The Human Body Plan, 11
Body Cavities and Membranes, 12
Dorsal Body Cavity, 12
Ventral Body Cavity, 12
Serous Cavities, 13
Other Cavities, 14
Abdominal Regions and Quadrants, 14
Microscopic Anatomy: An Introduction, 15
Light and Electron Microscopy, 15
Preparing Human Tissue for Microscopy, 16
Scanning Electron Microscopy, 16
Artifacts, 16
Clinical Anatomy: An Introduction to Medical Imaging Techniques, 17
X-Ray Imaging, 17
Advanced X-Ray Techniques, 18
Computed Tomography, 18
Digital Subtraction Angiography Imaging, 18
Positron Emission Tomography, 19
Sonography, 19
Magnetic Resonance Imaging, 20
Chapter Summary, 21
Review Questions, 22
Critical Reasoning and Clinical Application Questions, 24
2. Cells: The Living Units, 25
Introduction to Cells, 26
The Plasma Membrane, 27
Structure, 27
Functions, 28
Clinical Applications: Hypercholesterolemia, 29
The Cytoplasm, 29
Cytosol, 30
Cytoplasmic Organelles, 30
Ribosomes, 30
Endoplasmic Reticulum, 31
Rough Endoplasmic Reticulum, 31
Smooth Endoplasmic Reticulum, 31
Golgi Apparatus, 32
Lysosomes, 33
Clinical Applications: Tay-Sachs disease, 34
Mitochondria, 34
Peroxisomes, 34
Cytoskeleton, 36
Centrosome and Centrioles, 37
Cytoplasmic Inclusions, 37
The Nucleus, 38
Nuclear Envelope, 38
Nucleoli, 39
Chromatin and Chromosomes, 39
Cellular Diversity, 40
The Cell Life Cycle, 42
Interphase, 42
Cell Division, 42
Mitosis, 42
Cytokinesis, 42
Developmental Aspects of Cells, 42
Youth, 42
Aging, 45
Related Clinical Terms, 45
Chapter Summary, 46
Review Questions, 47
Critical Reasoning and Clinical Application Questions, 48
3. Basic Embryology, 49
The Basic Body Plan, 51
The Embryonic Period, 51
Week 1: From Zygote to Blastocyst, 51
Week 2: The Two-Layered Embryo, 53
Week 3: The Three-Layered Embryo, 53
The Primitive Streak and the Three Germ Layers, 53
The Notochord, 55
Neurulation, 56
The Mesoderm Begins to Differentiate, 56
Week 4: The Body Takes Shape, 56
Folding, 56
Derivatives of the Germ Layers, 58
Derivatives of Ectoderm, 58
Derivatives of Endoderm, 58
Derivatives of the Mesoderm and Notochord, 58
Weeks 5–8: The Second Month of Embryonic Development, 60
The Fetal Period, 61
A Closer Look: Focus on Birth Defects, 63
Related Clinical Terms, 64
Chapter Summary, 65
Review Questions, 66
Critical Reasoning and Clinical Application Questions, 67
4. Tissues, 68
I. Epithelia, 69
Special Characteristics of Epithelia, 69
Classification of Epithelia, 69
Simple Epithelia, 71
Simple Squamous Epithelium, 71
Simple Cuboidal Epithelium, 71
Simple Columnar Epithelium, 71
Pseudostratified Columnar Epithelium, 71
Stratified Epithelia, 76
Stratified Squamous Epithelium, 76
Stratified Cuboidal and Columnar Epithelia, 76
Transitional Epithelium, 76
Glands, 76
Exocrine Glands, 76
Unicellular Exocrine Glands, 77
Multicellular Exocrine Glands, 77
Endocrine Glands, 77
Epithelial Surface Features, 77
Lateral Surface Features: Cell Junctions, 78
Tight Junctions, 78
Adherens Junctions, 78
Desmosomes, 78
Gap Junctions, 79
Basal Feature: The Basal Lamina, 80
Clinical Applications: Basement membranes and diabetes, 80
Apical Surface Features: Microvilli and Cilia, 80
Clinical Applications: Kartagener’s syndrome, 81
II. Connective Tissue, 81
Special Characteristics of Connective Tissues, 81
Connective Tissue Proper, 83
Loose Connective Tissue, 83
Areolar Connective Tissue, 83
Clinical Applications: Scurvy, 84
Adipose Tissue, 85
Reticular Connective Tissue, 85
Dense Connective Tissue, 88
Dense Irregular Connective Tissue, 88
Dense Regular Connective Tissue, 88
Elastic Connective Tissue, 88
Other Connective Tissues: Cartilage, Bone, and Blood, 88
Cartilage, 88
Bone Tissue, 88
Blood, 88
Covering and Lining Membranes, 93
III. Muscle Tissue, 94
IV. Nervous Tissue, 96
Tissue Response to Injury, 96
Inflammation, 96
Repair, 97
Clinical Applications: Healing by first and second intention, 98
The Tissues Throughout Life, 98
A Closer Look: Cancer—The Intimate Enemy, 99
Related Clinical Terms, 101
Chapter Summary, 101
Review Questions, 103
Critical Reasoning and Clinical Application Questions, 104
5. The Integumentary System, 105
The Skin and the Hypodermis, 106
Epidermis, 107
Layers of the Epidermis, 107
Stratum Basale (Basal Layer), 107
Stratum Spinosum (Spiny Layer), 108
Stratum Granulosum (Granular Layer), 109
Stratum Lucidum (Clear Layer), 109
Stratum Corneum (Horny Layer), 109
Clinical Applications: Skin’s response to friction, 110
Dermis, 110
Clinical Applications: The patch drug delivery system, 110
Clinical Applications: Decubitus ulcer, 111
Hypodermis, 111
Skin Color, 111
Clinical Applications: Freckles and moles, 111
A Closer Look: Tattoos, 112
Clinical Applications: Cyanosis, 112
Appendages of the Skin, 113
Nails, 113
Hair and Hair Follicles, 113
Hair, 113
Hair Follicles, 115
Types and Growth of Hair, 115
Hair Thinning and Baldness, 116
Clinical Applications: Chemotherapy and hair loss, 116
Sebaceous Glands, 116
Clinical Applications: Acne, 116
Sweat Glands, 117
Disorders of the Integumentary System, 118
Burns, 118
Skin Cancer, 119
Basal Cell Carcinoma, 119
Squamous Cell Carcinoma, 120
Melanoma, 120
The Skin Throughout Life, 120
Related Clinical Terms, 120
Chapter Summary, 121
Review Questions, 122
Critical Reasoning and Clinical Application Questions, 123
6. Bones and Skeletal Tissues, 124
Cartilages, 125
Location and Basic Structure, 125
Types of Cartilage, 125
Hyaline Cartilage, 125
Elastic Cartilage, 125
Fibrocartilage, 125
Growth of Cartilage, 125
Bones, 126
A Closer Look: The Marvelous Properties of Cartilage, 127
Functions of Bones, 127
Classification of Bones, 128
Gross Anatomy of Bones, 129
Compact and Spongy Bone, 129
Structure of a Typical Long Bone, 129
Diaphysis and Epiphyses, 129
Blood Vessels, 130
The Medullary Cavity, 130
Membranes, 130
Structure of Short, Irregular, and Flat Bones, 130
Bone Design and Stress, 130
Microscopic Structure of Bone, 131
Compact Bone, 131
Spongy Bone, 134
Chemical Composition of Bone Tissue, 135
Bone Development, 135
Intramembranous Ossification, 135
Endochondral Ossification, 135
Stage 1: A Bone Collar Forms Around the Diaphysis, 135
Stage 2: Cartilage Calcifies in the Center of the Diaphysis, 136
Stage 3: The Periosteal Bud Invades the Diaphysis, and the First Bone Trabeculae Form, 136
Stage 4: Secondary Ossification Centers Form in the Epiphyses, 136
Anatomy of the Epiphyseal Growth Areas, 137
Clinical Applications: Achondroplasia, 137
Postnatal Growth of Endochondral Bones, 138
Bone Remodeling, 138
Repair of Bone Fractures, 140
Disorders of Bones, 140
Osteoporosis, 140
Osteomalacia and Rickets, 142
Paget’s Disease, 142
Osteosarcoma, 143
The Skeleton Throughout Life, 143
Related Clinical Terms, 143
Chapter Summary, 144
Review Questions, 145
Critical Reasoning and Clinical Application Questions, 147
7. Bones, Part 1: The Axial Skeleton, 148
The Skull, 150
Overview of Skull Geography, 150
Cranial Bones, 150
Frontal Bone, 150
Parietal Bones and the Major Sutures, 150
Sutural Bones, 153
Occipital Bone, 153
Temporal Bones, 155
Sphenoid Bone, 156
Ethmoid Bone, 158
Facial Bones, 158
Mandible, 159
Maxillary Bones, 160
Zygomatic Bones, 160
Nasal Bones, 160
Lacrimal Bones, 160
Palatine Bones, 160
Vomer, 160
Inferior Nasal Conchae, 160
Special Parts of the Skull, 160
Nasal Cavity, 160
Clinical Applications: Deviated septum, 164
Orbits, 164
Paranasal Sinuses, 164
The Hyoid Bone, 165
The Vertebral Column, 165
Intervertebral Discs, 166
Clinical Applications: Herniated disc, 166
Regions and Normal Curvatures, 167
General Structure of Vertebrae, 168
Regional Vertebral Characteristics, 168
Cervical Vertebrae, 168
Clinical Applications: The dens and fatal trauma, 169
Thoracic Vertebrae, 170
Lumbar Vertebrae, 172
Sacrum, 172
Coccyx, 173
The Thoracic Cage, 173
Sternum, 173
Ribs, 173
Disorders of the Axial Skeleton, 175
Abnormal Spinal Curvatures, 175
Stenosis of the Lumbar Spine, 176
The Axial Skeleton Throughout Life, 176
Related Clinical Terms, 177
Chapter Summary, 178
Review Questions, 179
Critical Reasoning and Clinical Application Questions, 180
8. Bones, Part 2: The Appendicular Skeleton, 181
The Pectoral Girdle, 182
Clavicles, 182
Clinical Applications: Fractures of the clavicle, 182
Scapulae, 182
The Upper Limb, 185
Arm, 185
Forearm, 187
Ulna, 187
Radius, 188
Clinical Applications: Palpation of Colles’ fracture, 188
Hand, 188
Carpus, 188
Clinical Applications: Carpal tunnel syndrome, 189
Metacarpus, 189
Phalanges of the Fingers, 189
The Pelvic Girdle, 192
Ilium, 192
Ischium, 192
Pubis, 192
True and False Pelves, 194
Pelvic Structure and Childbearing, 194
The Lower Limb, 196
Thigh, 196
Clinical Applications: Hip fracture as result of osteoporosis, 196
Leg, 196
Tibia, 196
Fibula, 199
Clinical Applications: Ankle fractures, 199
Foot, 199
Tarsus, 199
Metatarsus, 200
Clinical Applications: Metatarsal stress fracture, 200
Phalanges of the Toes, 200
Arches of the Foot, 200
Disorders of the Appendicular Skeleton, 200
The Appendicular Skeleton Throughout Life, 201
Related Clinical Terms, 201
Chapter Summary, 201
Review Questions, 202
Critical Reasoning and Clinical Application Questions, 203
9. Joints, 204
Classification of Joints, 205
Fibrous Joints, 205
Sutures, 205
Syndesmoses, 205
Gomphoses, 206
Cartilaginous Joints, 206
Synchondroses, 206
Symphyses, 206
Synovial Joints, 207
General Structure of Synovial Joints, 207
Bursae and Tendon Sheaths, 209
Functioning of Synovial Joints, 209
Factors Influencing the Stability of Synovial Joints, 209
Articular Surfaces, 210
Ligaments, 210
Muscle Tone, 210
Movements Allowed by Synovial Joints, 211
Gliding, 211
Angular Movements, 211
Flexion, 211
Extension, 212
Abduction, 212
Adduction, 212
Circumduction, 212
Rotation, 213
Special Movements, 213
Supination and Pronation, 213
Dorsiflexion and Plantar Flexion, 216
Inversion and Eversion, 216
Protraction and Retraction, 216
Elevation and Depression, 216
Opposition, 216
Synovial Joints Classified by Shape, 216
Plane Joints, 216
Hinge Joints, 216
Pivot Joints, 216
Condyloid Joints, 216
Saddle Joints, 217
Ball-and-Socket Joints, 217
Selected Synovial Joints, 218
Shoulder (Glenohumeral) Joint, 218
Clinical Applications: Shoulder dislocations, 220
Clinical Applications: Elbow Joint, 220
Clinical Applications: Elbow trauma, 220
Wrist Joint, 221
Hip Joint, 221
Knee Joint, 222
Clinical Applications: Knee injuries, 225
Ankle Joint, 225
Clinical Applications: Ankle sprains, 226
Temporomandibular Joint, 226
Clinical Applications: Temporomandibular disorders, 229
Sternoclavicular Joint, 229
Disorders of Joints, 230
Joint Injuries, 230
Sprains, 230
Dislocations, 230
Clinical Applications: Nursemaid’s elbow, 230
Torn Cartilage, 230
Clinical Applications: Autologous cartilage implantation, 231
Inflammatory and Degenerative Conditions, 231
Bursitis and Tendinitis, 231
Arthritis, 231
Osteoarthritis (Degenerative Joint Disease), 231
Rheumatoid Arthritis, 231
A Closer Look: The Development of Artificial Joints, 232
Gouty Arthritis (Gout), 233
Lyme Disease, 233
The Joints Throughout Life, 233
Related Clinical Terms, 234
Chapter Summary, 234
Review Questions, 236
Critical Reasoning and Clinical Application Questions, 237
10. Skeletal Muscle Tissue, 238
Overview of Muscle Tissue, 239
Functions, 239
Types of Muscle Tissue, 239
Skeletal Muscle, 239
Basic Features of a Skeletal Muscle, 240
Connective Tissue and Fascicles, 240
Nerves and Blood Vessels, 240
Muscle Attachments, 240
Microscopic and Functional Anatomy of Skeletal Muscle Tissue, 241
The Skeletal Muscle Fiber, 241
Myofibrils and Sarcomeres, 243
Sarcoplasmic Reticulum and T Tubules, 243
Mechanism of Contraction, 243
Clinical Application: Delayed-onset muscle soreness, 245
Muscle Extension, 246
Muscle Fiber Length and the Force of Contraction, 246
The Role of Titin and Other Myofibril Proteins, 247
Innervation of Skeletal Muscle, 247
Types of Skeletal Muscle Fibers, 248
Slow Oxidative Fibers (Type I), 248
Clinical Applications: Rhabdomyolysis, 249
Fast Glycolytic Fibers (Type IIx), 250
Fast Oxidative Fibers (Type IIa), 250
Disorders of Skeletal Muscle Tissue, 251
Muscular Dystrophy, 251
Myofascial Pain Syndrome, 251
Fibromyalgia, 251
Skeletal Muscle Tissue Throughout Life, 251
A Closer Look: Anabolic Steroid Abuse, 254
Related Clinical Terms, 255
Chapter Summary, 255
Review Questions, 256
Critical Reasoning and Clinical Application Questions, 257
11. Muscles of the Body, 258
Lever Systems: Bone-Muscle Relationships, 259
Arrangement of Fascicles in Muscles, 261
Organizational Scheme Based on Embryonic Development, 262
Skeletal Muscle Interactions, 264
Muscle Compartments of the Limbs, 264
Muscle Galleries Muscle Gallery: Table 11.1 Summary of Actions of Muscles Acting on the Arm, Forearm, and Hand, 266
Clinical Applications: Compartment syndrome, 267
Muscle Gallery: Table 11.2 Summary of Actions of Muscles Acting on the Thigh, Leg, and Foot, 268
Naming the Skeletal Muscles, 271
Major Skeletal Muscles of the Body, 272
Muscle Gallery: Table 11.3 Muscles of the Head, Part I: Facial Expression, 275
Muscle Gallery: Table 11.4 Muscles of the Head, Part II: Mastication and Tongue Movement, 277
Muscle Gallery: Table 11.5 Muscles of the Anterior Neck and Throat: Swallowing, 279
Muscle Gallery: Table 11.6 Muscles of the Neck and Vertebral Column: Head Movements and Trunk Extension, 282
Clinical Applications: Torticollis, 282
Muscle Gallery: Table 11.7 Deep Muscles of the Thorax: Breathing, 286
Muscle Gallery: Table 11.8 Muscles of the Abdominal Wall: Trunk Movements and Compression of Abdominal Viscera, 288
Clinical Applications: Hernia, 288
Muscle Gallery: Table 11.9 Muscles of the Pelvic Floor and Perineum: Support of Abdominopelvic Organs, 291
Muscle Gallery: Table 11.10 Superficial Muscles of the Anterior and Posterior Thorax: Movements of the Scapula, 294
Muscle Gallery: Table 11.11 Muscles Crossing the Shoulder Joint: Movements of the Arm (Humerus), 298
Muscle Gallery: Table 11.12 Muscles Crossing the Elbow Joint: Flexion and Extension of the Forearm, 301
Muscle Gallery: Table 11.13 Muscles of the Forearm: Movements of the Wrist, Hand, and Fingers, 302
Clinical Applications: Tennis elbow, 302
Muscle Gallery: Table 11.14 Intrinsic Muscles of the Hand: Fine Movements of the Fingers, 307
Muscle Gallery: Table 11.15 Muscles Crossing the Hip and Knee Joints: Movements of the Thigh and leg, 310
Muscle Gallery: Table 11.16 Muscles of the Leg: Movements of the Ankle and Toes, 317
Muscle Gallery: Table 11.17 Intrinsic Muscles of the Foot: Toe Movement and Foot Support, 323
Regional Surface Anatomy, 326
The Head, 326
The Cranium, 326
The Face, 327
The Neck, 328
Skeletal Landmarks, 328
Muscles of the Neck, 328
Triangles of the Neck, 328
The Trunk, 328
The Thorax, 329
Skeletal Landmarks, 329
Muscles of the Thorax, 330
The Abdomen, 330
Clinical Applications: Diagnosing inguinal hernias, 330
Skeletal Landmarks, 330
Muscles and Other Abdominal Surface Features, 330
Pelvis and Perineum, 330
The Back, 330
Bones of the Back, 330
Muscles of the Back, 332
Clinical Applications: The triangle of auscultation, 332
The Upper Limb and Shoulder, 332
The Axilla, 332
The Shoulder, 332
The Arm, 332
Elbow Region, 332
The Forearm and Hand, 333
The Lower Limb and Gluteal Region, 336
Gluteal Region, 336
Clinical Applications: Gluteal intramuscular injections, 336
The Thigh, 337
The Leg and Foot, 337
Related Clinical Terms, 340
Chapter Summary, 341
Review Questions, 343
Critical Reasoning and Clinical Application Questions, 344
12. Fundamentals of the Nervous System and Nervous Tissue, 345
Basic Divisions of the Nervous System, 346
Nervous Tissue, 348
The Neuron, 348
The Cell Body, 348
Neuron Processes, 349
Dendrites, 350
Axons, 350
Synapses, 351
The Signals Carried by Neurons, 352
Classification of Neurons, 352
Structural Classification of Neurons, 353
Functional Classification of Neurons, 353
Supporting Cells, 354
Neuroglia in the CNS, 354
Clinical Applications: Gliomas, 354
Neuroglia in the PNS, 355
Myelin Sheaths, 356
Clinical Applications: Tic douloureux, 356
Myelin Sheaths in the PNS, 356
Myelin Sheaths in the CNS, 356
Gross Anatomy of the Nervous System: An Introduction, 358
Gray and White Matter of the CNS, 358
Nerves, 359
Neuronal Integration, 360
Integration Between the PNS and CNS, 360
Reflex Arcs, 360
Simplified Design of the Nervous System, 361
Neuronal Circuits and Patterns of Neural Processing, 363
Disorders of Nervous Tissue, 364
Nervous Tissue Throughout Life, 365
Embryonic Development of Nervous Tissue, 365
Neuronal Regeneration, 366
A Closer Look: Stem Cells: A Medical Miracle?, 367
Clinical Applications: Regeneration and spinal cord injuries, 368
Related Clinical Terms, 369
Chapter Summary, 369
Review Questions, 370
Critical Reasoning and Clinical Application Questions, 371
13. The Central Nervous System, 372
The Spinal Cord, 373
White Matter of the Spinal Cord, 375
Gray Matter of the Spinal Cord and Spinal Roots, 375
Clinical Applications: Flaccid and spastic paralysis, 377
Protection of the Spinal Cord, 377
Meninges, 377
The Dura Mater, 377
The Arachnoid Mater, 377
The Pia Mater, 378
Cerebrospinal Fluid, 378
Clinical Applications: Meningitis, 378
The Brain, 378
Embryonic Development of the Brain, 379
Basic Parts and Organization of the Brain, 379
Ventricles of the Brain, 380
The Brain Stem, 382
The Medulla Oblongata, 382
The Pons, 383
The Midbrain, 385
Clinical Applications: Localization of a brain stem injury, 386
The Cerebellum, 387
Clinical Applications: Injury to the cerebellum, 389
The Cerebellar Peduncles, 389
The Diencephalon, 389
The Thalamus, 389
The Hypothalamus, 392
The Epithalamus, 393
Clinical Applications: Why won’t teenagers sleep at night?, 393
The Cerebrum, 393
The Cerebral Cortex, 393
Sensory Areas, 397
Clinical Applications: Agnosia, 399
Multimodal Association Areas, 399
Clinical Applications: Neglect syndrome, 400
Motor Areas, 400
Lateralization of Cortical Functioning, 401
Cerebral White Matter, 401
Deep Gray Matter of the Cerebrum, 401
Basal Ganglia, 402
Clinical Applications: Dyskinesia, 405
Basal Forebrain Nuclei, 405
Functional Brain Systems, 405
The Limbic System, 405
The Reticular Formation, 406
Protection of the Brain, 408
Meninges, 408
Production and Circulation of Cerebrospinal Fluid, 409
Clinical Applications: Hydrocephalus, 409
The Blood-Brain Barrier, 409
Sensory and Motor Pathways in the Central Nervous System, 410
Ascending Pathways, 411
Descending Pathways, 414
Disorders of the Central Nervous System, 416
Spinal Cord Damage, 416
A Closer Look: Traumatic Brain Injury, 417
Brain Dysfunction, 417
Cerebrovascular Accidents, 417
Alzheimer’s Disease, 418
The Central Nervous System Throughout Life, 419
Embryonic Development and Congenital Conditions, 419
Postnatal Changes in the Brain, 420
Related Clinical Terms, 420
Chapter Summary, 421
Review Questions, 423
Critical Reasoning and Clinical Application Questions, 424
14. The Peripheral Nervous System, 425
Peripheral Sensory Receptors, 427
Classification by Location, 427
Classification by Stimulus Detected, 427
Classification by Structure, 429
Free Nerve Endings, 429
Encapsulated Nerve Endings, 429
Meissner’s Corpuscles, 429
Pacinian Corpuscles, 429
Ruffini Endings, 430
Proprioceptors, 430
Clinical Applications: Paresthesia, 431
Cranial Nerves, 431
I The Olfactory Nerves, 433
Clinical Applications: Anosmia, 433
II The Optic Nerves, 433
Clinical Applications: Optic nerve damage, 433
III The Oculomotor Nerves, 433
Clinical Applications: Oculomotor nerve paralysis, 434
IV The Trochlear Nerves, 434
Clinical Applications: Trochlear nerve damage, 434
V The Trigeminal Nerves, 434
Clinical Applications: Anesthesia for upper and lower jaws, 434
VI The Abducens Nerves, 435
Clinical Applications: Abducens nerve paralysis, 435
VII The Facial Nerves, 436
Clinical Applications: Bell’s palsy, 436
VIII The Vestibulocochlear Nerves, 437
Clinical Applications: Vestibulocochlear nerve damage, 437
IX The Glossopharyngeal Nerves, 437
Clinical Applications: Glossopharyngeal nerve damage, 437
X The Vagus Nerves, 438
Clinical Applications: Vagus nerve damage, 438
XI The Accessory Nerves, 438
Clinical Applications: Damage to accessory nerves, 438
XII The Hypoglossal Nerves, 439
Clinical Applications: Hypoglossal nerve damage, 439
Spinal Nerves, 439
Innervation of the Back, 440
Innervation of the Anterior Thoracic and Abdominal Wall, 440
Introduction to Nerve Plexuses, 440
The Cervical Plexus and Innervation of the Neck, 441
The Brachial Plexus and Innervation of the Upper Limb, 442
Clinical Applications: Brachial plexus injuries, 445
Clinical Applications: Median nerve injury, 445
Clinical Applications: Ulnar nerve injuries, 446
Clinical Applications: Radial nerve injuries, 446
The Lumbar Plexus and Innervation of the Lower Limb, 446
The Sacral Plexus and Innervation of the Lower Limb, 448
Clinical Applications: Sciatic nerve injuries, 450
Innervation of Joints of the Body, 450
Innervation of the Skin: Dermatomes, 450
Clinical Applications: Clinical importance of dermatomes, 451
A Closer Look: Postpolio Syndrome: The Plight of Some “Recovered” Polio Victims, 452
Disorders of the Peripheral Nervous System, 452
The Peripheral Nervous System Throughout Life, 454
Related Clinical Terms, 454
Chapter Summary, 454
Review Questions, 456
Critical Reasoning and Clinical Application Questions, 457
15. The Autonomic Nervous System and Visceral Sensory Neurons, 458
Introduction to the Autonomic Nervous System, 460
Comparison of the Autonomic and Somatic Motor Systems, 460
Divisions of the Autonomic Nervous System, 460
Clinical Applications: Autonomic neuropathy, 461
The Parasympathetic Division, 462
Cranial Outflow, 463
Outflow Via the Oculomotor Nerve (III), 463
Outflow via the Facial Nerve (VII), 463
Outflow via the Glossopharyngeal Nerve (IX), 463
Outflow via the Vagus Nerve (X), 464
Sacral Outflow, 464
The Sympathetic Division, 465
Basic Organization, 465
Sympathetic Trunk Ganglia, 467
Collateral Ganglia, 467
Sympathetic Pathways, 467
Sympathetic Pathways to the Body Periphery, 468
Sympathetic Pathways to the Head, 468
Clinical Applications: Horner’s syndrome, 468
Sympathetic Pathways to the Thoracic Organs, 469
Sympathetic Pathways to the Abdominal Organs, 469
Sympathetic Pathways to the Pelvic Organs, 469
The Role of the Adrenal Medulla in the Sympathetic Division, 471
Clinical Applications: Stress-induced hypertension, 472
Visceral Sensory Neurons, 472
Visceral Reflexes, 473
Central Control of the Autonomic Nervous System, 473
Control by the Brain Stem and Spinal Cord, 473
Control by the Hypothalamus and Amygdala, 474
Control by the Cerebral Cortex, 474
Disorders of the Autonomic Nervous System, 474
The Autonomic Nervous System Throughout Life, 474
Related Clinical Terms, 475
Chapter Summary, 475
Review Questions, 477
Critical Reasoning and Clinical Application Questions, 478
16. The Special Senses, 479
The Chemical Senses: Taste and Smell, 480
Taste (Gustation), 481
Taste Buds, 481
Taste Sensations and the Gustatory Pathway, 481
Smell (Olfaction), 481
Disorders of the Chemical Senses, 483
Embryonic Development of the Chemical Senses, 483
The Eye and Vision, 483
Accessory Structures of the Eye, 483
Eyebrows, 483
Eyelids, 483
Conjunctiva, 484
Lacrimal Apparatus, 484
Extrinsic Eye Muscles, 484
Clinical Applications: Strabismus, 485
Anatomy of the Eyeball, 485
The Fibrous Layer, 486
Clinical Applications: Corneal transplants, 487
The Vascular Layer, 487
The Inner Layer, 488
Photoreceptors, 489
Regional Specializations of the Retina, 490
Blood Supply of the Retina, 490
Clinical Applications: Detached retina, 490
Internal Chambers and Fluids, 491
Clinical Applications: Glaucoma, 491
The Lens, 491
Clinical Applications: Cataract, 492
The Eye as an Optical Device, 492
Visual Pathways, 493
Visual Pathway to the Cerebral Cortex, 493
A Closer Look: Eye-Focusing Disorders, 494
Visual Pathways to Other Parts of the Brain, 496
Disorders of the Eye and Vision, 496
Embryonic Development of the Eye, 496
The Ear: Hearing and Equilibrium, 496
The External Ear, 496
Clinical Applications: Perforated eardrum, 497
The Middle Ear, 498
Clinical Applications: Middle ear infections, 499
Clinical Applications: Otosclerosis, 499
The Internal Ear, 500
The Cochlea, 500
The Vestibule, 502
The Semicircular Canals, 503
Auditory and Equilibrium Pathways, 505
Disorders of Equilibrium and Hearing, 506
Motion Sickness, 506
Ménière’s Syndrome, 506
Deafness, 506
Embryonic Development of the Ear, 506
The Special Senses Throughout Life, 506
Related Clinical Terms, 508
Chapter Summary, 508
Review Questions, 510
Critical Reasoning and Clinical Application Questions, 511
17. Blood, 512
Overview: Composition of Blood, 513
Blood Plasma, 513
Clinical Applications: Hemochromatosis, 514
Formed Elements, 514
Erythrocytes, 514
Clinical Applications: Thalassemia, 515
Leukocytes, 515
Granulocytes, 516
Neutrophils, 516
Eosinophils, 517
Basophils, 517
Agranulocytes, 517
Lymphocytes, 517
Monocytes, 517
Clinical Applications: Complete blood count, 518
Platelets, 519
Clinical Applications: Thrombus, 519
Blood Cell Formation, 519
Bone Marrow as the Site of Hematopoiesis, 520
Cell Lines in Blood Cell Formation, 521
Genesis of Erythrocytes, 521
Formation of Leukocytes and Platelets, 521
Disorders of the Blood, 523
Disorders of Erythrocytes, 523
Disorders of Leukocytes, 523
Disorders of Platelets, 523
A Closer Look: Transplants of Bone Marrow and Cord Blood, 524
The Blood Throughout Life, 525
Related Clinical Terms, 525
Chapter Summary, 525
Review Questions, 526
Critical Reasoning and Clinical Application Questions, 527
18. The Heart, 528
Location and Orientation within the Thorax, 529
Structure of the Heart, 531
Coverings, 531
Clinical Applications: Pericarditis and cardiac tamponade, 531
Layers of the Heart Wall, 532
Heart Chambers, 532
Right Atrium, 532
Right Ventricle, 532
Left Atrium, 533
Left Ventricle, 536
Pathway of Blood Through the Heart, 536
Heart Valves, 537
Valve Structure, 537
Valve Function, 537
Heart Sounds, 540
Cardiac Muscle Tissue, 540
Clinical Applications: Valve disorders, 540
Conducting System and Innervation, 542
Conducting System, 542
Clinical Applications: Damage to the conducting system, 543
Innervation, 544
Blood Supply to the Heart, 544
Disorders of the Heart, 545
Coronary Artery Disease, 545
Heart Failure, 545
A Closer Look: Coronary Artery Disease, 546
Disorders of the Conduction System, 548
The Heart Throughout Life, 548
Development of the Heart, 548
The Heart in Adulthood and Old Age, 550
Related Clinical Terms, 551
Chapter Summary, 551
Review Questions, 553
Critical Reasoning and Clinical Application Questions, 554
19. Blood Vessels, 555
Part 1: General Characteristics of Blood Vessels, 556
Structure of Blood Vessel Walls, 556
Types of Blood Vessels, 556
Arteries, 557
Elastic Arteries, 557
Muscular Arteries, 558
Arterioles, 559
Capillaries, 559
Capillary Beds, 559
Capillary Permeability, 560
Routes of Capillary Permeability, 560
Low-Permeability Capillaries: The Blood-Brain Barrier, 561
Sinusoids, 561
Veins, 561
Clinical Applications: Varicose veins, 562
Vascular Anastomoses, 562
Vasa Vasorum, 562
Part 2: Blood Vessels of the Body, 562
The Pulmonary Circulation, 563
The Systemic Circulation, 563
Systemic Arteries, 565
Aorta, 565
Ascending Aorta, 565
Aortic Arch, 565
Descending Aorta, 566
Arteries of the Head and Neck, 566
Common Carotid Arteries, 566
Vertebral Arteries, 566
Thyrocervical and Costocervical Trunks, 568
Arteries of the Upper Limb, 568
Axillary Artery, 568
Brachial Artery, 569
Radial Artery, 569
Ulnar Artery, 569
Palmar Arches, 569
Arteries of the Thorax, 569
Arteries of the Thoracic Wall, 569
Arteries of the Thoracic Visceral Organs, 569
Arteries of the Abdomen, 569
Inferior Phrenic Arteries, 569
Celiac Trunk, 570
Superior Mesenteric Artery, 570
Suprarenal Arteries, 571
Renal Arteries, 571
Gonadal Arteries, 571
Inferior Mesenteric Artery, 571
Lumbar Arteries, 571
Median Sacral Artery, 571
Common Iliac Arteries, 571
Arteries of the Pelvis and Lower Limbs, 572
Internal Iliac Arteries, 572
External Iliac Artery, 572
Femoral Artery, 572
Popliteal Artery, 573
Anterior Tibial Artery, 573
Posterior Tibial Artery, 574
Systemic Veins, 575
Venae Cavae and Their Major Tributaries, 577
Superior Vena Cava, 577
Inferior Vena Cava, 577
Veins of the Head and Neck, 577
Dural Sinuses, 577
Clinical Applications: Medical importance of the cavernous sinus, 577
Internal Jugular Veins, 578
External Jugular Veins, 578
Vertebral Veins, 578
Veins of the Upper Limbs, 578
Deep Veins, 579
Superficial Veins, 580
Veins of the Thorax, 580
Azygos Vein, 580
Hemiazygos Vein, 580
Accessory Hemiazygos Vein, 580
Veins of the Abdomen, 581
Lumbar Veins, 581
Gonadal (Testicular or Ovarian) Veins, 581
Renal Veins, 581
Suprarenal Veins, 581
Hepatic Veins, 581
Hepatic Portal System, 581
Veins of the Pelvis and Lower Limbs, 582
Deep Veins, 582
Superficial Veins, 582
Clinical Applications: Medical importance of the saphenous veins, 583
Portal-Systemic Anastomoses, 584
Disorders of the Blood Vessels, 584
A Closer Look: Atherosclerosis? Get Out the Cardiovascular Dr̄no, 586
Blood Vessels Throughout Life, 588
Fetal Circulation, 588
Vessels to and from the Placenta, 588
Shunts Away from the Pulmonary Circuit, 588
Blood Vessels in Adulthood, 590
Related Clinical Terms, 590
Chapter Summary, 590
Review Questions, 592
Critical Reasoning and Clinical Application Questions, 593
20. The Lymphatic and Immune Systems, 594
The Lymphatic System, 595
Lymphatic Capillaries, 595
Lymphatic Collecting Vessels, 596
Clinical Applications: The lymph vessels and edema, 597
Lymph Nodes, 597
Clinical Applications: Swollen lymph nodes, 599
Lymph Trunks, 599
Lymph Ducts, 600
The Immune System, 600
Lymphocytes, 600
Lymphocyte Activation, 601
A Closer Look: AIDS: The Modern-Day Plague?, 603
Clinical Applications: Vaccination, 604
Lymphoid Tissue, 605
Lymphoid Organs, 605
Thymus, 606
Lymph Nodes, 606
Spleen, 607
Clinical Applications: Splenectomy, 608
Tonsils, 608
Aggregated Lymphoid Nodules and the Appendix, 608
Disorders of the Lymphatic and Immune Systems, 609
The Lymphatic and Immune Systems Throughout Life, 609
Related Clinical Terms, 610
Chapter Summary, 610
Review Questions, 612
Critical Reasoning and Clinical Application Questions, 612
21. The Respiratory System, 613
Functional Anatomy of the Respiratory System, 614
The Nose and the Paranasal Sinuses, 615
The Nose, 615
The Nasal Cavity, 615
The Respiratory Mucosa, 617
Clinical Applications: Rhinitis, 617
The Nasal Conchae, 617
The Paranasal Sinuses, 618
Clinical Applications: Sinusitis, 618
The Pharynx, 618
The Nasopharynx, 618
Clinical Applications: Infection of the adenoids, 618
The Oropharynx, 618
The Laryngopharynx, 618
The Larynx, 619
Voice Production, 620
Clinical Applications: Laryngitis, 620
Sphincter Functions of the Larynx, 620
Innervation of the Larynx, 621
The Trachea, 621
The Bronchi and Subdivisions: The Bronchial Tree, 622
Bronchi in the Conducting Zone, 622
The Respiratory Zone, 624
The Lungs and Pleurae, 627
The Pleurae, 627
Clinical Applications: Pleurisy and pleural effusion, 629
Gross Anatomy of the Lungs, 629
Blood Supply and Innervation of the Lungs, 630
Ventilation, 630
The Mechanism of Ventilation, 630
Inspiration, 630
Clinical Applications: Collapsed lung, 633
Expiration, 633
Clinical Applications: Respiratory distress syndrome, 633
Neural Control of Ventilation, 634
Disorders of the Respiratory System, 634
Disorders of Lower Respiratory Structures, 634
Bronchial Asthma, 634
Cystic Fibrosis, 635
Chronic Obstructive Pulmonary Disease, 635
Disorders of Upper Respiratory Structures, 636
Epistaxis, 636
Epiglottitis, 636
The Respiratory System Throughout Life, 637
A Closer Look: Lung Cancer: The Facts Behind the Smoke Screen, 638
Related Clinical Terms, 640
Chapter Summary, 640
Review Questions, 642
Critical Reasoning and Clinical Application Questions, 643
22. The Digestive System, 644
Overview of the Digestive System, 645
Digestive Processes, 646
Abdominal Regions and Quadrants, 647
Clinical Applications: Bowel sounds, 648
Anatomy of the Digestive System, 648
Histology of the Alimentary Canal Wall, 648
The Mucosa, 648
The Submucosa, 648
The Muscularis Externa, 648
The Serosa, 648
Smooth Muscle, 649
Innervation of Smooth Muscle and Glands, 651
Nerve Plexuses, 651
The Peritoneal Cavity and Peritoneum, 652
Mesenteries, 652
Clinical Applications: Peritonitis, 654
The Mouth and Associated Organs, 655
The Mouth, 655
Histology of the Mouth, 655
The Lips and Cheeks, 655
The Palate, 655
The Tongue, 656
The Teeth, 656
Dentition and the Dental Formula, 656
Tooth Structure, 657
Clinical Applications: Gum disease, 658
The Salivary Glands, 658
Clinical Applications: Mumps, 659
The Pharynx, 659
Clinical Applications: Hiatal hernia and gastroesophageal reflux disease, 660
The Esophagus, 660
Gross Anatomy, 660
Microscopic Anatomy, 660
The Stomach, 660
Gross Anatomy, 660
Microscopic Anatomy, 662
A Closer Look: Peptic Ulcers, 664
The Small Intestine, 665
Gross Anatomy, 665
Microscopic Anatomy, 666
Modifications for Absorption, 666
Histology of the Wall, 668
The Large Intestine, 668
Gross Anatomy, 668
The Cecum and Vermiform Appendix, 669
Clinical Applications: Appendicitis, 669
The Colon, 670
Rectum, 670
Anal Canal, 670
Clinical Applications: Diverticulosis and diverticulitis, 670
Vessels and Nerves, 671
Defecation, 671
Clinical Applications: Hemorrhoids, 671
Microscopic Anatomy, 672
The Liver, 672
Gross Anatomy, 672
Microscopic Anatomy, 674
Clinical Applications: Cirrhosis, 676
The Gallbladder, 676
Clinical Applications: Gallstones, 677
The Pancreas, 677
Clinical Applications: Pancreatitis, 678
Disorders of the Digestive System, 678
Intestinal Obstruction, 678
Inflammatory Bowel Disease, 678
Viral Hepatitis, 679
Cystic Fibrosis and the Pancreas, 679
The Digestive System Throughout Life, 679
Embryonic Development, 679
Clinical Applications: Developmental abnormalities, 680
The Digestive System in Later Life, 680
Related Clinical Terms, 681
Chapter Summary, 681
Review Questions, 684
Critical Reasoning and Clinical Application Questions, 685
23. The Urinary System, 686
Kidneys, 687
Gross Anatomy of the Kidneys, 687
Location and External Anatomy, 687
Internal Gross Anatomy, 689
Clinical Applications: Pyelonephritis, 690
Gross Vasculature and Nerve Supply, 690
Microscopic Anatomy of the Kidneys, 690
Mechanisms of Urine Production, 691
Uriniferous Tubules, 691
Nephrons, 691
Collecting Ducts, 695
Microscopic Blood Vessels Associated with Uriniferous Tubules, 695
Juxtaglomerular Apparatus, 695
Ureters, 697
Gross Anatomy, 697
Clinical Applications: Pyelography, 697
Microscopic Anatomy, 698
Urinary Bladder, 698
Urethra, 700
Micturition, 701
Clinical Applications: Micturition dysfunctions, 702
Disorders of the Urinary System, 702
Urinary Tract Infections, 702
Renal Calculi, 702
A Closer Look: ADPKD: The Most Interesting Disease You’ve Never Heard Of?, 703
Polycystic Kidney Disease, 703
Cancer of Urinary Organs, 704
Clinical Applications: Kidney transplant, 705
The Urinary System Throughout Life, 705
Related Clinical Terms, 707
Chapter Summary, 707
Review Questions, 709
Critical Reasoning and Clinical Application Questions, 710
24. The Reproductive System, 711
The Male Reproductive System, 712
The Scrotum, 712
The Testes, 713
Gross Anatomy, 713
The Seminiferous Tubules and Spermatogenesis, 714
Clinical Applications: Varicocele, 714
Spermatogenic Cells, 715
Sustentacular Cells, 715
Myoid Cells, 717
Interstitial Cells, 717
The Reproductive Duct System in Males, 717
The Epididymis, 718
The Ductus Deferens, 718
Clinical Applications: Vasectomy, 719
The Spermatic Cord, 719
Clinical Applications: Inguinal hernia, 719
The Urethra, 720
Accessory Glands, 720
The Seminal Vesicles, 720
The Prostate, 721
Clinical Applications: Benign prostatic hyperplasia, 721
The Bulbourethral Glands, 721
The Penis, 722
Clinical Applications: Circumcision, 722
The Male Perineum, 722
The Female Reproductive System, 722
The Ovaries, 723
The Ovarian Cycle, 724
Follicular Phase (First Half of the Ovarian Cycle), 724
Ovulation (Midpoint of the Ovarian Cycle), 726
Luteal Phase (Second Half of the Ovarian Cycle), 726
Oogenesis, 726
The Uterine Tubes, 727
Clinical Applications: Pelvic inflammatory disease, 728
The Uterus, 728
Supports of the Uterus, 729
The Uterine Wall, 729
The Uterine Cycle, 730
A Closer Look: Contraception: To Be or Not To Be, 732
Clinical Applications: Endometriosis, 734
The Vagina, 734
The External Genitalia and Female Perineum, 734
Clinical Applications: Episiotomy, 735
The Mammary Glands, 735
Pregnancy and Childbirth, 736
Pregnancy, 736
Events Leading to Fertilization, 736
Implantation, 738
Formation of the Placenta, 738
Anatomy of the Placenta, 740
Clinical Applications: Displaced placenta, 741
Childbirth, 741
Disorders of the Reproductive System, 742
Reproductive System Cancers in Males, 742
Testicular Cancer, 742
Prostate Cancer, 742
Reproductive System Cancers in Females, 742
Ovarian Cancer, 742
Endometrial Cancer, 743
Cervical Cancer, 743
Breast Cancer, 743
The Reproductive System Throughout Life, 743
Embryonic Development of the Sex Organs, 743
Clinical Applications: Hypospadias, 746
Descent of the Gonads, 746
Clinical Applications: Cryptorchidism, 746
Puberty, 747
Menopause, 747
Related Clinical Terms, 747
Chapter Summary, 748
Review Questions, 750
Critical Reasoning and Clinical Application Questions, 751
25. The Endocrine System, 752
The Endocrine System: An Overview, 753
Endocrine Organs, 753
Hormones, 754
Classes of Hormones, 754
Basic Hormone Action, 754
Control of Hormone Secretion, 754
The Major Endocrine Organs, 755
The Pituitary Gland, 755
The Adenohypophysis, 755
Hypothalamic Control of Hormone Secretion from the Adenohypophysis, 757
The Neurohypophysis, 758
Clinical Application: Therapeutic uses of oxytocin, 759
The Thyroid Gland, 759
The Parathyroid Glands, 759
The Adrenal (Suprarenal) Glands, 760
The Adrenal Medulla, 762
The Adrenal Cortex, 762
Structure of Steroid-Secreting Cells, 763
The Pineal Gland, 763
The Pancreas, 764
The Thymus, 764
The Gonads, 765
Other Endocrine Structures, 765
Disorders of the Endocrine System, 765
Pituitary Disorders, 765
A Closer Look: Potential Uses for Growth Hormone, 766
A Disorder of the Pancreas: Diabetes Mellitus, 767
Disorders of the Thyroid Gland, 767
Disorders of the Adrenal Cortex, 768
The Endocrine System Throughout Life, 768
Related Clinical Terms, 770
Chapter Summary, 770
Review Questions, 772
Critical Reasoning and Clinical Application Questions, 773
Appendix A. The Metric System, 775
Appendix B. Answers to Multiple Choice and Matching Questions, 777
Glossary, 781
Photo and Illustration Credits, 793
Index, 797
End Papers, EP-1
Inside Back Covers, IBC-1

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