Parts: the head, body, tail. Ⅱ. The Duct

Ⅱ. The Duct: The pancreatic duct joints the common bile duct ot form the hepatopancreatic ampulla and opens into the major duodenal papulla.

Ⅲ. The Function The pancreas produce both exocrine and endocrine secretions. The exocrine fluid of pancreas are drain into duodenum by the series bile ducts. The Islets of Langerhans in the pancreas secrete insuline which control blood sugar in the body.

The respiratory system includes the respiratory tract and lungs. And the respiratory tract composed of the nose, pharynx, larynx, trachea and main bronchi.

Section 1 The Nose

The nose is not only the first part of the respiratory tract but also an organ of smell and phonation.

External nose-apex, dorsum, root, narse. wings

Ⅰ. The Nose left and right cavity

Nasal cavity nasal septum

four walls

Roof: nasal bone and ethmoid bone

Floor: roof of the mouth

Ⅱ. The Walls

Medial wall: nasal septum

Lateral wall: sup. , mid., jinf., concha, meatus

Ⅲ. The Paranasal Sinus: 4 pairs paranasal sinuses.

lie in the frontal bone.

1. The Frontal Sinuses

open into the middle nasal meatus.

lie in the maxillary bone.

2. The Maxillary Sinuses

open into the middle nasal meatus.

within the ethmoid bone.

3. The Ethmoidal Sinuses ant. mid. groups open into the mid. nasal meatus.

post. group opens into the sup. nasal meatus

lie in the sphenoid bone.

4. The Sphenoidal Sinuses

open into the sphenoethmoidal recess.

Section 2 The Pharynx and Larynx

The pharynx has already been discussed within the digestive system.

The larynx consists of the cartilages, joints, ligament and the muscles. It lies in the neck region in front of the C5,6 vertebrae and the laryngopharynx.

Ⅰ. The Position Changes with Age

1. In adult: Above, near the hyoid bone and root of the tongue.

Below, at the level of C6 vertebra.

2. In child and female: higher position.

Ⅱ. The Laryngeal Prominence-a median elevation

The thyroid notch-at the upper border of the thyroid cartilage.

Vestibule

vestibular folds, slit

Intermediate cavity

Ⅲ. Cavity of Larynx

Of larynx

vocal foldes, slit of glottidis

Infraglottic cavity

Section 3 The Trachea and Bronchi

The trachea is located in the midline of the neck and upper thorax, and in front of the esophagus. It extends from the lower border of the cricoid cartilage at the level of 6^th cervical vertebra to the level of the sternal angle, where it divides into the right and left main bronchi.

In child the trachea is smaller, deeper in position, and more movable than that in adult.

Tracheal cartilage

Smooth muscle

Ⅰ. The Composition of Trachea Connective tissue

Mucous membrane 14-16 C-shaped

ring of cartilage

Right main bronchus: shoter, wider, more vertical

Ⅱ. The Bronchi than the left one.

Section 4 The Lungs

The lungs are the essential organs of the respiration. There are two lungs within the thoracic cavity. Each lung is situated on the each side of thorax, and separated from each other by the heart, other contents of the mediastinum.

Ⅰ. The Features

1. Right lung is shorter, wider than the left.

2. Each lung is conical, has an apex, a base, two surfaces, three borders.

3. Hilus of lung: root of lung-bronchi, pulmonary artery and veins, bronchial vessels, lymphatics and lymph modes.

Ⅱ. The Lobes of the Lung

1. Horizontal fissure 1. Upper lobe

2. Oblique fissure 2. Lower lobe

3. Superior lobe 3. Lingulum

4. Middle lobe 4. Oblique fissure

5. Inferior lobe

The pleura is thin serous membrane which lies the inner surface of the thorax and the surface of the lungs.

Ⅰ. The Parts

1. Visceral pleura: cover the lungs and fissures of lung

2. Parietal pleura Diaphragmatic pleura

Mediastinal pleura

Cupula of pleura

Ⅱ. Pleural Cavity and Recesse

1. Pleural cavity: two cavities separated

2. Costal diaphragmatic recess

3. Costal mediastinal recess

Ⅲ. The Projection of Margin of the Lungs and Pleura

Midclavicular line Midaxillary line Post. median line

Inf. margin of lung 6th rib 8th rib at the level of spinal process of T10 costodiaphragmatic 8th rib 10th rib at the level of spinal line of reflexion of pleura

Chapter 4 The Urinary System

The urinary system includes two kidneys, two uriters, a urinary bladder and a urethra. Many waste materials which are produced in living body, such as urea and uric acid, excess water and some inorganic salts are excreted by this system. Also it can regulate the composition of the internal environment of the body. Of course, the system is important to remain the water contents, osmotic relations, and acid-base balance, in addition, the kidney has the endocrine function.

Section 1 The Kidneys

Ⅰ. The Location

1. On the posterior abdominal wall on both side of vertebral column.

2. The distance between the inferior extremities is longer than that of the superior extremities.

3. The superior extremity of the left kidney is at the level of the inferior border of the body of the T11 vertebra, and the inferior extremity of the left kidney is at the level of the body L2 vertebra.

4. The right kidney is lower half vertebra than the left one.

5. The renal hilus is at the level of the first lumbar vertebra.

Ⅱ. The Features

1. Bean-shaped

2. Med. and lat. border, ant. and post. surface, sup. and inf. extremity.

3. Renal hilus is on the medial border

4. Renal pedicle (Calyces, Renal A. V. N. L., Adipose tissue)

5. Left kidney is slender, right kidney is shorter and broader.

Ⅲ. The Structure

1. Cortex: Renal column

2. Medulla: Renal pyramids, Renal papulla, Foramina of papullae, Minor calyces, Major calyces, Renal pelvis.

Ⅳ. The Covering of the Kidneys

1. Fibrous capsule: Connective tissue fibre.

2. Adipose capsule: Adipose tissue layer.

3. Renal fascia: Two thin fascial membrane closely cover the kidney.

Section 2 The Ureters

The ureters are consist of two hollow muscular tubes which arises from the renal pelvis to the urinary bladder. They are divided into three parts according to their course.

Ⅰ. The Parts

1. Abdominal part lies in front of psous muscle and behind the paritonium.

At the superior aperture of the lesser pelvis the left ureter passes through the terminal part of the common iliac artery anteriorly, and the right ureter passes through the beginning of the right external iliac artery anteriorly, to continue with the pelvic part.

2. Pelvic part passes downwards along the lateral wall of the lesser pelvis, then turns medially at the level of the ischial spine to the base of the urinary bladder. Here the deferent ducts crosses it anteriorly to its medial side.

In the female the pelvic part of ureter turns downwards, forwards and medially. At the level of the ischial spine, 2cm lateral to the cervis of uterus, ti is crossed anteriorly by the uterine vessels.

3. Intramural part passes obliquely through the wall of the urinary bladder, which opens superolateral angle of the trigone of the bladder.

Ⅱ. The Constricted Part (Narrow Part):

1. At the junction of the ureter and renal pelvis.

2. At the point where ureter crosses the superior aperture of the lesser pelvis.

3. At the intramural part.

Section 3 The Urinary Bladder

The urinary bladder is a hollow, muscular organ which stores the urine. It varies in size, shape, position and relations according to the amount of urine that it contains. The volume of urinary bladder is quite difference with the age.

Ⅰ. The Feature

1. Four parts: Apex, Base, Body, Neck.

2. Four surfaces: Superior, Right and Left Lateral, Psoterior (Base).

Ⅱ. The Trigone of the Bladder It is a smooth triangular area on the base of the bladder. The right and left orifice of ureter are at the each lateral angle of the trigone. The interuteteric ridge is between the right and left orifice of ureter, which is the landmark to find the orifice of the ureter when the inner side of urinary bladder is examined by the cystoscope in the living body.

Ⅲ. The Position

At birth, the urinary bladder lies at he relatively higher level.

Inadult, it is entirely within the lesser pelvis. While it is descended expanding upwards and forwards into the abdominal cavity. In this case, the peritoneum is lifted away from the lower part of the anterior abdominal wall, and the reflection there fore becomes higher. So that the pucture and some operation on the bladder can be performed just above the symphsis pubis without injuring the peritoneum.

Section 4 The Urethra

The urethra extends from the urinary bladder to the body surface. It is very different in male and female.

Ⅰ. The Female: Narrow membrane canal, about 4cm long.

External orifice in the vestivule, and at the anterior to the vaginal opening.

Ⅱ. The Male: The urethra will be discussed in the male reproductive system.

The male reproductive system includes the internal and external genital organs. The internal genital organs are composed of the testis, ducts and the accessory gland. And the external genital organs consist of the scrotum and penis.

Ⅰ. The Internal Genital Organs

Ⅰ）The Testis are located in the scrotum.

They are paired oval-shaped organs. Each testis has the superior and inferior extremities. The lateral and medial surfaces, and anterior and posterior borders. The anterior border is free, and the posterior border is mesorchial border which is connected with the epididymis and attached by the misorchium. The blood vessels, nerves and the lymphatics pass through this border to enter of leave the testis.

Ⅱ）The Series of Duct

1. The Epididymis It lies the superior extremity and the posterolateral surface of the testis.

A comma-shaped

The head----superior enlarged portion

The Features The body----posterior portion

The tail----inferior portion

2. The Deferent Ducts It is the continuation of the epididymis duct. It can be divided into four parts: the testicular part, funicular past, inquinal part and the pelvic part.

The special notes: The vasectomy is performed at the funicular part. The terminal portion of the deferent duct is dilated, which termed the ampulla of the deferent duct. Here its end is narrow and joins the duct of the seminal vesicle to form the ejaculatory duct.

3. The Urethra From the internal orifice in the urinary bladder to the external opening at the end of the penis.

Prostatic part: urinary crest, seminal colliculu.

3 Parts Membranous part: shortest and narrowest part within urogenital diaphragm.

Spongy part: bulb of urethral orifice

at the internal urethral orifice

3 Narrow Part at the membranous part of urethra

at the external urethral orifice

at the prostatic part

3 Dilations at the bulb of urethra

at the navicular fossa

prepubic curvature

2 Curvatures

infrapubic curvature

Seminal vesicle

Ⅲ. The Accessory Glands Prostatic gland

Bulbourethral gland

1. The seminal vesicles are located the posterior to the base of the urinary bladder, lateral to the ampulla of deferent duct, in front of the rectum. Its excretory duct joins with terminal part of deferent duct to form the ejaculatory duct.

2. The prostate which lies in the lesser pelvic cavity, below the urinary bladder and around the superior part of the urethra, and is infront of the rectum.

The features of prostate:

①Chestnut-shaped

②The base----broad superior extremity.

③The apex----inferior extremity rests on the urogenital diaphragm.

④The prostic sulcus----lies the midline of the posterior surface.

⑤The five lobes----ant. and post. lobes, median lobe, and two lateral lobes.

3. The bulbourethral glands lie in the deep transverse muscle of perineum, and opens into the upper part of the spongy part of the urethra.

The female reproductive system includes the internal genital organs and the external organs.

I. The internal genital organs which lies in the pelvic cavity , and consist of the ovaries, conveying ducts, uterus and vagina.

I）The Ovaries

1. The position they lie in the ovarian fossa which is between the bifurcation of the internal and external iliac arteries on the lateral wall of the lesser pelvic cavity.

2. The features:

①Oval-shaped organ

②Med. and lat. surfaces; ant. and post. borders; sup. and inf. extremities.

③Sup extremity is termed the tubal extremity, and inf. one is called the uterine extremity.

④Post. Border is free, and ant. border is attached to the post .surface of the broad ligament by the mesorarium.

⑤The hilus of ovary is at the middle part of the anterior border.

⑥The size and the surface are much different between the childhood and adult.

3. The fixation The ovaries are maintained in the position by the ligaments.

①Suspensory ligament of ovary-ovarian vessels and ovarian plexus of nerves is in it.

②Proper ligament of ovary-rounded cord.

II）The Convey Ducts-The Uterine Tubes

1. The position : they are situated on the upper margins of the broad ligament of the uterus,

2. The parts: Infundibulum, ampulla, isthmus, uterine part.

III）The Uterus

1. The position It lies in the lesser pelvis between the urinary bladder and the rectum.

2. The features: In the adults, the uterus is shaped like an inverted pear and flatted from the front to backwords. There are following structures in the uterus: fundus, body, isthmus, cervix, cervical canal, uterine ostium, and lumen.

3. Supports of the uterus

①Muscles of the pelvic floor, neighbouring organs, and connective tissue.

②Broad ligament.

③Round ligament of uterus

④Cardinal ligament

⑤Sacro-uterne ligament.

4. Special notes:

The version angle of the uterus refers to the angle with which the cervix meets the vagina. The normal position is titled anteriorly.

The Flexion Angle of the uterus refers to the angle with which the body of the uterus meets the cervix. The normal position is titled anteriorly or anteflexed.

The structure in broad ligament of the uterus: uterine tube, ovary, proper ligament of ovary, round ligament of uterus, blood vessels，lymphatics and connective tissue.

IV）The Vagina

1. Position Anteriorly the bladder urethra

Posteriorly the rectum, anal canal

2. Features The upper end of vagina----fornix

The posterior of fornix----posterior fornis

Special notes The wall of the posterior fornix is only thin wall part of vagina and layer of peritoneum, which is between the fornix and rectouterine pouch, the drainage may be performed through the posterior fornix.

II. The External Reproductive Organs

1. Mons pubis----fat pad

2. Labia majora

3. Labia minora

4. Anterior commissure

5. Posterior commissure

6. Clitoris

7. Vaginal orifice

8. Hymen

10. Vaginal vestibule

11. Greater vestibuler gland

Ⅳ. The Mamma in Female

1. The location

①Vertically the anterolateral of thorax,3^rd-7^th ribs

②Transversely from the parastrnal line to the midaxillary line

③The nipple is on the centre of the mamma and commonly lies at the level of the 4^th intercostals space.

2. The features In the young adult female

①Each mamma forms a round eminence lying within the superficial fascia

②The nipple is on the centre of the mamma, which has orifices of 15—20 lactiferous ducts.

③The base of the nipple is encircled by a pigment area of the skin called the areola of mamma.

3. The structures

①Mammary gland and adipose tissue

②Each mammary gland--15-20 lobes→excretery ducts→lactiferous ducts→lactiferous sinus→opens on the nipple.

③The Cooper ligament.

V. The Perineum

The perineum is the diamond-shaped region of the outlet of the pelvis, which include all soft tissue between the symphysis pubs and the coccyx.

The perineum may be divided into the anterior urogenital triangle and the posterior anal triangle.

In the clinic the perineum is the soft tissue between the anus and external genital organs.

And in the female the region between the vagina and anus is known as the obstetrical perineum.

The pelvic diaphragm: the levator ani; coccygeal muscle; and superior and inferior fasciae of the pelvic diaphragm.

I.The Concept

1. The peritoneum is the serous membrane in the abdominal cavity and partly also in THD pelvic cavity, which lies on the surfaces of the visceral organs and the wall of the abdominal and pelvic cavity.

2. The parietal peritoneum lies on the walls of the abdominal and pelvic cavity.

3. The Visceral peritoneum lies the surface of the visceral organs.

4. The peritoneal cavity: The parietal and visceral layers of the peritoneum are in actual contact continued .The potential space between them is the peritoneal cavity.

5. The communications in the male, the peritoneal cavity is closed. In the female, it communicates with the external indirectely through the uterine tubes, uterus, and vagina.

Ⅱ. The Relationship between Viscera and Peritoneum

1. The intraperitoneal viscera

2. The interperitoneal viscera

3. The retroperitoneal viscera such as kidney, ureters, supernal gland , pancreas , middle part of the rectum , the descending and inferior parts of the duodenum.

Ⅲ. The Peritoneal Reflections: The lesser omentum and the greater omentum.

1. The lesser omentum extends from the liver to the stomach and the duodenum, which include the hepatogastric ligament and hepatoduodenal ligament.

2. The epiploic foramen lies the posterior to the free margin of the hepatoduodenal ligament. It is only a passage from the epiploic bursa to the peritoneal cavity.

3. The greater omentum is the largest peritoneal fold. It is made up of four layers which extend between the stomach, duodenum and the transverse colon.

4. The gastrocolic ligament extends between the stomach and the transverse colon.

5. Omental barsa is a flattened narrow space behind the lesser omentum and the stomach.

IV.The mesenteries it is usually double layers fold of the peritoneum, which fix the organs, such as jejunum, ilium, to the posterior abdominal wall.

1. The mesenterium the root of mesentery is attached to the posterior wall of the abdomen, which is directly obliquely downwards from the duodenojejunal flexure to the upper part of the right sacro-iliac joint.

2. The mesoappendix

3. The mesocolon transversum

4. The mesocolon sigmoideum

V.The Ligaments

1. The ligaments of the liver

①Falciform ligament

②Coronary ligament

③Right and left triangular ligament

④Round ligament of the liver

⑤lesser omentum hepatogastric lig

hepatoduodenal lig.

2. The ligaments of the stomach

①Gastrohepatic ligament.

②Gastrosplenic ligament

③Gastrocolic ligament

④Gastrophrenic ligament

3. The ligaments of the spleen

①Gastrosplenic ligament

②Lienorenal ligament

③Lienophrenic ligament

4. The structures in the hepatoduodenal lig.

①Hepatic proper artery

②Portal vein

③Bile duct

④Lymph vessels and nodes

⑤Hepatic plexus of nerves

VI.The Pouches and Recesses

1. The pouches in the lesser pelvis, the peritoneum drips downwards to from the large fossa termed the pouch. In the male, the rectovesical pouch lies between the rectum and urinary bladder. In the female, the rectouterine pouch is located between the rectum and the uterine, and the vesicouterine pouch is formed between the anteroinferior surface of the uterus and the posterior surface of the urinary bladder.

2. The Recesses: Duodenojejunal recesses, retrocaecal recesses, and the intersigmoid recess.

(Liu zhi-yu）