o Cut and spread the wall of the gallbladder and the cystic duct attached to the liver. Examine the inside.
o See that the ligamentum venosum connects the portal vein and the inferior vena cava. Then discuss the fetal circulation.
o Dissect the liver and observe that the common hepatic duct, proper hepatic artery, and portal vein branch out and supply two lobes. The rt, intermediate, and left hepatic vein which enter the inferior vena cava lie between two areas.
o See which branch of the celiac trunk goes to which mesentery.
o Peel off one layer of peritoneum from the mesentery of the small intestine and the large intestine. Find the branches of the superior and the inferior mesenteric artery. To do this, remove the superior and the inferior mesenteric vein.
o (One can only guess this in reality) Observe that the branches of the celiac trunk and the superior mesenteric artery connect at the descending part of duodenum (anastomosis). See that the branches of the superior and the inferior mesenteric artery connect at the transverse colon.
o Observe that the appendicular artery, and a branch of the ileocolic artery are originated from the superior mesenteric artery, exists in the appendix.
o Detach the front part of the pancreas. Find the relationship between the accessory pancreatic duct, pancreatic duct, common bile duct and the hepatopancreatic ampulla. Cut and open the descending part wall of the duodenum. Observe that the hepatopancreatic ampulla opens into the major duodenal papilla.
o Confirm that the peritoneum covering the spleen is easily removable but the fibrous capsule inside is not easily removable due to the splenic trabecula.
o Remove the wall of the stomach and see the outer longitudinal muscle, middle circular muscle, and inner oblique muscle.
o Remove the wall of the large intestine and see the relationship between the tenia coli and the outer longitudinal muscle.
o See that the celiac ganglion connects with the greater splanchnic nerve. See that the celiac plexus, superior mesenteric plexus, inferior mesenteric plexus, superior hypogastric plexus and hypogastric nerve link.
o Cut the suprarenal gland Distinguish the relatively white cortex and the relatively black medulla.
o Remove a small part of the anterior kidney and see the pathway for urine.
o Confirm that the end of the common iliac artery pushes the ureter.
o Look for the caval opening which can be found at the central tendon of the diaphragm. Also, find the esophageal hiatus and the aortic hiatus from the muscle belly.
o Observe that the intestinal lymphatic trunk and the lumbar lymphatic trunk enters the chyle cistern. If necessary, remove the abdominal aorta and find them.
o Cut out the psoas major, and observe that the femoral nerve and the obturator nerve emerge from the 2nd - 4th lumbar nerves.
10. Stomach & intestine
ⓓ If interested, a group can take out the gut from the stomach to the sigmoid colon. Cut vertically, open and then remove the food inside the gut. Use sink and paper towel when removing the food.
o Observe that there are vertical gastric folds in the stomach, and transverse circular folds in the small intestine.
o Understand that the digestion and absorption in the jejunum are more active than in the ileum by considering their appearance.
o See if there is an ileal diverticulum located 50 cm apart from the ileocecal valve facing the umbilicus. There is a 1-2% chance of the ileal diverticulum.
Chapter IX. Pelvis & perineum
1. Peritoneal cavity in pelvis
2. Arteries & nerves in gluteal region
3. Pelvic organs
1. Peritoneal cavity in pelvis
ⓓ The pelvis also has the peritoneal cavity. From a male cadaver, touch the rectovesical pouch. From a female cadaver, touch the vesicouterine pouch. For a female cadaver, put one hand in the rectouterine pouch and the other hand in the back of the vaginal fornix to feel the thin boundary.
o For a female cadaver, see that the mesosalpinx and the mesovarium continue to the mesometrium and that the round ligament of uterus originates from the uterus and goes into the deep inguinal ring.
o For a female cadaver, insert a wire into the uterine tube and check if the peritoneal cavity and the uterine cavity are connected. Also check how far the ovary is from the fimbria.
2. Arteries & nerves in gluteal region
ⓓ Cut and reflect the origin of the left gluteus maximus. Be careful not to disconnect the inferior gluteal nerve and the inferior gluteal artery which innervate the gluteus maximus.
3. Pelvic organs
ⓓ Cut the intervertebral disc of the 4th - 5th lumbar vertebrae located at the level of the iliac crest. In order to divide the whole body into the upper and the lower body, cut out the structures that connect the abdominal cavity and the pelvic cavity. While cutting the border of the sigmoid colon and the rectum, tie them well with a string to prevent the food inside from leaking out. Cut the left sacroiliac jointernal and the pubic symphysis. Detach the left pelvic wall and the left leg. For this, cut the structure that connects the pelvic wall and the pelvic cavity. For some cadavers, do the median section instead of this method.
o Observe the nucleus pulposus and the anulus fibrosus that form the intervertebral disc.
o Put one hand in the pelvis and the other hand in the ischioanal fossa of the perineum. Feel the pelvic diaphragm which is the boundary of the pelvis and the perineum.
o The tendinous arch which is the origin of levator ani lies from the pubic symphysis to the ischial spine.
o See that the piriformis passes the greater sciatic foramen and reaches the gluteal region while the obturator internus passes the lesser sciatic foramen and reaches the gluteal region.
o Recognize that the superficial transverse perineal muscle and the external anal sphincter are on the same layer as the ischiocavernosus and the bulbospongiosus.
o Detach the white and tough perineal membrane and observe the deep transverse perineal muscle and the external urethral sphincter that form the urogenital diaphragm. From a male cadaver, see the bulbourethral gland in the urogenital diaphragm.
o See that the both sides of the sympathetic trunk meet to form the ganglion impar. See that the sacral ganglion and the anterior ramus of the sacral nerve link to the gray ramus communicans.
o See that the sciatic nerve originates from 4th lumbar - 3rd sacral nerves.
o Observe that the pudendal nerve originates from the 2nd - 4th sacral nerves and follows the internal pudendal artery. Observe that the inferior rectal nerve originates from the pudendal nerve and then the perineal nerve and the dorsal nerve of penis branch off. (in case of female, dorsal nerve of clitoris).
o Observe that the superior gluteal artery originates from the posterior branches of the internal iliac artery, and the inferior gluteal artery, umbilical artery, obturator artery, internal pudendal artery and uterine artery from the anterior branches.
o In a female cadaver, observe the anastomosis of the ovarian artery and the uterine artery.
o Cut and open the wall of the urinary bladder. Observe the vesical trigone and the ureteric orifice. See that the ureteric orifice is tilted by inserting a wire.
o From a male cadaver, cut the wall of the ductus deferens, seminal vesicle, and ejaculatory duct. Find that their lumen are connected.
o From a male cadaver, detach the prostate in front of the prostatic urethra. Observe the prostatic utricle in the seminal colliculus.
o From a male cadaver, skin the penis. Split the two corpora cavernosa and the one corpus spongiosum. Cut the corpus spongiosum vertically and open to find the urethra.
o From a female cadaver, detach the wall of the uterus. Observe the lumen of the cervix and the body of the uterus.
o From a female cadaver, see that the crus of clitoris and the bulb of vestibule is spongy tissue. Observe the greater vestibular gland behind the bulb of vestibule.
o Cut the rectum and posterior wall of anal canal vertically and open to pull out the food inside. From the section of the anal canal, observe the external anal sphincter which is relatively red and the internal anal sphincter which is relatively white. Observe that the internal anal sphincter and the inner circular muscle of the rectum connect.
ⓓ Remove the skin of the lower limb including the toes.
o The fixative might have been injected to the cadavers through the femoral artery. Cut and remove the string.
o Observe that the great saphenous vein passes the medial malleolus anteriorly, penetrates the saphenous opening, and enters the femoral vein. Also, the small saphenous vein passes the lateral malleolus posteriorly and enters the popliteal vein. Find the perforating vein.
o Remove the fascia lata except the iliotibial tract.
o From the femoral triangle, there are femoral vein, artery, and nerve respectively from posterior to anterior.
o Put your finger inside the peritoneal cavity, and through the femoral ring to the femoral canal. While doing this, confirm that the femoral ring is situated lateral to the lacunar ligament, and anterior to the pectineal line. (Femoral hernia is a condition caused by protrusion of small intestine through the femoral ring to the femoral canal.)
2. Rectus femoris
ⓓ Cut and reflect the rectus femoris.
o Observe that the adductor canal is located lateral to the sartorius, medial to the vastus medialis, and the adductor canal ends with the adductor hiatus. The opening of the adductor magnus is the adductor hiatus.
3. Pectineus & adductor longus
ⓓ Cut and reflect the pectineus and the adductor longus.
o The medial and lateral femoral circumflex artery emerge from the deep femoral artery which lies inside the adductor longus.
o Recognize that the obturator externus and the obturator internus have the same function by examining the appearance.
4. Gluteus medius
ⓓ Cut and reflect the gluteus medius. Be careful not to cut off the superior gluteal nerve that supplies the gluteus medius, the gluteus minimus, and superior gluteal artery.
o Observe at which position the sciatic nerve branches into to the tibial nerve and the common fibular nerve.
5. Gastrocnemius & soleus
ⓓ Cut and reflect the gastrocnemius.
ⓓ Cut and reflect the soleus.
7. Leg & ankle
ⓓ From the posteriorcompartment of leg, situated are the tibialis post, flexor digitorum longus, and flexor hallucis longus, in that order from the inside.
o Clean and remove the three retinaculums of the ankle. Inside the retinaculums, the synovial sheath wraps around the tendon.
o Cut the fibularis longus. See that the common fibular nerve is being divided to the superficial fibular nerve and the deep fibular nerve.
o Observe that the popliteal artery branches out to the anterior tibial artery and the posteriortibial artery. The fibular artery originates from the posteriortibial artery.
o Find that the dorsalis pedis artery divides into the arcuate artery and the deep plantar artery.
8. Plantar aponeurosis
ⓓ Remove the plantar aponeurosis.
9. 1st layer of sole
ⓓ Cut and reflect the flexor digitorum brevis and the abductor hallucis.
10. 2nd layer of sole
ⓓ Cut and reflect the quadratus plantae and the flexor digitorum longus.
o See that the posteriortibial artery divides into the medial and the lateral plantar artery. Confirm that the lateral plantar artery and the deep plantar artery meet to form the plantar arch.
11. 3rd & 4th layers of sole
ⓓ Cut and reflect the oblique head of the adductor hallucis and the flexor hallucis brevis.
12. Hip joint
ⓓ Cut and open the hip joint capsule. (Do either the right or the left.)
o Observe that the acetabular labrum deepens the acetabulum. Also, the ligament of head of femur attaches to the transverse acetabular ligament.
13. Knee & ankle joint
ⓓ Cut and reflect the quadriceps femoris to see the knee joint. (Do either the right or the left.)
o Examine the form of the tibial and the fibular collateral ligament and the anterior and the posteriorcruciate ligament. Determine the functions of these structures by considering their appearance.
o The medial meniscus is oval. The lateral meniscus is circular. Find the narrow articular cavity under the meniscus.
o Observe the movement of the patella while bending the knee. Remove the thick articular cartilage of the patella.
o Move the ankle jointernal and see the following actions: It requires the joints above the talus for dorsiflexion and plantar flexion. It requires the joints below the talus for inversion and eversion.