As we sharpen our perception and appreciation of the details of whole body layers, continuity's of texture and the repeating patterns of our form, we increase our range of motion and maximize the potential of our human experience. We take a moment now to express our gratitude to the donors and their families who make study at this level possible. The relentless stream of abundance which blesses our creative endeavors here, waits only for our readiness to step into it and receive
I suggested the body could be understood as a series of thin fibrous covering layers and thicker fluffy layers all related and interpenetrated by tree-like neurovascular branchings. So the skin would be the relatively thin outermost covering layer overlying the relatively fluffy superficial Fascia, which itself over lies that thin fibrous deep Fascia, which in turn covers and invests the relatively fluffy muscle layer. Superficial Fascia and muscle are shaping layers of the body, the massive, which can change considerably over a lifetime. These thicker layers can grow and and thickness substantially so that any given person's overall shape is defined by them more or less. In the membernation wrappings of the Oregon's and central nervous tissues and in these viscera themselves, we have yet another reiteration of the pattern of thin covering layer and a relatively thick covered layer.
The membranes are thin, the Oregon's relatively thick or fluffy and greatly changeable in dimension over time. Of course, every layer actually consists of multiple layers at a cellular level. And to hear this is so even at a gross level, the multiple wrappings of our organs and central nervous tissues share common textures and patterns and defined several important potential spaces within our form. These fibrous and membranous layers of the cranial and visceral spaces have earned their very own volume in this series due to their relative complexity as a layer and due to the fact that they have gotten so little clear attention. Otherwise it is very difficult to figure out these truly bag like balloon, like layers from book descriptions and still imagery. And even in the dissection lab, they're easy enough to miss and the pursuit of structures whose fame surpasses them. Yet, these tissues are incredibly important to our experience of overall health, and they are easily affected by our every movement and touch.
I present them here as an invitation to integrate them into your general understanding and vision of the whole human body and your internal experience of yourself.
So far we've explored the layers of the skin, then the superficial Fascia on volume one, the deep fascia and dropping in deeper the muscle on volume two. Uh, at the end of that volume we encountered the bony layer, uh, as well as the fibrous coverings of the viscera themselves. Now it's our turn to explore those. And because they're slightly more complicated in their layering, uh, I've decided to diagram it here for you, uh, to make understanding more simply. So let's look at this black layer here. The black layer will represent, uh, that first, uh, fibrous layer of Fascia that one encounters.
It's like a balloon, a one counter, sort of a fiber spoke, just literally just like a balloon, a, we take a balloon here and we can imagine as we're dropping in skin, superficial Fascia, deep fascia muscle. And then, uh, we saw for instance, the, the, the posterior rectus sheath that, that uh, fibers Fascia or, um, in the chest area we have the endo thoracic fashion, that cranium, we have the Dura or surrounding the heart, the fibers pericardium. Now immediately deep to that, it's like balloons within balloons. So immediately deep to the fibers layer, whatever it's called in whichever visceral space we have here, you see immediately adhering, stuck to literally stuck to the fibrous layer. We have a cirrus membrane. Now the Sirus membrane has slightly different anatomical and physiological properties relative to the fibrous membrane. And again, it will have a different name depending upon which visceral space we're in.
But for now, let's just get the lay of the land. The idea that there are these one, two, three, uh, fascicle and membranous layers surrounding each of our visceral spaces. So we have the fibrous layer, then the membrane, this layer. Now it's interesting about the membranous layers as sort of double backs upon itself. So it's like if you had a balloon, you push your fist into it, uh, you could imagine that. Then there would be sort of two balloon shapes. Uh, so the outer balloon would be the, uh, outer layer of the cirrus membrane. And then this inner layer, I call it the well, the inner cirrus membrane or the skin of the organ.
When you're doing dissection, you cut deeply into the body and you encounter the organs, whether it's the brain or the heart or the or the lungs or the abdominal viscera, the abdominal organs. And when you see those organs, what you're actually seeing is they're covering layer and they're covering layer is the doubling back of the cirrus membrane. So we see the Oregon layer here in blue, and we'll call the inner Sirus membrane, the skin of the Oregon. It doesn't matter what you are. Again, the skin of the organ and the skin of the organ immediately adheres to the Oregon. But the Oregon itself with its skin does not adhere to the outer cirrus membrane. It's actually a slick sliding surface. So we'll let this little white area here represent the place where the cirrus fluids lie and creating, which creates a sliding surface between these two cirrus layers that the organs can, can move, uh, happily between themselves.
So we have here the outer layer. The outer crs layer is adhered to the fibrous layer, and then we have a sliding surface between the two cirrus layers, the outer and the inner. Now the outer layer, well you can see how it sort of hugs the perimeter or hugs the wall. So it's like the wall layer, we'll call it Latin. We use the word parietal to reference the wall layer. So this layer could be the parietal pericardium or the parietal peritoneum or the parietal Pleura, meaning the outer layer or the wall layer of the cirrus membrane.
And then this layer here, we would call it the visceral layer because that adheres to the viscus, the Oregon. It adheres to the, to the Oregon. So this visceral layer, this could be the visceral peritoneum in the belly or the visceral pericardium, that surface of the heart, the skin of the heart or the visceral Pleura, the skin of the lung. So, and in the case of the brain, we have the PIA
The end of thoracic fashion invests and coats all of the ribs and the muscle between the ribs from the inside, just as the fibrous deep fascia coats the outside of the rib cage coming from the outside into the body. Then the endo thoracic fashion is that first fibrous fascia layer inside the thorax, which surrounds the contents of the thorax and contains them within itself. So this fibrous inner lining of the thorax, it's not an independent structure. It invests the inner layer
We've also encountered the inner layer of the intercostal muscles immediately deep to this fibrous Endo Thoracic Fascia. We encounter the parietal layer of the Pleura, the outermost cirrus membrane of the thorax within which the lungs enjoy their motion.
The pleura is a balloon that coats the entire space there. So we can see the Pleura here. It's tough. Uh, it's not fight tough like the end of thoracic fat fashion in the sense that it's, it's not filled with, um, with strapping tape at the same time. It has a definite integrity. If you punctured it with a needle, you'd feel a little pop as you went through it. Um, it's a, it's a, it's a durable bag because you breathe 20,000 times a day and this thing is going with the flow of that breath here though, we look inside and what do we see? You can say, hey, that doesn't look like a long, well, it's not a along any more, any more than than, than, than when we look over here, we see like instead we see the diaphragm, but the diaphragm is covered with Pleura as well. Remember, the Pleura is folding its way and coding every surface inside the thorax. So this is plural here and I can't pass my finger through from the 12th rib into the abdominal space or vice versa. See, I get stuck. I can't go through.
It turns back up and then covers the diaphragm. It goes this way and then rule it comes back this way. Okay.
So those would be the four regions. The couple of would be the, the peak or dome, uh, of, of the, of the thorax here. Like the Dome of a church, the couple of St Peter's Cathedral here we have the couple of our, of our thorax. So so the cupola the Pleura on the couple of would indicate in this, this region within our body. Uh, then the Madea Steinle Pleura at, well all of these structures within the middle which aren't lung is lung, here's lung. And then on within we have the heart and the aorta coming from it in the the thoracic doctor [inaudible] and all sorts of other structures in that it will explore later. So all those things which stand in the middle or in the media Steinle space and the media Steinem references the space that's created by the non, the non touching of the Pleura on either side.
So the Pleura does the two Pleura, the two pleural sex, one for each side don't actually touch each other, but they, there's a space in between them and everything that's within that space. Those structures aren't media Steinle. So the structure, the spaces, the media, Steinem, and the structures within it are media Steinle structures. And the Pleura which is surfacing those structures as it as it comes around would be the media Steinle Pleura. Now finally we have a costal pleura and that's the Pleura which we've already encountered in the dissection. As we dropped through the end of thoracic fashion, encountered that Pleura and we've even seen the light passing through.
That would be the Pleura that surfaces all the rib surfaces. So we have costal Pleura, the diaphragmatic Pleura, the, the, the Pleura that's surfacing the domes of the diaphragm, the media Stein up Pleura, the Pleura that brushes up against the structures in the middle and, and uh, and creates the media style space. And then finally the Pleura of a couple of [inaudible].
And this a potential space realized, although my fingers for that can fit in here. Now in the living, there is no space here. There's no space. The Oregon's fill the space. We breathe and we fill the space. This the air fills the lung, not the intervening space. If you had space in here, it would hurt. We can see how round and dome shape the diaphragm, as I say.
What do you mean the diaphragm? That can't be the dark, right? Well that is the shape of the diaphragm. The diaphragm is filled like bubbles on either side. With the contents of the abdominal [inaudible] space, the abdominal viscera bulging upward, they're bulging upward into thoracic space. Uh, they don't pass into thoracic space because the balloons prevent the contents of the balloons and the muscle prevent the contents of the diaphragm. The contents below the diaphragm from entering there lift up a little higher on the lung who go over the hill here and it's just round and around.
It's like a pair of shoe on either side. A parachute of diaphragm here is covered with a film. That film is the of the diaphragmatic poorer because we're looking at the diaphragm from the thoracic space. So on the northern side, on the head side, on the thoracic side of the diaphragm, the diaphragm is painted over, covered with a cirrus membrane called the pleura there. It's called the Coryell player because it's covering all the wall and more particularly at that point, it's called the diaphragmatic floor, but it's all just the same skin ballooned skin. Either way, you slice it to the line of the 12th rib, where the Pleura here, the Pleura is, is covering the diaphragm. And then scrolling back like an ocean wave here, like an ocean, wave the curls back over and paints the paints to the end of the Thoracic Fascia of the, uh, the fibrous covering of the rib cage.
Uh, so that's the, that's the terminus of the thoracic space right there. That's the end of the road. That's the end of the thorax. And on the far side of it, we have the abdominal territory here. I say sweet in my hand, in, I come over the diaphragm on either side, over the diaphragm in this. Great, great arch. And then of course we have our lungs and the lungs are huge.
Your pulleys are ribs back. You can see we're on the right side. All right. We have this big joint. There's a joint in the lungs. I had enabled it to spiral on itself and the breadth of motion and down here we see the Pura come off in a sheet. Which weekend, which will I anticipate our anterior view.
The rest of it we cut away as we went through the ribs and the other tissues to be able to see the immensity of the lungs from the side here and inside you see these giant lobes. When you get an anterior view, it's a very superficial, you only see the superficial projection of the lungs, but pleura means side, Pleura, mean side. It's a Greek word pleura and so it's really a side organ and it fills in your whole size. Huge along the huge, the parietal peritoneum here, which we can see out puffing when I move the organs around. This filmy layer here puffing up and down that layer. How's the kidney underneath it? Whenever he marked out the border over our liver.
And then our kidney care, we had our spleen, spleen here. So the shape of the spleen to the diaphragm and the shape of the great liver here, leaving the kidneys,
So I can pull across here and we can see how the shortening of the fibers of the transversus abdominis muscle would, um, create a tension in this sheet over the guts, over the viscera of the abdomen. It's this rib here and these ribs are going to be three now, cause they're freed from their muscular attachment here and in the back. They're freed from the spine as well. So I pry up here and see. Cool. See that the continuity of the transversus abdominis muscle with the diaphragm. This is my diaphragm. This is my trans versus have down.
It's look like one big bag. The only difference that the, the diaphragmatic pleura that's covering here has come down to this point and doubled back here. We've cut through the PLEURA. What I just did was cut through the Pleura that was attaching here and cutting away the attachment of the diaphragm to the ribcage. So, uh, although it appears to be a complete continuity
I'm just, can you hear that? That's the, that's,
These vessels are now commonly borrowed to bypass coronary vessels during an open heart surgery. The surgeons peel them from the chest wall and sew them onto the heart. Scar tissue will then cause the injured layers to add here.
Then the lung gets carried along with the movements of the ribcage in a way that it really would have a sliding surface. As we look inside the wall here, we've seen the fibrous layer covering the intercostal muscles and exactly covering the intercostal walls as well as the bone [inaudible].
At the belly. We still have the entire trans or Salus fashion at the fibrous layer still intact to explore a bit later.
But here we have a adhesion. They're stuck to each other. Do we have more lung over here
This is the skin of the lung. Here. I haven't broken into the lung tissue at all here, and we shouldn't be surprised that there would be adhesions here as along the parietal layer to the visceral layer because here, in fact, the lung tissue itself has been broken, right? We saw it on the back of the, on the, on the chest wall, and it was stuck so that the skin of the lawn actually was torn away, stuck to the rib cage because the skin of the lung was adhered to this and this was adhere to that. And the three of them all stuck to each other and taking it apart yielded a rip. That shouldn't happen. It should be a smooth, uh, point of contact.
But again, there was a massive chest surgery. We can see, see how the long bounces back. It's very elastic along as in an inlet and elastic structure. It should be elastic. This is good. Also, when you press down and you're pressing air out, when you let go and it's intruded like this, the air fills in again. I create a vacuum and it fills in again.
So the lungs should be elastic and responsive to pressure, right? Like the pressure haunted chest or something. So, so this is, this is good. At same time we see a lot of black and a blackness on the tissue represents the patterning of the, of the lymphatic vessels filled with carbon dip deposition. So here we have some remnants of the parietal layer of the pleura. And then this layer here, this is the visceral layer. This is the skin of the lung. When I lift up this layer, then I'm, I'm, I'm actually exposing little Alveoli and things like that. So this is the, the visceral layer just to prove there is one. This is the visceral pleura.
We've encountered it where it adheres to the diaphragm and when differentiated away from the Endo Thoracic fashion inside the rib cage.
He's his, um,
I'll be able to press down and draw. See the, the peritoneum really has a lot of integrity. It's not just see that fibrous bag. Cirrus bag will air in there. Now that's inside the peritoneum. Normally we don't have any gases free floating in the peritoneum. I note how, how thin at this point, so you can see right through the fibers, back transmitter, south stashes super thin here.
It's thickest up here. It drops a layer here, it gets thinner and then it gets thinner still here. So this is the weakest point of the whole trans or Salads Fascia. And sure enough we ended up getting there. Cutting and as I do
They are our life. We breathe them 20,000 times a day. Our heart is beating 100,000 times a day echoing through the organs of your abdomen. This is a miracle, folks. I've never done this in my 11 years of dissection to actually peel off the, I mean I, I've known a tear. I've talked about it. I Brag about it, I tell people about it. Look at that. I mean, now I'm, I've got the diaphragm by the throat here. This is the diaphragm freed from the abdominal surface covering terms. You see the muscle fibers here of the diaphragm right now that I've peeled the parietal peritoneum away from the diaphragm.
And as I do so, I reveal through it what will be modeled. Parietal peritoneum. Again, of course it's not adherent, it's just a pillow case. But if I continue to cut away in this manner, eventually you'll see that I'm creating a diaphragm here that I can put my hand under and grab. And as I come across the front and differentiated away along this margin as we did with the cadaver form, we create a larger and larger window on the underlying wall layer of the cirrus membrane. That being the parietal peritoneum, I've created this cutaway just as I did in the cadaver. So as I lift up the Trans Ourselves Fasher, we see the fibers of the transversus abdominis muscle and the fires fibers of the diaphragm being lifted along with it to reveal the underlying parietal peritoneum that great sac around the organs which we were able to differentiate so the organs remain within their sac.
Although the transverse Sallus Fascia has been differentiated away
That's my new motto. So I'm peeling up the diaphragmatic Pleura. That is to say the parietal Pleura in the region of the diaphragm. Okay, I'm, that's what's being lifted here. Diaphragmatic pleura and never doubted that there is this layer. It's here, it's here.
So of course it started disintegrating in my hand as I pull it. But you are having the benefit of seeing it, a lift up like this. So that's a full contact tissue with the diaphragm. It's adhered to it
That's all that's left and look at me. Now I'm, I'm on the, so as from the front, but I haven't, I haven't touched the visceral look. I have the whole, the, the viscera in its giant here. The Sec of the V. Can you see that? Oh my gosh. This is cool. I just, I just, I'm overwhelmed by, I look at that
You can follow that diaphragm player over the bell shape.
And when the person lifts their leg, it actually pops up.
What I love is this relationship with the diaphragm. That edge right there, that's the edge of the diaphragm. Interdigitating like a tendinous insertion right there on your finger is the tenderness insertion that you, that where the done the diaphragm and the size yield to one another. Now, lift up a sec.