Moore Clinically Oriented Anatomy 8E
Anatomy is the setting (structure) in which the events (functions) of life occur. This book deals mainly with functional human gross anatomy—the examination of structures of the human body that can be seen without a microscope. The three main approaches to studying anatomy are regional, systemic, and clinical (or applied), reflecting the body’s organization and the priorities and purposes for studying it.
Regional anatomy (topographical anatomy) considers the organization of the human body as major parts or segments (Fig. 1.1): a main body, consisting of the head, neck, and trunk (subdivided into thorax, abdomen, back, and pelvis/perineum), and paired upper limbs and lower limbs. All the major partsmay be further subdivided into areas and regions. Regional anatomy is the method of studying the body’s structure by focusing attention on a specific part (e.g., the head), area (the face), or region (the orbital or eye region); examining the arrangement and relationships of the various systemic structures (muscles, nerves, arteries, etc.) within it; and then usually continuing to study adjacent regions in an ordered sequence.
This book follows a regional approach, and each chapter addresses the anatomy of a major part of the body. This is the approach usually followed in anatomy courses that have a laboratory component involving dissection. When studying anatomy by this approach, it is important to routinely put the regional anatomy into the context of that of adjacent regions, of parts, and of the body as a whole. Regional anatomy also recognizes the body’s organization by layers: skin, subcutaneous tissue, and deep fascia covering the deeper structures of muscles, skeleton, and cavities, which contain viscera (internal organs). Many of these deeper structures are partially evident beneath the body’s outer covering and may be studied and examined in living individuals via surface anatomy. Surface anatomy is an essential part of the study of regional anatomy. It is integrated into each chapter of this book in “surface anatomy sections” that provide knowledge of what lies under the skin and what structures are perceptible to touch (palpable) in the living body at rest and in action. We can learn much by observing the external form and surface of the body and by observing or feeling the superficial aspects of structures beneath its surface. The aim of this method is to visualize (recall distinct mental images of) structures that confer contour to the surface or are palpable beneath it and, in clinical practice, to distinguish any unusual or abnormal findings. In short, surface anatomy requires a thorough understanding of the anatomy of the structures beneath the surface. In people with stab wounds, for example, a physician must be able to visualize the deep structures that may be injured. Knowledge of surface anatomy can also decrease the need to memorize facts because the body is always available to observe and palpate.
Physical examination is the clinical application of surface anatomy. Palpation is a clinical technique, used with observation and listening for examining the body. Palpation of arterial pulses, for instance, is part of a physical examination. Students of many of the health sciences will learn to use instruments to facilitate examination of the body (such as an ophthalmoscope for observation of features of the eyeballs) and to listen to functioning parts of the body (a stethoscope to auscultate the heart and lungs). Regional study of deep structures and abnormalities in a living person is now also possible by means of radiographic and sectional imaging and endoscopy.
Radiographic and sectional imaging (radiographic anatomy) provides useful information about normal structures in living individuals, demonstrating the effect of muscle tone, body fluids and pressures, and gravity that cadaveric study does not. Diagnostic radiology reveals the effects of trauma, pathology, and aging on normal structures. In this book, most radiographic and many sectional images are integrated into the chapters where appropriate. The medical imaging sections at the end of each chapter provide an introduction to the techniques of radiographic and sectional imaging and include series of sectional images that apply to the chapter. Endoscopic techniques (using a flexible fiber-optic device inserted into one of the body’s orifices or through a small surgical incision [“portal”] to examine internal structures, such as the interior of the stomach) also demonstrate living anatomy. The detailed and thorough learning of the threedimensional anatomy of deep structures and their relationships is best accomplished initially by dissection. In clinical practice, surface anatomy, radiographic and sectional images, endoscopy, and your experience from studying anatomy will combine to provide you with knowledge of your patient’s anatomy.
The computer is a useful adjunct in teaching regional anatomy because it facilitates learning by allowing interactivity and manipulation of two- and threedimensional graphic models. Prosections, carefully prepared dissections for the demonstration of anatomical structures, are also useful. However, learning is most efficient and retention is highest when didactic study is combined with the experience of firsthand dissection—that is, learning by doing. During dissection, you observe, palpate, move, and sequentially reveal parts of the body. In 1770, Dr. William Hunter, a distinguished Scottish anatomist and obstetrician, stated: “Dissection alone teaches us where we may cut or inspect the living body with freedom and dispatch.”
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