Dissection Guide
2011
Gross Anatomy Dissection
Guide
Lock Haven University
Physician Assistant Program
John Leffert, MPAS, PA-C, Assistant Professor Physician Assistant Studies
Daniel J. Gales, ATC, Associate Professor of Health Sciences
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Table of Contents
Page
1. Dissection Lab 1- Introduction/Anterior Thorax
3
2. Dissection Lab 2- Upper Extremity
6
3. Dissection Lab 3- Back and Spine
8
4. Dissection Lab 4- Lower Extremity
10
5. Dissection Lab 5- Practical Examination
6. Dissection Lab 6- Head and Neck
15
7. Dissection Lab 7- Thorax
25
8. Dissection Lab 8- Heart and Mediastinum
33
9. Dissection Lab 9- Abdomen
45
10. Dissection Lab 10- Retroperitoneum/GU
57
11. Dissection Lab 11- Central Neuro
68
12. Dissection Lab 12- Final Practical
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Introduction
The purpose for this course is somewhat different from what you might expect. In ten
weeks we will dissect a cadaver discovering clinically relevant structures that are
important for the practice of medicine.
You will learn important structures as well as become experienced in handling surgical
instruments, begin to think critically and problem solve.
At the conclusion of this course you will be able to do the following:
• Be able to correlate anatomical structural locations with the clinical examination.
• Be able to locate clinically significant structures.
• Describe their location and relative function.
• Be able to communicate using appropriate terminology anatomical landmarks to
others.
To aid in correlating the anatomy lab to clinical medicine you will be given three
exercises to complete prior to your dissection lab. You will divide your group into 3
sections and each section takes one case and researches it. You are to determine the
probable diagnosis, pathophysiology, clinical examination and treatment. These
presentations will be made orally during the first hour of the lab. Then we will go to the
lab and perform the dissection searching for the structures we just discussed.
You will have two practical examinations. The first will be when you completed
dissections labs 1 through 4. Your final practical examination will be performed dealing
with the clinically important structures found during dissection labs 6-11.
It is understood that a complete dissection will not be possible in the short period of
time we meet as a group in the lab. It is expected that you will have to spend time after
hours to complete the assignments, identify and learn the structures outlined in each
chapter. The lab will be available to you and your fellow students 24/7. You student ID
card will allow you access to the lab here and in Clearfield.
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Rules
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Laboratory use: No unauthorized people may be admitted to the lab at any time. Food
and drinks including bottled water are NOT permitted in the laboratory area.
Attire: Proper attire is required in the laboratory at all times. Attire that is not appropriate
includes: flip-flop, open-toed or beach-type sandals and non-rubber soled shoes.
Laboratory coats, face shields and latex gloves are available for use in the laboratory.
Non-latex gloves are available; please let me know if you need them.
Laboratory Security: Lab door must be locked when unoccupied. This includes taking
breaks or leaving the vicinity of the laboratory. The door between the classroom and the
lab should remain locked.
Cadaver care: Care should be taken to preserve the skin of the extremities in one
continuous sheet. The skin will be used to rewrap the limb segment to delay drying out of
the limbs. Bodies should be thoroughly moistened and covered when not in use. Be sure
to cover bodies with plastic to prevent evaporation of preservative.
Tissue fragments: All tissue fragments should be placed in appropriate containers. A
container for each cadaver will be identified. Keep fragments from each cadaver in their
appropriate container. Gloves and trash DO NOT go in tissue containers.
Cleaning: The cadaver room is maintained by a contracted cleaning crew. They will keep
the floors mopped. However, they will not clean the room if tissue fragments are present.
Scan the room before you leave each session to make sure all fragments are stored
properly. A mop, bucket and floor soap are available for use if an emergency arises,
please use them.
Access: Access to the lab is through a card reader system. You have been given authority
to access the lab with your student ID. Pass your card by the reader and the door should
become unlocked. This access should also work on the outside door of the Health
Professions Building. If you leave the lab, do not forget to take your ID with you otherwise
you could be locked out of the room.
Instruments: Instruments should be cleaned with soap and water and dried after each
session. Scalpels are not to be recapped or washed. Store them in the provided metal
container. Dull scalpels should be discarded in the appropriate red sharps container.
Supplies: The supply closet contains supplies for both the Physician Assistant Program
AND the undergraduate program. These are not community use supplies. You are not
allowed in the supply closet. If we run low on an item, let an instructor know immediately
once an item gets low before the item runs out.
Windows: The laboratory is equipped with a downdraft system that removes the majority of
odors created by the specimens. The room is also air conditioned. Please do not open
laboratory windows at all. The air condition system works best with the windows closed.
The air conditioning is on a timer and is shut off during the weekends. I will show you how
to turn it on when you are here in the evenings or weekends.
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ANTERIOR THORAX
LABORATORY WORKSHEET
Dissection instructions:
1.
Skin removal: Make the following incisions as outline in the image below. Make sure your
cuts are into the superficial fascia but not into the deep fascia.
2.
Reflect the skin of the cadaver starting from the medial side and proceeding laterally. Near
the deltopectoral triangle, remove the cephalic vein from the superficial fascia. Identify the
pectoralis major muscle. Identify the clavicular and sternal portions of this muscle
3.
Cut the pectoralis major from its origin. Reflect this muscle laterally. Remove the fascia
covering the pectoralis minor. Identify the subclavius muscle. Remove the pectoralis minor
muscle from its origin. Clean and identify the branches of the thoraco-acromial artery.
4.
Identify the lateral thoracic artery. Do not follow this artery. Identify the serratus anterior
muscle.
5.
Brachial plexus: The following steps are to be followed to identify the components of the
brachial plexus.
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Anterior Arm and Forearm
Laboratory Worksheet
Dissection instructions:
1.
Place the cadaver in a supine position. Separate the cephalic vein from the skin and
subcutaneous fascia and make a longitudinal cut from the arm to the forearm and wrist. Be
sure to not transect the median cubital vein in this step.
2.
Work laterally and medially to separate the skin from the deep fascia. Using your fingers,
separate the three muscles of the anterior arm. Identify the short head and long heads of
the biceps brachii. Identify the tendon of the biceps brachii and the bicipital aponeurosis
(lacertus fibrosis).
3.
Find the musculocutaneous nerve in the axilla. Follow this nerve into the coracobrachialis.
Transect the biceps brachii and identify the brachialis muscle.
4.
Find the median nerve. Follow this nerve into the cubital fossa.
5.
Find the ulnar nerve. Follow this nerve distally.
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6.
Identify the brachial artery. Verify that the brachial artery courses with the median nerve.
Identify the profunda brachial artery.
7.
In the cubital fossa, review the positions of the cephalic, median cubital and basilic veins.
8.
Cut the lacertus fibrosis and reflect it medially. Do not cut the brachial artery. Follow the
median nerve and brachial artery into the cubital fossa. What are the relative positions of
the biceps brachii tendon, median nerve and brachial artery?
9.
Superficial dissection of the anterior forearm: Remove the superficial fascia. Use blunt
dissection to clean the superficial group of flexor muscles.
10.
Identify the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and
flexor digitorum superficialis. Note the common flexor tendon.
11.
Identify the superficial structures of the wrist: abductor pollicis longus, radial artery, tendon
of the flexor carpi radialis muscle, median nerve, palmaris longus muscle, flexor digitorum
superficialis muscle, ulnar artery, ulnar nerve, and tendon of the flexor carpi ulnaris muscle.
12.
Identify the brachial artery in the cubital fossa. Using blunt dissection, identify the radial
artery, ulnar artery, common interosseous artery, anterior interosseous artery and posterior
interosseous artery.
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Posterior Thorax
Laboratory Worksheet
Dissection Procedures
1.
Skin incisions and reflection of the skin: Make the incisions indicated and reflect the skin
laterally.
2.
Removed the superficial fascia and expose the trapezius and latissimus dorsi muscles.
Identify the thoracolumbar fascia and the triangle of auscultation. What muscles make up
the borders of this triangle?
3.
Cut through the trapezius muscle near its attachment and reflect it laterally. Begin the
incision at the level of T12 and proceed superiorly to the external occipital protuberance.
Remove the trapezius from the spine of the scapula and the acromion process. Find the
spinal accessory nerve’s innervation into the trapezius muscle.
4.
Cut the latissimus dorsi muscle from his attachment at the thoracolumbar fascia and reflect
it laterally.
5.
Identify the rhomboid major, rhomboid minor and levator scapula muscles. Remove the
rhomboid muscles from their insertion and identify the serratus posterior superior and
serratus posterior inferior muscles. (See images below). Remove these muscles from their
insertion.
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6.
Identify the erector spinae muscles: iliocostalis, longissimus and spinalis muscles.
7.
Identify the deltoid muscle. Remove the deltoid muscle from its origin. Identify the muscles
of the rotator cuff including the supraspinatus, infraspinatus, teres minor and subscapularis
as well as the teres major muscle.
8.
Identify the long head and lateral head of the triceps brachii muscle.
9.
Identify the axillary nerve and the posterior humeral circumflex artery in the quadrangular
space.
Posterior Arm and Forearm
Laboratory Worksheet
Dissection instructions:
1.
Remove the remainder of the skin from the posterior arm and forearm. Identify the medial,
lateral and long heads of the triceps brachii. Separate the lateral and long heads of the
triceps brachii and identify the quadrangular and triangular spaces. Identify the nerve and
artery found in these two spaces. Verify that these nerves and arteries are continuous with
the anterior dissection of the arm.
2.
Remove the deep fascia of the posterior forearm. Identify the muscles that form the
borders of the anatomical snuffbox. Identify the radial artery in the anatomic snuffbox.
Identify the superficial branch of the radial nerve.
3.
On the dorsum of the hand, identify and clean the extensor retinaculum.
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Now identify the muscles of the extensor region of the forearm. These muscles will include
brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor
digitorum, extensor digiti minimi, extensor carpi ulnaris.
ANTERIOR THIGH
Dissection instructions:
1.
Skin removal: Make the following circular incisions on the anterior thigh as outline in the
diagram. The incision should be superficial enough to cut through the skin and not into the
deep fascia.
2.
Remove the skin and superficial fascia. Identify the great saphenous vein and remove it
from the superficial fascia. You should attempt to maintain this vein from the femoral
triangle through your dissection into the posterior knee.
3.
Remove the deep fascia and identify the muscles of the anterior and medial thigh that are
listed on your identification sheet. You should remove the fascia of each muscle from its
origin to its insertion.
4.
Identify the contents of the femoral triangle. Identify the femoral nerve. You should be able
to clear the individual components of this nerve as they enter into muscles of the anterior
thigh. Open the femoral sheath. Identify the femoral artery and femoral vein. You should
remove all fascia covering these structures.
5.
Follow the femoral artery and femoral vein through the adductor hiatus.
6.
Make a longitudinal cut into the vein. Identify the valves of the femoral vein.
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Posterior Thigh, Glut and Posterior Knee Regions
Dissection Instructions:
1.
Skin removal: Using a scalpel, make incisions according the lines indicated in the diagram.
Do not make the incision along line AB. Your area of responsibility extends to the distal
popliteal fossa. Remove the skin and superficial fascia in this area.
2.
Identify the gluteus maximus muscle. The proximal attachment of this muscle is the
sacrum, ilium, coccyx and sacrotuberous ligament. Remove the fascia lata from this area.
3.
Separate the gluteus maximus muscle from the gluteal aponeurosis. Insert your fingers
deep into the space and palpate the inferior gluteal artery, gluteal vein and gluteal nerve.
Cut the gluteus maximus muscle from its origin and reflect this muscle laterally. You will
have to cut the gluteal artery, vein and nerve to complete this action.
4.
Identify the gluteus medius muscle. Identify the piriformis muscle. Identify the nerves and
blood vessels inferior to this muscle.
5.
Identify the sciatic nerve. Identify the obturator internus and gemelli superior and gemelli
inferior muscles. Identify the quadratus femoris muscle. Identify the tensor fascia lata
muscle.
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6.
Clean the sciatic nerve distally. Identify the long head of the biceps femoris muscle.
Identify the short head of the biceps femoris muscle. Identify the semitendinosus and
semimembranosus muscles.
7.
Identify the division of the sciatic nerve into the tibial and common fibular nerves. Follow
the path of these two nerves distally.
8.
Identify the borders of the popliteal fossa. Pull the heads of the gastrocnemius apart for
about 5 cm. Identify the common connective tissue that contains the popliteal artery and
popliteal vein. Open this sheath and separate these two structures. Identify the superior
lateral and superior medial genicular arteries.
9.
Identify the attachment site called the pes anserine. What muscles make up this
attachment?
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Leg and Foot
Dissection instructions:
1.
Skin removal: Make superficial incisions on the cadavers at the sites indicated in this
image. Leave the deep fascia intact. Remove all skin in one sheet if possible to be used to
rewrap the cadaver to reduce moisture loss due to evaporation. Be sure to separate the
great saphenous vein, saphenous nerve, and the musculocutaneous (superficial
fibular) nerve from the superficial fascia and keep this structure intact until it appears to
end in the foot.
2.
Identify the superior and inferior extensor retinacula. Use a scalpel to make a vertical cut
into the deep fascia that extends along the tibia crest to the inferior extensor retinaculum.
Remove the deep fascia over the anterior compartment. Identify the following structures:
a. Tibialis anterior
b. Extensor hallucis longus
c. Deep fibular nerve
d. Anterior tibial artery and vein
e. Extensor digitorum longus
f. Fibularis tertius
3.
Observe the insertion points of the muscles listed above. Notice the insertion of the
extensor hallucis longus and extensor digitorum longus muscles.
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4.
Identify the anterior tibial artery. Notice that the anterior tibial artery is located on the
interosseous membrane. Trace the anterior tibial artery to the inferior extensor
retinaculum. This artery changes names to the dorsal pedis artery.
5.
Identify the anterior tibial nerve. Trace this nerve proximally to the common fibular nerve.
6.
Examine the deep fascia that covers the lateral compartment. Using scissors, remove the
deep fascia over this compartment and identify the muscles found here. Follow the
tendons of these muscles to their insertion.
7.
Turn the cadaver prone. Incise the deep fascia from the popliteal fossa to the calcaneus.
Identify both heads of the gastrocnemius muscle. Identify the small saphenous vein.
Transect the gastrocnemius muscle heads and identify the soleus muscle. Identify the
tendon of the plantaris muscle.
8.
Remove the soleus muscle from its origin on the tibia. Leave the soleus attached to the
fibula. Identify the tibial nerve and posterior tibial artery and veins in the intermuscular
septum. Follow the tibial nerve proximally. The posterior tibial artery is usually
accompanied by two posterior tibial veins. Remove these veins. Follow the posterior tibial
artery proximally. Locate the junction of the posterior tibial artery and the anterior tibial
artery.
9.
Retract the contents of the popliteal fossa and locate the popliteus muscle.
10.
Identify the posterior tibialis, flexor digitorum longus and flexor hallucis longus
muscles. Notice that the posterior tibial artery and tibial nerve lays between the tendons
of the flexor digitorum longus and flexor hallucis longus. Posterior to the medial malleolus,
the following pneumonic device may be used: Tom, Dick and Harry: Tom: tibialis
posterior, Dick: flexor digitorum longus, AN: Artery, Nerve, Harry: flexor hallucis longus.
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Head and Neck Dissection
Reference readings:
Atlas of Clinical Gross Anatomy: Pgs 6-12,24-27, 42-44, 58-61, 72-73, 82-84, 94-96, 104-106, 120121,128-130, 144-147
Identify the following topical landmarks in the head and neck:
Frontal Bone
Zygoma
TMJ
Mandible
Parietal Bone
Zygomatic Arch
Infraorbital Foramen
Mastoid Bone
Occipital Bone
Infraorbital Rim
Mental Foramen
Thyroid Cartilage
Temporal Bone
Supraorbital Rim
Maxilla
Cricothyroid
Membrane
In this lab you will be required to dissect the neck and locate the following structures:
Internal and External
Carotid arteries
Carotid Sinus
Internal and External
Jugular Veins
Thyroid Gland
Parathyroid Gland
Superior Thyroid Vein
Middle Thyroid Vein
Inferior Thyroid Vein
Cricothyroid Membrane
SCM Muscle
Larynx and Vocal Cords
Esophagus
Trapezius Muscle
Thyroid cartilage
Recurrent Laryngeal Nerves
Vagus Nerve
Phrenic Nerve
Recurrent Laryngeal Nerve
Trachea
Cricoid Cartilage
Lingual artery
Inferior Thyroid Artery
Superior Thyroid Artery
Facial artery
Case Presentations
1. 27 year old female presents to the clinic with paralysis to the left side of her face.
The paralysis was sudden. There is no history of trauma. She is unable to close
her eyelids and when she tries the left eye remains open and the eye rotates
upward. When she smiles the right side of her mouth points upward but the left
side doesn’t move.
2. 65 year old male presents with sudden onset of weakness to his right side of his
body, slurred speech and slightly altered sensorium. He has a history of
hypertension and hyperlipidemia.
3. 40 year old female C/O fatigue, cold intolerance and weight gain over the past 3
months. Now noticing swelling in her lower anterior neck. Her past medical
history is negative and was healthy up until 3 months ago.
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Be prepared to report the following:
1. Basic pathophysiology for each condition to include typical presentation, physical
exam findings, and risk factors that contributes to each disease, the appropriate
lab and imaging studies and treatment for each condition.
2. Identify the anatomical structure that is involved in each scenario and define its
anatomical location and function. Identify the arterial and venous blood supply,
and nervous innervations.
In our first dissection we will not be dissecting the face but you will still be responsible
for knowing what the structures are and what they do.
Parotid Region and Facial Vasculature
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Branches of the Facial Nerve
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Superficial structures in the anterior triangle
1. Make a midline incision from the mandible to the suprasternal notch.
2. Make another incision at the base of the mandible laterally to the mastoid area of
the head.
3. Make a third incision from the acromion to the suprasternal notch then carefully
reflect the skin and subcutaneous tissue laterally to view the structures noted
above.
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Lateral view of veins and superficial lymph nodes
1. After indentifying the SCM muscle locate the external jugular vein which lays
over the SCM. Carefully transect the SCM at the manubrium and reflect it
superiorly without damaging the external jugular vein.
2. The internal jugular should come into view.
3. Remove the Omohyoid muscle.
4. Bluntly dissect the internal jugular vein away from the carotid sheath. As you do
you should be able to identify the vagus nerve.
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1. Trace the branches of the jugular vein and identify the superior, middle and
inferior thyroid veins.
2. Expose the thyroid cartilage and cricothyroid membrane.
3. Continue to carefully expose the thyroid gland.
4. Remember that arteries, veins and nerves tend to go together so be careful in
your dissections not to damage other structures that you will need to find in later
dissections.
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Venous System of the Neck and
Branches of the external carotid artery
1. With the carotid sheath open carefully dissect superiorly and identify the carotid
sinus, and the internal and external carotid arteries.
2. Identify the superior and inferior thyroid artery and superior laryngeal artery.
3. Completely expose the arterial supply from the arch of the aorta to the internal
carotid arteries.
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Lower Neck Structures
1. Since the recurrent laryngeal nerves are branches of the vagus nerve carefully
dissect one lobe of the thyroid and identify the recurrent laryngeal nerve which
lies under the thyroid and close to the trachea.
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Posterior View of Thyroid
1. Carefully dissect half of the thyroid away from the trachea and identify the
recurrent laryngeal nerve and attempt to see the parathyroids.
2. Note that the parathyroids usually are not visible to the naked eye.
Clinical Correlates:
What is a possible complication associated with a thyriodectomy?
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1. Transect the trachea at the 3rd tracheal ring and remove the larynx. (superior
to the Thyroid gland)
2. Divide the larynx to view the vocal cords.
3. With the larynx removed you will be able to view the esophagus.
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Thorax Dissection
Reference readings:
Atlas of Clinical Gross Anatomy: Pgs: 331,334-337, 342-343, 362-365, 370
In this lab you will be required to dissect the thorax and locate the following structures:
Pectoralis major
Xiphoid process
Intercostal veins
Visceral pleura
Carina
Left segmental bronchus
Right segmental bronchus
Pulmonary arteries
Mediastinum
Manubrium
First cervical rib
Intercostal nerves
Internal thoracic arteries
Left main bronchus
Right main bronchus
Phrenic nerve
Pulmonary veins
Body of Sternum
Intercostal arteries
Parietal pleura
Trachea
Left lobar bronchus
Right lobar bronchus
Vagus Nerve
Diaphragm
Case Presentations:
Case 1: 27 year old male presents with sudden onset of SOB, dyspnea and left sided chest pain. No
recent illness or injury. You note he is tall and thin. Physical exam reveals a patient in moderate
respiratory distress, lips slightly cyanotic and capillary refill is >5 seconds. His trachea is deviated to
the right. Breath sounds on the left are absent.
Case 2: 35 year old female with sudden onset of right sided chest pain, SOB and severe dyspnea.
Her PE is normal. Medications, OCP, Vitamins. Smokes 1 pack of cigarettes per day for 20 years.
Case 3: 65 year old male with chills, fever, green productive cough, and wheezing. PE reveals
basilar rales but no rhonchi or wheezing. Dullness to percussion noted in the Right middle and lower
lobes of lungs. He smokes 2 packs a day and drinks beer daily.
Be prepared to report the following:
1. Basic pathophysiology for each condition to include typical presentation, physical exam
findings, and risk factors that contributes to each disease, the appropriate lab and imaging
studies and treatment for each condition.
2. Delineate what structures are involved in each disease.
3. Identify the anatomical structure that is involved in each scenario and define its anatomical
location and function. Identify the arterial and venous blood supply, and nervous innervation.
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Rib Cuts
1. After dissecting the musculature away for the ribs cut the ribs as noted above
using the cast saw.
2. With the rib cage removed examine the inferior surface to identify the internal
thoracic artery and vein.
3. Identify the parietal pleura. It usually is adhered to the posterior rib cage.
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Intercostal structures
Notice the direction of
each of the intercostals
muscles
1. Carefully dissect out the internal and external intercostals muscles. (Note that
they will go in opposite directions)
2. After dissecting the intercostals muscles carefully dissect down the superior
aspect of a rib and identify the intercostal artery, vein and nerve.
Clinical Correlates:
Why do we place a chest tube using the superior portion of the rib as a guide?
What aspect of respiration are the external and internal intercostals muscles
responsible for?
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Pleural sacs
1. There are 4 parietal pleura.
a. Cervical- superior to the 1st rib.
b. Costal- lines internal surface of rib cage.
c. Mediastinal- lines mediastinum
d. Diaphragmatic- lines superior surface of diaphragm
2. The parietal pleura usually adhere to the rib cage and the visceral pleura adhere
to the surface of the lung and are difficult to see.
Clinical Correlation:
Place an endotracheal tube in the trachea and inflate the balloon. Attach an ambu
bag and inflate the lungs. Then deflate the ET tube balloon & advance it and repeat
the procedure. What did you find?
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Incisions at the root of the lungs
1. To expose the root of the lung carefully use your hand to pull the lung laterally so
you can expose the pulmonary vasculature and bronchus.
2. Transect the vasculature and the bronchus WITHOUT damaging the heart (or
your fingers!)
3. Remove the lungs.
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Lateral view of the left lung
1. Examine the lobes of the lungs.
a. Do you see any abnormal structures?
b. What is its coloring?
c. Any deformities noted?
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Medial view of the left lung
Medial Aspects of right and left Lungs
General Rules:
1.
2.
3.
4.
Pulmonary arteries are generally in the superior portion of the lung.
Pulmonary veins are generally in the posterior and inferior portions of the lung.
Lymphnodes are typically in the root of the lung around the bronchus.
Contact impressions you should know are:
a. Cardiac
b. Aortic arch groove
c. Descending aortic arch groove
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Lymphatic Drainage of the Thorax
Right Side
Left Side
Subclavian/jugular vein
Subclavian/jugular vein
Jugular trunk
Jugular trunk
Right
lymphatic
duct
Subclavian trunk
Intercostal trunk
Thoracic
duct
Subclavian trunk
Intercostal trunk
Posterior mediastinal nodes
Bronchomedistinal trunk
Bronchomedistinal trunk
Right Tracheal Nodes Left
Parasternal nodes
Anterior mediastinal
Nodes
Anterior mediastinal
nodes
Ant. & Lat
Diaphragmatic
Nodes
Parasternal nodes
Ant. & Lat
Diaphragmatic
Nodes
Superior Tracheobronchial
Nodes
Superior Tracheobronchial
Nodes
Inferior Tracheobronchial
or carinal Nodes
Bronchopulmonary/Hilar
Nodes
Bronchopulmonary/Hilar
Nodes
Pulmonary Nodes
Pulmonary Nodes
Left lower
Lobe
Right Lung
Left upper
Lobe
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Heart Dissection
Reference readings:
Atlas of Clinical Gross Anatomy: Pgs 346-348,360
In this lab you will be required to dissect the thorax and locate the following structures:
Phrenic Nerve
Internal jugular vein
Inferior vena cava
Left and right pulmonary arteries
Right atrium
Right coronary artery
Left anterior descending artery
(Anterior interventicular artery)
Middle cardiac vein
Pulmonary valve
Coronary sinus opening in right
atrium
Left and right pulmonary veins
Brachiocephalic trunk
Vagus Nerve
Subclavian vein
Aorta
Coronary sulcus
Left ventricle
Left coronary artery
Coronary sinus
Ligamentum Arteriosum
Superior vena cava
Pericardial sac
Left atrium
Right ventricle
Circumflex artery
Great cardiac vein
Mitral valve
Aortic valve
Left common carotid artery
Tricuspid valve
Papillary muscle
Chordae tendineae
Right subclavian artery
Right common carotid artery
Left subclavian artery
Case Studies
Case #1- 70 year old male C/O dizziness and palpitations with activity. Occasionally it is associated
with chest pressure. The symptoms quickly dissipate when he rests. This has been going on for 3
months. He had smoked 1 pack/day for 30 years but quit 5 years ago. He has hyperlipidemia but no
other diseases. No surgeries or hospitalizations. Upon examination his blood pressure is 100/60
pulse 88. PE reveals normal lung exam and a grade 3 systolic murmur heard over the 2nd intercostal
space, right sternal border.
Case #2- 65 year old female C/O chest tightness and SOB occurring 1 hour ago while gardening.
She was somewhat sweaty and the pain radiated down her right arm. She stopped gardening and the
pain lessened but didn’t go completely away. Upon examination her blood pressure was 150/94,
Pulse 90 and weak. PE is unremarkable. Past medical history of hypertension, Type II diabetes and
migraines. Current meds- Glucophage, Atenolol and baby Aspirin. Family history negative
Case #3- 25 year old male recently had an Upper Respiratory infection and about a week after it
resolved he developed chest pain which is sharp and made worse with deep breathing. It is relieved
with sitting up and leaning forward. Denies chest pressure, dizziness, syncope, or palpitations. Past
medical and family history is negative. PE: Vital signs are normal. Lungs are clear. Heart exam
reveals muffled heat sounds.
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Be prepared to report the following:
1. Basic pathophysiology for each condition to include typical presentation, physical exam
findings, and risk factors that contributes to each disease, the appropriate lab and imaging
studies and treatment for each condition.
2. Delineate what structures are involved in each disease.
3. Identify the anatomical structure that is involved in each scenario and define its anatomical
location and function. Identify the arterial and venous blood supply, and nervous innervation.
Heart in situ
1. Before opening the pericardial sac identify the ligamentum arteriosum, left
recurrent laryngeal nerve and major arteries and veins.
2. Identify the subclavian vein, superior vena cava and the aorta.
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Phrenic nerves and pericardiacophrenic vessels
1. Again, before you open the pericardial sac attempt to find the phrenic nerves and
pericardial artery and vein.
2. Remember they all run together!
3. After identifying these structures make an incision through the pericardial sac
and peel it back to reveal the heart.
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1. You will now remove the heart.
2. Carefully transect the following:
a. Superior and inferior vena cava
b. Descending aorta
c. Left subclavian, left common carotid, and right brachiocephalic arteries
d. Pulmonary arteries and veins.
e. Right and Left Brachiocephalic veins
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1. Carefully begin to dissect out all the coronary arteries and veins.
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Posterior view of the heart to demonstrate the cardiac veins
Anterior view of the heart to demonstrate the cardiac veins
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Right atrial incisions and structures
1. Do not cut through the coronary arteries. Identify the structures noted below.
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Right Ventricle Incisions
1. Make the incision into the Rt. Ventricle without cutting through the coronary arteries.
2. Refer to the following page to identify the important structures.
3. When deciding where to incise the upper portion of the right ventricle, carefully palpate the area
for the pulmonary valve. Once you have felt where it is located make your incision inferiorly to it
so as not to destroy the valve.
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Left atrium. A, Left atrial incisions. B, Left atrium open
1. Repeat the procedure you did on the right side of the heart on the left side.
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Left ventricular structures. A, Left ventricular incision, B, Left ventricle open
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Valves of the heart
1. Try to obtain a spatial relationship for the valve locations with the locations of auscultation.
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Abdominal Dissection
Reference readings:
Atlas of Clinical Gross Anatomy: Pg:372-374, 386-389, 392, 402-406, 414,422-425, 436-439
In this lab you will be required to dissect the thorax and locate the following structures:
Greater/Lesser omentum
Ascending Colon
Transverse colon
Sigmoid Colon
Rt & Lt Triangular ligaments
Mesentery
Coronary Lig
Cecum
Descending colon
Stomach with anatomical
Landmarks
Falciform Lig
Gall Bladder
Portal vein
Duodenum
Jejunum
Mesocolon
Cystic Duct
Renal cortex
Cystic triangle of calot
Renal medulla
Ilium
Iliocecal valve
Common hepatic duct
Pancreatic duct
Hepatic artery
Rt/Lt Gastric Arteries
Sigmoid arteries
Celiac Trunk
Superior mesenteric artery
Superior/Middle/Inferior
mesenteric arteries
Lt/Rt Gastroepiploic arteries
Inferior mesenteric artery
Rt/Left Colic arteries
Case Studies
Case 1: 30 year old male is admitted to the hospital for severe, constant abdominal pain with nausea
and vomiting since the previous day. Pain radiates to his back and it feels “like it’s boring a hole
through me from front to back.” He denies diarrhea and fever. He has no other medical problems.
Social history: smokes 2 packs per day/20 years. Binge drinks 1-2 six packs on weekends. Physical
exam reveals mild jaundice, bluish discoloration to the flanks and severe RUQ pain with palpation.
Bowel sounds are diminished. Vital signs: B/P 90/50, P-104, Temp 101.
Case #2: 44 year old female C/O sudden onset of RUQ pain that radiates to the right shoulder after
eating at a local restaurant. The pain comes in “waves”. She had one episode of vomiting but no
diarrhea. PE- Height- 60”, Weight-210, B/P-140/90, P- 88, temp-99.8. Abdomen- soft with RUQ
tenderness on percussion and palpation. (+) Murphy Sign but negative straight leg raise, psoas, and
obturator sign.
Case #3- 15 year old make C/O tenderness and pain in the LLQ. Started a few weeks ago when he
was working out for football camp. No N/V/D. No constipation. Vital signs are normal. Abdominal
exam normal except for a ? bulge in the Left inguinal canal.
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Be prepared to report the following:
1. Basic pathophysiology for each condition to include typical presentation, physical exam
findings, and risk factors that contributes to each disease, the appropriate lab and imaging
studies and treatment for each condition.
2. Delineate what structures are involved in each disease.
Identify the anatomical structure that is involved in each scenario and define its anatomical location
and function. Identify the arterial and venous blood supply, and nervous innervation.
Abdominal Incisions
1. Make the incisions as noted above.
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Greater omentum in situ
Lesser omentum in situ
1. Identify the greater and lesser omentum.
2. Follow the lesser omentum to determine its attachments.
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Abdominal viscera in situ
1. Grossly identify these structures and relate them to how you perform an abdominal exam. Note
where the liver is in conjunction with the rib cage. Find the proximal ascending colon and
identify the appendix and note its relationship with the RLQ of the abdomen.
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Celiac trunk topography
Branches of the celiac trunk
1. Carefully dissect through the lesser omentum between the stomach, inferior surface of the liver
superior to the pancreas and identify the celiac truck, common hepatic artery, splenic artery
and left gastric artery. These structures will emerge from the retroperitoneal area up to the
stomach and liver.
2. Identify the right gastric artery which supplies blood to the rt. Gastro-omental artery.
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Stomach regions
Coronal section of the stomach
1. Identify the gross structures of the stomach.
2. Carefully tie off the esophagus and duodenum then cut above the cardiac sphincter and
distal to the pyloric sphincter.
3. Remove the stomach and open it up to view the internal contents.
4. Be careful not to disturb that arterial supply from the celiac artery.
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Small Intestine
1. With the duodenum tied off from your stomach dissection carefully trace the duodenum
through the retroperitoneal cavity and follow the small intestines to the Cecum.
2. Tie off the ileum with two ties and transect in between the ties at the Iliocecal valve and lift it
out of the abdominal cavity.
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1. To get a visual representation of the vascular structures of the small intestine dissect out the
blood vessels as illustrated on this page and the following pages.
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Superior mesenteric artery and its branches. A, Branches of the superior
mesenteric artery. B, Superior mesenteric lymph nodes
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Inferior mesenteric artery and its branches. A, Branches of the inferior
mesenteric artery. B, Inferior mesenteric lymph nodes
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Anterior view of the liver (diaphragm reflected)
Inferior surface of the liver
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Portal venous system
1. Carefully remove the liver for gross inspection.
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Lab 10: Retroperitoneum/GU Dissection
Reference readings:
Atlas of Clinical Gross Anatomy: Pg: 450-452,459, 470-473,477
In this lab you will be required to dissect the thorax and locate the following structures:
Pancreas
Bladder
Inferior mesenteric artery/vein
Fimbria
Pancreatic duct
Renal papilla
Minor calyces
Testicular/ovarian art/vein
Abdominal aorta
Kidney
Uterus
Penis
Ovaries
Renal cortex
Renal pelvis
Rt/Lt renal art/vein
Ureter
Testes
Fallopian Tube
Splenic vein
Renal medulla
Maj calyces
Suprarenal arteries and veins
Lumbar art/veins
Inf Vena cava
Case Studies
Case 1: 55 year old male C/O severe, sudden onset of left flank pain for past 30 minutes. He did
urinate 15 minutes ago and it was all blood. Denies any chills or fever. Has bouts of nausea and 1
episode of vomiting. No history of trauma
Case 2: 24 year old female C/O right flank pain, fevers of 102-103, dysuria and increased frequency
for 2 days. Patient has some nausea and with 2 episodes of vomiting. Last menstrual period was 7
weeks ago.
Case 3: 30 year old male C/O severe, constant, abdominal pain with nausea and vomiting for 24
hours. Pain radiates straight to his back and feels “like someone is boring a hole right through me.”
He drinks 1-2 six packs of beer on weekends.
Be prepared to report the following:
1. Basic pathophysiology for each condition to include typical presentation, physical exam
findings, and risk factors that contributes to each disease, the appropriate lab and imaging
studies and treatment for each condition.
2. Delineate what structures are involved in each disease.
3. Identify the anatomical structure that is involved in each scenario and define its anatomical
location and function. Identify the arterial and venous blood supply, and nervous innervation.
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Overview of the posterior abdominal wall. B, Lymphatic’s of the posterior
abdominal wall
1. After removing the small intestine and stomach and opening the retroperitoneal area take
time to visualize the location of the kidneys, pancreas, spleen and vasculature.
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Branches of inferior vena cava
2011
Branches of Abd.Aorta
1. Note that the inferior vean cava is on the right and abdominal aorta on the left of the
midline. Take time to locate the iliac arteries and veins and femoral arteries and veins and
corrleate their position to the external abdomen.
2. Identify all the arteries and veins noted in the photo above.
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Kidneys in situ
1. Prior to removing one kidney trace the ureter to the bladder and gonadal arteries and veins.
2. Also identify the spleen and dissect it completely out. Again note its location and correlate its
location with your physical exam technique.
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Coronal section of the kidney
1. Transect the ureter, renal artery and vein and carefully remove the kidney.
2. Make a longitudinal incision all the way around the kidney and open it identifying all the gross
anatomical structures
3. Be prepared to discuss the function of each structure.
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Scrotal incisions
1. Make scrotal incisions as noted above and carefully dissect down to the testes.
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Spermatic cord and scrotum
1. Identify the structures noted above.
2. On the contralateral side transect through the vasculature and spermatic cord and remove the
testicle.
3. Make a longitudinal incision and open the testes to view the internal structures.
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Testis
1. Grossly identify the structures noted above.
2. Begin to correlate the location of the epididymis and its location on the testes. It is important to
be able to differentiate the the epididymis from an abnormal growth on the testicle.
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Cross-section of the penis
1. Completely transect the penis and view its internal structures.
2. Be prepared to discuss the function of each structure.
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Female Pelvis
1.
2.
3.
4.
Deep in the pelvis you will find the uterus. (only if you have a female patient)
Carefully dissect out the important structures and again visualize their position in the pelvis.
Identify the structures around the uterus and ovaries.
Gain an appreciation for how difficult it can be to differentiate the cause of abdominal pain
particularly in a female.
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Female Pelvic Structures
1. After viewing the uterus and ovaries in the cadaver carefully dissect them out and open the
uterus and fallopian tubes in the same manner you opened the kidney.
2. Identify the structures noted above.
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Central Neuro Dissection
Reference readings:
Atlas of Clinical Gross Anatomy: Pg: 10-12,19
In this lab you will be required to dissect the brain and locate the following structures:
VENTRICULAR SYSTEM
MIDDLE CRANIAL FOSSA
Calvarium







Lateral ventricles
o Interventricular
foramen
Third ventricle
o Cerebral aqueduct
Fourth ventricle
o Median aperture
o Lateral apertures
o Central canal of the
spinal cord
Sagittal suture
Coronal suture
Lambdoid suture
External occipital
protuberance
Internal occipital
protuberance
Grooves for the transverse
and occipital sinuses, and
confluence of sinuses

NERVES
Cranial
o
o
o
o
o
o
o
o
Mastoid process
o
o
o

Cribriform plate and crista
galli
o






Anterior cranial fossa
Middle cranial fossa
nn.
Olfactory n. (CN I)
Optic n. (CN II)
Oculomotor n. (CN III)
Trochlear n. (CN IV)
Trigeminal n. (CN V)
Abducens n. (CN VI)
Facial n. (CN VII)
Vestibulocochlear n.
(CN VIII)
Glossopharyngeal n.
(CN IX)
Vagus n. (CN X)
Spinal accessory n.
(CN XI)
Hypoglossal n. (CN
XII)






ANTERIOR CRANIAL FOSSA
o
o
Posterior cranial fossa
Foramen magnum
Frontal Bone
Orbital plates
Foramen cecum
o Emissary vv.
to the superior
sagittal sinus
Ethmoid Bone
MENINGES
Sphenoid Bone
o
o
Crista galli
Cribriform plate

Greater wings
Grooves for
the middle
meningeal a.
Chiasmatic groove
(optic chiasma for
CN II)
Sella turcica and
pituitary gland
Foramen spinosum
Middle
meningeal a.
and v.,
meningeal
branch of the
mandibular
n.
Foramen ovale
Mandibular
division of
the
trigeminal
nerve (CN V3)
Foramen rotundum
Maxillary
division of
the
trigeminal
nerve (CN V2)
Superior orbital
fissures
Oculomotor
n. (CN III),
trochlear n.
(CN IV),
ophthalmic
division of
the
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




Dura mater
Falx cerebri
Tentorium cerebelli
Falx cerebelli
Arachnoid mater
Arachnoid
granulations
Subarachnoid
space
Pia mater\
BRAIN
2011
trigeminal
(bulbs of CN I)
nerve (CN
Sphenoid Bone
o
o
Lesser wings
Anterior clinoid
processes

V-1),
abducens n.
(VI), and
superior
ophthalmic v.
Optic canal
Optic n. (CN
II) and
ophthalmic a.
Cerebrum

POSTERIOR CRANIAL
FOSSA

Lobes


Frontal lobe
Temporal
lobe
Parietal
lobe
Occipital
lobe
Cerebellum
Temporal Bone
Internal acoustic
meatus
o Facial n. (CN
VII),
vestibulococ
hlear n. (CN
VIII), and
labyrinthine


Occipital Bone


Foramen magnum
Medulla oblongata
Spinal cord
Hypoglossal canal
Hypoglossal n. (CN
XII)
Jugular foramen
Inferior petrosal
sinus,
glossopharyngeal n.
(CN IX), vagus n.
(CN X), spinal
accessory n. (CN XI),
sigmoid sinus, and
posterior meningeal
a.
Case Studies
Case 1: 47 year old female presents to your clinic with a severe headache. She states; “This is the
worst headache of my life.” H/A started 8 hours ago. Pain is diffuse, throbbing, and worse with
exposure to sunlight.
Case 2: 59 year old male complains of lower back pain that radiates down the back of his right leg.
Pain worsens with coughing or lifting but relieved with lying down. Denies any back trauma
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Case 3: 43 year old male was washing his car when he suddenly complained of a severe headache
and then slumped to the ground. Exam reveals the patient to be lethargic but responsive to deep pain
stimuli. Pupils are dilated OU. Sluggish to reaction of light.
Be prepared to report the following:
1. Basic pathophysiology for each condition to include typical presentation, physical exam
findings, and risk factors that contributes to each disease, the appropriate lab and imaging
studies and treatment for each condition.
2. Delineate what structures are involved in each disease.
3. Identify the anatomical structure that is involved in each scenario and define its anatomical
location and function. Identify the arterial and venous blood supply, and nervous innervation.
Dissection
1. For this dissection you will be guided by a faculty member.
2. Care must be undertaken as to preserve important structures.
3. Come to lab prepared to discuss the various gross structures and what they do.
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Opening the Cranial Cavity
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Remove all soft tissue from the spinal column as indicated by the red lines.
Using the chisel and hammer fracture each vertebrae just lateral to the spinous
processes. Once this is done carefully elevate the spinal processes and incise the dura
of the spinal column exposing the spinal cord.
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Brain Removal
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Brain Removal Continued
Carefully lift the entire brain and spinal cord out as one complete specimen.
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Dural Folds
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Gross Brain Structures
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Ventricular System
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Arterial Blood Supply of the Brain
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Venous Sinuses
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Foramina of the Skull
Bone
Sphenoid
Sphenoid/temporal
Temporal
Foramen
Optic canal
Superior orbital fissure
Foramen rotundum
Foramen ovale
Foramen spinosum
Foramen venosum
Pterygoid canal
Foramen lacerum
Internal acoustic meatus
External acoustic meatus
Stylomastoid foramen
Carotid canal
Temporal/occipital
Occipital
Mandible
Ethmoid
Ethmoid/frontal
Frontal
Mastoid foramen
Petrotympanic fissure
Jugular foramen
Foramen magnum
Hypoglossal canal
Condylar canal
Mandibular canal
Mental foramen
Cribriform foramina
Anterior ethmoidal foramen
Posterior ethmoidal foramen
Supraorbital foramen
Frontal foramen
Corresponding Structures
Optic n.
Ophthalmic, oculomotor,
abducens, and trochlear n.
Maxillary n.
Mandibular n.
Middle meningeal vessels
Emissary v.
Nerve of the pterygoid canal
(Vidian n.)
Emissary vessels
Vestibulocochlear and facial n.
Sound waves traveling to the
tympanic membrane
Facial n.
Internal carotid a. and
sympathetic nerve plexus
Emissary v.
Chorda tympani n.
Internal jugular v.;
glossopharyngeal, vagus, and
spinal accessory n.
Spinal cord and vertebral aa.
Hypoglossal n.
Emissary v.
Inferior alveolar n.
Mental n.
Olfactory nn.
Anterior ethmoid n.
Posterior ethmoid n.
Supraorbital vessels and n.
Supratrochlear vessels and n.
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Cranial Fossa
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Anterior Fossa
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Middle Cranial Fossa
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Posterior Cranial Fossa
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Cranial Nerves Inferior Surface of Brain
86