Clinical Anatomy - Applied Anatomy for Students and Junior Doctors

501 Pages·2013·29.66 MB·english

by  Harold Ellis

Clinical Anatomy
To my wife, Wendy, and my late parents
H. E.
To my wife, Neila, and my late parents
V. M.
Clinical Anatomy
Applied Anatomy for Students
and Junior Doctors
HAROLD ELLIS
CBE, MA, DM, MCh, FRCS, FRCP, FRCOG, FACS (Hon)
Clinical Anatomist, Guy’s, King’s and St Thomas’ School of Biomedical Sciences;
Emeritus Professor of Surgery, Charing Cross
and Westminster Medical School, London;
Formerly Examiner in Anatomy, Primary FRCS (Eng)
VISHY MAHADEVAN
MBBS, PhD, FRCSEd, FDSRCSEng (Hon), FRCS
Barbers’ Company Professor of Anatomy & Professor of Surgical Anatomy
The Royal College of Surgeons of England
Lincoln’s Inn Fields
London;
Member of the Court of Examiners, RCS England
THIRTEENTH EDITION
This edition first published 2013 © 1960, 1962, 1966, 1969, 1971, 1977, 1977, 1983, 1992, 1992,
2002, 2006, by Harold Ellis; 2010 by Harold Ellis and Vishy Mahadevan; 2013 by John Wiley
& Sons, Ltd
Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West
Sussex, PO19 8SQ, UK
Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
111 River Street, Hoboken, NJ 07030-5774, USA
For details of our global editorial offices, for customer services and for information about
how to apply for permission to reuse the copyright material in this book please see our
website at www.wiley.com/wiley-blackwell
The right of the author to be identified as the author of this work has been asserted in
accordance with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act
1988, without the prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as
trademarks. All brand names and product names used in this book are trade names, service
marks, trademarks or registered trademarks of their respective owners. The publisher is not
associated with any product or vendor mentioned in this book. It is sold on the
understanding that the publisher is not engaged in rendering professional services. If
professional advice or other expert assistance is required, the services of a competent
professional should be sought.
The contents of this work are intended to further general scientific research, understanding,
and discussion only and are not intended and should not be relied upon as recommending or
promoting a specific method, diagnosis, or treatment by health science practitioners for any
particular patient. The publisher and the author make no representations or warranties with
respect to the accuracy or completeness of the contents of this work and specifically disclaim
all warranties, including without limitation any implied warranties of fitness for a particular
purpose. In view of ongoing research, equipment modifications, changes in governmental
regulations, and the constant flow of information relating to the use of medicines, equipment,
and devices, the reader is urged to review and evaluate the information provided in the
package insert or instructions for each medicine, equipment, or device for, among other
things, any changes in the instructions or indication of usage and for added warnings and
precautions. Readers should consult with a specialist where appropriate. The fact that an
organization or Website is referred to in this work as a citation and/or a potential source of
further information does not mean that the author or the publisher endorses the information
the organization or Website may provide or recommendations it may make. Further, readers
should be aware that Internet Websites listed in this work may have changed or disappeared
between when this work was written and when it is read. No warranty may be created or
extended by any promotional statements for this work. Neither the publisher nor the author
shall be liable for any damages arising herefrom.
Library of Congress Cataloging-in-Publication Data
Ellis, Harold, 1926– author.
Clinical anatomy : applied anatomy for students and junior doctors /
Harold Ellis, Vishy Mahadevan. – Thirteenth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-37377-4 (pbk. : alk. paper) – ISBN 978-1-118-37376-7
(ePDF) – ISBN 978-1-118-37375-0 (ePub) – ISBN 978-1-118-37374-3 (Mobi) – ISBN 978-1-118-
37373-6 – ISBN 978-1-118-37372-9
I. Mahadevan, Vishy, author. II. Title.
[DNLM: 1. Anatomy. QS 4]
QM23.2
612–dc23
2013012750
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in
print may not be available in electronic books.
Cover image: The Wellcome Museum of Anatomy and Pathology, Royal College of Surgeons
of England, London
Cover design by Sarah Dickinson
Set in 9/12 pt Palatino by Toppan Best-set Premedia Limited
01 2013
Contents
Preface to the Thirteenth Edition, xiii
Preface to the First Edition, xv
Acknowledgements to the Thirteenth Edition, xvii
Acknowledgements to the First Edition, xix
About the Companion Website, xxi
Part 1: The Thorax
Introduction, 3
Surface anatomy and surface markings, 3
The trachea, 4
The pleura, 4
The lungs, 6
The heart, 6
The thoracic cage, 7
The thoracic vertebrae, 7
The ribs, 8
The costal cartilages, 11
The sternum, 11
The intercostal spaces, 12
The diaphragm, 14
The pleurae, 19
The lower respiratory tract, 20
The trachea, 20
The bronchi, 25
The lungs, 25
The mediastinum, 30
The pericardium, 30
The heart, 31
The superior mediastinum, 46
The thymus, 46
The oesophagus, 47
The thoracic duct, 50
The thoracic sympathetic trunk, 52
On the examination of a chest radiograph, 55
Radiographic appearance of the heart, 56
vi Contents
Part 2: The Abdomen and Pelvis
Surface anatomy and surface markings, 61
Vertebral levels, 61
Surface markings of individual viscera, 63
The fasciae and muscles of the abdominal wall, 64
Fasciae of the abdominal wall, 64
The muscles of the anterior abdominal wall, 65
The anatomy of abdominal incisions, 67
The inguinal canal, 70
Peritoneal cavity, 72
Intraperitoneal fossae, 76
The subphrenic spaces, 76
The gastrointestinal tract, 77
The stomach, 77
The duodenum, 82
Small intestine, 85
Large intestine, 86
The appendix, 87
The rectum, 89
Arterial supply of the intestine, 94
The portal system of veins, 95
Lymph drainage of the intestine, 96
The structure of the alimentary canal, 97
The development of the intestine and its congenital
abnormalities, 98
The gastrointestinal adnexae: liver, gall bladder and its
ducts, pancreas and spleen, 101
The liver, 101
The biliary system, 106
The gall bladder, 107
The pancreas, 110
The spleen, 112
The urinary tract, 114
The kidneys, 114
The ureter, 118
The embryology and congenital abnormalities of the kidney
and ureter, 119
The bladder, 121
The urethra, 124
Contents vii
The male genital organs, 125
The prostate, 125
The scrotum, 128
Testis and epididymis, 129
Vas deferens (ductus deferens), 133
The seminal vesicles, 134
The bony and ligamentous pelvis, 134
The os innominatum, 134
The sacrum, 135
The coccyx, 136
The functions of the pelvis, 136
Joints and ligamentous connections of the pelvis, 137
Differences between the male and female pelvis, 137
Obstetrical pelvic measurements, 138
Variations of the pelvic shape, 139
Sacral (caudal) anaesthesia, 142
The muscles of the pelvic floor and perineum, 143
The anterior (urogenital) perineum, 144
The posterior (anal) perineum, 146
The female genital organs, 147
The vulva, 147
The vagina, 148
The uterus, 150
The Fallopian tubes, 154
The ovary, 156
The endopelvic fascia and the pelvic ligaments, 157
Vaginal examination, 158
Embryology of the Fallopian tubes, uterus and vagina, 159
The posterior abdominal wall, 161
The suprarenal glands, 162
Abdominal aorta, 163
Inferior vena cava, 164
Lumbar sympathetic chain, 166
Computed axial tomography, 167
Part 3: The Upper Limb
Surface anatomy and surface markings of
the upper limb, 171
Bones and joints, 171
Muscles and tendons, 172
viii Contents
Vessels, 172
Nerves, 176
The bones and joints of the upper limb, 177
The scapula, 177
The clavicle, 177
The humerus, 179
The radius and ulna, 180
The bones of the hand, 183
The shoulder joint, 185
The elbow joint, 190
The wrist joint, 193
The joints of the hand, 194
Three important zones of the upper limb: the axilla,
the cubital fossa and the carpal tunnel, 197
The axilla, 197
The cubital fossa, 197
The carpal tunnel, 199
The arteries of the upper limb, 199
The axillary artery, 199
The brachial artery, 200
The radial artery, 200
The ulnar artery, 201
The brachial plexus, 201
The segmental cutaneous supply of the upper limb, 203
The course and distribution of the principal nerves of
the upper limb, 205
The axillary nerve, 205
The radial nerve, 205
The musculocutaneous nerve, 206
The ulnar nerve, 207
The median nerve, 208
Compartments of the upper limb, 209
Compartments in the segments of the upper limb, 209
Compartment syndrome, 210
The female breast, 210
Structure, 210
Blood supply, 211
Lymphatic drainage, 211
Development, 213