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At the left end of the liver in adults depression cherry lyrics buy cheapest zoloft, there is a fibrous band may appear as an atrophied remnant extensive part of the left lobe of the liver mood disorder kinds zoloft 50mg free shipping. It is a paired mood disorder nos symptoms cheap 100 mg zoloft amex, bean shaped depressive symptoms vs depression order 25mg zoloft amex, retroperitoneal vital organ of excretory system, situated in the abdomen. Ureter hangs downwards vertically, which is the posterior most structure of the hilum. It is a vertical cleft in the center of the medial border of the kidney, through which some structures are going in and out from the kidney. The transpyloric plane passes above the hilum in case of right kidney and in case of left kidney the transpyloric plane passes below the hilum. From the neck of the gallbladder a small diverticulum projects downwards and backwards towards the duodenum. It is the mucous membrane of gallbladder formed some folds in the form of an oblique ridge. Bile of gallbladder is 10 times more concentrated than the hepatic bile due to absorption of water from the gallbladder. Identification of this triangle is very important for putting ligature to the pedicles of gallbladder during surgery. Inflammatory pain of gallbladder causes irritation of the right dome of diaphragm and diaphragm is supplied by the phrenic nerve. It is a thick walled, hollow, muscular organ situated in the lesser pelvis, between the urinary bladder below and in front, and the rectum and sigmoid colon above and behind, which is concerned with the embedding of fertilized ovum and delivery. The lateral angles or cornu of the uterus projected outwards from the junction of the fundus and body d. Uterus is anteflexed (it is the angle between body and the cervix, which is normally 125 degree) f. The position is maintained by the pull of the body and fundus by the round ligaments along with the weight of the body and fundus. On digital examination of vagina, if the anterior lip of cervix is first felt, it is confirmed that uterus is anteverted. On digital examination on the lateral wall of the vagina the ischial spine is palpable. If external os descends in the vagina, lower than the level of ischial spine, it is diagnosed that uterus descended. If uterus descends in the vagina and external os descends up to vaginal introitus, it is called 1st degree prolapse. If external os descends outside the vaginal introitus, but rest of the uterus remains in the vagina. If whole uterus comes outside the vagina is called 3rd degree prolapse or Procidentia uteri. It is a ridge on the posterior aspect of the uterus, opposite the isthmus, at the junction between cervix and body. The mucous membrane of the cervix on the midline, there is a median longitudinal fold is present. Along the anterior and posterior walls of the cervical canal from these longitudinal folds numerous transverse folds passes upwards and laterally. The arrangement of median longitudinal fold with the palmate folds resembling the branches of a tree. It fundus is more tilted to the right pelvic wall, due to the pressure of sigmoid colon. Sometimes cervical glands of the uterus blocked and secretion produces cystic dilatation of the glands which buldge into the cervical canal, this feature is known as Nabothian cyst. Cornu of uterus is the outwards projection from the junction of the fundus and the body. It is a fold of peritoneal pouch between the anterior surface of rectum and posterior surface of uterus. So tortuous uterine artery become straight without any chance of rupture or tearing. An opening present in the ovarian fimbriae for entry of ovum in the fallopian tube is called the pelvic ostium. It is the junction between the upper mobile part and lower fixed part of the uterus b. Isthmus plays the important role in lower part of upper uterine segment during delivery or labor. If the uterus is retroverted, during pregnancy there is most common chance of prolapse of uterus. It is a condition when fertilized ovum fails to migrate into uterine cavity and may produce, rupture of the fallopian tube with alarming hemorrhage. If uterine tube is filled with a bag of pus, due to infection of tube, the condition is called pyosalpinx (pyopus, salpinx - uterine tube /fallopian tube). Its involvement in perineal tear during parturition may produce prolapse of the following: a. In the submucous coat of appendix, contains excessive lymphoid tissue, that is why it is called abdominal tonsil. Medially: Lateral border of rectus abdominis Laterally: Inferior epigastric artery.
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Hypoglossal Canal Immediately above the anterior end of each condyle presents the anterior opening of hypoglossal canal mood disorder nos dsm generic 100 mg zoloft otc. Medial aspect of the condyles present a rough area or a tubercle attachment to-alar ligament mood disorder bipolar order generic zoloft online. From the junction of the condylar part and the squamous part presents a short process projects laterally known as jugular process depression trigonometry definition order genuine zoloft. Superior surface: Presents a curved groove anxiety disorder test purchase zoloft pills in toronto, which lodges the terminal part of sigmoid sinus. The anterior surface of jugular process presents a concavity known as jugular notch. After articulation with the petrous part of temporal bone forming posterior margin of jugular foramen. Lateral surface: It articulates with the inferior aspect of the petrous part of the temporal bone. Jugular Foramen It is divided into anterior, posterior, and intermediate compartments by two bony spicules known as intrajugular processes. One of the meningeal branches of ascending pharyngeal artery and an emissary vein may also pass through this foramen. It is bounded anteriorly by the basilar part, posteriorly by the squamous part and laterally by the condylar part. The alar ligament, which divides the foramen into smaller anterior and larger posterior compartments. It forms the greater part of the temporal fossa which gives origin to temporalis muscle. Posterior part marked by a vertical groove just above the external auditory meatus. Supramastoid crest: It is a curved ridge, which passes backwards, and upwards from above the anterior part of the external auditory meatus, which demarcates the posterior boundary of temporal fossa. Suprameatal triangle: It is a triangular depression between the posterosuperior part of external acoustic meatus and the anterior end of the supramastoid crest. Suprameatal Spine: A bony projection on the medial side of the suprameatal triangle. Internal Surface/Cerebral Surface It is concave and marked by irregular impressions caused by temporal gyri of the cerebrum and presents groove for middle meningeal vessels. It is an elongated bony process projects forwards from the lower part of temporal surface. Articulation: Anterior end of the zygomatic process articulates with temporal process of zygomatic bone and complete the zygomatic arch. Roots (Anterior and Posterior): Two roots unite to form a tubercle known as tubercle of the root of zygoma attachment of temporomandibular ligament. Anterior portion of the zygomatic process: It consists of two surfaces Lateral surface: Convex and subcutaneous. Mandibular fossa: It is a depression formed partly by the squamous part which is articular and partly by the tympanic part which is non-articular. Articulation: Condyle of mandible with an intervening articular disc forming temporomandibular joint. Postglenoid tubercle: Laterally articular part is separated from the non-articular part by a small conical eminence called postglenoid tubercle. Squamotympanic fissure: A fissure separating the medial aspect of articular part from the tympanic part. Origin of auricularis posterior from the mastoid part and mastoid process and origin of occipital belly of occipitofrontalis. Origin of posterior belly of digastric from the mastoid notch present at the medial aspect of the mastoid process and part of the bone, below. Superior Border Articulates with postero-inferior part of parietal bone takes part in the forming asterion. Posterior Border It articulates with inferior border of squamous part of occipital bone. Mastoid Air Cells A section of mastoid bone presents number of small irregular spaces called mastoid air cells and a large irregular space called mastoid or tympanic antrum. Trigeminal impression: Immediately behind the apex there is a depression known as trigeminal impression. Between arcuate eminence and squamous part on the lateral side there is a thin plate of bone called tegmen tympani, which forms the roof of tympanic antrum, tympanic cavity and canals for the tensor tympani and the auditory tube. Anteriorly tegmen tympani presents a narrow groove which leads into a hiatus transmit greater petrosal nerve. Opposite the middle of the posterior surface of the petrous part a circular aperture which leads into internal acoustic (auditory) meatus, roughly horizontal. A perforated plate of bone is constitute its bottom or the fundus or at the lateral end of the canal. Posterior part called superior vestibular area: Presents numerous small foramina for nerves to utricle and to the ampullae of superior and lateral semicircular ducts. Foramen singulare in the posterior most part (behind the inferior vestibular area) for nerves to ampulla of posterior semicircular duct. Opening of aqueduct of the vestibule: A slit under cover of a thin plate of bone behind the circular aperture (beginning of internal acoustic meatus).
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Reflected head of the rectus femoris-rough grooved area between the inferior gluteal line and acetabular margin bipolar depression 5dht buy zoloft 100 mg with visa. Again upper quadrilateral area subdivided into upper lateral area and lower medial area by an oblique ridge v teenage depression symptoms quiz buy 100 mg zoloft visa. The lower triangular area further subdivided into lateral and medial areas by a ridge postpartum depression psychology definition purchase line zoloft. The notch between the upper end of the ischial tuberosity and acetabular margin transmits the tendon of obturator externus depression symptoms 11 year old order zoloft from india. The upper part of lateral border and adjoining part of the acetabular margin give attachment of ischio-femoral ligament. Common tendon of origin of the long head of the biceps femoris and the semitendinosus- from the lower medial area. Medial margin of the medial area of the lower triangular area gives attachment to the sacrotuberous ligament, covered by fibrofatty tissue and presents the ischial bursa of the gluteus maximus. Rest of the surface is covered by the obturator internus muscle and its fascia (forms the lateral wall of the ischiorectal fossa). Pudendal (Alcok`s) canal-lies on the lateral wall of the ischiorectal fossa formed by the splitting of the obturator fascia containing i. Pudendal nerves with its divisions the dorsal nerve of penis or clitoris and the perineal nerve. Ends Upper end Character: It is fused with the ilium and pubis at the acetabulum (along the floor). Borders Anterior border Character: It forms the posterior margin of obturator foramen. It is converted into lesser sciatic foramen by the sacrotuberous and sacrospinous ligaments. Nerve to the obturator internus Except the tendon of obturator internus all structures enter into the pelvis again. It starts from the body and passes upward, forwards and medially to join with the inferior pubic ramus. Anterior or external surface Directed towards the thigh, continuous with the anterior surface of the inferior pubic ramus. Divided into three areas-upper, intermediate and lower by upper and lower bony ridges b. Anterior surface of the ramus-origin of obturator externus laterally and adductor magnus medially. Upper ridge gives attachment to the superior fascia of the urogenital diaphragm ii. Lower ridge gives attachment to the perineal membrane or inferior fascia of urogenital diaphragm iii. Symphyseal surface Character: Rough, elongated and articulates with similar surface of the opposite side to form the symphysis pubis. Origin of adductor longus-immediately below the junction of pubic crest and pubic tubercle ii. Upper part separated from the urinary bladder by the fibrofatty tissues with a plexus of veins. Between the two symphyseal surfaces lies the fibrocartilage and forms the symphysis pubis which is a secondary cartilaginous joint. Origin of lateral head of rectus abdominis and pyramidalis (if present) muscles d. Begins from the posterior part of the pubic tubercle then goes laterally and backwards, continuous with the arcuate line. Obturator membrane is attached along the margins of the foramen except in the above. Its periphery gives attachments to a fibrocartilage called acetabular labrum except below where forms the acetabular notch. Two ends of acetabular notch gives attachment transverse acetabular ligament and the base of the ligamentum teres femoris. Ilium contributes two-fifths, ischium contributes two-fifths and pubis contributes one-fifth of the acetabulum. Attachments Medial to lateral: Origin of gracilis, adductor brevis, adductor magnus and obturator externus. Superior layer of urogenital diaphragm-to the ridge between the intermediate and lateral areas. Secondary centers: these appears with commencement of puberty in the iliac crest, at the bottom of acetabulum triradiate cartilage, in the ischial tuberosity, anterior inferior iliac spine and symphyseal surface of the pubis. Side Determination On holding the bone in anatomical position the head on which side belongs will determine the opposite side of the bone. Upper End the upper end consists of head, neck, greater and lesser trochanters and intertrochanteric crest. It is covered by the articular cartilage except near its center where presents a rough depression called fovea capitis femoris or pit. Attachments Articulation: Head articulates with the acetabulum of the hipbone to form the hip joint (ball socket joint). Ligament: Ligament of the head of the femur (ligamentum teres femoris)-to the fovea capitis Neck Characters 1. Hipbone fractures and dislocation is uncommon but fracture may occur in highenergy motor vehicle accident, falls during skiing and ice dancing. Anterior and posterior compression of the hipbones pubic rami fracture commonly occurs. Junction between the neck and the shaft is marked anteriorly by a rough ridge called inter-trochanteric line.
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