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Richard L. Drake, PhD, FAAA
Director of Anatomy
Professor of Surgery
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University Cleveland, Ohio
A. Wayne Vogl, PhD, FAAA
Professor of Anatomy and Cell Biology
Department of Cellular and Physiological Sciences
Faculty of Medicine
University of British Columbia Vancouver, British Columbia
Adam W.M. Mitchell, MBBS, FRCS, FRCR
Consultant Radiologist
Chelsea and Westminster Hospital
Honorary Senior Lecturer Imperial College London, UK
Illustrations by Richard Tibbitts and Paul Richardson
Photographs by Ansell Horn
SECOND EDITION
Preface
Gray’s Basic Anatomy was developed in response to students and colleagues from around the world who requested a more concise description of anatomy than that presented in Gray’s Anatomy for Students. To accomplish this goal, we reworked the material to focus mainly on regional anatomy and integrated the clinical material, imaging, and surface anatomy information directly into the text as:
• Clinical apps, which give students context for why a strong anatomical background helps facilitate the solving of clinical problems;
• Imaging apps, which offer students a great introduction to the different techniques and modalities available for imaging relevant anatomy; and
• Surface anatomy boxes, which help students visualize the relationship between anatomical structures and surface landmarks necessary for any kind of patient examination.
In addition, at the beginning of each chapter students are directed to additional learning resources available on Student Consult (Elsevier’s online educational website).
Summarizing, Gray’s Basic Anatomy uses a regional approach, similar to Gray’s Anatomy for Students, with eight
chapters: The Body, Back, Thorax, Abdomen, Pelvis and Perineum, Lower Limb, Upper Limb, and Head and Neck. The artwork presents the same familiar illustrations from Gray’s Anatomy for Students, but they have been resized to fit within a smaller format while retaining a close physical location to the text with which each figure is associated. Finally, while some verbiage has been sacrificed in keeping with the goal of presenting a concise textbook of anatomy (e.g., muscle descriptions have for the most part been incorporated into tables with no loss of content), additional clinical and imaging material has been added to enhance learning in context.
This second edition includes numerous edits resulting from reader feedback, some new and revised figures, and revisions based on current research in the field of the anatomical sciences.
We hope you will continue to find this new edition a useful and valuable resource whether you are an educator or a student.
Richard L. Drake A. Wayne Vogl Adam W.M. Mitchell
Index of Clinical Apps, Imaging Apps, and Surface Anatomy Boxes
Segmental anatomy of the liver 168
Annular pancreas 169
Pancreatic cancer 171
Gallstones 171
Jaundice 172
Spleen disorders 173
Vascular supply to the gastrointestinal system 178
Hepatic cirrhosis 180
Portosystemic anastomosis 180
Psoas muscle abscess 190
Diaphragmatic hernias 190
Hiatal hernia 190
Urinary tract stones 194
Urinary tract cancer 194
Kidney transplant 194
Abdominal aortic stent graft 197
Inferior vena cava filter 199
Retroperitoneal lymph node surgery 201
IMAGING APPS
Visualizing the stomach 155
Visualizing the jejunum and ileum 157
Endoscopic examination of the abdominal gastrointestinal tract 159
Visualizing the liver 167
Visualizing the pancreas 170
Visualizing the diaphragm 189
Investigation of the urinary tract 195
SURFACE ANATOMY
Using abdominal quadrants to locate major viscera 135
Defining surface regions to which pain from the gut is referred 135
How to find the superficial inguinal ring 148
Visualizing the position of major blood vessels 199
5 Pelvis and Perineum
CLINICAL APPS
Bone marrow biopsy 210
Common problems with the sacro-iliac joints 212
Pelvic fracture 213
Pelvic measurements in obstetrics 216
Defecation 217
Episiotomy 219
Digital rectal examination 221
Carcinoma of the colon and rectum 221
Bladder cancer 222
Bladder stones 223
Suprapubic catheterization 223
Bladder infection 224
Urethral catheterization 225
Undescended testes 225
Hydrocele of the testis 225
Testicular tumors 225
Vasectomy 226
Prostate problems 226
Ovarian cancer 228
Hysterectomy 228
Tubal ligation 229
Carcinoma of the cervix and uterus 229
The recto-uterine pouch 232
Pudendal block 236
Prostatectomy and impotence 239
Hemorrhoids 244
Abscesses in the ischio-anal fossae 246
Urethral rupture 252
SURFACE ANATOMY
Defining the margins of the perineum 245
Superficial features of the external genitalia in women 248
Superficial features of the external genitalia in men 250
6 Lower Limb
CLINICAL APPS
Pelvic fractures 269
Femoral neck fractures 271
Intertrochanteric fractures 272
Femoral shaft fractures 272
Varicose veins 277
Deep vein thrombosis 277
Harvesting veins for grafts 277
Vascular access in the lower limb 281
Trendelenburg’s sign 282
Intramuscular injection in the gluteal region: avoiding the sciatic nerve 285
Shin splints 291
Quadriceps injury 293
Hamstring injuries 294
Compartment syndrome 294
1 The Body
What is anatomy? 2
How can gross anatomy be studied? 2
Important anatomical terms 2
Imaging 3
Diagnostic imaging techniques 3
Image interpretation 6
Plain radiography 6
Computed tomography 7
Magnetic resonance imaging 7
Nuclear medicine imaging 7
Safety in imaging 8
Body systems 8
Skeletal system 8
Cartilage 8
Bone 8
Joints 10
Skin and fascias 13
Skin 13
Fascia 14
Muscular system 14
Cardiovascular system 15
Lymphatic system 16
Lymphatic vessels 16
Lymph nodes 16
Lymphatic trunks and ducts 17
Nervous system 18
Central nervous system 18
Functional subdivisions of the CNS 19
Other systems 30
2 Back
Regional anatomy 32
Skeletal framework 32
Vertebrae 32
Intervertebral foramina 37
Posterior spaces between vertebral arches 38
Curvatures of vertebral column 38
Joints 40
Joints between vertebrae in the back 40
Ligaments 41
Anterior and posterior longitudinal ligaments 41
Ligamenta flava 42
Supraspinous ligament and ligamentum nuchae 42
Interspinous ligaments 42
Back musculature 43
Superficial group of back muscles 43
Intermediate group of back muscles 45
Deep group of back muscles 46
Thoracolumbar fascia 48
Spinal cord 49
Vasculature 50
Meninges 52
Arrangement of structures in the vertebral canal 53
Spinal nerves 53
3 Thorax
Regional anatomy 58
Pectoral region 58
Breast 58
Muscles of the pectoral region 60
Thoracic wall 60
Superior thoracic aperture 61
Inferior thoracic aperture 62
Skeletal framework 62
Intercostal spaces 71
Diaphragm 75
Venous drainage 77
Innervation 77
Movements of the thoracic wall and diaphragm during breathing 77
Pleural cavities 78
Pleura 78
Lungs 81
Mediastinum 93
Middle mediastinum 94
Superior mediastinum 116
Posterior mediastinum 123
Anterior mediastinum 129
Contents
Accessory nerve [XI] 450
Hypoglossal nerve [XII] 450
Face 450
Muscles 450
Parotid gland 455
Innervation 457
Vessels 460
Scalp 463
Layers 463
Innervation 464
Vessels 465
Lymphatic drainage 466
Orbit 467
Bony orbit 467
Eyelids 468
Lacrimal apparatus 471
Sensory innervation 473
Fissures and foramina 473
Fascial specializations 475
Muscles 476
Vessels 479
Innervation 480
Eyeball 483
Ear 486
External ear 487
Middle ear 491
Internal ear 495
Temporal and infratemporal fossae 499
Bony framework 499
Temporomandibular joints 501
Masseter muscle 503
Temporal fossa 504
Infratemporal fossa 505
Pterygopalatine fossa 513
Skeletal framework 514
Gateways 515
Contents 515
Neck 519
Fascia 520
Superficial venous drainage 523
Anterior triangle of the neck 523
Posterior triangle of the neck 534
Root of the neck 538
Pharynx 544
Skeletal framework 545
Pharyngeal wall 546
Fascia 547
Gaps in the pharyngeal wall and structures passing through them 547
Nasopharynx 548
Oropharynx 549
Laryngopharynx 549
Tonsils 549
Vessels 549
Nerves 551
Larynx 552
Laryngeal cartilages 553
Extrinsic ligaments 555
Intrinsic ligaments 556
Laryngeal joints 557
Cavity of the larynx 558
Intrinsic muscles 558
Function of the larynx 560
Vessels 562
Nerves 563
Nasal cavities 563
Lateral wall 564
Regions 564
Skeletal framework 565
External nose 566
Paranasal sinuses 566
Walls, floor, and roof 568
Choanae 570
Gateways 570
Vessels 571
Innervation 572
Oral cavity 575
Skeletal framework 575
Walls: the cheeks 578
Floor 578
Salivary glands 584
Roof—palate 587
Oral fissure and lips 590
Oropharyngeal isthmus 590
Teeth and gingivae 591
ADDITIONAL LEARNING RESOURCES FOR CHAPTER 1, THE BODY, ON STUDENT CONSULT (www.studentconsult.com):
n Short Questions—These are questions requiring short responses, Chapter 1
n Clinical Case Appendicitis
