Introduction to the Course (30 min): In this introduction the main lines of thought used in analyzing the structure and function of the human body will be briefly discusssed. The general objectives, organization, and the overall expectations of the course will also be presented
Module I: Early Development, Autonomic Nervous System, Microscopic Anatomy of Nervous System
A) Lectures (6)
Introduction to development. Fertilization, cleavage, formation of blastula and bilaminar disc (50 min). This lecture will provide an overview of the developmental biology and embryology segment of the course, an outline of the lectures and laboratory segments of the course. We will discuss the stages of prenatal development, the distinction between embryonic and fetal stages, and then proceed to examine fertilization, cleavage, formation of the morula, compaction, movement from the uterine tube (fallopian tube) to the uterus proper, and development of the blastocyst with its inner cell mass. We will then discuss implantation and development to the bilaminar disc stage. (pages 1-60, Moore and Persaud; pp. 24-42 and 48-58 (Carlson).
Manipulation of early mammalian embryos, embryonic stem cells, and gene targeting. (50 min). This lecture will address the regulative properties of the early embryo and the isolation of ES (embryonic stem) cells from the inner cell mass, and their growth in vitro. It will then proceed to a discussion of transgenesis, homologous recombination, gene knock-outs, and animal cloning. Techniques and implications of these procedures will be explored at greater depth in the accompanying laboratory (pp. 44-49, Carlson).
Gastrulation and formation of the Germ Layers (50 min). This lecture will address the stages of development from the inner cell mass through gastrulation, formation of the three germ layers, establishment of the body axis and the layout of the body plan. Concepts of induction and morphogenetic processes will also be introduced. (pp. 47-74, Carlson; pp. 63-72, Moore and Persaud).
Segmentation. Somite formation. Somite derivatives (50 min). This lecture will address the formation of the body plan, introduce the concept of segmentation and its genetic basis, and the formation of axial, intermediate and lateral mesoderm, closure of the body wall and formation of the coelom, development of the somites and their derivatives. (pp. 75-83, 88-93, 97-100, 160-165, 177-179, Carlson; pp. 73-75. 84-89, 92, 412-413, 426-428, Moore and Persaud).
The Notochord and formation of the Central Nervous System (50 min). This lecture, which is tightly linked to the preceding lecture, will explore the formation of the notocord, development of the ectodermal germ layer, neurulation, and formation of the neural tube. It will then proceed to a discussion of segmentation of the neural tube, formation of neural crest, and the basic subdivisions of the CNS. (pp. 83-87, Carlson; pp. 451-469, Moore and Persaud).
Organization and general functions of the autonomic nervous system (50 min). This lecture is a broad overview of the origin, ganglionic connections, and destination of autonomic nerve fibers and thebroad functional attributes of the sympathetic and parasympathetic innervation of organs.
B) Histology Laboratory (1)
Nervous tissue (2.5h). This structural and functional lab will include: a) Identification and function of various cell types in nervous tissues: neurons and glia; b) spatial organization of nervous tissue in CNS and PNS with examples of spinal cord, cerebellum, sensory-dorsal root and sympathetic ganglia; c) meninges; d) peripheral nerve and myelination
C) Embryology/Developmental Biology Computer Labs (2)
First and Second Weeks of Development. Discussion of transgenic mice, knockouts, and stem cell biology (2h)
Topics: The basic events of development from fertilization to the bilaminar disc stage: cleavage, compaction, appearance of two cell types (trophoblast and inner cell mass), implantation, and appearance of the amnion and yolk sac.
The experimental formation of chimeras.
Transgenic mice with a randomly inserted gene: how they are made and what they are used for.
ES cells, and gene targeting (homologous recombination). Cloning mammals.
Reading
Carlson, pp. 38-58.
Moore and Persaud, pp. 41-45.
Alberts, pp. 327-328,1056-1058.
Lab exercise
Computer Programs (under PathMac/Genes and Development) Images of preimplantation development (under: labs/lab 2) BERP: 'Overview'- scan through the whole sequence, Then look at weeks 1 and 2 in detail
MacBaby: 'Cleavage' (use apple Q on keyboard to change topic) 'Blastula'
'Preview of things to come' 'Bilaminar disc'
Lab discussion
Chimeras. How are they made from morulae and from ES cells?
Transgenic mice. How are they made? And what can they be used for? ES cells. How are they derived?
Homologous recombination. Take the following real example. You have sequenced the gene encoding a transcription factor gene called Oct4. It has 5 exons. You know that it is expressed in early cleavage stages of the mouse embryo and in the ICM, and later in the germ cells. You want to find out whether this gene has a required function in early development. What would you do?
One approach is to target the gene by homologous recombination, i.e. knock-out the gene. For this method, discuss the design of the DNA fragment, methods for selecting the desired recombinants, and how to breed mice with a homozygous deletion within the gene. If the gene is lethal early in development of homozygous mutants, how would you determine this?
In fact, the result is that homozygous mutants cannot form a normal inner cell mass, and all cells differentiate toward trophoblast. Thus Oct4 appears to be required for maintenance of the pluripotent state.
Cloning of mammals. How is cloning carried out? Discuss possible reasons for the low rate of success. Discuss the use of ES cells for transplantation to replace abnormal or lost cells.
Gastrulation and Body Folds (2.5 h)
Objectives
To understand the main events of gastrulation at a descriptive level- conversion of a bilaminar disc to a trilaminar disc, origin of embryonic endoderm and mesoderm, and appearance of the cranial-caudal axis, the patterns of major cell movements, and origin of the neural plate.
To understand the main events oftubulation at a descriptive level- origin of the neural tube, tubulation of the body wall and gut to form a tube within a tube, structure of the definitive cross section, the division of mesoderm into paraxial, intermediate, and lateral mesoderm, and the appearance of the coelom dividing lateral mesoderm into somatic and splanchnic mesoderm.
To understand segmentation and the formation of the vertebrae.
Reading
Carlson, pp. 47- 74,75-83,88-93,97-100 Moore and Persaud, pp. 63- 72, 84-89
Laboratory exercise: Computer programs
- MacBaby:
'Gastrulation',
'Trilaminar disc'
'Differential growth'
'First Fold'
'Tube within a Tube'
Optional "Intraembryonic Coelom"
Note: the embryonic endoderm comes from cells that come through the primitive 'Neural tube' streak, not from hypoblast - BERP
Under Overview,
Embryonic Disc'
'Nervous System' - Animated embryo
Under'Development'
Do: Cross section animation step by step with labels.
Find the mesentery in the last image.
Optional: 'Nervous System' days 33-35,
(this may assist in other parts of the course) - Embryo Images
Under 'Early Cell Populations and Establishment of Body Form'
Optional: images 1-21
Under 'Body Cavities, and Limb'
Do: I, II, III, images 1-10.
Optional: Under 'Nervous System'
Cell Populations, images 4-8 ( somites )
MODULE II: SKELETAL-MUSCLE- SKIN-INTRODUCTION TO EMBRYOLOGY
A) PBL( 2 cases)
B) LECTURES(4)
The Structure and Function of Skin (50 min). An overview of the functions of skin, organization of dermis and epidermis, resident and nonresident cell populations in the epidermis, renewal of the epidermis, and glandular appendages.
Introduction to Anatomy (30 min). The introduction will give a historical perspective in dissecting human cadavers, emphasizing the expected demeanor of medical students in performing dissection and using a human cadaver for their training to become healers of the human body. In addition, in this introduction the students will be given a general orientation in gross anatomy -radiology laboratories
Clinical Anatomy of the Breast (50 min). The clinical presentation will focus on carcinoma of the breast and its staging and surgical treatment
Clinical Anatomy: Overview of Upper Extremity Joints (50 min) This lecture will cover the general classification of joints of the upper extremity with major emphasis on the shoulder, elbow and wrist joints.. A detailed description of the attachment of the joint capsule, synovial membrane, surrounding ligaments, muscles and their contribution to the stability of the individual joints will be discussed. Movements and nerve supply to these joints will also be addressed. Injuries (dislocations and fractures) to these joints and their management will be described in detail.
C) HISTOLOGY LABORATORIES (1)
Skin (2 h):In this laboratory exercise students will examine several histological sections of the skin in order to: 1) identify the dermis and epidermis; 2) identify the various layers and cell types in the epidermis and understand how they are involved in the functions and renewal of skin; and iv)identify the various skin appendages.
GROSS ANATOMY - RADIOLOGY LABORATORIES(7)
Back and Spinal Cord (7 h)
We will begin by reviewing the surface anatomy of the back and various surface landmarks. Bony features of the vertebral column will be reviewed: cervical, thoracic, lumbar, and sacral vertebrae.
Arthrology of the vertebral column including the synovial joints, fibrous joints and fibrocartilaginous joints: intervertebral discs (annulus fibrosus, nucleus pulposus) will be reviewed.
Primary and secondary curvatures of the spinal column. The superficial, intermediate and deep muscles of the back will be dissected.
Laminectomy will be performed to expose the meninges: dura, arachnoid and pia mater.The spinal cord and its surface features will be exposed.
Radiological Anatomy
Normal radiographs (PA, lateral, oblique) of cervical, thoracic and lumbar vertebrae, sacrum and coccyx, MRIs (axial, coronal, and sagittal of vertebral column and spinal cord. Pathological: Abnormal curvatures (kyphosis, lordosis, herniated disc, osteoporosis and spondylolisthesis.
Pectoral region, and axilla 1 (2.5 h)
The laboratory exercise will begin by studying the surface anatomy of the pectoral region and axilla. The main bony landmarks of this region: clavicle, sternum, and ribs will also be reviewed before any dissection is done. The male and female breast will be examined in the superficial fascia of the anterior thoracic wall. The female breast will be sectioned to identify the lobes, lactiferous ducts, lactiferous sinuses, axillary tail, suspensory ligaments, areolae and nipple. Students should identify and clean the pectoralis major and minor and their attachments, actions and innervations. Understand the blood vessels as well as the lymphatic drainage of the breast. Start the superficial dissection of the axillla by removing the skin and the underlying fat.
The students will review the surface anatomy and the boundaries of the axilla. Identify the apex, base, anterior and posterior wall. Clean and identify axillary sheath and its contents: axillary artery and its branches, axillary vein and its tributaries, the lateral, medial, posterior cords of the brachial plexus and its branches. Understand the distribution of the Radiological Imaging will include: bone radiography, coronal and enhanced axial CT scans. axillary lymphatics.
Shoulder region. Arm (3.5h)
Students will review the surface anatomy and the dermatomal patterns of the arm. The bony features of the humerus will be reviewed. Students will then skin the flexor and the extensor region of the arm to expose the underlying muscles , nerves and veins.
In the flexor compartment the biceps brachii, brachialis and coracobrachialis muscles will be exposed. The musculocutaneous nerve will be identified. The brachial artey and the superficial veins will be identified.
In the extensor compartment the three heads of triceps will be dissected and the anconeus muscle. The radial nerve , the profunda brachii artery and vein will be exposed.
Forearm (2 h)
During this lab, the students will begin by reviewing the main surface features of the forearm. Bony landmarks on the radius and ulna will be reviewed. The dissection will begin by removing the skin both on the flexor and extensor aspects of the forearm. Superficial nerves and veins will be identified. In the flexor compartment, students will identify muscles in the superficial and intermediate layer (pronator teres, flexor carpi radialis, palmaris longus,, flexor digitorum superficialis,and flexor carpi ulnaris. In the deep layer (flexor pollicis longus, pronator quadratus, and flexor digitorum profundus ). Arteries: Branches of the radial and ulna arteries will be dissected. Nerves: Radial nerve, median nerve, anterior interosseous nerve will be exposed. Veins: Branches of the cephalic and basilic veins will be identified. In deep dissection the interosseous membrane will be cleaned and the orientation and attachment of the fibers reviewed. in the extensor compartment, the following muscles will be exposed: anconeus, brachioradialis, extensor carpi radialis longus and brevis, supinator, extensor digitorum, extensor indicis, abductor pollicis longus, extensor pollicis longus and brevis, extensor digiti minimi, extensor carpi ulnaris. Arteries: Branches of radial artery (posterior interosseous artery): muscular and deep branch of radial.
Nerves: Posterior interosseous nerve and its branches. Veins: Cephalic veins and its branches Radiological Imaging will include bone radiography, coronal MRI, and arteriography
Hand and Joints ( 2.5 h): Review the surface anatomy of the hand including the palmar creases. On the palmar side of the hand identify the cutaneous nerves (digital branches of the median and ulnar nerves, palmar branches of the median nerve and ulnar nerves; identify palmaris brevis muscle.
Identify flexor retinaculum with its attachments, palmar aponeurosis, fibrous tendon sheaths, thenar and hypothenar fasciae
Muscles: Thenar group: abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
Hypothenar: abductor digit minimi, flexor digit minimi, opponens digit minimi.
Others: Adductor pollicis, lumbricals, palmar interossei and dorsal interossei
Nerves: identify superficial and deep branches of ulnar nerve, ulnar nerve and branches of radial nerve
Arteries and Veins: Identify branches of ulnar artery and radial artery. Identify the venae comitantes of the ulnar and radial arteries and their branches.
Synovial tendon sheaths: Radial and ulnar bursae.
Identify the thenar and midpalmar spaces.
Dorsum of hand: identify the cutaneous nerves and the dorsal venous arch.
Radiological Imaging will include bone radiography, coronal MRI, and arteriography
Shoulder joint: Students will review the bony features pertinent to this joint, dissect the overlying muscles to expose the fibrous capsule and its attachments, explore the synovial cavity, identify the labrum glenoidale, identify glenohumeral ligament and the long head of biceps. Identify and clean the coracoacromial ligament.
Elbow joint: Review the bony features of this joint. Identify the ulnar collateral, radial collateral and anular ligament. Expose the joint capsule anteriorly to explore the synovial capsule.
Wrist joint (radiocarpal Joint)
Start by reviewing the carpal bones. Observe the radiocarpal ligaments. Expose the articular disc which holds the distal ends of radius and ulnar firmly together.
The radiology component will consist of bone radiography, and shoulder, elbow and wrist MRIs in multiple planes.
F) JOURNAL CLUB
One article on Developmental Biology
MODULE III: CARDIOVASCULAR SYSTEM
A) PBL(2 cases)
B) LECTURES(9)
Embryology of the Heart (50 min)
Molecular and cellular aspects of cardiac development (50 min)
Cardiac Action Potentials(50 min). Two main topics are covered: 1) the initiation of the action potential and the spread of excitation throughout the heart; 2) the ionic basis of cardiac action potentials in pacemaker cells, and atrial and ventricular myocytes. Basic concepts of ion channels and control of membrane potential given in "Molecules to Cell" are reviewed. The ECG is introduced but not explained in detail (see ECG lab). Arrhythmias are discussed briefly.
Excitation-Contraction Coupling in the Heart (50min). The events starting with the action potential through the contraction of myocytes are described. Basic properties of E-C coupling given in "Molecules to Cell" are briefly reviewed. The concept of contractility is introduced and mechanisms underlying changes in contractility are discussed. Volume-pressure relationships in the cardiac chambers and the Frank-Starling mechanism are introduced.
The Heart as a Pump (50min). The cardiac cycle is discussed in detail. Opening and closing of valves, pressures of atria, ventricles, veins and arteries during the cardiac cycle are presented through the Wigger's diagram, and related to heart sounds, ECG, and echocardiogram.The concepts of ventricular hypertrophy (concentric and eccentric)are presented in conjunction with the concepts of wall stress (Laplace's law), and their underlying mechanisms are introduced.
Circulatory Hemodynamics (50min). Pressures and flows through the circulatory system are described. The relationship between pressure and flow (i.e., resistance) is discussed with explanations of laminar vs turbulent flow and Poiseuille's law. Interactions between the heart and the vascular system are also discussed. Measurements of arterial pressure and cardiac output are introduced.
Regulation of Arterial Blood Pressure (50 min). Several overlapping modes of regulation of arterial blood pressure are described: autonomic control (baroreceptors, sympathetic and parasympathetic control of arterial smooth muscle), and control by circulating hormones (angiotensin, vasopressin, atrial peptides). Hypertension and its treatment is briefly discussed in relationship to normal control mechanisms.
Special Circulations(50 min). Control of blood flow to different organs is discussed. Concepts of intrinsic (metabolic) and extrinsic (autonomic) regulation are introduced. Autoregulation is explained. Specific mechanisms governing flow to the brain, coronary circulation, skeletal muscle, skin, renal, GI and lung are covered.
Microcirculation (50 min). The structure and function of various types of capillaries are discussed with emphasis on the mechanisms of movement of various types of substances across the capillary wall. Starling forces (hydrostatic pressure, oncotic pressure) are explained and factors affecting fluid filtration and absorption are discussed in terms of these forces. The lymphatic capillaries and circulation will be briefly addressed.
C) HISTOLOGY LABORATORIES(2)
The Heart(2 h). In this lab the students will examine cardiac muscle and contrast it with skeletal and smooth muscle. The components of the heart wall (endocardium, myocardium, and pericardium), and the "cardiac skeleton" (annuli fibrosis, - trigona and septum ), will be identified. The structure of atrioventricular and arterioventricular valves will be examined and contrasted
Blood and Lymphatic Vessels(2 h). This lab will consider the structure and function of elastic arteries, muscular or distributing arteries, arterioles, capillaries, venules, veins, and lymphatic vessels.
D) EMBRYOLOGY/DEVELOPMENTAL BIOLOGY COMPUTER LAB (1)
Embryology of the heart and great vessels (2h)
E) ANATOMY-RADIOLOGY LABORATORIES(3)
Thoracic Wall and the Lungs (3.5 h)
Students will review the characteristics of the cervical and thoracic vertebrae, the ribs and the sternum. Dissection of one or two inercostal spaces will be carried out to identify the contents of an intercostal space: external intercostal muscle and its membrane, internal and innermost intercostal layer. The internal thoracic artery and its branches will also be exposed. The anterior thoracic cage will be resected to expose the innermost layer: transversus thoracis muscle and the subcostalis muscle posteriorly. The parietal and visceral pleura will be exposed. The pleural cavities will be explored and the various parts of the parietal pleura will be visualized. The costomediastinal and costodiaphragmatic recesses will be explored. The phrenic nerve will be exposed. Both lungs will be removed and examined. Identify the lobes of the right and left lungs, the fissures horizontal and oblique, the impressions on both lungs, Identify the structures related to the hilus of both lungs. The radiology component will consist of contrasted enhanced computed tomography
Heart (3 h)
The coverings of the heart will be reviewed: fibrous and serous pericardium. The transverse and oblique sinuses will be identified. The pericardial reflections will be demonstrated. The extent of the pericardial cavity will be established. The heart will be removed by sectioning the pulmoary trunk, ascending aorta, superior venae cavae, and inferior venae cavae.
The right and left coronary arteries and its branches will be dissected. Identify coronary sinus and the veins draining into it: great, middle and small cardiac veins. In the right atrial chamber identify the following: pectinate muscle, sinus venerum, openings for superior venae cavae, inferior venae cavae, coronary sinus. Identify tricuspid valve, fossae ovalis, limbus of the fossae ovalis, location of SA and AV nodes. Cristae terminalis on the inside of the right atrium and sulcus terminalis on the exterior of the right atrium.
Right ventricle: Identify: moderator band, trabeculae carnae, papillary muscles, chordae tendinae, infundibulum.
Left ventricle: Identify: papillary muscles, chordae tendinae and aortic vestibule, and the opening for Aorta.
Left Atrium: Identify: Four pulmonary veins, mitral valve, site of closure of foramen ovale, pectinate muscles in left auricle.
The radiology component will consist of contrast enhanced CT, multiplanar MRI, and electron beam CT.
Superior and Posterior Mediastinum (2.5h)
Review the boundaries of both superior and inferior mediastinum. In the posterior mediastinum the students will identify the esophagus, the two main bronchi, the two vagal nerves, ligamentum arteriosum, left recurrent laryngeal nerves and the esophageal plexus.
The thoracic duct, Azygos vein, accessory hemiazygos and the hemiazygos veins will be exposed. Descending aorta and its branches will be dissected. Posterior intercostal arteries and veins will be demonstrated.
The sympathetic trunk, the greater and lesser splanchnics will be visualized.
In the superior mediastinum: Look for the remnants of the thymus gland. Identify the great veins: Right and Left Brachiocephalic veins, the superior venae cavae. Expose the arch of the aorta and its branches: the brachiocephalic trunk, left common carotid, and the left subclavian artery. Identify left and right Phrenic nerves. Identify and clean the tracheobronchial lymph nodes. Observe the bifurcation of the trachea. Identify tracheal rings and the carina..
The radiology component will consist of contrast enhanced CT and multiplanar MRI.
F) PHYSIOLOGY LABORATORIES (2)
ECG(2.5 h) A. Introduction (entire class)(50 min). Electrogenesis of the ECG (electrical volume conduction); waves and intervals (waves and intervals (P, QRS,T,PR interval, ST segment, QT interval); construction of ECG leads: Einthoven triangle. augmented frontal plane leads (aVR, aVL, aVF), precordial (Vl-V6); projections of P,QRS,T on frontal plane leads; determination of direction of electrical phenomena (mean electrical axis of the heart). B. Laboratory (2 h) Class will break into groups of 20 for measurement and analysis of ECG's on student volunteers.
Note: It is expected that students will have the opportunity to acquire additional experience with ECGs during their stay in offices of physicians in the MPSL course.
Blood Pressure Regulation in Humans(2 h). Students will become familiar with the use of sphygmomanometer, stethoscope, and pulse palpation to measure : 1. Heart rate: palpatory method; systolic and diastolic pressure, auscultatory and palpatory methods. 2. Normal variations in heart rate and blood pressure will be determined in: New">A phasic @ sinus arrhythmia, effect of posture, isometric and isotonic exercise, and diving reflex. Students will be divided in groups of five-six, and use classmates as subjects.
G) DEMONSTRATION (1)
Functional Radiology and Angiography (2 h ). Discussion and illustrations of the various methods of determining global and regional cardiac ejection fraction, amplitude of contraction and wall motion in the heart with emphasis on nuclear medicine studies, and coronary angiography.
H) JOURNAL CLUB
One article on angiogenesis and vasculogenesis
MODULE IV: RESPIRATORY SYSTEM
A)PBL(2 cases).
B)LECTURES(6)
Introduction to Respiration (30 min). This is part of the Histology Lab Orientation. Overview of functional anatomy/airway and alveolar structure, volume and capacities: definition of anatomical and physiological dead space
O2 Transport (50 min). An overview on: properties of hemoglobin (brief review of subject was addressed in "Molecules to Cell"), partial pressure of gases vs concentration, 02 carrying capacity, oxygen dissociation curve , and modulation of oxygen binding (Bohr effect). C02 Transport (50 min) C02/HCO3 equilibrium, anion exchange in RBC'S, C02 capacity of blood, C02 titration curve, and interaction witho2binding ( Haldane effect).
Respiratory Mechanics (50 min). Overview of alveolar and intrapleural pressures, lung compliance, surface tension/surfactant, airway resistance, and pressure/flow relationships in airways.
Ventilation-Perfusion Mismatch (50 min). The distribution of gas exchange and blood flow in lung, effects of gravity, and consequences of V/Q mismatch in disease states will be presented. This demo will also cover additional radiological imaging, including: videoesophagram, and aspiration from esophagus. Control of Respiration ( 50 min ). Neural control of respiration, generation of automaticity, pulmonary stretch receptors and Hering-Breuer reflexes, and chemoreceptors for 02 and C02.
C) HISTOLOGY LABORATORY (1)
Respiratory System (2h). Students will examine the micro-anatomical organization of the conducting division of the respiratory system including: larynx, trachea, bronchi, and bronchioles. Also, the respiratory division of the respiratory system including respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli will be examined.
D) PHYSIOLOGY LABORATORY (1)
Lung Volumes Pulmonary Function Tests (2.5 h). Class will be divided into groups of 20. Laboratory exercises will include determinations of lung volumes, ventilation and pressure/flow relationships using student volunteers as subjects.
E) DEMONSTRATIONS: FUNCTIONAL RADIOLOGY- PHYSIOLOGY(2)
Functional Radiology: Lung Imaging.In this demo to be to be conducted in the gross anatomy lab described above the students will be exposed to the techniques of : diaphragmatic fluoroscopy, V.Q. scanning with 133Xe, DSA pulmonary arteriography. The demo will include a review of anatomy of the pulmonary system.
Movie on Respiratory Mechanics. This will be part of lecture/demo presentation on respiratory mechanics (see lectures above)
F) JOURNAL CLUB
One article involving the respiratory system
MODULE V: GASTRO-INTESTINAL SYSTEM
A) PBL (2 cases)
B) LECTURES(8)
Overview: Structure and Innervation of the Gastrointestinal Tract (50 min).
An overview of the anatomical organization of the GI system, including: radial organization of the tubular gut; regional variations in structure and cell types; epithelial renewal; intrinsic nervous system; enteroendocrine cells, and gut associated lymphoid tissue; structure function relationships for fluid reabsorption in the intestine
GI Secretions: Salivary, Pancreatic, Gastric, Intestinal and Biliary Secretions(50 min). Salivary Secretion:Quantities, functions. Salivary gland structure-function relationships. Mechanisms of salivary secretion, flow dependence of composition and regulation. Pancreatic Digestive secretions of the exocrine pancreas. Mechanisms of secretion: acinar cells and duct cells.Composition of gastric juice acid and fluid secretion: quantities. Structure-function relationships of oxyntic cells, oxyntic gland and surface pit. Cellular mechanisms of gastric acid Secretion by oxyntic cells. Chloride and bicarbonate secretion in crypt cells. Physiologic basis of secretary diarrheas. This lecture will consider: organic constituents of bile, including bile acids, phospholipids, cholesterol and bile pigments, the molecular and cell mechanisms of bile secretion by hepatocytes, including bile salts, bilirubin, water and electrolytes, the mechanisms of concentration bile in the gallbladder, including transport of fluid and electrolytes by the gallbladder epithelium, and the formation of micelles, mechanisms of expulsion of bile from the gallbladder, and a brief overview of the mechanism of formation of gallstones.
GI Salt and Water Absorption(50 min). Daily loads and sites of intestinal water and electrolyte absorption; duodenal transport of fluid and electrolytes: quantities, mechanisms; jejunal transport of fluid and electrolytes: quantities, mechanisms; ileum transport of fluid and electrolytes: quantities and mechanisms; transport of fluid and electrolytes in the colon: quantities, mechanisms, regulation; cellular and molecular mechanisms of transport of water,sodium, potassium, chloride, and bicarbonate; role of intestinal circulation on fluid reabsorption: villar countercurrent blood flow.
Structure and Function of the Liver(50 min). An overview of the microanatomical organization of the liver including: classical portal and acinus models of hepatic lobulation, structural specialization to maximize exchange between hepatocytes and blood, specializations to sequester and transport secretary bile. Overview of multifaceted roles of hepatocytes and Kupffer cells.
Nutrient Absorption(50 min). Carbohydrates: Digestion: sites, enzymes, end products; Absorption: quantities, cellular and molecular mechanisms, Na dependent and independent absorption of glucose and galactose, fructose absorption. Proteins and amino acids: Digestion: sites, enzymes, end products; Absorption: intact proteins in the new born: cellular and molecular mechanisms; amino acid , di and tripeptide absorption: cellular and molecular mechanisms. Lipids: Digestion: sites and enzymes; intraluminal digestion, micella solubilization, reesterification, chylomicron formation. Absorption: Transport to lymph. Calcium absorption: sites, and cellular control; vitamin D3, calcium binding protein, calmodulin. Iron absorption: sites, cellular control, iron deficiencies. Bile acid absorption: the enterohepatic circulation.
Control of Gastrointestinal function(50 min). The enteric nervous system. Gastrointestinal peptides: hormones, paracrines, neurocrines. GI hormones: Gastrin, CCK, Secretin, GIP: sites of release, structure, effects, regulation of secretion. GI paracrines: Somatostatin and Histamine: site of release, actions, regulation. GI neurocrines: VIP, GRP, Enkephalins: sites of release, actions, regulation. Coordination of the GI nervous and hormonal systems in the processing of a meal. Cephalic, gastric and intestinal phases of digestion.
Development of the Gut and Associated Organs (50 min). This lecture will consider the formation of foregut, midgut and hind gut. Formation of esophagus and a review of mechanisms involved in esophageal atresia. Formation of the stomach from foregut: rotation of stomach, greater and lesser curvatures, fundus, pylorus, omental bursae, and epiploic foramen.
Clinical: pyloric stenosis. Development of the duodenum from caudal foregut and cranial midgut, change of position with rotation of stomach. Clinical: Duodenal atresia and stenosis. Formation of the hepatic diverticulum. Role of septum trasversum, appearance of the bile duct, gallbladder, and cystic duct. Formation of lesser omentum and falciform ligament. Formation of pancreas from dorsal and ventral pancreatic buds. Clinical: Anular pancreas. Formation of the small intestine and the cranial two thirds of transverse colon from midgut. Rotation and fixation of intestinal loop.
Clinical: Meckels Diverticulum, omphalocele and umbilical fistula. Formation of remainder of the large intestine from hind gut. Urorectal septum dividing cloaca into anorectal canal and primitive urogenital sinus. Anal membrane. Clinical: Imperforate Anus. Review and Overview of Abdominal Anatomy (50min)
The major emphasis of this lecture will be on male and female internal genital organs. The anatomical features, blood supply, innervation and lymphatics of the prostate,uterus and urinary bladder will be reviewed. . Surgical management of malignancies involving these viscera will be discussed.
C) HISTOLOGY LABORATORIES(3)
Esophagus and Stomach(2 h), and Small and large intestine(2 h). In these laboratories the students will: Identify the basic architectural landmarks of the G.I. system; recognize regional variations in structure of the tract and correlate them with function; identify the various epithelial cells that line the tract and understand their function; become familiar with the major regulatory systems that control G.I. functions; identify elements of the G.A.L.T. system.
Liver and Pancreas (2 h). In this laboratory the students willexamine the micro-anatomical organization of the livefr and pancreas. The principal landmarks of hepatic lobulation will be identified, including: central veins and portal tracts. The components of portal tracts will be identified, including branches of hepatic artery, portal vein, bile duct and lymphatic. The student should understand intralobular hepatic bloodflow and metabolic gradients through the lobule.
D) ANATOMY - RADIOLOGY LABORATORIES(5)
Anterior Abdominal wall, Inguinal Canal (3 h). In this laboratory the students will review: The surface anatomy of the anterior abdominal wall. In the dissections: the skin will be exposed. The Campers and Scarpas fascia will be exposed.
Muscles: external and internal oblique, transversus abdominis, rectus sheath,rectus abdominis, aponeurosis, conjoint tendon (falx inguinalis): attachments, actions, innervations.
Folds: Median, medial, and lateral umbilical ligaments.
Ligaments: Inguinal, lacunar, and pectineal ligaments.
Rectus sheath: Layers, contents, arcuate line.
Nerves: Intercostal, subcostal, iliohypogastric, and ilioinguinal (origin, course, structures innervated).
Vessels: Superior and inferior epigastric, deep circumflex iliac, posterior intercostal, and subcostal (origin and course).
Lymphatics: Superficial inguinal, and axillary node (pattern of drainage).
Inguinal canal:Boundaries: Anterior wall, Posterior wall, roof and floor, Deep and Superficial rings. Contents: Spermatic cord/ Round ligament, and the ilioinguinal nerve. Hasselbachs triangle (boundaries).
The radiology component will consist of: Coronal and axial MR and angiography of abdominal wall and inguinal region. MR imaging and vasography of the scrotum.
Peritoneal cavity and Abdominal Viscera I (3h). Supracolic Viscera(3h). Infracolic Viscera (3h) In these three laboratories students will dissect and/or view:
Scrotum: Testis, epididymis, and layers of scrotal wall.
Vessels: testicular, cremasteric, and ductus deferens, arteries, pampiniform plexus.
Nerves: ilioinguinal, and genital branch of genitofemoral
Female external genitalia: Round ligament and external genitalia: mons pubis, labia majora, pudendal cleft, labia minora, vaginal vestibule, clitoris.
Peritoneum: Parietal and visceral layers, the peritoneal reflections, peritoneal folds, the greater and lesser omentum, peritoneal ligaments. This will be followed by the inspection of viscera: diaphragm, gallbladder (fundus, body and neck), the liver, the spleen, small and large intestine, the stomach, hepatogastric and hepatoduodenal ligaments, duodenum, jejunum, ileum, cecum, vermiform appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, tenia coli, haustra, appendices epiploicae, Foramen of Winslow (epiploic foramen), omental bursae, falciform ligament, ligamentum venosum, right and left paracolic gutters.
Biliary System: right and left hepatic duct, main hepatic duct, cystic duct, common bile duct, Ampulla of Vater, Sphincter of Oddi.
Arteries: Celiac trunk: left gastric, splenic and common hepatic arteries: Gastroduodenal, hepatic proper, right gastric and cystic arteries.
Portal Vein: Splenic, superior mesenteric vein and inferior mesenteric vein. Celiac plexus. Lymphatic drainage.
Infracolic viscera and their vessels:
Branches of superior mesenteric artery: inferior pancreaticoduodenal, middle colic, right colic and Ileocolic arteries.
Branches of Inferior Mesenteric Arteries: left colic, sigmoidal branches, superior rectal arteries.
Veins: Superior mesenteric Vein, Inferior Mesenteric Veins.
Identify jejunum, ileum, vermiform appendix, cecum. Ascending colon, transverse colon, descending colon, Sigmoid colon.
Understand the pattern of lymphatic drainage and Innervation of all the infracolic Viscera.
Portosyste mic Anastomosis: sites involved and clinical manifestations.
The radiology component will consist of axial CT images, coronal MR images and angiography.
E) EMBRYOLOGY LAB (1)
Embryology of the gut and associated organs (1.5 h) In this computer lab session the students will view the embryology of the gut and associated organs that were discussed in the corresponding lecture
F) DEMONSTRATION (1)
Physiological basis of motility. Functional radiology- GI motility ( 1h). This demonstration will start with an exposition of the physiologic mechanisms and control of peristalsis. The radiological demonstration will consist of upper G.I. series and small bowel series, videoesophagrams, video small bowel series, nuclear gastric emptying times and nuclear biliary function studies.
G) JOURNAL CLUB
One article involving theGastrointestinal System
MODULE VI: KIDNEY, URINARY SYSTEM, PERINEUM, AND PELVIS
A) PBL(3 cases)
B) LECTURES(9)
Kidney Overview: Fundamental of Kidney Structure and Function(50 min). An overview of kidney structure including : General renal organization (cortex and medulla) and blood supply.The structure/function of nephron segments (proximal and distal nephron), and examination of tubule cell types. The structure/function of glomeruli and juxtaglomerular apparatus. Relationships between tubules and blood supply: why vasa recta and Henle = s loop through the inner medulla; what is the role of cortical peritubular capillaries. The lecture will also consider the main fundamentals of kidney function with definitions of filtration, reabsorption, secretion, excretion, renal clearance.
Development of the Genito-Urinary System(50 min). The development of the reproductive tract and of the kidney, ureter, and bladder from the intermediate mesoderm will be considered. During development all embryos develop both male and female reproductive ducts; subsequently one or the other is lost depending on the presence of absence of a Y chromosome, a process starting in the gonad. The molecular processes underlying the interactions of the ureter and the surrounding mesenchyme to form the definitive kidney will be presented.
Glomerular Filtration. Organic Solute Transport(50 min). This lecture will consider: Starling forces driving ultrafiltration - hydrostatic and oncotic pressure; filtration coefficient; measurements of glomerular filtration rate, autoregulation of renal blood flow and glomerular filtration rate; renal blood flow- measurement and control of renal blood flow; definition of filtration fraction.Tm limited reabsorption of organic solutes, including glucose, amino acids, phosphates- measurements, clearances, renal titration curves, cellular and molecular mechanisms of transport. Tm limited secretion of organic solutes (PAH): measurement, clearances, renal titration curves, cellular and molecular mechanisms. Reabsorption of proteins in the proximal tubule: measurement, cellular mechanisms (endocytosis), role in homeostasis of plasma levels of low molecular weight proteins, overview of mechanisms of albuminuria and proteinuria.
Salt and Water Transport (50 min). NaCl transport along the nephron: quantities, molecular and mechanisms . Glomerulo-tubular balance: relationship between filtration and excretion; hormonal control of fluid and sodium reabsorption along the nephron: ANF, aldosterone, volume contraction and expansion.
Renal Acid-Base Balance (50 min). Renal and respiratory acidosis and alkalosis. Mechanisms of renal acid-base transport: bicarbonate reabsorption (proximal tubule), proton secretion (distal tubule). Ammonium excretion. Titratable acidity. Regulation of renal acid-base transport.
Renal Concentrating Mechanism (50 min). Osmolal and free water clearance. Loop of Henle and maintenance of medullary hypertonicity. Antidiuretic hormone and water excretion. Regulation of water permeability in distal nephron: molecular and cellular mechanisms. Countercurrent exchange system.
Potassium Homeostasis (50 min). Overall potassium homeostasis in humans. Effects of hyperkalemia and hypokalemia. Intracellular/extracellular distribution of K. Renal K balance: sites of reabsorption and excretion. Cellular mechanisms of K absorption and secretion. Regulation of K secretion: tubular flow rate, hormonal factors, acid/base status.
Hormonal Volume Control(50 min). 1) Water balance and ADH. Chemistry and secretion of ADH: the posterior pituitary. Regulation of ADH secretion: plasma osmolality, and plasma volume. Renal effects of ADH: organ and cellular mechanisms. Vasoconstrictive effects of ADH. ADH receptors, structure and signaling. 2) Renin-Angiotensin-Aldosterone. Generation of angiotensin 11. Physiological effects of angiotensin 11: kidney, vasculature, adrenal. Cellular mechanisms of angiotensin 11: angiotensin receptors: structure, and signaling. (Note: Aldosterone is given in lecture on adrenocortical hormones). 3)Atrial Natriuretic Factor (ANF) and other Natriuretic Peptides. Chemistry and biosynthesis. Regulation of secretion by atrial stretch. Physiological effects of ANF : kidney and vasculature . Cellular mechanisms of ANF effects: ANF receptors: structure and signaling. The coordinated actions of ADH, Angiotensin, Aldosterone and ANF in effecting volume-pressure homeostasis
Clinical Anatomy Lecture: Applied Pelvic Anatomy(50 min). The major emphasis of this lecture will be on male and female internal genital organs. The anatomical features, blood supply, innervation and lymphatics of the prostate,uterus and urinary bladder will be reviewed. . Surgical management of malignancies involving these viscera will be discussed.
C) HISTOLOGY LABORATORIES (1)
Kidney, Ureter, Bladder, Urethra(2 h). In ths laboratory exercise, students will examine the micro-anatomical organization of the renal cortex and medulla. The structure and cell types of the renal corpuscle (glomerulus) will be examined. Regional variations in the nephron & #151; together with their cell types & #151; will be identified. The structure and cell types comprising the bladder, ureter, and urethra will be examined.
D) ANATOMY - RADIOLOGY LABORATORIES(7)
Posterior Abdominal Wall and the Diaphragm I and II(3h + 3h = 6h)
In these two labs the dissection will involve the removal of the parietal peritoneum covering the posterior abdominal wall viscera exposing the abdominal aorta and its branches, the inferior venae cavae with its branches, the kidneys with its coverings, renal capsule, perirenal fat and renal fascia, renal arteries and veins, suprarenals and its blood supply, ureter and the gonadal vessels. Nerves: lumbar plexus and its branches: iliohypogastric, ilioinguinal nerves, genitofemoral nerves, lateral cutaneous nerve of the thigh, femoral nerve, obturator nerve. The lumbosacral trunk and sympathetic trunk will also be exposed during this dissection. Muscles of the posterior abdominal wall will be exposed: transversus abdominis muscle, quadratus lumborum, psoas major and minor, iliacus and the diaphragm.
The radiology component will consist of axial CT images, coronal MR images and angiography.
Perineum I and II(3h + 3 h= 6h)
Perineum: Identify location of perineum and the location of the anal region and urogenital region.
Anal triangle of perineum: Boundaries and contents.i) anal canal- internal anatomy, anal sphincter, innervation and blood supply (submucosal venous plexus), lymphatics (inferior mesenteric and superficial inguinal lymph nodes, pattern of drainage); ii). ischiorectal (ischioanal fossae) boundaries and contents iii) Urogenital triangle of perineum: deep perineal pouch (urogenital diaphragm) - superior fascia of the urogenital diaphragm; inferior fascia of the urogenital diaphragm (perineal membrane); sphincter urethra and deep transverse perineal muscle (attachments, action, innervation); membranous urethra; vagina (female); bulbourethral glands (male); superficial perineal pouch: inferior fascia of the urogenital diaphragm (perineal membrane);. deep perineal fascia; superficial transverse perineal, ischiocavernosus and bulbospongiosus muscles (attachments, actions, innervation); crura of the clitoris, bulbs of the vestibule, greater vestibular glands, vagina, urethra (female); crura and bulb of the penis (male); potential space: deep and superficial perineal fasciae; -perineal body: composition, muscle insertion; female external genitalia: mons pubis, labia majora, pudendal cleft, labia minora, vestibule of the vagina (external urethral and vaginal orifices, orifices of the ducts of the greater vestibular glands), clitoris (body, glands, prepuce, frenulum); male external genitalia: penis - root, body, glans, prepuce, corpora cavernosa, corpus spongiosum, tunica albuginea, superficial and deep penile fasciae, suspensory and fundiform ligaments; innervation and blood supply,- scrotum - (see abdominal wall); nerves- origins (segmental derivation), course, structures innervated. pudendal nerve - perineal nerve (posterior scrotal/labial nerves), dorsal nerve of the clitoris/penis-perineal branch of the posterior femoral cutaneous nerve.genital branch of the genitofemoral and ilioinguinal.
innervation of perineal viscera: preganglionic parasympathetic fibers (pelvic visceral nerves, preganglionic sympathetic (hypogastric and sacral splanchnic nerves). postganglionic parasympathetic cell bodies (terminal ganglia).postganglionic sympathetic cell bodies (inferior hypogastric plexus). visceral afferent fibers (pain and non-pain). 1. vessels- origin, course. ].internal pudendal (perineal artery, artery of the bulb, deep artery of the penis/clitoris). 2. deep dorsal vein of the penis/clitoris. lymphatics-internal iliac, lumbar, and superficial inguinal lymph nodes; pattern of drainage. The radiology component will consist of coronal MR, and axial CT.
Pelvis I, II, and III (3h + 2h + 2h = 7h - Hemisected pelvis: Female and Male(2.5 h) Review the Osteology of the pelvic bones Hip bone- (ilium, ischium, pubis), sacrum, coccyx and their bony landmarks including articular surfaces and areas muscular/tendinous attachments. pelvic inlet and outlet. Pelvis major and minor pelvis Arthrology- Pubic symphysis, sacroiliac joints; sacroiliac, sacrotuberous, and sacrospinous ligaments (attachments, role in resisting movement at the sacroiliac joint), obturator membrane Muscles- attachments, action, innervation : pelvic wall- piriformis, obturator internus (obturator fascia). pelvic diaphragm- levator ani (puborectalis, pubococcygeus, iliococcygeus) and coccygeus; Viscera- urinary bladder- parts (body, neck, apex), detrusor muscle, internal features (trigone, ureteral and internal urethral orifices), peritoneal relations (vesicouterine, rectouterine (pouch of Douglas, [female] and rectovesical [male] pouches), Ligaments:puboprostatic [male], pubovesical [female], and median umbilical ligament, innervation and blood supply, lymphatics(pattern of drainage).
female urethra- orientation, relationships, innervation and blood supply male urethra- prostatic (urethral crest, orifices of the prostatic utricle and ejaculatory ducts, prostatic sinuses), membranous and penile (navicular fossa) urethrae prostate gland, ductus (vas) deferens, seminal vesicle, ejaculatory duct; relationships, innervation and blood supply, lymphatics (pattern of drainage) ovary- mesovarium, suspensory ligament of the ovary, ligament of the ovary, relationships, blood supply, lymphatic drainage uterine tube- parts (infundibulum [fimbriae], ampulla, isthmus, intramural part), mesosalpinx, blood supply and lymphatic drainage uterus- parts (fundus, body, cervix), relationships; peritoneal relationships (vesicouterine and rectouterine pouches); orientation (anteflexion, anteversion); ligaments (broad round,transverse cervical [cardinal], uterosacral); innervation, blood supply, lymphatic drainage. vagina- walls, fornices; innervation, blood supply, lymphatic drainage rectum- external and internal anatomy, relationships, peritoneal relationships, innervation and blood supply, lymphatic drainage Vessels- origin, course, anastomoses
1. internal iliac artery- anterior trunk (umbilical, superior and inferior vesical, middle rectal, uterine [female, relationship to ureter], vaginal [female], internal pudendal, inferior gluteal, and obturator arteries), posterior trunk (superior gluteal, iliolumbar, and lateral sacral arteries)
2. internal iliac vein- middle rectal, uterine (female), vaginal (female), internal pudendal, inferior and superior gluteal, obturator, and lateral and median sacral veins, prostatic (male), vesical, and rectal venous plexuses f Lymphatics- sacral lymph nodes, internal, external and common iliac lymph nodes, drainage patterns Nerves- origin (segmental derivation), course, structures innervated somatic nerves (branches of the sacral plexus)- sciatic, pudendal, superior and inferior gluteal, posterior femoral cutaneous nerves; nerves to piriformis, levator ani, coccygeus, obturator internus, and quadratus femoris autonomic nerves- sacral sympathetic trunk, sympathetic ganglia, gray rami communicantes, visceral afferent fibers innervation of pelvic viscera- preganglionic parasympathetic fibers (pelvic visceral nerves, S2-4), preganglionic sympathetic fibers (superior hypogastric plexus, hypogastric and sacral splanchnic nerves), postganglionic parasympathetic cell bodies (terminal ganglia), postganglionic sympathetic cell bodies (inferior hypogastric plexus), visceral afferents fibers (pain and non-pain)
The radiological component will consist of MR, CT, hysterosalpingography, urethrogram, vasogram, and cavenosogram.
E) EMBRYOLOGY LAB(1)
Development of the Urogenital System(2h). The development of the reproductive tract in male and female embryos will be covered, including the development of the mesonephric and paramesonephric ducts in male and female, and the morphogenetic steps in formation of the kidney, ureter, and bladder.
F) SMALL GROUP REVIEW(2)
Exercises on renal function(1.5h). In this section the students will calculate major renal function parameters (GFR, RPF, CH20, Cosm, excretion and reabsorption of fluid and electrolytes) from laboratorial data of patients with congestive heart failure, hypoosmolarity/hyponatremia; hyperosmolarity/ hypernatremia.
Acid-base exercises(1h). In this session the students will calculated acid-base parameters in diabetic keto acidosis, posthypercapnic alkalosis, respiratory alkalosis, and vomiting alkalosis.
G) JOURNAL CLUB
One article involving the kidney
MODULE VII: REPRODUCTION- ENDOCRINOLOGY
A) PBL(3 cases)
B) LECTURES(9)
Pituitary(50 min). Structure and development of the anterior and posterior pituitary. Relationship of pituitary gland to hypothalamus: parvicellular neurons, magnocellular neurons, hypothalamic-hypophyseal portal system. Anterior and posterior pituitary hormones. Identification of cell types in pars distalis: secretions and regulation. Target tissue and feedback inhibition. Circadian rhythms and pulsatile release of hypothalamic-pituitary hormones.
The Male Reproductive System(50 min). Endocrine regulation of spermatogenesis. Structure-function of spermatozoa. Epididymis: sperm maturation and storage. Structure and function of accessory glands.
The Female Reproductive System(50 min). Oogenesis. Endocrine regulation of follicular development and the menstrual cycle.
Conception(50 min). Endocrine regulation of oviducts and cervix. Capacitation. Sperm-ovum interactions: acrosome reaction, cortical reaction, and zona pellucida.
Insulin-Glucagon(50 min). Insulin chemistry. Overview of physiological actions of insulin: Insulin deficiency (hyperglycemia, glucosuria, polyuria, polyphagia, weight loss); brief review of actions of insulin on adipose tissue, muscle, and liver (glucose production, lipogenesis, and ketogenesis). Mechanisms of insulin action: the insulin receptor, structure and signaling. Regulation of insulin secretion: cellular mechanism of the secretary effects of glucose. Regulation by other circulating metabolites; hormonal and neural control of insulin secretion. Glucagon chemistry, secretion and metabolism. Physiological actions of glucagon : glucose production, glyconeogenesis, gluconeogenesis, lipogenesis and ketogenesis, ureogenesis. Regulation of glucagon secretion. The cross talk between insulin and glucagon.
Adrenocortical Hormones(50 min). Biochemistry of principal adrenal steroid hormones Adrenal steroid hormone biosynthesis. ACTH and regulation of glucocorticoid secretion: circadian rhythm, systemic feedback , cellular mechanisms. Angiotensin 11 and regulation of mineralocorticoid secretion: cellular mechanisms, systemic feedback. Effects and mechanisms of action of glucocorticoids: effects on energy metabolism, antiinflamatory effects, immune response effects, glucocorticoid and cytokines, glucorticoids and arachidonic acid metabolites, effects on lymphoid tissues; other systemic effects of glucorticoids effects Metabolism and excretion of adrenocortical hormones. Generic overview of effects of aldosterone in the kidney.
Growth Hormone and Growth Factors(50 min). Synthesis, secretion and metabolism of GH. Physiological effects and mechanisms of action of GH: skeletal growth; role of somatomedin; role of IGF- effects of GH on body composition; effects on energy metabolism. Regulation of GH secretion: effect of age; regulators; actions of GHRH and somatostatin.
Thyroid Gland(50 min). Function and regulation of the thyroid gland. Extracellular storage of hormone precursor (thyroglobulin). Biochemical and morphological pathway for the synthesis of thyroid hormone. Feedback mechanisms. Physiological effects of thyroid hormone. Disturbances of thyroid function.
Parathyroid Gland and Calcium Metabolism (50 min). Brief overview of calcium homeostasis: distribution in body, balance, intestinal absorption, calcium and bone formation, renal handling of calcium. Relationship between calcium and phosphorus balance. Regulation of Calcium balance: 1) PTH. Biosynthesis, storage, and secretion of PTH. Physiological effects of PTH : bone, kidney, intestinal absorption: organ, cellular and molecular mechanisms. Regulation of PTH secretion. 2) Calcitonin: biosynthesis, secretion and metabolism; physiological actions (bone, kidney); regulation of secretion. 3) Vitamin D. Synthesis and metabolism. Physiological actions of Vit D3:intestine, bone, kidney. Regulation of Vit D3 production. Integrated actions of calcitropic hormones: Response to hypocalcemic and hypercalcemic challenges.
C) HISTOLOGY LABORATORIES(6)
The Pituitary Gland(2.5 h). Students will identify and learn: neural and epithelial omponents of the gland; vascular architecture and its relation to endocrine cells; cell types in anterior pituitary.
Testes, Ducts, and Accessory Glands(2.5 h). Students will identify: spermatogenic series and Leydig cells in testes; structure-function of genital ducts: tubuli recti, efferent ductules, epididymis, and vas deferens; structure-function of accessory glands: seminal vesicle and prostate.
Ovary and Follicular Development(2.5 h). Students will identify: stages of oocyte and follicular development; formation and degeneration of corpus luteum; atretic follicles.
Uterus, Vagina, and Exfoliative Cytology (2.5 h). Students will identify: structure of oviduct, uterus, cervix, and vagina; alterations in uterine morphology during menstrual cycle; exfoliative cytology.
The Adrenal Gland. Placenta(1.5 h). Adrenal - Students will identify: organization and functional morphology of the adrenal; cortical zones and their principal secretions: glomerulosa, fasciculata, and reticularls; functional basis for regulation of medullary secretion by cortex.Placenta- Students will identify: structure of the placenta: chorionic plate, basal plate and villi; synciciotrophoblast, cytotrophoblast, and decidual cells; alterations in placenta morphology during gestation
Thyroid and Parathyroid Glands (2 h). Students will identify the: structure of thyroid and parathyroid glands; thyroid follicles and follicular epithelium. Students will correlate morphology of follicular epithelium with functional status of the gland; recognize and understand role of parafollicular cells in calcium metabolism; examine goiter.
MODULE VIII: LOCOMOTOR SYSTEM
A)LECTURE (1)
Clinical Anatomy Lecture: Joints of Lower Extremity (50 min) This lecture will address the hip and knee joints. The main anatomical features relating to this joint will be reviewed. Major emphasis will be on the modern surgical techniques utilized in the management of common hip and knee injuries. Anatomical changes related to the common degenerative disorders will be addressed
B) ANATOMY-RADIOLOGY(4)
Anterior and Medial Thigh (3h)
The students will review the bony landmarks: Anterior superior Iliac spine, Anterior inferior Iliac spine, pubic tubercle, greater trochanter, lateral condyle, medial condyle, adductor tubercle linea aspera, patella and tibial tuberosity Femoral triangle Review the superior, medial and lateral boundaries of the femoral triangle. Clean the femoral artery and vein. Identify-profunda femoris, lateral femoral circumflex, and medial femoral circumflex artery Femoral sheath and its contents: femoral artery, vein and some deep lymph nodes. Muscles: pectineus, adductor longus and iliopsoas. Identify femoral nerve and its branches. Identify boundaries of the adductor canal. Muscles of Anterior thigh: vastus lateralis, vastus intermedius, vastus medialis and rectus femoris. Identify ligamentum patellae. Muscles of the medial thigh includes the adductor magnus, adductor longus, adductor brevis, gracilis obturator externus and pectineus. The nerve supply to this group of muscles is obturator nerve.
Gluteal Region, Posterior thigh and Popliteal fossae(3h)
Review the surface anatomy of the gluteal region and the posterior thigh.Review the major bony landmarks: greater sciatic notch, lesser sciatic notch, ischial spine, ischial tuberosity, sacrotuberous ligament, sacrospinous ligament, greater/lesser sciatic foramen, greater trochanter of femur, intertrochanteric crest, trochanteric fossae.
Muscles: Dissect the gluteus maximus, medius, minimus, piriformis, superior and inferior gemelli, obturator internus, quadratus femoris and understand their origin, insertion, innervation and action.
Nerves: Inferior gluteal, superior gluteal, sciatic nerve, posterior femoral cutaneous, pudendal nerve and the internal pudendal vessels.
Posterior thigh muscles: semitendinosus, semimembranosus, and the long head of biceps femoris.
Popliteal fossae: Review the boundaries and contents of this diamond shaped area.
Leg. Dorsum of the Foot(3h) Review the surface anatomy of the leg.
Osteology: The tibia and fibula Anterior and lateral crural septa–anterior, lateral (peroneal) and posterior compartments Superficial fascia cutaneous nerves- saphenous, superficial peroneal, lateral and medial; sural, sural nerves (origin, area of distribution); great and small saphenous veins- origin, course; Muscles- attachments, actions, innervation anterior compartment- tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus (fibularis) tertius; lateral compartment- peroneus (fibularis) longus, peroneus (fibularis) brevis; posterior compartment:. superficial muscles- gastrocnemius, soleus, plantaris, deep muscles- popliteus, flexor hallucis longus, tibialis posterior, flexor digitorum longus; tendo calcaneus (Achilles tendon)- Nerves- origin (segmental derivation), course, structures innervated tibial nerve; common peroneal (fibular) nerve- superficial and deep peroneal (fibular) nerves Vessels- origin, course, arterial anastomoses around the knee joint popliteal- superior, middle, and inferior genicular vessels: anterior tibial, posterior tibial and its peroneal branch Interosseous membrane and its attachments. Dorsum of foot-Superficial fascia: cutaneous nerves- saphenous, superficial peroneal, sural (origin, area of distribution),dorsal venous arch; deep fascia- flexor, superior and inferior extensor, superior and inferior peroneal retinacula. muscles- extensor digitorum brevis, extensor hallucis brevis (attachments, actions, innervations); deep peroneal nerve- origin (segmental derivation), course, structures innervated; dorsalis pedis artery- origin, course; extensor expansions composition, muscular insertions The radiology component will consist of axial and coronal MR, arteriography, venography, and Doppler ultrasound.
Sole of the Foot. Hip and Knee Joints(1.5 h)
Sole of the foot: -superficial fascia: cutaneous nerves (medial calcaneal, medial and lateral plantar), origin, area of distribution;
- deep fascia- plantar aponeurosis, fibrous tendon sheaths;
- muscles: attachments, actions, innervation:. first layer- abductor halluces, flexor digitorum brevis, abductor, digiti minimi,. second layer- tendon of the flexor digitorum longus, tendon of the flexor hallucis longus, quadratus plantae, lumbricals- . third layer: flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis, fourth layer: plantar and dorsal interossei nerves- medial and lateral plantar nerves (origin [segmental derivation], course, structures innervated); vessels- medial and lateral plantar vessels, plantar arch (origin, course);
- archestransverse
Students will review the essential bony features of the hip joint. The joint will be exposed by cutting the sartorius, rectus femoris, pectineus and the femoral nerve and vessels. Identify the ligaments: iliofemoral, puboemoral and ishiofemoral. The joint capsule will be opened to observe the articular area of the head of femur. In addition the students will expose the ligament of the head of the femur and the acetabular fossae.
Knee joint:
Review the bony landmarks of the knee joint. Detach the tendons of the sartorius, gracilis, and semitendinosus from their insertions. Identify the tibial collateral ligament and the medial meniscus. On the lateral aspect identify the iliotibial tract, fibular collateral ligament. On the anterior aspect the students will identify ligamentum patellae and the prepatella bursa. Students will also identify the anterior cruciate and posterior cruciate ligament. The medial and lateral will also be exposed.
Ankle joint:
Review the bony components, fibrous capsule and ligaments of the ankle joint:- medial (deltoid) ligament, lateral ligament (anterior and posterior talofibular, calcaneofibular), attachments, role in resisting movement at the ankle joint,the proximal and distal tibiofibular joints, subtalar (interosseous talocalcaneal ligament), talocalcaneonavicular (plantar calcaneonavicular ligament), calcaneocuboid (long and short plantar ligaments), transverse tarsal, tarsometatarsal, metatarsal, metatarsophalangeal, and interphalangeal joints, crural interosseous membrane; movements- muscles/muscle groups producing them. Review the innervation of the joint.
The radiology component will consist of axial and coronal MR images and arteriography, including plantar aspects of the foot. knee joint: articular components- bony components, fibrous capsule (quadriceps tendon, patellar ligament, medial and lateral patellar retinacula, arcuate and oblique popliteal ligaments),. ligaments- tibial and fibular collateral ligaments, anterior and posterior cruciate ligaments (attachments, role in resisting movement at the knee joint), medial and lateral menisci- change in position during movement of the knee, transverse ligament of the knee, coronary ligament, synovial membrane- infrapatellar fat pad, alar fold, bursae- suprapatellar, prepatellar, superficial and deep infrapatellar, biceps femoris, popliteal semimembranosus, and gastrocnemius bursae.
