(BQ) Part 1 book Color atlas of human anatomy Vol.2 - Internal organs presents the following contents: Cardiovascular system (overview, heart, heart, lymphaticsystem, arterialsystem,...), respiratory system (overview, nose, larynx, mediastinum,...), alimentary system (overview, topographical anatomy i, abdominal cavity, large intestine,...).
H.Fritsch W.Kuehnel 5th edition !olume lnternal Organs Ielga Fritsch, MD rofessor lead of Department of Anatomy, Histology, and Embryology iivision of Clinical and Functional Anatomy ~edical University of Innsbruck rnsbruck Austria 'Volfgang Kuehnel, MD lonorary Doctor rofessor ormer Head of the Institute of Anatomy fniversity of Lubeck ubeck, Germany th edition 94 color plates lustrations by Professor Gerhard Spitzer hierne tuttgart New York !!!!!:!=- :!;~::::!!:!!~ A sound understanding of the structure and function of the human body in all of its intricacies is the foundation of a complete medical education This classic work-now enhanced with many new and improved drawings-makes the task of mastering this vast body of information easier and less daunting with its many user-friendly features: ~ ~ ~ • Hundreds of outstanding full-color illustrations Clear organization according to anatomical system Abundant clinical tips Side-by-side images and explanatory text elpful color-coding and consistent formatting throughout ~ Durable, compact design, fits in your pocket ~ Useful references and suggestions for further reading Emphasizing clinical anatomy, the text integrates current information from an array of medical disciplines into the discussion of the inner organs, including: ~ Cross-sectional anatomy as a basis for working with modern imaging modalities ~ Detailed explanations of organ topography and function ~ Physiological and biochemical information included where appropriate ~ An entire chapter devoted to pregnancy and human development Volume Contents Overview: Cardiovascular System, Respiratory System, Alimentary System, Urinary System, Male Genital System, Female Genital System, Pregnancy and Human Development, Endocrine System, Blood and Lymphatic Systems, Integument Volume 2: Internal Organs and its companions Volume 1: Locomotor System and Volume 3: Nervous System and Sensory Organs comprise a must-have resource for students of medicine, dentistry, and all allied health fields Rest of World The Americas ISBN978·3·13·533405·9 ISBN 978·1·58890·097·5 911~1111Illll~ll~ ~~~IJIIII www.thieme.com 911~Ill111l1l1111JIJ11 ~IIIJII IV Library of Congress Cotaloging-in-Publication Data Fritsch, H (Helga), 1957Color atlas of human anatomy Volume 2, Internal organs/Helga Fritsch, Wolfgang Kuehnel 5th ed p.;cm Includes bibliographical references and index ISBN 978-3-13-533405-9 (alk paper) ISBN 978-1-58890-097-5 (alk paper) Human anatomy Atlases I Kuhnel, Wolfgang, 1934-11 Title III Title: Internal organs [DNLM: Anatomy Atlases QS 17 F919c 20071 QM25.F742007 611.022'2 dc22 This book is an authorized and revised translation of the 9th German edition published and copyrighted 2005 by Georg Thieme Verlag, Stuttgart, Germany Title of the German edition: Taschenatlas Anatomie, Band 2: Innere Organe Translated by Stephanie Kramer, Berlin, Germany Illustrated by Professor Gerhard Spitzer, Frankfurt, Germany, with the cooperation of Stephan Spitzer 1st German edition 1976 2nd German edition 1978 3rd German edition 1979 4th German edition 1982 5th German edition 1986 6th German edition 1991 7th German edition 2001 8th German edition 2003 1st English edition 1978 2nd English edition 1984 3rd Englishedition 1986 4th Englishedition 1993 1st Dutch edition 1978 2nd Dutch edition 1981 3rd Dutch edition 1990 4th Dutch edition 2001 1st French edition 1979 2nd French edition 1993 ist Greek edition 1985 1st Hungarian edition 1996 1st Indonesian edition 1983 Ist Italian edition 1979 2nd Italian edition 1987 3rd Italian edition 2001 Ist japanese edition 1979 2nd japanese edition 1981 3rd japanese edition 1984 4th japanese edition 1990 Ist Polish edition 1998 Ist Serbo-Croatian edition 1991 1st Spanish edition 1997 2nd Spanish edition 1998 1st Turkish edition 1987 Important note: Medicine is an ever-changing science undergoing continual development Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book Every user is requested to examine carefully the manufacturers' leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book Such examination is particularly important with drugs that are either rarely used or have been newly released on the market Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain © 2008 Georg Thieme Verlag, Rudigerstrasse 14,70469 Stuttgart, Germany http://www.thieme.de Thieme New York, 333 Seventh Avenue, New York, NY WOOl, USA http://www.thieme.com Cover design: Thieme Publishing Group Typesetting by Druckhaus Gbtz, Ludwigsburg, Germany Printed in Germany by APPL aprinta druck, Wemding, Germany ISBN 978-3-13-533405-9 (TPS, Rest of World) ISBN 978-3-58890-097-5 (TPN, The Americas) 123456 This book, including all parts thereof is legally protected by copyright Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher's consent, is illegal and liable to prosecution This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage v Preface Consistent with previous editions of the pocket volume, written by Professor Dr Helmut Leonhardt, the revised atlas, under new authorship since 2001, retains the original work's emphasis on the use of illustrations and images Modern imaging technologies allow the depiction of internal organ systems in a multitude of ways, making thorough knowledge of the anatomy of organ systems more crucial than ever for physicians and other healthcare practitioners Current medical training needs to acknowledge and stay abreast of these changes In addition, new teaching methods in medicine, especially integrated and interactive forms of teaching, require a combination of interdisciplinary thinking and systematic structure It was our aim in refining this atlas to take all of these factors into consideration while still maintaining its concise format Each individual organ is presented in a brief overview, followed by a systematic discussion of its gross and microscopic anatomic features This is followed by descriptions of functional aspects, neurovascular supply, and lymphatic drainage Organspecific topographical features are then presented as well as useful tips for the clinician; relevant cross-sectional anatomy is described when, in addition to organ systems, knowledge of general regional topography should be known A new chapter, "Pregnancy and Human Development," has been added to the present book, now in its fifth edition This chap- ter integrates knowledge of anatomy, histology, embryology, gynecology, obstetrics, and pediatrics, without losing sight of morphology Not only was it readily incorporated into the fifth edition, it also supports modern interdisciplinary teaching methods of today's curricula This chapter was written with the help of Dr K Hauser (editing), K.Wesker (graphics), and K Baum (graphic design) We are indebted to them as well as to those who assisted with the previous two editions, all of whom understood perfectly how to carry on the work of the "old crew," especially Dr P Kundmiiller and Professor G Spitzer, and how to integrate a newly written chapter by the coauthors into existing text We would especially like to thank Professor A Bergant, Clinic for Gynecology and Obstetrics in lnnsbruck for permission to use the images from pregnancy ultrasounds Not least we would like to thank the secretary at the Institute of Anatomy at the University of Liibeck, R.Jiinsson, for preparing portions of the manuscript and providing a clean copy We hope that the revised and expanded fifth edition will also be well received by medical and dental students and that it will make the challenging field of anatomy of internal organs more accessible We appreciate any comments or suggestions for improvement for future editions Wolfgang Kuehnel Helga Fritsch VI Table of Contents Viscera at a Glance Arrangement Arrangement Cardiovascular by Function by Region • 2 System (H Fritsch) Overview Circulatory System and Lymphatic Vessels Fetal Circulation (A) '''''''''''''' Circulatory Adjustments at Birth (B) Heart """'''''''''''''''''''''''' External Features Chambers of the Heart Cardiac Skeleton " Layers of the Heart Wall '"'''''''' Layers of the Heart Wall Histology and Ultrastructure Heart Valves Vasculature of the Heart Conducting System of the Heart Innervation Pericardium """'''''''''''''''' Position of the Heart and Cardiac Borders Radiographic Anatomy Auscultation Cross-Sectional Anatomy Cross-Sectional Echocardiography Functions ofthe Heart 6 8 10 12 14 18 18 20 22 24 26 28 30 32 34 34 36 40 42 Arterial System 44 Aorta Arteries of the Head and Neck Common Carotid Artery External Carotid Artery Maxillary Artery '''''''''''''''''' Internal Carotid Artery Subclavian Artery Arteries of the Shoulder and Upper Limb Axillary Artery '"'''''''''''''''' Brachial Artery Radial Artery Ulnar Artery 44 46 46 46 48 50 52 54 54 54 56 56 Arteries of the Pelvis and Lower Limb Internal Iliac Artery External Iliac Artery Femoral Artery Popliteal Artery Arteries of the Leg and Foot Vascular Arches of the Feet 58 58 60 60 62 62 64 Venous System 66 Caval System Azygos Vein System Tributaries of the Superior Vena Cava Brachiocephalic Veins Jugular Veins """""""",,,,, Dural Venous Sinuses Veins of the Upper Limb Tributaries of the Inferior Vena Cava Iliac Veins Veins of the Lower Limb 66 66 Lymphatic System 78 Lymphatic Vessels Regional Lymph Nodes of the Head Neck and Arm """""""'"'' Regional Lymph Nodes of the Thorax and Abdomen Regional Lymph Nodes of the Pelvis and Lower Limb Structure and Function of Blood and Lymphatic Vessels Vessel Wall " Regional Variation Structure-Arterial Regional Variation Structure-Venous 68 68 68 70 72 74 74 76 " """." in Vessel Wall Vessels in Vessel Wall Vessels 78 80 82 84 86 86 88 90 Table of Contents Respiratory System (H Fritsch) Overview 93 94 Anatomical Division of the Respiratory System Clinical Division of the Respiratory System Nose 94 94 96 External Nose 96 Nasal Cavity 98 Paranasal Sinuses 102 Openings of Paranasal Sinuses and Nasal Meatuses 104 Posterior Nasal Apertures 106 Nasopharynx 106 Larynx Laryngeal Structures Laryngeal Laryngeal Laryngeal Glottis Alimentary Skeleton Connecting the Cartilages Muscles Cavity 108 108 110 112 114 116 Trachea Trachea and Extrapulmonary Main Bronchi Topography of the Trachea and Larynx Lung Surfaces of the Lung Divisions of the Bronchi and Bronchopulmonary Segments Microscopic Anatomy Conducting Portion Gas-exchanging Portion Vascular System and Innervation Pleura Cross-Sectional Anatomy Mechanics of Breathing Mediastinum Right View of Mediastinum Left View of Mediastinum System (H Fritsch) Overview 118 118 120 122 122 124 126 126 126 128 130 132 134 136 136 138 141 142 General Structure and Functions 142 Oral Cavity 144 General Structure 144 Palate 146 Tongue 148 Muscles of the Tongue 150 Inferior Surface of the Tongue (A) 152 Floor of the Mouth 152 Salivary Glands 154 Microscopic Anatomy of the Salivary Glands 156 Teeth 158 Parts of the Tooth and the Periodontium 160 Deciduous Teeth 162 Eruption of the Primary and Permanent Dentition 162 Development of the Teeth 164 Position of the Teeth in the Dental Arcades 166 Pharynx 168 Organization and General Structure The Act of Swallowing 168 170 Topographical Anatomy I 172 Sectional Anatomy of the Head and Neck Esophagus General Organization and Microscopic Anatomy Topographical Anatomy of the Esophagus and the Posterior Mediastinum : Neurovascular Supply and Lymphatic Drainage Abdominal Cavity General Overview Topography of the Opened Abdominal Cavity Relations of the Parietal Peritoneum 172 176 176 178 180 182 182 184 188 VII VIII Table of Contents Stomach 0 0 0 0 0 0 0 Gross Anatomy Microscopic Anatomy Stomach Neurovascular Supply Lymphatic Drainage Small Intestine Gross Anatomy Structure of the Small Wall Neurovascular Supply Lymphatic Drainage 0 0 0 0 0 0 0000000000000000000 0 0 0 0 0 0 0 of the 0 0 0 0 0 0 0 0 0 0 0 0 0 0 194 0 0 0 0 0 0 0 196 196 Intestinal 0 0 198 and 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Kidney 0 200 0 0 202 0 0 0 0 0 0 0 0 202 0 0 0 0 0 0 0 0 0 206 0 0 0 0 0 208 0 0 0 0 • 0 0 0 •••• 0 0 0 0 0 0 Pancreas 0 0 o ••• 0 0 214 0 0 0 0 218 0 0 0 0 0 0 0 0 0 0 0 218 0 0 0 0 0 0 0 0 0 0 0 220 0 0 0 0 0 • 0 0 •••• 0 0 230 0 0 Topographical Anatomy II 0 0 0 0 0 0 0 0 0 0 222 0 0 0 0 224 0 0 0 0 0 0 0 224 0 0 0 0 0 0 0 226 229 0.0.0000 •• 0 Renal Pelvis and Ureter Urinary Bladder Female Urethra Topography of the Excretory Organs • • 0.0000 •• 0 230 •• 220 ••••••• Excretory Organs 000 Sectional Anatomy of the Upper Abdomen Sectional Anatomy of the Upper and Lower Abdomen 0000000000000000000000000000000000000 0 0 0 0 0 0 0 0 0 240 0 0 242 000000000000.000000 000000000000 •••• Gross Anatomy Microscopic Anatomy Topography of the Kidneys 00232 0000000000000000000 232 0 • 0 •• 0 Testis and Epididymis 0 Gross Anatomy Microscopic Anatomy 0 0 0 0 • • 0 0 0 0" 0 0 0 0 •• 0000000000000000000000000 0 0 0 ••• 0 0 0 0 250 0 250 252 0 0 Ductus Deferens (Vas Deferens) Seminal Vesicles Prostate 0 0 •• 256 o 256 000000000000000000 0 0 0 0 0 0 • •• 248 0000000000000 • 0 244 238 248 Seminal Ducts and Accessory Sex Glands 0 00000000 0000000000 •• 234 Male Genital System (Ho Fritsch) Overview Male Reproductive Organs 240 244 000000000000000000000000 0000000000000 214 216 Gross and Microscopic Anatomy Topography of the Omental Bursa and Pancreas 212 212 0000000000000 0 Overview Organization and Position of the Urinary Organs 0 Urinary System (H Fritsch) 0 00000000000.0000000 0 Segments of the Large Intestine: Overview Colon Segments Rectum and Anal Canal 000000000000000 Gross Anatomy Liver Segments Microscopic Anatomy Portal Vein System (C) Bile Ducts and Gallbladder Gallbladder 000000000000 00000000000000000000000000000 192 and Liver 0000000000 0000000000000000000 Large Intestine 190 190 •••• 258 0 258 0 0 0 0 Male External Genitalia Penis Male Urethra 000 •• 00 •• 0 0 0 00000000 0 0 •••• 0000000000000 0 0 0 0 0260 •••• Topographical Anatomy Sectional Anatomy 247 000000000000 00000 0 0 o • 0000 260 262 • 0 0 264 • 0 0 264 Table of Contents 'ernale Genital System lverview [H Fritsch) 00000000000000000000000000000000000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 268 Female Reproductive Organs lvary and Uterine Tubes 0 0 0 268 0 0 0 0 0 270 Gross Anatomy of the Ovary 0 0 0 Microscopic Anatomy of the Ovary 0000000000000000000000000000 Follicular Maturation 0 0 0 0 0 0 Gross Anatomy of the Uterine Tube 00000000000000000000000000000 Microscopic Anatomy of the Uterine Tube 000000000000000000000 o Jterus 00000000000000 Gross Anatomy 'regnancy 0000 'regnancy (w Kuehnel) 0 •••• 274 274 0 000 276 Development 00 •••.•••.•• ••• ertilization 270 272 larly Development 'lacenta •• •.• 0 ••• ••• o ••.•• 0 0 • 0 0 • and Contraception ••••• ••• lirth (Parturition) Dilation Stage Expulsion Stage ndocrine System ;lands ••.• Gross Anatomy Topographical 282 282 o' Anatomy ••.••••••• 286 Sectional Anatomy •• • ••.•••• 286 Comparative Anatomy of the Female and Male Pelves 288 Soft Tissue Closure of the Pelvis 294 Human Development 294 Overview 296 Prenatal o 298 0 •• • 300 ••• •• •• • 302 •••.•••••••.• 304 ••••.•••.••••• ••.•• • o 0 288 (w Kuehnel) (H Fritsch) 0.0.310 310 Period 0 0 0 0 310 Stages in Prenatal Development 312 Pre-embryonic Period 0 0 0 312 Embryonic Period 00 0.00 o' 0.0312 Fetal Period (Overview) 314 Fetal Period (Monthly Stages) •• The Newborn Postnatal •• ••••••• Periods ••.• ••••• 316 •• 318 ••.••.• 320 306 308 ••.••.•• 324 Overview 0 ••• ••• •• ••.• 324 Light Microscopic Classification of Exocrine Secretory Units 00 •• •• 326 General Principles of Endocrine Gland Function •• •••• 328 Iypothalamic-Pituitary Vagina and External Genitalia 0 0 • 0 0 • 0 0 0 0 0 0 0 0 293 Capacitation and Acrosome Reaction • 0 ••• •••• •• ••• o 296 Formation of the Zygote • 0 • 0 • 296 lormones Microscopic Anatomy • 278 Neurovascular Supply and Lymphatic Drainage 00.0 • •• 0 •• 280 Support of the Uterus o 0 • • o 280 ••• •• •• 0 0 276 and Human ameres 00000 270 267 Axis •• • 330 Gross Anatomy ••• 0 ••• 0 •• 0 •• • 330 Microscopic Structure of the •• •• •• ••••• •• 0.0 ••.•••• Hypothalamus-Pituitary tions •••• 323 Connec334 Efferent Connections of the Hypothalamus • •• •• •• 334 Hypothalamic-Posterior Pituitary Axis (A) •••.• •• •• •• •••• ••.•• 336 Hypothalamic-Anterior Pituitary Axis (B) 336 Pineal Gland 340 IX X Table of Contents Gross Anatomy Microscopic Anatomy Adrenal Glands Gross Anatomy Microscopic Anatomy Microscopic Anatomy of the Adrenal Medulla Thyroid Gland 340 340 Pancreatic Islets 342 Diffuse Endocrine System 342 344 346 348 Gross Anatomy Microscopic Anatomy Parathyroid Glands 348 350 352 Microscopic Anatomy Testicular Endocrine Functions Ovarian Endocrine Functions Ovarian Cycle Endocrine Functions of the Placenta Atrial Natriuretic Peptides-Cardiac Hormones Diffuse Endocrine Cells in Various Organs Blood and Lymphatic Systems (w Kuehnel) Blood 372 Components of Blood Hematopoiesis Immune System 380 Cells ofthe Immune System Lymphatic Organs 384 386 The Integument 356 356 358 358 360 362 364 Microanatomy of the Thymus Lymph Nodes Spleen Microscopic Anatomy of the Spleen The Tonsils Mucosa-Associated Lymphoid Tissue (MALT) 388 390 392 394 396 398 401 402 General Structure and Functions Skin Color Surface of the Skin The Layers ofthe Skin Epidermis Dermis (Corium) Subcutaneous Tissue (Subcutis) 354 371 (w Kuehnel) Skin 402 402 404 406 406 408 408 Appendages ofthe Skin 410 Skin Glands Hair Nails Skin as a Sensory OrganCutaneous Sensory Receptors 410 412 414 Breast and Mammary Glands 416 Gross Anatomy Microscopic Structure and Function of the Female Breast 414 416 418 420 References Index 382 384 Overview Thymus Illustration 372 376 354 Credits 423 424 Gross Anatomy of Liver 213 iE A Position of liver B Liver anterior aspect Cliver superior aspect o Visceral surface of liver f 214 Alimentary System: Liver Liver Segments I f The liver may be divided either into lobes based on macroscopic features, or into liver segments based on the distribution of intrahepatic vessels, i.e., the hepatic portal vein, hepatic artery proper, and bile ducts These segments are variable and are also described differently in the literature, but are generally seen as consisting of a right part of liver and a leftpartofliver The left part of the liver can be further subdivided into medial and lateral parts (see p 216 A) The boundaries between these segments, or functional units, differ from the boundaries between the right and left lobes Microscopic Anatomy The liver is enclosed in a fibrous capsule that accompanies the hepatic vessels as they pass into the interior of the organ forming a supporting framework of connective tissue also known as the perivascular fibrous capsule (Glisson's capsule) Lying in the spaces within the connective tissue framework are hepatocytes (Al), the epithelial cells of the liver Together the connective tissue, hepatocytes, and vessels form the architectonic structural units of the liver known as the lobules of liver (AB2) Lobules of the Liver Classical lobule model Located at the center of each functional unit is a central vein (AB3) Each polygonal lobule is surrounded by a small amount of connective tissue that becomes denser at the corners between adjacent lobules, forming triangular regions called portal areas (84) Each portal area contains three main structures-a branch of the hepatic portal vein, i.e., an interlobular vein (AS), a branch of the hepatic artery proper, i.e., an interlobular artery (A6), and a bile duct, i.e., an interlobar duct (A7)-encased in the connective tissue of the Glisson's capsule and collectively known as a portal or Glisson's triad The hepatocytes radiate toward the periphery ofthe lobule They are composed of cell plates between which long, sinusoidal capillaries (AS) also radiate outward The sinusoidal capillaries receive blood from both the hepatic artery proper and the hepatic portal vein; in other words, they receive oxygenated, nutrient-rich blood After transfer of substances within the sinusoids between the blood and hepatocytes, the blood drains via the central vein into the collecting veins and then into the hepatic veins Between the vessel walls of the hepatic sinusoids and the surfaces of the hepatocytes is a space called the perisinusoidal space (C09) (Disse's space) The microvilli (010) of the hepatocytes project into this space which also contains fat-storing cells called Ito cells The walls of the hepatic sinusoids are composed of fenestrated endothelium (011) and a rudimentary basement membrane; they also contain phagocytic cells called hepatic stellate cells The microvilli projecting into the perisinusoidal space have direct contact with blood fluids that percolate past the sinusoidal wall to reach them Portal lobule model (B) This model places the portal area at the center of the lobule, emphasizing the flow direction ofthe bile Bile is produced by the hepatocytes and secreted into the bile canaliculi (C12) Bile canaliculi resemble channels whose sides are formed by cell contacts in the spaces between the hepatocytes Bile flows from the region around the central veins to the interlobular ducts which in turn form biliaryductules that empty into the right hepatic duct and left hepatic duct The portal lobule is triangular in shape and contains the central veins at its corners The axis ofrhe rhombic hepatic acinus (8) contains a branch of the hepatic artery proper In the outer zone (zone 1), the adjacent hepatocytes have a high metabolic rate Outer zone cells receive highly oxygenated because of their proximity to distributing arteries In the inner zone (zone 3) the metabolic rate of the hepatocytes as well as their oxygen supply is diminished Liver functions As the largest metabolic organ in the body, the liver fulfills important functions such as assisting in the metabolism of carbohydrates, proteins and fats as well as detoxification processes In its function as an exocrine gland it produces bile which is secreted as needed into the duodenum via a duct system Duringfetallife it is involved in hematopoiesis Liver Segments 215 and Microanatomy 5 E i 12 A Lobule of liver diagram 12 C Hepatocytes and sinusoidal capillaries light micrograph B Lobule of liver (blue) portal lobule (green) acinus (orange) D Hepatocytes and sinusoidal capillaries electron micrograph III f 216 Alimentary Neurovascular Drainage System: Liver Supply and Lymphatic Arteries (B) The liver receives oxygenated blood from the hepatic artery proper (B1) (