Clinical anatomy- An overview , various conditions related to Skeletal system, Cardiovascular system, Lymphatic system .
[1]. Skeletal System clinical anatomy .
Cleidocranial dysostosis .
A defect in membranous ossification causes a rare syndrome called cleidocranial dysostosis. It is characterized by three cardinal features:
(a) Varying degrees of aplasia of the clavicles;
(b) increase in the transverse diameter of cranium, and
(c) retardation in fontanelle ossification (Srivastava et al, 1971). It may be hereditary or environmental in origin.
Achondroplasia .
A defect in endochondral ossification causes a common type of dwarfism called achondroplasia, in which the limbs are short, but the trunk is normal. It is transmitted as a Mendelian dominant character.
Periosteum Sensitivity .
Periosteum is particularly sensitive to tearing or tension. Drilling into the compact bone without anaesthesia causes only mild pain or an aching sensation; drilling into spongy bone is much more painful. Fractures, tumour and infections of the bone are very painful. Blood supply of bone is so rich that it is very difficult to interrupt it sufficiently to kill the bone. Passing a metal pin into the medullary cavity hardly interferes with the blood supply of the bone.
Fracture .
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| Types of fractures |
Fracture is a break in the continuity of a bone. The fracture which is not connected with the skin wound is known as simple (closed) fracture. The fracture line may be (a) oblique or (b) horizontal. The fracture which communicates with the skin wound is known as (c) compound (open) fracture. A fracture requires “reduction” by which the alignment of the broken ends is restored .
Fracture Healing .
Healing (repair) of a fracture takes place in three stages: (a) Repair by granulation tissue;
(b) union by callus; and
(c) consolidation by mature bone.
2nd Cervical Vertebra fracture .
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| fracture of dens of axis vertebra |
Axis or 2nd cervical vertebra may get fractured. If dens of axis gets separated from the body, it hits the vital centres in the medulla oblongata causing instantaneous death . Even fracture of laminae may cause death.
Rickets .
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| (a) Rickets, (b) Normal |
[1]. In rickets (deficiency of vitamin D), calcification of cartilage fails and ossification of the growth zone is disturbed. Rickets affects the growing bones and, therefore, the disease develops during the period of most rapid growth of skeleton, i.e. 3 months to 3 years.
[2]. Osteoid tissue is formed normally and the cartilage cells proliferate freely, but mineralization does not take place. This results in craniotabes, rachitic rosary at the costochondral junctions, Harrison’s sulcus at the diaphragmatic attachments, enlarged epiphyses in limb bones and the spinal and pelvic deformities.
[3]. For proper development of bones, a child requires adequate amounts of proteins, calcium, vitamin D, etc. Deficiency of calcium and vitamin D in growing children leads to widening of ends of bones with inadequate ossification. This condition is called as rickets .
Scurvy .
In scurvy (deficiency of vitamin C), formation of collagenous fibres and matrix is impaired. Defective formation of the intercellular cementing substances and lack of collagen cause rupture of capillaries and defective formation of new capillaries. Haematoma in the muscles and bones (subperiosteal) cause severe pain and tenderness. The normal architecture at the growing ends of the bones is lost.
Vertebral deficient .
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| Types of spina bifida: (a) Spina bifida occulta, (b) Meningocele, (c) meningo-myelocele |
The vertebral arch or laminae of the vertebral column may remain deficient, the spinal cord may be covered by skin, i.e. (a) spina bifida occulta. There may be protrusion of the meninges surrounding the spinal cord placed in the vertebral canal, i.e. (b) meningocele or there may be protrusion of the spinal cord as well as meninges, i.e. (c) meningo-myelocele .
Osteomalacia .
If deficiency of calcium, vitamin D occurs in adult life, it leads osteomalacia. The bones on X-rays examination do not reveal enough trabeculae.
Osteoporosis .
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| Kyphosis due to osteoporosis |
Deficiency of calcium in bones in old age leads to osteoporosis, seen both in females and males. Due to osteoporosis, there is forward bending of the vertebral column, leading to kyphosis .
Bone marrow biopsy .
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| Bone marrow biopsy |
[1]. Bone marrow can be taken either from manubrium sterni or iliac crest in various clinical conditions . Bone marrow biopsy are clinical diagnosis Procedure often performed on in outpatient and inpatient settings for diagnosis of multiple hematologic disorder .
[2]. It is not limited to diagnosis of hematologic disorder Such as leukemia , multiple myeloma , lymphoma, unexplained anemia & myelodysplastic syndrome but also used for aneuploidy in neonates and unknown origin fever . This procedure also used for detection of atypical fungal and parasitic disorder such as histoplasmosis , leishmaniasis, Cryptococcus , Q fever etc .
Bone tumour .
Benign or malignant tumour can occur in the bone . The causes of bone tumor is unknown . Bone tumors
[2]. Cardiovascular System Clinical anatomy .
Blood Pressure .
The blood pressure is the arterial pressure exerted by the blood on the arterial walls. The maximum pressure during ventricular systole is called systolic pressure; the minimum pressure during ventricular diastole is called diastolic pressure. The systolic pressure is generated by the force of contraction of the heart; the diastolic pressure is chiefly due to arteriolar tone (peripheral resistance). The heart has to pump the blood against the diastolic pressure which is a direct load on the heart. Normally, the blood pressure is roughly 120/80 mm Hg, the systolic pressure ranging from 110-130, and the diastolic pressure from 70-80. The difference between systolic and diastolic pressure is called ‘pulse pressure’.
Heamorrhage .
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| Heamorrhage (bleeding) |
Heamorrhage (bleeding) is the obvious result of rupture of the blood vessels. Venous haemorrhage causes oozing of blood; arterial haemorrhage causes spurting of blood . Vascular catastrophies are of three types: (a) Thrombosis (b) Embolism . (c) Haemorrhage. All of them result in a loss of blood supply to the area of distribution of the vessel involved, unless it is compensated by collateral circulation.
Arteriosclerosis .
In old age the arteries become stiff. This phenomenon it called arteriosclerosis. This causes a variable reduction in the blood supply to the tissues and a rise in systolic pressure.
Arteritis and Phlebitis .
Inflammation of an artery is known as arteritis, and inflammation of a vein as phlebitis.
Atheroma .
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| Atheroma |
Atheroma are patchy changes developed in the tunica intima of arteries due to accumulation of cholesterol and other lipid compounds. Arteries most commonly narrowed are those in the heart, brain, small intestine, kidneys and lower limbs. The changes are called thrombi .
Coronary arteries blockage .
These may be opened up by stents . Blocked coronary artery may be replaced by a graft .
Aneurysm .
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| Aneurysms in circle of Willis |
Aneurysm is the swelling or dilation of blood vessels where part of the wall of artery inflates like a balloon. The wall of the blood vessel at the site of aneurysm is weaker and thinner than the rest of the blood vessels. Due to its likelihood to burst it poses a serious risk to health .
Buerger’s disease (thromboangitis obliterans) .
This is a very painful condition. There is inflammation of small peripheral arteries of the legs. The victim is a young person and a heavy smoker.
Raynaud’s phenomenon.
In this condition there is spasmodic attack of pallor of the fingers due to constriction of small arteries and arterioles in response to cold.
Acute phlebothrombosis .
The veins of the lower limbs are affected. Due to lack of movement of the legs there is thrombus formation with mild inflammation. This thrombus may get dislodged and flow in the blood and may block any other artery. This condition is called as embolism.
Varicose veins .
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| Varicose veins in lower limb |
When the vein wall is subjected to increased pressure over long time there is atrophy of muscle and elastic tissue with fibrous replacement. This leads to stretching of the vein with tortuosity and localized bulging. Venous congestion of the feet is relieved by putting feet on the stool, that is higher than the trunk, helping in venous return and relief in tiredness . Varicose veins may occur at the lower end of :- Varicose veins in oesophagus or in the anal canal.
[3]. Lymphatic System clinical anatomy .
Lymphatics .
Lymphatics are primarily meant for coarse drainage, including cell debris and microorganisms, from the tissue spaces to the regional lymph nodes, where the foreign and noxious material is filtered off by the phagocytic activity of the macrophage cells for its final disposal by the appropriate immune responses within the node. Thus the lymphatic system forms the first line of defence of the body.
Lymphangitis and lymphadenitis .
While draining from an infected area, the lymphatics and lymph nodes carrying infected debris may become inflammed resulting in lymphangitis and lymphadenitis. In acute cases the lymphatics are marked on the skin as painful red lines leading to the painful and tender swollen lymph nodes which may suppurate. Chronic infections (tuberculosis, syphilis, etc.) cause chronic lymphadenitis.
Elephantiasis .
[1]. The filarial parasite lives in the lymphatics, which may become blocked, giving rise to solid oedema (elephantiasis) in the peripheral area of drainage. Elephantiasis is characterized by enormous enlargement of the limb or scrotum due to the thickened skin.
[2]. The microfilariae enter the blood stream only during night and, therefore, the blood for examination must be collected during night. The lymphatics provide the most convenient route of spread of the cancer cells .
The lymphatic drainage of those organs which are commonly involved in cancer should be studied in greater details and with special interest for many reasons:-
(a) It is helpful in the diagnosis of the primary site of the cancer.
(b) It helps in predicting the prognosis and in classifying the stage of cancer.
(c) It helps the surgeon in doing the block dissections during operative removal of the cancer.
The spread of cancer causes enlargement of the regional lymph nodes, which become fixed and stony hard. Many a time the primary site of cancer is quite insignificant or even difficult to define and the enormous enlargement of the draining lymph nodes due to secondary malignant deposits forms the most prominent part of the disease. A retrograde spread of cancer cells, after the blockage of lymphatics, may occur by a reversed flow of the lymph.
Splenomegaly .
Splenomegaly is the enlargement of spleen mainly due to infections, circulatory disorders, blood diseases and malignant neoplasms. It causes excessive and premature haemolysis of red cells or phagocytosis of normal white cells and platelets leading to anemia, leukopenia and thrombocytopenia. Spleen also may enlarge due to congestion of blood in portal venous congestion, in right-sided heart failure and in fibrosis caused due to cirrhosis of liver. Splenomegaly also occurs to meet the extra workload for removing damaged and abnormal blood cells. Commonest cause of splenomegaly is malaria.
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