Human Anatomy, 3rd Edition

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 third edition

Michael McKinley
Glendale Community College

Valerie Dean O’Loughlin

Indiana University

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 TM

HUMAN ANATOMY, THIRD EDITION

Published by McGraw-Hill, a business unit of The McGraw-Hill Companies, Inc., 1221 Avenue of the
Americas, New York, NY 10020. Copyright © 2012 by The McGraw-Hill Companies, Inc. All rights
reserved. Previous editions © 2008 and 2006. No part of this publication may be reproduced or
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ISBN 978–0–07–337809–1
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Library of Congress Cataloging-in-Publication Data

McKinley, Michael P.
Human anatomy / Michael McKinley, Valerie O'Loughlin.— 3rd ed.
p. cm.
Includes index.
ISBN 978–0–07–337809–1 — ISBN 0–07–337809–7 (hard copy : alk. paper)
1. Human anatomy. I. O'Loughlin, Valerie Dean. II. Title.

QM23.2.M38 2012
612--dc22
2010032046

www.mhhe.com

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 About the Authors
M I C H A E L M C K I N L E Y received his undergraduate degree from the University of California, and
both his M.S. and Ph.D. degrees from Arizona State University. In 1978, he accepted a postdoctoral
fellowship at the University of California at San Francisco (UCSF) Medical School in the laboratory of
Dr. Stanley Prusiner, where he worked for 12 years investigating prions and prion-diseases. In 1980,
he became a member of the anatomy faculty at the UCSF Medical School, where he taught medical
histology for 10 years while continuing to do research on prions. During this time, he was an author
or co-author of more than 80 scientific papers.
Since 1991, Mike has been a member of the biology faculty at Glendale Community College, where
he teaches undergraduate anatomy and physiology, general biology, and genetics. Between 1991 and 2000,
in addition to teaching at Glendale Community College, he participated in Alzheimer disease research and
served as director of the Brain Donation Program at the Sun Health Research Institute, while also teaching
For Jan, Renee, Ryan, developmental biology and human genetics at Arizona State University, West. Mike’s vast experience
and Shaun: I appreciate
in histology, neuroanatomy, and cell biology greatly shaped the related content in Human Anatomy.
all of your support and love.
Mike is an active member of the Human Anatomy and Physiology Society (HAPS). He resides in
Tempe, AZ, with his wife Jan.

VA L E R I E D E A N O ’ L O U G H L I N received her undergraduate degree from the College of

William and Mary and her Ph.D. in biological anthropology from Indiana University. She is a member
of the Indiana University School of Medicine faculty, where she teaches human gross anatomy to first-year
medical students and basic human anatomy to undergraduates. Valerie has performed numerous cadaver
dissections and she drew heavily on this experience to ensure that both the narrative and the gross
anatomy artwork in this book conform to standards typically seen in medical atlases and medical
textbooks.
Valerie’s research interests currently focus on educational research and the scholarship of teaching
and learning. She has received many educational research grants as well as several teaching awards,
including the American Association of Anatomists Basmajian Award for excellence in teaching and for her
work in scholarship of education. Valerie is an active member of the American Association of Anatomists
For Bob and Erin: (AAA), the American Association of Physical Anthropologists (AAPA), and the Human Anatomy and
Thank you for all of your
Physiology Society (HAPS). She resides in Bloomington, IN, with her husband Bob and her daughter Erin.
support and love.

Your Feedback Is Welcome!

We are dedicated to producing the best materials available to help students learn human anatomy and engender a love of this topic. Your
suggestions for improving this textbook are always welcome!
Michael P. McKinley Valerie Dean O’Loughlin
Department of Biology Jordan Hall 010A
Glendale Community College Medical Sciences
6000 W. Olive Avenue Indiana University
Glendale, AZ 85302 Bloomington, IN 47405
[email protected] [email protected]
iii

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 Brief Contents

Chapter 1 A First Look at Anatomy 1

Chapter 2 The Cell: Basic Unit of Structure and Function 23
Chapter 3 Embryology 54
Chapter 4 Tissue Level of Organization 80
Chapter 5 Integumentary System 118

S K E L E T A L S Y S T E M
Chapter 6 Cartilage and Bone 146
Chapter 7 Axial Skeleton 173
Chapter 8 Appendicular Skeleton 220
Chapter 9 Articulations 252

M U S C U L A R S Y S T E M
Chapter 10 Muscle Tissue and Organization 288
Chapter 11 Axial Muscles 322
Chapter 12 Appendicular Muscles 354

Chapter 13 Surface Anatomy 397

N E R V O U S S Y S T E M
Chapter 14 Nervous Tissue 415
Chapter 15 Brain and Cranial Nerves 439
Chapter 16 Spinal Cord and Spinal Nerves 486
Chapter 17 Pathways and Integrative Functions 518
Chapter 18 Autonomic Nervous System 539
Chapter 19 Senses: General and Special 561

Chapter 20 Endocrine System 605

C A R D I O V A S C U L A R S Y S T E M
Chapter 21 Blood 637
Chapter 22 Heart 656
Chapter 23 Vessels and Circulation 683

Chapter 24 Lymphatic System 724

Chapter 25 Respiratory System 747
Chapter 26 Digestive System 779
Chapter 27 Urinary System 817
Chapter 28 Reproductive System 842
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 Contents
Preface xiii 2.6 Life Cycle of the Cell 46
2.6a Interphase 47
Chapter 1 2.6b Mitotic (M) Phase 47
A First Look at Anatomy 1 2.7 Aging and the Cell 50
1.1 History of Human Anatomy 2
1.2 Definition of Anatomy 3 Chapter 3
1.2a Microscopic Anatomy 3 Embryology 54
1.2b Gross Anatomy 4 3.1 Overview of Embryology 55
1.3 Structural Organization 3.2 Gametogenesis 56
of the Body 5 3.2a Meiosis 57
1.3a Characteristics of Living Things 6 3.2b Oocyte Development (Oogenesis) 58
1.3b Introduction to Organ Systems 6 3.2c Sperm Development (Spermatogenesis) 59
1.4 Precise Language of Anatomy 11 3.3 Pre-embryonic Period 60
1.4a Anatomic Position 11 3.3a Fertilization 62
1.4b Sections and Planes 11 3.3b Cleavage 63
1.4c Anatomic Directions 12 3.3c Implantation 63
1.4d Regional Anatomy 13 3.3d Formation of the Bilaminar Germinal Disc 64
1.4e Body Cavities and Membranes 14 3.3e Formation of Extraembryonic Membranes 65
1.4f Abdominopelvic Regions and Quadrants 16 3.3f Development of the Placenta 66
3.4 Embryonic Period 67
Chapter 2 3.4a Gastrulation 68
The Cell: Basic Unit 3.4b Folding of the Embryonic Disc 68
of Structure and Function 23 3.4c Differentiation of Ectoderm 69
2.1 The Study of Cells 24 3.4d Differentiation of Mesoderm 72
2.1a Using the Microscope to Study Cells 24 3.4e Differentiation of Endoderm 72
2.1b General Functions of Human Body Cells 25 3.4f Organogenesis 72
2.2 A Prototypical Cell 27 3.5 Fetal Period 74
2.3 Plasma Membrane 30
2.3a Composition and Structure of Membranes 30 Chapter 4
2.3b Protein-Specific Functions of the Plasma Tissue Level
Membrane 31 of Organization 80
2.3c Transport Across the Plasma Membrane 32 4.1 Epithelial Tissue 81
2.4 Cytoplasm 36 4.1a Characteristics of Epithelial Tissue 81
2.4a Cytosol 36 4.1b Functions of Epithelial Tissue 82
2.4b Inclusions 36 4.1c Specialized Structure of Epithelial Tissue 82
2.4c Organelles 36 4.1d Classification of Epithelial Tissue 84
2.5 Nucleus 44 4.1e Types of Epithelium 85
2.5a Nuclear Envelope 44 4.1f Glands 92
2.5b Nucleoli 45 4.2 Connective Tissue 95
2.5c DNA, Chromatin, and 4.2a Characteristics of Connective Tissue 95
Chromosomes 45 4.2b Functions of Connective Tissue 95
4.2c Development of Connective Tissue 96

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 4.2d Classification of Connective Tissue 98 6.3 Classification and Anatomy of Bones 150
4.3 Body Membranes 108 6.3a General Structure and Gross Anatomy of Long
4.4 Muscle Tissue 109 Bones 150
4.4a Classification of Muscle Tissue 109 6.4 Ossification 157
4.5 Nervous Tissue 111 6.4a Intramembranous Ossification 157
4.5a Characteristics of Neurons 112 6.4b Endochondral Ossification 157
4.6 Tissue Change and Aging 112 6.4c Epiphyseal Plate Morphology 160
4.6a Tissue Change 112 6.4d Growth of Bone 161
4.6b Tissue Aging 113 6.4e Blood Supply and Innervation 162
6.5 Maintaining Homeostasis and Promoting Bone
Chapter 5 Growth 163
Integumentary System 118 6.5a Effects of Hormones 163
5.1 Structure and Function of the 6.5b Effects of Vitamins 164
Integument 119 6.5c Effects of Exercise 165
5.1a Integument Structure 119 6.5d Fracture Repair 165
5.1b Integument Functions 120 6.6 Bone Markings 167
5.2 Epidermis 121 6.7 Aging of the Skeletal System 168
5.2a Epidermal Strata 121
5.2b Variations in the Epidermis 122 Chapter 7
5.3 Dermis 125 Axial Skeleton 173
5.3a Papillary Layer of the Dermis 126 7.1 Skull 175
5.3b Reticular Layer of the Dermis 126 7.1a Views of the Skull and Landmark
Features 176
5.3c Stretch Marks, Wrinkles, and Lines of Cleavage 126
7.1b Sutures 183
5.3d Innervation and Blood Supply 127
7.1c Bones of the Cranium 185
5.4 Subcutaneous Layer (Hypodermis) 128
7.1d Bones of the Face 194
5.5 Epidermal Accessory Organs 129
7.1e Nasal Complex 198
5.5a Nails 129
7.1f Paranasal Sinuses 199
5.5b Hair 130
7.1g Orbital Complex 200
5.5c Exocrine Glands of the Skin 133
7.1h Bones Associated with the Skull 201
5.6 Integument Repair and Regeneration 136
5.7 Aging of the Integument 138 7.2 Sex Differences in the Skull 201
5.7a Skin Cancer 139
7.3 Aging of the Skull 201
5.8 Development of the Integumentary System 140 7.4 Vertebral Column 204
7.4a Divisions of the Vertebral Column 204
5.8a Integument Development 140
7.4b Spinal Curvatures 205
5.8b Nail Development 140
7.4c Vertebral Anatomy 206
5.8c Hair Development 140
5.8d Sebaceous and Sweat Gland Development 140
7.5 Thoracic Cage 212
7.5a Sternum 213
5.8e Mammary Gland Development 141
7.5b Ribs 213
Chapter 6 7.6 Aging of the Axial Skeleton 214
Cartilage and Bone 146 7.7 Development of the Axial Skeleton 214
6.1 Cartilage 147
6.1a Functions of Cartilage 147
Chapter 8
6.1b Growth Patterns of Cartilage 148
Appendicular Skeleton 220
6.2 Bone 148 8.1 Pectoral Girdle 221
8.1a Clavicle 221
6.2a Functions of Bone 148
8.1b Scapula 221
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 8.2 Upper Limb 225 10.3 Contraction of Skeletal Muscle Fibers 298
8.2a Humerus 225 10.3a The Sliding Filament Theory 298
8.2b Radius and Ulna 225 10.3b Neuromuscular Junctions 298
8.2c Carpals, Metacarpals, and Phalanges 230 10.3c Physiology of Muscle Contraction 301
8.3 Pelvic Girdle 232 10.3d Muscle Contraction: A Summary 303
8.3a Os Coxae 232 10.3e Motor Units 303
8.3b True and False Pelves 233 10.4 Types of Skeletal Muscle Fibers 305
8.3c Sex Differences Between the Female and Male 10.4a Distribution of Slow, Intermediate, and Fast
Pelves 233 Fibers 307
8.4 Lower Limb 236 10.5 Skeletal Muscle Fiber Organization 307
8.4a Femur 237 10.5a Circular Muscles 307
8.4b Patella 240 10.5b Parallel Muscles 307
8.4c Tibia and Fibula 240 10.5c Convergent Muscles 307
8.4d Tarsals, Metatarsals, and Phalanges 241 10.5d Pennate Muscles 307
8.5 Aging of the Appendicular Skeleton 245 10.6 Exercise and Skeletal Muscle 309
8.6 Development of the Appendicular Skeleton 245 10.6a Muscle Atrophy 309
10.6b Muscle Hypertrophy 309
Chapter 9 10.7 Levers and Joint Biomechanics 309
Articulations 252 10.7a Classes of Levers 309
9.1 Articulations (Joints) 253 10.7b Actions of Skeletal Muscles 310
9.1a Classification of Joints 253 10.8 The Naming of Skeletal Muscles 311
9.2 Fibrous Joints 254 10.9 Characteristics of Cardiac and Smooth Muscle 312
9.2a Gomphoses 254 10.9a Cardiac Muscle 312
9.2b Sutures 255 10.9b Smooth Muscle 313
9.2c Syndesmoses 255 10.10 Aging and the Muscular System 313
9.3 Cartilaginous Joints 255 10.11 Development of the Muscular System 317
9.3a Synchondroses 255
9.3b Symphyses 256 Chapter 11
9.4 Synovial Joints 256 Axial Muscles 322
9.4a General Anatomy of Synovial Joints 257 11.1 Muscles of the Head and Neck 323
9.4b Types of Synovial Joints 258 11.1a Muscles of Facial Expression 323
9.4c Movements at Synovial Joints 260 11.1b Extrinsic Eye Muscles 328
9.5 Selected Articulations in Depth 265 11.1c Muscles of Mastication 332
9.5a Joints of the Axial Skeleton 265 11.1d Muscles That Move the Tongue 332
9.5b Joints of the Pectoral Girdle and Upper Limbs 268 11.1e Muscles of the Pharynx 334
9.5c Joints of the Pelvic Girdle and Lower Limbs 274 11.1f Muscles of the Anterior Neck 335
9.6 Disease and Aging of the Joints 282 11.1g Muscles That Move the Head and Neck 337
9.7 Development of the Joints 284 11.2 Muscles of the Vertebral Column 340
11.3 Muscles of Respiration 343
Chapter 10 11.4 Muscles of the Abdominal Wall 345
Muscle Tissue and Organization 288 11.5 Muscles of the Pelvic Floor 348
10.1 Properties of Muscle Tissue 289
10.2 Characteristics of Skeletal Muscle Chapter 12
Tissue 289 Appendicular Muscles 354
10.2a Functions of Skeletal Muscle Tissue 289 12.1 Muscles That Move the Pectoral Girdle and
10.2b Gross Anatomy of Skeletal Muscle 290 Upper Limb 355
10.2c Microscopic Anatomy of Skeletal Muscle 293 12.1a Muscles That Move the Pectoral Girdle 355
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 12.1b Muscles That Move the Glenohumeral Joint/ 14.2b Glial Cells 422
Arm 360 14.3 Myelination of Axons 425
12.1c Arm and Forearm Muscles That Move the Elbow 14.3a Myelination 425
Joint/Forearm 363
14.3b Nerve Impulse Conduction 426
12.1d Forearm Muscles That Move the Wrist Joint, Hand,
14.4 Axon Regeneration 427
and Fingers 366
14.5 Nerves 428
12.1e Intrinsic Muscles of the Hand 374
14.6 Synapses 430
12.2 Muscles That Move the Pelvic Girdle and Lower
Limb 377 14.6a Synaptic Communication 431

12.2a Muscles That Move the Hip Joint/Thigh 377 14.7 Neural Integration and Neuronal Pools 432
12.2b Thigh Muscles That Move the Knee Joint/Leg 381 14.8 Development of the Nervous System 434
12.2c Leg Muscles 385
12.2d Intrinsic Muscles of the Foot 391
Chapter 15
Brain and Cranial Nerves 439
Chapter 13 15.1 Brain Development and Tissue
Organization 440
Surface Anatomy 397
15.1a Embryonic Development of the Brain 441
13.1 A Regional Approach
to Surface Anatomy 398 15.1b Organization of Neural Tissue Areas in the
Brain 446
13.2 Head Region 398
15.2 Support and Protection of the Brain 448
13.2a Cranium 399
15.2a Cranial Meninges 448
13.2b Face 399
15.2b Brain Ventricles 450
13.3 Neck Region 399
15.2c Cerebrospinal Fluid 450
13.4 Trunk Region 401
15.2d Blood-Brain Barrier 454
13.4a Thorax 401
15.3 Cerebrum 454
13.4b Abdominopelvic Region 403
15.3a Cerebral Hemispheres 454
13.4c Back 404
15.3b Functional Areas of the Cerebrum 457
13.5 Shoulder and Upper Limb Region 405
15.3c Central White Matter 459
13.5a Shoulder 405
15.3d Cerebral Nuclei 461
13.5b Axilla 405
15.4 Diencephalon 462
13.5c Arm 405
15.4a Epithalamus 462
13.5d Forearm 406
15.4b Thalamus 463
13.5e Hand 406
15.4c Hypothalamus 463
13.6 Lower Limb Region 408
15.5 Brainstem 465
13.6a Gluteal Region 408
15.5a Mesencephalon 465
13.6b Thigh 408
15.5b Pons 465
13.6c Leg 409
15.5c Medulla Oblongata 468
13.6d Foot 411
15.6 Cerebellum 469
Chapter 14 15.6a Cerebellar Peduncles 470

Nervous Tissue 415 15.7 Limbic System 470

14.1 Organization of the Nervous 15.8 Cranial Nerves 473
System 416
14.1a Structural Organization: Central and Chapter 16
Peripheral Nervous Systems 416 Spinal Cord and Spinal
14.1b Functional Organization: Sensory and Motor Nerves 486
Nervous Systems 416 16.1 Gross Anatomy of the Spinal
14.2 Cytology of Nervous Tissue 418 Cord 487
14.2a Neurons 418 16.2 Spinal Cord Meninges 489
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 16.3 Sectional Anatomy of the Spinal Cord 491 18.3c Effects and General Functions of the Parasympathetic
16.3a Location and Distribution of Gray Matter 491 Division 545
16.3b Location and Distribution of White Matter 493 18.4 Sympathetic Division 547
16.4 Spinal Nerves 493 18.4a Organization and Anatomy of the Sympathetic
Division 547
16.4a Spinal Nerve Distribution 493
18.4b Sympathetic Pathways 550
16.4b Nerve Plexuses 495
18.4c Effects and General Functions of the Sympathetic
16.4c Intercostal Nerves 496
Division 550
16.4d Cervical Plexuses 496
18.5 Other Features of the Autonomic Nervous
16.4e Brachial Plexuses 499 System 552
16.4f Lumbar Plexuses 503 18.5a Autonomic Plexuses 552
16.4g Sacral Plexuses 506 18.5b Neurotransmitters and Receptors 553
16.5 Reflexes 510 18.5c Dual Innervation 554
16.5a Components of a Reflex Arc 510 18.5d Autonomic Reflexes 555
16.5b Examples of Spinal Reflexes 512 18.6 CNS Control of Autonomic Function 556
16.5c Reflex Testing in a Clinical Setting 512 18.7 Development of the Autonomic Nervous System 557
16.6 Development of the Spinal Cord 513
Chapter 19
Chapter 17 Senses: General
Pathways and Integrative and Special 561
Functions 518 19.1 Receptors 562
17.1 General Characteristics of Nervous 19.1a Classification of Receptors 563
System Pathways 519 19.2 Tactile Receptors 566
17.2 Sensory Pathways 519 19.2a Unencapsulated Tactile Receptors 566
17.2a Functional Anatomy of Sensory Pathways 520 19.2b Encapsulated Tactile Receptors 567
17.3 Motor Pathways 523 19.3 Gustation 569
17.3a Functional Anatomy of Motor Pathways 523 19.3a Gustatory Discrimination 570
17.3b Levels of Processing and Motor Control 528 19.3b Gustatory Pathways 570
17.4 Higher-Order Processing and Integrative 19.4 Olfaction 571
Functions 529
19.4a Olfactory Receptor Cells 571
17.4a Development and Maturation of Higher-Order
19.4b Olfactory Discrimination 572
Processing 529
19.4c Olfactory Pathways 573
17.4b Hemispheric Lateralization 529
19.5 Vision 573
17.4c Language 530
19.5a Accessory Structures of the Eye 573
17.4d Cognition 531
19.5b Eye Structure 575
17.4e Memory 532
19.5c Visual Pathways 582
17.4f Consciousness 532
19.5d Development of the Eye 584
17.5 Aging and the Nervous System 534
19.6 Equilibrium and Hearing 586
19.6a External Ear 586
Chapter 18
19.6b Middle Ear 587
Autonomic Nervous System 539
19.6c Inner Ear 588
18.1 Comparison of the Somatic and
Autonomic Nervous Systems 540 19.6d Development of the Ear 598
18.2 Overview of the Autonomic Nervous
System 542 Chapter 20
18.3 Parasympathetic Division 545 Endocrine System 605
18.3a Cranial Nerves 545 20.1 Endocrine Glands and Hormones 606
18.3b Sacral Spinal Nerves 545 20.1a Overview of Hormones 606
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 20.1b Negative and Positive Feedback Loops 606 Chapter 22
20.2 Hypothalamic Control of the Endocrine System 609 Heart 656
20.3 Pituitary Gland 611 22.1 Overview of the Cardiovascular
20.3a Anterior Pituitary 611 System 657
20.3b Posterior Pituitary 615 22.1a Pulmonary and Systemic Circulations 657
20.4 Thyroid Gland 617 22.1b Position of the Heart 658
20.4a Synthesis of Thyroid Hormone by Thyroid 22.1c Characteristics of the Pericardium 659
Follicles 617 22.2 Anatomy of the Heart 660
20.4b Thyroid Gland–Pituitary Gland Negative Feedback 22.2a Heart Wall Structure 660
Loop 618
22.2b External Heart Anatomy 660
20.4c Parafollicular Cells 619
22.2c Internal Heart Anatomy: Chambers and Valves 660
20.5 Parathyroid Glands 621
22.3 Coronary Circulation 666
20.6 Adrenal Glands 622
22.4 How the Heart Beats: Electrical Properties of Cardiac
20.6a Adrenal Cortex 624 Tissue 668
20.6b Adrenal Medulla 626 22.4a Characteristics of Cardiac Muscle Tissue 668
20.7 Pancreas 627 22.4b Contraction of Heart Muscle 669
20.8 Pineal Gland and Thymus 629 22.4c The Heart’s Conducting System 670
20.9 Endocrine Functions of the Kidneys, Heart, 22.5 Innervation of the Heart 672
Gastrointestinal Tract, and Gonads 630
22.6 Tying It All Together: The Cardiac Cycle 673
20.9a Kidneys 630
22.6a Steps in the Cardiac Cycle 673
20.9b Heart 630
22.6b Summary of Blood Flow During the
20.9c Gastrointestinal Tract 630 Cardiac Cycle 673
20.9d Gonads 630 22.7 Aging and the Heart 677
20.10 Aging and the Endocrine System 631 22.8 Development of the Heart 677
20.11 Development of the Endocrine System 631
20.11a Adrenal Glands 631 Chapter 23
20.11b Pituitary Gland 631 Vessels and Circulation 683
20.11c Thyroid Gland 633 23.1 Anatomy of Blood Vessels 684
23.1a Blood Vessel Tunics 684
Chapter 21 23.1b Arteries 685
Blood 637 23.1c Capillaries 688
21.1 General Composition 23.1d Veins 689
and Functions of Blood 638
23.2 Blood Pressure 691
21.1a Components of Blood 638
23.3 Systemic Circulation 692
21.1b Functions of Blood 638
23.3a General Arterial Flow Out of the Heart 693
21.2 Blood Plasma 639
23.3b General Venous Return to the Heart 693
21.2a Plasma Proteins 640
23.3c Blood Flow Through the Head and Neck 693
21.2b Differences Between Plasma and Interstitial
23.3d Blood Flow Through the Thoracic and Abdominal
Fluid 640
Walls 697
21.3 Formed Elements in the Blood 640
23.3e Blood Flow Through the Thoracic Organs 700
21.3a Erythrocytes 641
23.3f Blood Flow Through the Gastrointestinal Tract 701
21.3b Leukocytes 648
23.3g Blood Flow Through the Posterior Abdominal Organs,
21.3c Platelets 650 Pelvis, and Perineum 705
21.4 Hemopoiesis: Production of Formed Elements 651 23.3h Blood Flow Through the Upper Limb 705
21.4a Erythropoiesis 653 23.3i Blood Flow Through the Lower Limb 709
21.4b Thrombopoiesis 653 23.4 Pulmonary Circulation 712
21.4c Leukopoiesis 653
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 23.5 Review of Heart, Systemic, and Pulmonary 25.6 Thoracic Wall Dimensional Changes During External
Circulation 714 Respiration 767
23.6 Aging and the Cardiovascular System 715 25.7 Innervation of the Respiratory System 769
23.7 Blood Vessel Development 716 25.7a Ventilation Control by Respiratory Centers of the
23.7a Artery Development 716 Brain 770
23.7b Vein Development 717 25.8 Aging and the Respiratory System 771
23.7c Comparison of Fetal and Postnatal Circulation 718 25.9 Development of the Respiratory System 774

Chapter 24 Chapter 26
Lymphatic System 724 Digestive System 779
24.1 Functions of the Lymphatic 26.1 General Structure and Functions
System 725 of the Digestive System 780
24.2 Lymph and Lymph Vessels 726 26.1a Digestive System Functions 780
24.2a Lymphatic Capillaries 726 26.2 Oral Cavity 781
24.2b Lymphatic Vessels 726 26.2a Cheeks, Lips, and Palate 781
24.2c Lymphatic Trunks 727 26.2b Tongue 782
24.2d Lymphatic Ducts 727 26.2c Salivary Glands 782
24.3 Lymphatic Cells 729 26.2d Teeth 784
24.3a Types and Functions of Lymphocytes 729 26.3 Pharynx 786
24.3b Lymphopoiesis 734 26.4 General Arrangement of Abdominal GI Organs 787
24.4 Lymphatic Structures 735 26.4a Peritoneum, Peritoneal Cavity, and Mesentery 787
24.4a Lymphatic Nodules 735 26.4b General Histology of GI Organs (Esophagus to Large
Intestine) 788
24.4b Lymphatic Organs 736
26.4c Blood Vessels, Lymphatic Structures, and Nerve
24.5 Aging and the Lymphatic System 741
Supply 790
24.6 Development of the Lymphatic System 741
26.5 Esophagus 790
26.5a Gross Anatomy 791
Chapter 25
26.5b Histology 791
Respiratory System 747
26.6 The Swallowing Process 792
25.1 General Organization and Functions
of the Respiratory System 748 26.7 Stomach 793
25.1a Respiratory System Functions 748 26.7a Gross Anatomy 793

25.2 Upper Respiratory Tract 750 26.7b Histology 793

25.2a Nose and Nasal Cavity 750 26.7c Gastric Secretions 794

25.2b Paranasal Sinuses 750 26.8 Small Intestine 797

25.2c Pharynx 750 26.8a Gross Anatomy and Regions 797
25.3 Lower Respiratory Tract 753 26.8b Histology 799
25.3a Larynx 753 26.9 Large Intestine 799
25.3b Trachea 757 26.9a Gross Anatomy and Regions 799

25.3c Bronchial Tree 758 26.9b Histology 801

25.3d Respiratory Bronchioles, Alveolar Ducts, and 26.9c Control of Large Intestine Activity 802
Alveoli 760 26.10 Accessory Digestive Organs 803
25.4 Lungs 762 26.10a Liver 804
25.4a Pleura and Pleural Cavities 762 26.10b Gallbladder 805
25.4b Gross Anatomy of the Lungs 762 26.10c Pancreas 807
25.4c Blood Supply To and From the Lungs 763 26.10d Biliary Apparatus 808
25.4d Lymphatic Drainage 765 26.11 Aging and the Digestive System 810
25.5 Pulmonary Ventilation 766
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 26.12 Development of the Digestive System 810 28.2 Anatomy of the Female Reproductive System 844
26.12a Stomach, Duodenum, and Omenta 28.2a Ovaries 845
Development 810 28.2b Uterine Tubes 852
26.12b Liver, Gallbladder, and Pancreas Development 810 28.2c Uterus 852
26.12c Intestine Development 810 28.2d Vagina 855
28.2e External Genitalia 857
Chapter 27 28.2f Mammary Glands 857
Urinary System 817 28.3 Anatomy of the Male Reproductive System 861
27.1 General Structure and Functions 28.3a Scrotum 861
of the Urinary System 818
28.3b Spermatic Cord 863
27.2 Kidneys 820
28.3c Testes 863
27.2a Gross and Sectional Anatomy of the Kidney 820
28.3d Ducts in the Male Reproductive System 866
27.2b Blood Supply to the Kidney 821
28.3e Accessory Glands 867
27.2c Nephrons 824
28.3f Semen 868
27.2d How Tubular Fluid Becomes Urine 828
28.3g Penis 869
27.2e Juxtaglomerular Apparatus 828
28.4 Aging and the Reproductive Systems 871
27.2f Innervation of the Kidney 828
28.5 Development of the Reproductive Systems 872
27.3 Urinary Tract 829
28.5a Genetic Versus Phenotypic Sex 872
27.3a Ureters 829
28.5b Formation of Indifferent Gonads and Genital
27.3b Urinary Bladder 830 Ducts 872
27.3c Urethra 833 28.5c Internal Genitalia Development 874
27.4 Aging and the Urinary System 834 28.5d External Genitalia Development 874
27.5 Development of the Urinary System 835
27.5a Kidney and Ureter Development 835 Appendix: Answers to Challenge Yourself Questions A-1
27.5b Urinary Bladder and Urethra Development 835 Glossary G-1
Credits C-1
Chapter 28 Index I-1
Reproductive System 842
28.1 Comparison of the Female and Male
Reproductive Systems 843
28.1a Perineum 843

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 Preface

What Makes
This Book Special?
uman anatomy is a fascinating field that has many layers of 3. EMBRYOLOGY Updated the discussion regarding the
H complexity. The subject is difficult to teach, and students can
often be overwhelmed by its massive amount of material. Our goal
acrosomal reaction to include most recent research information.
Added a short description to the cleavage discussion regarding
in writing Human Anatomy was to create a textbook that guides how the blastocyst leaves the zona pellucida.
students on a clearly written and expertly illustrated beginner’s
path through the human body. Across three editions, we have 4. TISSUE LEVEL OF ORGANIZATION Updated the discussion
striven to make this book enjoyable to read, easy to understand, of the basement membrane and figure 4.1 to include three layers.
pedagogically efficient, and visually engaging. The following New examples of apocrine secretion to mammary glands and
pages highlight the enhancements we’ve made to the third edition ceruminous glands. Expanded the descriptions of hyaline and
as well as the hallmark features that define this book. fibrocartilage. Updated the description of the synovial membrane.
New micrographs and drawings of ciliated columnar epithelium,
What’s New in This Edition? cardiac muscle, and smooth muscle.

New research findings, shifting terminology, technological

advancements, and the evolving needs of students and instructors
in the classroom require textbook authors to continually monitor
and revise their content. Throughout the third edition, changes
have been made to incorporate the latest information, bring
terminology up to date, and improve wording to make discussions
easier for students to read and understand. In addition, we have
implemented some simple pedagogical changes to facilitate easier
referencing and coordination with supplemental resources.

■ Each chapter section begins with a set of numbered learning

objectives.
■ All first- and second-level section headings are numbered to
allow easier reference to specific areas of the book.

Content Updates
The following list is by no means exhaustive, but it highlights
some of the changes made in each chapter.

1. A FIRST LOOK AT ANATOMY Changed figure 1.5 to an

anterolateral view so the coronal plane is more obvious. Added a
brief discussion on orienting sections right to left in the Clinical
View on medical imaging.

2. THE CELL: BASIC UNIT OF STRUCTURE AND

FUNCTION Clarified that simple diffusion can occur without
a membrane. Updated figure 2.8 to show the endoplasmic
reticulum is continuous with the nuclear membrane. Modified
figure 2.9 (Golgi apparatus) to adjust the relative sizes of the
receiving and shipping regions.

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 Preface
5. INTEGUMENTARY SYSTEM New Clinical View CLINICAL VIEW
describing several current surgical and laser treatments
Congenital Muscular Torticollis
for aging skin. Added information on sensible and Congenital muscular torticollis (CMT), often known as wryneck, is a
condition where a newborn presents with a shortened and tightened
insensible perspiration; the transfer of melanosomes sternocleidomastoid muscle. CMT is relatively common with estimates
between 0.4% and 2% of births. It is thought to be a result of trauma
from melanocytes to keratinocytes via phagocytosis or resulting from either a difficult birth or prenatal position of the fetus.
The trauma causes a hematoma and fibrosing of the muscle tissue.
exocytosis; the number of ceruminous glands in the Pediatricians also have seen an increase in acquired muscular torticol-
lis among newborns who are kept in their infant seats for extended
external auditory meatus and the presence of lysozyme periods of time outside of the car. Infants and children with CMT often
tilt their heads to the affected side and their chins to the unaffected
in cerumen; and hair stiffness. Updated the information side. Since the infant favors a particular head position, plagiocephaly
(flattening of the head) often accompanies CMT.
about friction ridges and grip. Revised figure 5.7 (lines CMT treatment typically involves repeated daily stretching of the
affected muscle, changing sleeping positions, and making the child
of cleavage) to clarify potential for gaping wounds with use the affected side while playing and interacting with others. More
severe cases may require surgery. A newer approach to treatment of
perpendicular versus parallel incisions. New micrograph CMT is the use of botulinum toxin (Botox) combined with stretching.
Botox is injected into the muscle to impair contraction in response to Photo of a 7-year-old boy with CMT. Notice the prominence of the
of longitudinal section of hair (figure 5.9b) and expanded nerve stimulation, and thus the muscle responds better to stretching. sternocleidomastoid on the left (affected) side.

coverage of the hair growth cycle.

6. THE SKELETAL SYSTEM: CARTILAGE AND BONE Added 8. THE SKELETAL SYSTEM: APPENDICULAR SKELETON
the medullary cavity as a location of red bone marrow in children. Added new photos with improved contrast and detail for figures
Made the distinction between bone as organ and bone connective 8.9a, 8.9b, 8.11a, 8.13a, and 8.13d. Improved contrast of photos in
tissue. Reorganized bone fracture coverage to reflect the different figures 8.4a, 8.4d, 8.5a, and 8.5f.
classifications used in describing fractures. Reworked the fracture
repair discussion. 9. THE SKELETAL SYSTEM: ARTICULATIONS Added Clinical
View on joint replacement. Updated information on osteoarthritis.
7. THE SKELETAL SYSTEM: AXIAL SKELETON Rotated
10. THE MUSCULAR SYSTEM: MUSCLE TISSUE AND
lateral views of skulls so photos and drawings are oriented in
ORGANIZATION New analogy for sliding filament. Clarified
the Frankfort plane. Added new photos with improved contrast
role of ATP in powering muscle contraction and added concept of
and detail for figures 7.4, 7.5b, 7.6, 7.7, 7.8, 7.13a, 7.13b, and table
recruitment. Updated role of intermediate fibers.
7.4. Improved contrast of photos in figures 7.5a, 7.10, 7.12a, and
7.12b. Added information about how angles of vertebral facets
11. THE MUSCULAR SYSTEM: AXIAL MUSCLES New Clinical
contribute to different movements; size of vertebral foramen; and
View on congenital muscular torticollis. Clarified discussion of
palpation of vertebra prominens.
pelvic floor muscles.

12. THE MUSCULAR SYSTEM: APPENDICULAR

MUSCLES Added Study Tip for rotator cuff muscles. Reorganized
discussion of pectoral girdle muscles superficial to deep.

13. SURFACE ANATOMY Updated CPR Clinical View per current

American Heart Association information. Added landmarks for
posterior, superior iliac spine. Clarified landmark and clinical use of
dorsalis pedis artery.

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 20. ENDOCRINE SYSTEM Updated information on adrenal
Study Tip! gland hormones. Added new information to Clinical Views on
It is sometimes difficult to remember the relationships between parathyroid gland disorders and diabetes.
"afferent and sensory" and "efferent and motor" and their general
locations, This mnemonic will help keep them straight in your mind: 21. THE CARDIOVASCULAR SYSTEM: BLOOD Updated
"SAME DAVE" (Sensory-Afferent, Motor-Efferent; Dorsal-Afferent, counts and percentages of formed elements. Revised illustration
Ventral-Efferent). Don't forget that Dorsal is Posterior and Ventral is
of megakaryocyte (figure 21.9) and the discussion of platelet
Anterior in humans.
formation. Updated Clinical Views on blood doping and
transfusions.

14. THE NERVOUS SYSTEM: NERVOUS TISSUE

22. THE CARDIOVASCULAR SYSTEM: HEART New
Added SAME-DAVE mnemonic as Study Tip. Better defined
information regarding male versus female symptoms of
anaxonic neurons. Expanded table 14.2 to include perikaryon,
myocardial infarction. Updated Clinical Views on valve defects
neurotubules, neurofilaments, and neurofibrils.
and angina pectoris. Added heart sounds to figure 22.14 and
corresponding text.
15. THE NERVOUS SYSTEM: BRAIN AND CRANIAL
NERVES Clarified that a nucleus is in the CNS and a nerve
plexus is in the PNS. Added information about the olfactory tract,
the functional aspects of the limbic system, and hemispheric
lateralization.

16. THE NERVOUS SYSTEM: SPINAL CORD AND SPINAL

NERVES Modified figure 16.1 to make cervical and lumbar Megakaryocyte
enlargements more distinct. Clarified the course of posterior and
anterior roots, and the segmental pattern of thoracic nerves. New
Clinical View describing multifocal motor neuropathy.

17. THE NERVOUS SYSTEM: PATHWAYS AND INTEGRATIVE

FUNCTIONS Updated information on hemispheric lateralization.
Combined information about principal sensory spinal cord
pathways into table 17.2.

e ssel
19. THE NERVOUS SYSTEM: SENSES: GENERAL AND SPECIAL t hrough v
Blood flow
Updated information regarding kinocilium. Added otitis externa
to the Clinical View on otitis media. Modified the information
Endothelial cells Proplatelets Platelets
about inaudible sounds. Adjusted labels in figure 19.18 to
(b)
correspond to inferior view.

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 Preface
23. THE CARDIOVASCULAR SYSTEM: VESSELS AND the Heimlich maneuver and bronchoscopy. New Study Tip for
CIRCULATION New Clinical View on cerebral aneurysm. Added envisioning the organization of respiratory structures. Revised
image of abdominal aortic aneurysm and depiction of graft stent figure 25.10a based on recent histologic information.
placement to corresponding Clinical Views.
26. DIGESTIVE SYSTEM New Clinical View on diverticulosis
24. LYMPHATIC SYSTEM Reworked introduction to clarify and diverticulitis. Added images showing the ADA-adopted
the roles of the different parts of the lymphatic system. Updated Universal Tooth Numbering System and mouth quadrants to
numerous terms to correspond with current immunology texts. figure 26.6. Added information on sensory neurons, sympathetic
Updated HIV Clinical View. postganglionic axons, and parasympathetic ganglia of submucosa.
Explained variance in thickness of the muscularis mucosae at the
25. RESPIRATORY SYSTEM Relocated the Clinical View level of the laryngopharynx versus the stomach. Quantified the
on tracheotomy from chapter 13 to chapter 25 and added average length of esophagus, weight of liver, and percentage of
cricothyrotomy. Added explanation of differences between the absorption in small intestine. Indicated the regions of the pylorus
right and left primary bronchi and their clinical significance. and the gallbladder. Clarified flow of bile within the biliary
New Clinical View on the aspiration of foreign bodies, including apparatus. Added new section on gastric pits and glands.

CLINICAL VIEW

Aneurysms vessel that appears berry-shaped. Usually, berry aneurysms develop at

the point where a blood vessel bifurcates because the blood vessel walls
An aneurysm is a localized, abnormal dilation of a blood vessel.
near this location are structurally weaker. Most cerebral aneurysms are
Although an aneurysm can form in any type of vessel, aneurysms are CLINICAL VIEW
located along the arteries that form the cerebral arterial circle. All cere-
particularly common in arteries, especially the aorta, because of the
bral aneurysms have the potential to rupture and cause bleeding within
higher blood pressure on the arterial side of the circulation. After being Diverticulosis and Diverticulitis
the brain, which can cause serious complications such as hemorrhagic
initiated by a weakness in the wall of the vessel, an aneurysm tends
stroke, subarachnoid hemorrhage, nerve damage, or death. The disorder
to increase in size over a period of weeks or months until it ruptures. Diverticulosis is the presence of out-pocketings of the
may result from congenital defects or from otherintestinal
conditions such as
wall known as diverticula. Diverticula are acquired
Abdominal aortic aneurysm is a relatively common medical problem, and high blood pressure, atherosclerosis, head trauma, protrusions
or infection.ofA the
small
mucosa through the colonic wall that have
is most often a consequence of atherosclerosis. Most abdominal aortic aneurysm generally will not produce symptoms, butevaginated
a larger onethrough
that is the submucosa and a weakened and/or
aneurysms develop between the level of the renal arteries and the point steadily growing may press on tissues and nerves. Symptoms
diminishedmaymuscularis
include mucosa. Diverticula occur in weakened
near where the aorta bifurcates into the common iliac arteries. Since no pain above and behind the eye, numbness, weakness, or paralysis
areas on onewall where the nutrient vessels pierce the
in the bowel
pain fibers are associated with the aorta, an aneurysm can increase in side of the face, dilated pupils, and vision changes. When a berry aneurysm
muscularis near the teniae coli and the omental appendices.
size and reach the point of rupture without the patient ever being aware ruptures, an individual may experience a sudden and Theseextremely
defectssevere
can become weaker with age. Diverticula are
of it. A ruptured aorta is a surgical emergency that few people survive. headache (described by patients as the "worst headache of my life"),
most common in the sigmoid colon (95%) but may be con-
An abdominal aortic aneurysm may be detected during a physical exam double vision, nausea, vomiting, stiff neck, and/or loss of conscious-
centrated along the course of the teniae coli for the entire
as a pulsating abdominal mass. X-ray and ultrasound studies can confirm ness. A ruptured berry aneurysm is an emergency condition;
length of about 25%
the colon.
the diagnosis and determine the size and extent of the aneurysm. For of people die within one day, and another 25% die within 3 to 4 months.
a number of years, aortic aneurysm repair has involved removing the The exact etiology of diverticulosis is poorly understood;
Treatment of the aneurysm typically involves using sutures, clamps, or
however, high intraluminal pressures caused by straining in
dilated segment of aorta and replacing it with an artificial vascular other materials to repair the ruptured site.
people with motility problems or constipation may be a sig-
prosthesis. This risky surgical proce-
nificant factor. Most scientists agree that a low-fiber diet is
dure requires making a large abdominal
an underlying cause of diverticulosis. Most individuals with
incision to gain access to the dilated
Aorta diverticulosis are asymptomatic, without evidence of com-
segment of aorta. More recently, stent
plications.
BloodComplications
flows of diverticulosis include bleeding,
grafts have been developed that can
through stent
peridiverticular abscess, perforation, stricture, and fistula
be inserted through an incision in the graft If some of the diverticula become infected or
formation.
femoral artery, positioned in the area
inflamed, the condition is known as diverticulitis. Diverticulitis
of the aneurysm using x-ray guidance,
Stent graft occurs in only about 10-20% of patients with diverticulosis.
and then expanded to reinforce the released Endovasular
Treatment for diverticulitis requires the use of a special diet,
weakened and dilated area of the aortic from catheter Abdominal stent graft
aortic antibiotics, and inoccasionally surgery.
wall. This procedure is less invasive and place
aneurysm
traumatic than major abdominal surgery.
Unfortunately, the stent graft does not Plaque
always lead to a complete cure, and
complications are still possible. Abdominal
aneurysm
A berry (cerebral or saccular) aneu- Catheter
rysm is a weak area in a cerebral blood insterted Common
into femoral iliac artery
vessel that balloons out and fills with artery
blood. It is so named because it is a
saclike outpocketing of a cerebral blood

(a) (b)
Diverticulosis (a) An external view of the sigmoid colon showing
diverticula. (b) An endoscopic view of diverticula.

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 27. URINARY SYSTEM Added new micrographs of the renal importance of surface anatomy landmarks and how they are
cortex (figure 27.7b) and renal medulla (figure 27.7d). Updated used daily in health care.
the Clinical View of renal calculi. Simplified several points ■ Nervous System. In order to understand the workings of the
about sodium ion and water reabsorption. nervous system, it is best to learn how the brain controls
all aspects of the nervous system. Thus, in this text we
28. REPRODUCTIVE SYSTEM Added HPV vaccines to the examine the brain first, followed by a chapter comparing
cervical cancer Clinical View and newest research and failure its similarities, differences, and relationships to the spinal
rates to the contraception Clinical View. Clarified information cord. It seemed appropriate to use central nervous system
on the release of GnRH. Specified epithelial role in the acidic terminology to describe the brain first and then the spinal
environment of the vagina. Updated the roles of the male cord. Additionally, because the nuclei of the cranial nerves
accessory reproductive glands. Provided the latest information are housed within the brain, we felt it made more sense to
on menopausal hormone therapy. present the cranial nerves along with the brain.
■ Arteries and Veins. Arteries and veins are covered in unison

Themes and Distinctive Topic by region. For example, we present the arteries and veins
of the upper limb together. This approach emphasizes to
Approaches students that arteries often have corresponding veins and that
Through our teaching experience, we have developed a few both are responsible for the blood flow in a general region.
approaches that really seem to help students grasp certain topics
or spark their interest. Thus, we have tried to incorporate these
successful ideas from our own courses into our book.
■ Embryology. Learning about embryologic events can
increase understanding of the adult anatomy. For this
reason, chapter 3: Embryology appears early in the book.
In addition, “systems embryology” sections in each systems
chapter (e.g., integumentary system, digestive system)
provide a brief but thorough overview of the developmental
processes for that particular system.
■ Forensic Anthropology. Forensic examples are a great way
to reinforce learning, and students enjoy the “real-life”
application of anatomic knowledge in forensic analysis. The
skeletal system chapters (6–8) feature discussions on topics
such as determining age of death by evaluating epiphyseal
plates and the pubic symphysis, and determining sex by
noting differences in the skull and pelvis.
■ Surface Anatomy. To best serve our audience, we have
dedicated a full chapter (13) to surface anatomy. This
chapter contains beautiful photographs and clear, concise
text as well as numerous Clinical Views that illustrate the

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 Preface

Accurate and Engaging

Illustrations Frontal sinus
Ethmoidal sinuses
ecause anatomy is a visual subject, quality illustrations
B are crucial to understanding and retention. The brilliant
illustrations in Human Anatomy bring the study of anatomy to
Sphenoidal sinus

Maxillary sinus
life! Drawn by a team of medical illustrators, all figures have been
carefully rendered to convey realistic, three-dimensional detail.
Each drawing has been meticulously reviewed for accuracy and
consistency, and precisely labeled to coordinate with the text
discussions.

Interstitial space Capillary bed Venule

Neuron

Perivascular feet

Astrocyte

Capillary

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 ●
3 What muscles cause medial rotation of the arm? (figure 12.7). The biceps brachii is a large, two- View Orientation
●
Anterior
4 How can the deltoid extend and flex the arm? headed muscle on the anterior surface of the
Reference diagrams
clarify the view or
plane an illustration
represents.
Biceps brachii
View of
cross
section Brachialis

Anterior
Lateral Medial compartment of arm

Humerus

Posterior
compartment Medial head
of arm Triceps Lateral head Figure 12.6
brachii Actions of Arm Muscles on
Long head
the Forearm. A cross-sectional
view shows the compartments of
the right arm. The anterior and
posterior compartment muscles
are responsible for different
movements.

Posterior

Color-Coding
Many illustrations use color-coding to organize
information and clarify concepts for visual learners.

Tendon

Deep fascia

Artery
Skeletal muscle Nerve
Vein

Epimysium Perimysium
Nuclei

Perimysium Endomysium
Artery
Vein
Nerve

Muscle fiber

Fascicle

(b) Fascicle
Endomysium

Muscle fiber Endomysium

Nuclei Multilevel Perspective

Illustrations depicting complex
structures connect macroscopic
Myofibrils
and microscopic views to show the
(a) Muscle Sarcoplasm
relationships between increasingly
Sarcolemma
detailed drawings.
Satellite cell
(c) Muscle fiber

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