It's that time again - anatomical enlightenment! Day four of dissection completed and I'm even more intrigued than before! What is this wonder we live in? An engineering masterpiece, which isn't only functional, but truly beautiful. Even guts, when looking through the right lens..
We started out again by preparing the cadavers on the tables, laying on the back. It was time for evisceration!
Todd first showed us how it's done - going through the transversus right into the peritoneum. The incisions were made on both sides, with a final straight cut over the pubic line. That way it was possible to just fold the abs over the chest and get right into the organs. What first met the eye weren't what we expected - many of us didn't know of the greater omentum and it's function! It's a fatty tissue that lies in between the abs and the organs. Its not attached, so it moves to where it's most needed. It's purpose is to protect and help the organs to heal. Apparently it's common with the omentum going to the spleen, especially when people are nearing death (as the spleen will have a lot on its plate by then). The cadaver Todd opened had a perfect omentum, but our cadaver had a small, dried out omentum that lay right above the spleen. It was really interesting to see the differences in the bodies!
One cadaver had swollen or gassy intestines, and they were arranged like four vertical (had she been standing) collars, at least 2" wide. It filled up the whole cavity! Most of the others were either like Todd's or ours.
Anyways, evisceration. So evisceration means removing the organs. For this, the cadavers were on their sides so that gravity could help with the "fallout".. I got to do the evisceration on our cadaver, and it was pretty great actually. Luckily we had no punctures on any of the tissue, and so the smell stayed away. It was detailed work that required precision, and it was SO exciting as I also got to uncover the psoas (hip flexor) as I went. When done we could lay out the whole system on the table, and look at it in its entirety. Awesome. I didn't know that the whole small intestines is connected to the same membrane that supports the system with blood and makes sure that nutrients end up where they're needed. That was really good to see! It looked almost like some sort of sponge like structure, wavy at the edges and intestine-y on the edges.. Other things that were in the same "goo" were the liver, pancreas, kidneys, adrenal glands, gall bladder, large intestine, stomach and the spleen.
Another really interesting thing is how the large intestines fasten right on the psoas. Ever heard that you should take a walk to make things move in there? Yeah, me too. And now I know why!
The psoas is a really big muscle, and with its close association to the large intestine that means that what we do (activity wise) can have a huge effect on regularity and we'll being. Nobody likes to be constipated! The size of the psoas really surprised me. I knew it was important, but it is a lot thicker than what I could have imagined! The only other muscle that was actually bigger than expected was the adductor magnus (inside thigh).
After evisceration I continued in the now empty space with uncovering the spine, diaphragm and muscles. More about the spine tomorrow (I didn't get very far yet). There was quite a lot of fat to remove still, but it looked really nice at the end of the day.
Tomorrow I'm hoping I'll get deeper into the pelvic floor!
Right next to the psoas I found the femoral nerve, which was real easy to trace down in the thigh. Beautiful to see it all make sense.
Speaking of thighs. Today we successfully took off someone's leg! First he removed the gluteus max, then the medius. From there it was easy to see the superior and inferior gemellus, piriformis and quadratus femoris. And the sciatic nerve. We also had the tfl still in place. Here we did plenty of movement to see how these small muscles, and the movement of the lower extremity, can possibly affect somebody. The risk for trouble is HUGE. We kinda already knew that, but this confirms that there really are a hundred possibilities when we get a client with pain. The only way to know if we're doing the right thing is to listen closely to what your body is saying.
We did movement testing in the leg, while Todd cut up ligaments around the hip joint. Suddenly you could see the structure coming out (and coming in - we didn't stop moving). Eventually we cut all the way round and got to feel the femoral head outside its capsule. Pretty cool. The bones in there doesn't actually tough - the fluid in there makes joints "float". It's almost poetic.
We also got to see the elbow and shoulder joint opened, which was also extraordinary!
Anyways, just a quickie back to hips. I told you yesterday about the four toed lady we have. She had some quite interesting anomalies in her hip and hip flexor. We can't say why for sure, but we can observe and guess. She first seemed to be lacking a piriformis, but we threw discovered something that looked like a split muscle, with some attachment to the glute minimus. Every single cadaver had something different.
Speaking of attachments - turns out that the male cadaver had a fracture of the left trochanter! The piece that was broken off was nicely encapsulated in tissue, so it would probably have been there many years! Very cool to see!
One thing that wasn't very pleasant was when I found the aorta coming down from the heart along the spine and going down in the legs. Just by touching it I could feel the buildup in there. LOADS. So I removed it (it looked like an inverse Y with the vessels leading into the legs). I had to cut it up with scissors, and I struggled, to get it open. The rock hard buildup varied form about 1-2mm thick - that is a lot. I think it was eye opening for everybody to see a blood vessel like that. Imagine we could be full of that stuff, right this second.
Todd said something in class today that really stood out to me. The body strives for perfection. Which means, whatever we give it, it will try to make good things with it. So I'm thinking that if we can only make sure that we're going on the right direction with our clients, it doesn't have to be 100% right all the time, but it need to always improve.