Pleura: its sections, borders, pleural cavity, pleural sinuses. Pleural cavity - structure and functions Pleura border structure
Pleura- serous membrane of the lungs. It is divided into parietal and visceral, between which there is a pleural cavity.
Pleural cavities with lungs (a), mediastinum with pericardium, heart and large
vessels (6).a: 1 - trachea; 2 - left common carotid artery; 3 - left subclavian artery;
4 - left brachiocephalic vein; 5 - 1 rib; 6 - upper lobe of the lung; 7 - intrathoracic fascia;
8 - heart (covered by pericardium); 9 - cardiac notch (left lung); 1 0 - uvula of the left lung; 11- costal pleura (cut off); 12 - lower lobe of the lung; 13 - diaphragmatic pleura; 14 - costophrenic sinus; 15 - lower lobe ( right lung); 16 - middle lobe (right lung); 17 - upper lobe of the right lung; 18 - thymus gland; 19 - right brachiocephalic vein; 20 – right subclavian artery; 21 - dome of the pleura; 22 - right common carotid artery, b: 1 - left common carotid artery; 2 - left subclavian artery; 3 - 1 rib; 4 - aortic arch; 5 - pulmonary trunk; 6 - transition of the visceral pleura into the mediastinal; 7 - pericardium; 8 - apex of the heart; 9 - uvula of the left lung; 10 - costal pleura; 11 - top vena cava; 12 - mediastinal pleura; 13 - brachiocephalic trunk; 14 - right subclavian artery; 15 - dome of the pleura; 16 - trachea; 17 - right common carotid artery.
Areas of the parietal pleura:
Costal pleura (pleuracostalis) covers inner surface chest and is tightly fused with the intrathoracic fascia.
· The diaphragmatic pleura (pleuradiaphragmatica) lines the upper surface of the diaphragm.
· The mediastinal pleura (pleuramediastinalis) serves as the lateral walls of the mediastinum.
· The dome of the pleura (cupulapleurae) has at the top front a groove of the subclavian artery (a. subclavia) from the artery of the same name. Strengthened by: transverse pleural ligament (lig. transversopleurale) - from the transverse process of the VII cervical vertebra, vertebral pleural ligament (lig.vertebrepleurale) - from the anterior surface of the body of the I thoracic vertebra, costopleural ligament (lig.costepleurale) - stretches from I ribs
Sinuses of the pleura:
· Costophrenic sinus (recessus costodiaphragmaticus) formed by layers of the costal and diaphragmatic pleura that come into contact. Located horizontally. When you inhale, the leaves diverge, with the lower edge of the lung extending there.
· Costomediastinal sinus (recessus costomediastinalis) formed by the layers of the costal and mediastinal pleura, also in contact. Located vertically. When inhaling, the leaves diverge, extending into the sinus with the anterior edges of the lungs. Starting from the IV rib on the left side, the border of the sinus extends to the left, forming the cardiac notch.
· Phrenic-mediastinal sinus (recessusphrenicomediastinalis) located horizontally in the sagittal direction at the transition of the mediastinal pleura to the diaphragmatic one.
Pleural sinuses (diagram), a - horizontal cut. 1 - parietal pleura (costal part); 2 - posterior costomedial sinus; 3 - parietal pleura (mediastinal part); 4 - esophagus; 5 - pericardium; 6 - anterior costomedial sinus; 7 - aorta; 8 - phrenic nerve, b - frontal cut. 1 - parietal pleura (costal part); 2 - costophrenic sinus; 3 - parietal pleura (mediastinal part); 4 - pericardium; 5 - phrenic-mediastinal sinus; 6 - parietal pleura (diaphragmatic part).
.: , pleural pocket) part of the pleural cavity located at the junction of one part of the parietal pleura to another.
1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what “Pleural sinus” is in other dictionaries:
- (recessus pleuralis, PNA; sinus pleurae, BNA, JNA; synonym: pleural recess, pleural pocket) part of the pleural cavity located at the point of transition of one part of the parietal pleura to another ... Large medical dictionary
See Pleural sinus... Large medical dictionary
- (lat.). A trigonometric quantity meaning half the chord of a double arc or angle, as well as the perpendicular dropped from the end of the arc to the radius. Dictionary foreign words, included in the Russian language. Chudinov A.N., 1910. SINE in trigonometry... ... Dictionary of foreign words of the Russian language
- (recessus costomediastinalis, PNA: sinus costomediastinalis, BNA, JNA: synonym: costal mediastinal recess, costal mediastinal sinus) pleural sinus located vertically at the junction of the costal pleura in front and back in ... ... Large medical dictionary
- (recessus phrenicomediastinalis, PNA; sinus phrenicomediastinalis, JNA; synonym diaphragmomediastinal recess) pleural sinus, located at the junction of the phrenic pleura into the mediastinal ... Large medical dictionary
- (recessus costodiaphragmaticus, PNA; sinus phrenicocostalis, BNA, JNA; synonym costodiaphragmatic recess) deep pleural sinus, located at the point of transition of the costal pleura into the diaphragmatic ... Large medical dictionary
- (recessus costomediastinalis, PNA; sinus costomediastinalis, BNA, JNA; synonym: costal mediastinal recess, costal mediastinal sinus) pleural sinus located vertically at the junction of the costal pleura in front and back in ... ... Medical encyclopedia
Lungs covered pleura, pleura (fig.; see fig.,). It, like the peritoneum, is a smooth, shiny serous membrane, tunica serosa. Distinguish parietal pleura, pleura parietalis, And visceral (pulmonary), pleura visceralis (pulmonalis), between which a gap is formed - pleural cavity, cavitas pleuralis, filled a small amount pleural fluid.
Visceral(pulmonary) pleura directly covers the parenchyma of the lung and, being tightly fused with it, extends into the depths of the interlobar grooves.
Parietal the pleura is fused with the walls of the chest cavity and forms costal pleura, pleura costalis, And diaphragmatic pleura, pleura diaphragmatica, as well as laterally limiting the mediastinum mediastinal pleura, pleura mediastinalis(see fig.,). In the area of the hilum of the lung, the parietal pleura passes into the pulmonary pleura, covering the root of the lung with a transitional fold in front and behind.
Below lung root the transitional fold of the pleura forms a duplication – pulmonary ligament, lig. pulmonary.
In the area of the apex of the lungs, the parietal pleura forms dome of pleura, which in the upper sections is adjacent dorsally to the head of the first rib, and with its anterolateral surface adjoins the scalene muscles.
Parts of the pleural cavity in the form of an acute angle between two parietal layers, passing from one wall to another, are called pleural sinuses, recessus pleurales(see fig.).
The following sines are distinguished:
- costophrenic sinus, recessus costodiaphragmaticus, located at the transition point of the costal pleura to the diaphragmatic pleura;
- costomediastinal sinuses, recessus costomediastinales, are formed at the junction of the costal pleura into the mediastinal; anterior sinus - behind the sternum, posterior sinus, less pronounced, - in front spinal column;
- diaphragmomediastinal sinus, recessus phrenicomediastinalis, lies at the transition point of the mediastinal pleura to the phrenic pleura.
The lower boundaries of the lungs do not coincide with the boundaries of the parietal pleura (see Fig. , , , ).
Bottom line the parietal pleura passes: along the linea mediana anterior - on the VI-VII rib; along the linea medioclavicularis (mamillaris) – on the VII rib (lower edge); along linea axillaris media – on the X rib; along the linea scapularis - on the XI-XII rib; along the linea paravertebralis - on the XII rib.
Thus, the depth of the costophrenic sinus is greatest along the linea axillaris media.
The anterior border of the parietal pleura of both lungs runs from the sternoclavicular joints down behind the manubrium and body of the sternum to the lower edge of the sternal ends of the fourth ribs. Here, the anterior edge of the pleura of the right lung continues down to the intersection of the VI rib with the linea mediana anterior, and the left lung at the level of the IV rib turns to the left and, describing the arc of the cardiac notch, follows down to the intersection of the VII rib with the linea medioclavicularis.
Respiratory system. General information………………………………………………………...4
Nose………………………………………………………………………………………..5
Larynx………………………………………………………………………………...7
Trachea………………………………………………………………………………...13
Main bronchi………………………………………………………...15
Lung………………………………………………………………………………...15
Pleura………………………………………………………………………………...21
Mediastinum………………………………………………………………………………...24
Urinary system. Male reproductive system. Female reproductive system. General information………………………………………………………..………………….26
Urinary organs…………………………………………………………………………………27
Kidney………………………………………………………………………………28
Ureter………………………………………………………………………………..33
Bladder………………………………………………………..35
Female urethra……………………………………37
Male genital organs………………………………………………………37
Internal male genital organs…………………………………..37
External male genitalia……………………………………44
Female genital organs……………………………………………………….48
Internal female genital organs…………………………………..48
External female genitalia…………………………………….53
Crotch………………………………………………………………………………..55
Questions of test self-control of knowledge……………………………………...59
Situational tasks………………………………………………………...74
Standards of correct answers……………………………………………………………..83
Respiratory system
General information
Respiratory system, sistema respiratorium ensures gas exchange between inhaled air and blood, and is also the main part of the voice-formation apparatus. The respiratory system consists of the airways and the respiratory organ– lungs.
The airways are hollow organs that conduct air to the pulmonary alveoli. There are upper respiratory tracts - the external nose, nasal cavity and pharynx, and lower respiratory tracts - larynx, trachea, bronchi.
Development. During the process of phylogenesis, the respiratory organs of terrestrial vertebrates are formed in the form of an outgrowth of the intestinal tube. The nasal cavity is separated in the class of reptiles from the oral cavity as a result of the formation of the palate. These same processes are repeated in the development of the human embryo. The formation of the palate occurs in the 2nd month of the embryonic period. At the same time, a nasal septum is formed, which divides the nasal cavity into right and left parts. The external nose is formed from the median, medial and lateral nasal protrusions on the fetal face. The larynx and trachea are formed on the ventral wall of the primary pharynx in the form of a laryngeal-tracheal groove, which is separated from the primary esophagus and forms the laryngeal-tracheal tube - the rudiment of the larynx and trachea. In the larynx primordium, laryngeal cartilages are formed from the cartilages of the III-IV branchial arches.
The distal end of the laryngeal-tracheal tube expands to form the pulmonary kidney. The latter is divided into the rudiments of the right and left main bronchi. By budding, lobar bronchi are formed first (3 in the right and 2 in the left lung), and then bronchi of the third and next orders. As a result, the bronchial tree is formed. The respiratory parenchyma of the lungs is formed from the mesenchyme that surrounds the bronchi. Serous pleural cavities form around the lungs. Starting from the 5th month of the intrauterine period, pulmonary alveoli are formed, and the lungs can provide breathing for the fetus outside the mother’s body.
There is a distinction between the external nose and the nasal cavity (internal nose).
External nose, nasus externus , (Greek – rhis, rhinos ) It has:
1) root, radix nasi ;
2) backrest, backsum nasi ;
3) top, apex nasi ;
4) wings, alai nasi .
The lower edges of the wings of the nose limit the openings leading from the outside into the nasal cavity - the nostrils, nares. The bony basis of the external nose is formed by the nasal bones and the frontal processes of the upper jaws. The bony skeleton is supplemented by nasal cartilages, cartilagines nasi:
A) lateral nasal cartilage, cartilage nasi lateralis ;
b) large and small cartilages of the wings,cartilagines alares major et minores ;
V) accessory nasal cartilages, cartilagines nasalis accesoriae ;
G) nasal septum cartilage, cartilage septi nasi .
The external nose is a specific feature of humans; it is not expressed even in anthropoids. Nose shapes and sizes vary across race and ethnicity and are highly variable individually. The sizes are divided into large and small; by weight - thin and thick; in shape - narrow, wide, curved. The line of the back of the nose can be straight, convex (humpbacked nose) or concave (saddle nose). The base of the nose can be horizontal, raised (snub) or downturned.
Nasal cavity, cavitas nasi , steam room, separated nasal septum, septum nasi . In the partition there are:
1) the membranous part, which is adjacent to the nostrils;
2) the cartilaginous part, the basis of which is the cartilage of the nasal septum;
3) the bone part, which consists of a perpendicular plate of the ethmoid bone, vomer, sphenoid and palatine ridges.
The part of the nasal cavity adjacent to the nostrils is called vestibule of the nose, vestibulum nasi ; it is separated from the nasal cavity proper protruding threshold, limen nasi ; covered with skin that contains sweat and sebaceous hair glands - vibrissae. The nasal cavity itself is divided into two parts - olfactory, pars olfactoria , And respiratory, pars respiratoria . The olfactory region occupies the superior turbinate and the upper part of the nasal septum. This is where the olfactory receptor cells are located and where the olfactory nerves begin. The respiratory region covers the rest of the nasal cavity. It is lined with ciliated epithelium and contains numerous serous and mucous glands, blood and lymphatic vessels. In the submucosa of the middle and inferior turbinates there are cavernous venous plexuses; damage to the mucous membrane in this part of the nasal cavity can lead to severe nosebleeds.
The mucous membrane of the nasal cavity continues into the mucous membrane lining the paranasal sinuses, which open into the nasal passages. In newborns, the nasal cavity is low and narrow, the nasal turbinates are thick, the nasal passages are short and narrow; Of the paranasal sinuses, only the maxillary sinus is expressed, the rest are in their infancy and are formed in childhood. In old age, atrophy of the mucous membrane and its glands occurs.
Functions of the nasal cavity:
1) conducting air during breathing;
2) humidification of inhaled air;
3) purification of air from foreign particles.
Anomalies of the external nose and nasal cavity
1. Arinia – congenital absence of the nose.
2. Dirynia - doubling of the nose, most often its apex is split.
3. Deviation of the nasal septum. Leads to difficulty in nasal breathing and the outflow of fluid from the paranasal sinuses.
4. Choanal atresia. Makes it impossible nasal breathing, observed in some hereditary congenital malformations (syndromes).
Larynx
Larynx, larynx, belongs to the lower respiratory tract and is a voice-forming organ.
Topography
Holotopia: The larynx is located in the middle part of the anterior region of the neck; it protrudes under the skin, forming laryngeal prominence, prominentia laryngis , more pronounced in men (Adam's apple).
Skeletotopia: in adults, the larynx is located at the level of the IV-VI cervical vertebrae.
Syntopy: at the top the larynx is suspended from the hyoid bone, at the bottom it continues into the trachea. The thyroid gland lies in front and to the sides of it. The main neurovascular bundle of the neck (carotid arteries, internal jugular vein and vagus nerve) runs laterally. In front, the larynx is not completely covered by the sublingual muscles with the pretracheal plate of the cervical fascia. The laryngeal part of the pharynx is located at the back. Here it is entrance to the larynx, aditus laryngis ; it is limited by the epiglottis and two folds of the mucous membrane that extend from the epiglottis downward and posteriorly. At the posterior end of these folds protrudes horn-shaped tubercle, tuberculum corniculatum , And wedge-shaped tubercle, tuberculum cuneiforme , which correspond to the cartilages of the same name located in the thickness of the fold.
From the upper edge of the epiglottis, the unpaired median and paired lateral glossoepiglottic folds, plicae glossoepiglotticae mediana et laterales, go to the root of the tongue. They limit the fossae of the epiglottis, valleculae epiglotticae.
Structure of the larynx
The skeleton of the larynx is formed by unpaired and paired cartilages.
Thyroid cartilage, cartilago thyroidea , unpaired, hyaline. It consists of two plates that converge at an angle to each other. For men this angle is acute. At the junction of the plates on top there is tenderloin, incisura thyroidea . From the rear edge of each plate, the upper horns, cornu superior, are long and narrow, and the lower horns, cornu inferior, are short and wide. The inferior horns connect to the cricoid cartilage. Visible on the outer surface of the thyroid cartilage oblique line, linea oblique , – the place of attachment of the sternothyroid and thyrohyoid muscles.
Cricoid cartilage, cartilago cricoidea , unpaired, hyaline, lies at the base of the larynx. Its front part forms an arc, the back part – a plate. On the sides of the plate there is a paired articular surface for articulation with the thyroid cartilage, and in its upper part there is a paired surface for articulation with the arytenoid cartilages.
Arytenoid cartilage, cartilago arytenoidea , paired, hyaline, pyramid-shaped. It has a top and a base. At the base there is an articular surface for articulation with the cricoid cartilage. Two branches extend from the base:
2) muscular process, processus muscularis , - the place of attachment of the muscles of the larynx, is built of hyaline cartilage.
Epiglottis, epiglottis , unpaired, elastic. At the bottom it narrows, forming stalk, petiolus .
Wedge-shaped and cornicular cartilages, cartilagines cuneiformis et corticulatae , paired, elastic, located above the apex of the arytenoid cartilages.
The cartilages of the larynx are connected to each other and to neighboring formations through ligaments, membranes and joints.
Between the larynx and hyoid bone located thyrohyoid membrane, membrana thyrohyoidea , in which the median and paired lateral thyrohyoid ligaments are distinguished. The latter arise from the superior horns of the thyroid cartilage. The epiglottis fixes two ligaments:
1) sublingual-epiglottic, lig. hyoepiglotticum;
2) thyroid-epiglottic, lig. thyroepiglotticum .
The thyroid cartilage is connected to the arch of the cricoid cartilage through cricothyroid ligament, lig. cricothyroideum . The cricoid cartilage connects to the trachea cricotracheal ligament, lig. cricatracheale . Located under the mucous membrane fibro-elastic membrane of the larynx, membrana fibroelastica laryngis ; in the upper part of the larynx it forms quadrangular membrane, membrane quadrangularis , and in the lower part – elastic cone, cone elasticus . The lower edge of the quadrangular membrane forms a steam room vestibular ligament, lig. vestibulare , and the upper edge of the elastic cone is the steam room vocal cord, lig. vocal , which is stretched between the angle of the thyroid cartilage and the vocal process of the arytenoid cartilage.
The joints of the larynx are paired, combined:
1. cricothyroid joint, art. cricothyroidea , formed by the articulation of the articular surfaces of the cricoid cartilage with the lower horns of the thyroid cartilage. Has one transverse axis of rotation. When the thyroid cartilage moves forward, the vocal folds lengthen and tighten, and when it moves backward, they relax.
2. Cricoarytenoid joint, art. cricoarytenoidea , formed by the articulation of the articular surfaces of the cricoid cartilage with the articular surfaces of the arytenoid cartilages. Has a vertical axis of rotation. When the arytenoid processes rotate inward, the vocal cords come closer together (the glottis narrows), and when they rotate outward, they move away from each other (the glottis widens).
The muscles of the larynx are striated, voluntary, move the cartilages of the larynx relative to each other, change the size of the glottis and the tension of the vocal cords (folds). There are external and internal muscles of the larynx.
According to function, the muscles of the larynx are divided into three groups.
A) lateral cricoarytenoid muscle, m. crycoarytenoideus lateralis.
Start: upper edge of the cricoid cartilage arch.
Attachment: muscular process of the arytenoid cartilage.
Function: rotates the arytenoid cartilage around vertical axis; in this case, the vocal process moves medially and the vocal cords come closer together.
b) thyroarytenoid muscle , m. thyroarytenoideus .
Start: inner surface of the lamina of the thyroid cartilage.
Attachment: anterolateral surface of the arytenoid cartilage.
Function: similar to the previous muscle.
V) transverse arytenoid muscle, m. arytenoideus transversus.
G) oblique arytenoid muscle, m. arytenoideus obliquus .
Start and Attachment: posterior surfaces of the arytenoid cartilages.
Function: Both muscles bring the arytenoid cartilages closer to the midplane, promoting closure of the glottis.
d) aryepiglottic mouse, m. aryepiglotticus , is a continuation of the oblique arytenoid muscle, passes in the fold of the same name.
Function: narrows the entrance to the larynx and the vestibule of the larynx, pulls the epiglottis back and down, covering the entrance to the larynx when swallowing.
A) posterior cricoarytenoid , m. cricoarytenoideus posterior .
Start: posterior surface of the cricoid cartilage plate.
Attachment: muscular process of the arytenoid cartilage.
Function: rotates the arytenoid cartilage around a vertical axis, turning the vocal processes laterally, while the glottis expands.
A) cricothyroid muscle, m. cricothyroideus.
Start: arch of cricoid cartilage.
Attachment: the lower edge of the thyroid cartilage and its lower horn.
Function: tilts the thyroid edge forward, increasing the distance between it and the vocal process, while the vocal cords lengthen and stretch;
Start: inner surface of the thyroid cartilage.
Function: the muscle contains longitudinal, vertical, and oblique fibers. Longitudinal fibers shorten the vocal cord, vertical fibers strain it, and oblique fibers strain individual parts of the vocal cord.
Laryngeal cavity, cavitas laryngis , resembles an hourglass and is divided into three sections: the vestibule of the larynx, the interventricular part and the subglottic cavity.
Vestibule of the larynx, vestibulum laryngis , extends from the entrance to the larynx to the vestibular folds, which include the vestibular ligaments.
Interventricular part, pars interventricularis , located from the vestibule to the vocal folds, the narrowest place of the larynx, up to 1 cm high. Vocal folds, plicae vocals , contain in their posterior part the vocal processes of the arytenoid cartilages, and in the anterior part - the elastic vocal fold and vocal muscle. Both vocal folds limit the glottis, rima glottidis s. vocalis . It distinguishes the back - intercartilaginous part, pars intercartilaginea , and the front - intermembranous part, pars intermembranacea . Between the vestibular and vocal folds on each side there is a depression - ventricle of the larynx , ventriculus laryngis .
Subglottic cavity, cavitas infraglottica , extends from the vocal folds to the beginning of the trachea. The mucous membrane of the larynx is lined with stratified ciliated epithelium. The exception is the vocal folds, which are covered with stratified squamous epithelium.
The function of the larynx as a respiratory and vocal organ. The muscles attached to the hyoid bone (supra- and hyoid) raise, lower, or fix the larynx. When swallowing, the larynx is raised by the action of the suprahyoid muscles, the root of the tongue moves posteriorly and presses on the epiglottis so that it covers the entrance to the larynx. This is facilitated by the contraction of the thyroepiglottic and aryepiglottic muscles.
With quiet breathing and whispering, the intermembranous part of the glottis is closed, and the intercartilaginous part is open in the form of a triangle by the action of the lateral cricoarytenoid muscle. During deep breathing, both parts of the glottis are opened in a diamond shape by the action of the posterior cricoarytenoid muscle. At the beginning of vocal production, the glottis closes and the vocal cords become tense. The flow of exhaled air causes vibrations in the vocal folds, resulting in sound waves. The strength of sound is determined by the strength of the air flow, which depends on the lumen of the glottis, and the timbre of the voice is determined by the frequency of vibration of the vocal folds. The installation of the vocal folds is carried out by the cricothyroid muscle and the muscles attached to the muscular process, and more precisely, it is modeled by the vocal muscle.
The resonators of sound produced by the vocal apparatus are the pharynx, oral and nasal cavities, and paranasal sinuses. The pitch of the voice depends on the individual structural features of the sound resonators. Due to the position of the larynx in a person, the sounding air flow is directed to the speech organs - palate, tongue, teeth and lips. When coughing, a closed glottis opens with expiratory impulses.
Age characteristics. In newborns, the larynx is located at the level of the II-IV cervical vertebrae. The epiglottis touches the uvula. The larynx is short and wide, its cavity is funnel-shaped, and there is no laryngeal prominence. The vocal folds are short, the ventricles of the larynx are shallow. Fast growth larynx occurs in children 3 years old, at 5-7 years old, and especially during puberty. At 12-13 years old, the length of the vocal folds in girls increases by 1/3, and in boys at 13-15 years old, by 2/3. This causes a mutation (fracture) of the voice in boys. In men, growth of the vocal folds continues until the age of 30. Gender differences in voice are due to the greater length of the vocal folds and glottis in men. In old age, the cartilage of the larynx becomes calcified, the vocal cords become less elastic, which leads to a change in voice.
Anomalies of the larynx
1. Atresia, stenosis.
2. Formation of septa in the laryngeal cavity.
3. Aplasia of the epiglottis. In this case, the entrance to the larynx is not closed.
4. Laryngeal-esophageal fistulas. They are formed when the laryngeal primordium is incompletely separated from the digestive tube.
Trachea
Trachea, trachea , (windpipe), - an unpaired tubular organ, serves to conduct air.
Topography
Holotopia: cervical part, pars cervicalis, is located in the lower part of the anterior cervical region; The thoracic part, pars thoracica, lies in the anterior part of the upper mediastinum.
Skeletotopia: in adults it begins at the level of the VI cervical vertebra and ends at the level of the V thoracic vertebra (2-3 rib), where it forms a bifurcation, bifurcatio tracheae , that is, it is divided into two main bronchi.
Syntopy: the thyroid gland is adjacent to the cervical part in front and on the sides, and the hypoglossal muscles are also located. There is a gap between the edges of the muscles in the midline, where the trachea is covered only by the pretracheal plate of the cervical fascia. Between this plate and the trachea there is a pretracheal cellular space that communicates with the mediastinum. The thoracic part of the trachea borders in front with the aortic arch, brachiocephalic trunk, left brachiocephalic vein, left common carotid artery, thymus gland, laterally with the mediastinal pleura, behind with the esophagus throughout the trachea.
Structure of the trachea
The tracheal skeleton is 16-20 hyaline half rings, cartilagines tracheales . They are connected to each other by fibrous annular ligaments, ligg. anularia . At the top, the trachea is connected to the cricoid cartilage of the larynx by the cricotracheal ligament. The cartilages of the trachea form the anterior and lateral walls, the posterior wall of the trachea - membranous, paries membranaceus , contains connective tissue, circular and longitudinal bundles of smooth muscles. The tracheal cavity is lined with a mucous membrane with stratified ciliated epithelium; it contains branched mucous glands and lymphatic follicles. Externally, the trachea is covered with an adventitial membrane.
Age characteristics. In newborns, the trachea begins at the level of the IV cervical vertebra, and its bifurcation projects to the III thoracic vertebra. Tracheal cartilages and glands are poorly developed. The growth of the trachea occurs most intensively in the first 6 months after birth and during puberty. The final position of the trachea is established after 7 years. In old age, atrophy of the mucous membrane, glands, lymphoid tissue, and calcification of cartilage are observed.
Tracheal anomalies
1. Atresia and stenosis.
2. Deformation and splitting of cartilage.
3. Tracheo-esophageal cartilages.
Main bronchi
Main bronchi, right and left, bronchi principales dexter et sinister , depart from the bifurcation of the trachea and go to the gates of the lungs. The right main bronchus has a more vertical direction, wider and shorter than the left bronchus. The right bronchus consists of 6-8 cartilaginous half-rings, the left - 9-12 half-rings. Above the left bronchus lie the aortic arch and the pulmonary artery, below and anteriorly there are two pulmonary veins. The right bronchus is surrounded by the azygos vein from above, and the pulmonary artery and pulmonary veins pass below. The mucous membrane of the bronchi, like the trachea, is lined with stratified ciliated epithelium and contains mucous glands and lymphatic follicles. At the hilum of the lungs, the main bronchi are divided into lobar bronchi. Further branching of the bronchi occurs inside the lungs. The main bronchi and their branches form the bronchial tree. Its structure will be discussed when describing the lungs.
Lung
Lung, pulmo (Greek pneumonia ), is the main organ of gas exchange. The right and left lungs are located in the chest cavity, occupying its lateral sections together with their serous membrane - the pleura. Each lung has top, apex pulmonis , And base, basis pulmonis . The lung has three surfaces:
1) costal surface, facies costalis , adjacent to the ribs;
2) diaphragmatic surface, facies diaphragmatica , concave, facing the diaphragm;
3) medial surface, facies medialis . The medial surface in its anterior part borders mediastinum – pars mediastinalis , and in its rear part – with spinal column, pars vertebralis .
Separates the costal and medial surfaces anterior edge of the lung, margo anterior ; in the left lung the anterior edge forms heart tenderloin, incisura cardiaca , which is bounded below uvula of the lung, lingula pulmonis . The costal and medial surfaces are separated from the diaphragmatic surface the lower edge of the lung, margo inferior . Each lung is divided into lobes by interlobar fissures, fissurae interlobares. Oblique slot, fissura obliqua , begins on each lung 6-7 cm below the apex, at the level of the III thoracic vertebra, separating the upper from the lower lung lobes, lobus pulmonissuperior et inferior . Horizontal slot , fissura horizontalis , present only in the right lung, located at the level of the IV rib, and separates the upper lobe from the middle lobe, lobus medius . The horizontal gap is often not expressed throughout its entire length and may be completely absent.
The right lung has three lobes - upper, middle and lower, and the left lung has two lobes - upper and lower. Each lobe of the lungs is divided into bronchopulmonary segments, which are the anatomical and surgical unit of the lung. Bronchopulmonary segment- this is a section of lung tissue surrounded by a connective tissue membrane, consisting of individual lobules and ventilated by a segmental bronchus. The base of the segment faces the surface of the lung, and the apex faces the root of the lung. In the center of the segment there are a segmental bronchus and a segmental branch of the pulmonary artery, and in the connective tissue between the segments there are pulmonary veins. The right lung consists of 10 bronchopulmonary segments - 3 in the upper lobe (apical, anterior, posterior), 2 in the middle lobe (lateral, medial), 5 in the lower lobe (upper, anterior basal, medial basal, lateral basal, posterior basal). The left lung has 9 segments - 5 in the upper lobe (apical, anterior, posterior, superior lingular and inferior lingular) and 4 in the lower lobe (superior, anterior basal, lateral basal and posterior basal).
On medial surface each lung at the level of the V thoracic vertebra and II-III ribs are located gate of the lungs , hilum pulmonis . Gate of the lungs- this is the place where the root of the lung enters, radix pulmonis, formed by a bronchus, vessels and nerves (main bronchus, pulmonary arteries and veins, lymphatic vessels, nerves). In the right lung, the bronchus occupies the highest and dorsal position; the pulmonary artery is located lower and more ventral; even lower and more ventral are the pulmonary veins (PAV). In the left lung, the pulmonary artery is located highest, lower and dorsal is the bronchus, and even lower and ventral are the pulmonary veins (PV).
Bronchial tree, arbor bronchialis , forms the basis of the lung and is formed by the branching of the bronchus from the main bronchus to the terminal bronchioles (XVI-XVIII orders of branching), in which air movement occurs during breathing (Fig. 1).
The total cross-section of the respiratory tract increases from the main bronchus to the bronchioles by 6,700 times, so as air moves during inhalation, the speed of the air flow decreases many times. The main bronchi (1st order) at the gates of the lung are divided into lobar bronchi, btonchi lobares . These are the bronchi of the second order. The right lung has three lobar bronchi - upper, middle, lower. The right upper lobar bronchus lies above the pulmonary artery (epiarterial bronchus), all other lobar bronchi lie below the corresponding branches of the pulmonary artery (hypoarterial bronchi).
The lobar bronchi are divided into segmental bronchi(3 orders), bronchi segmentales , ventilating bronchopulmonary segments. Segmental bronchi are divided dichotomously (each into two) into smaller bronchi of 4-9 orders of branching; included in the lobules of the lung, these are lobular bronchi, bronchi lobulares . lobe of lung, lobules pulmonis, is a section of lung tissue limited by a connective tissue septum, with a diameter of about 1 cm. There are 800-1000 lobules in both lungs. The lobular bronchus, having entered the lung lobule, gives off 12-18 terminal bronchioles, bronchiole terminales . Bronchioles, unlike bronchi, do not have cartilage and glands in their walls. Terminal bronchioles have a diameter of 0.3-0.5 mm; smooth muscles are well developed in them, with the contraction of which the lumen of the bronchioles can decrease by 4 times. The mucous membrane of the bronchioles is lined with ciliated epithelium.
Each terminal bronchiole is divided into respiratory bronchioles, bronchiole respiratorii , on the walls of which pulmonary vesicles appear, or alveoli, alveolae pulmonales . The respiratory bronchioles form 3-4 orders of branching, after which they are radially divided into alveolar ducts, ductuli alveolares . The walls of the alveolar ducts and sacs consist of pulmonary alveoli with a diameter of 0.25-0.3 mm. The alveoli are separated by septa in which networks of blood capillaries are located. Through the wall of the alveoli and capillaries, exchange takes place between blood and alveolar air. The total number of alveoli in both lungs is about 300 million in an adult, and their surface is about 140 m2. Respiratory bronchioles, alveolar ducts and alveolar sacs with alveoli make up alveolar tree, or respiratory parenchyma of the lung. The functional and anatomical unit of the lung is considered acini. It is part of the alveolar tree into which one terminal bronchiole branches (Fig. 2). Each lung lobe contains 12-18 acini. The total number of branches of the bronchial and alveolar tree from the main bronchus to the alveolar sacs is 23-25 orders of magnitude in an adult.
The structure of the lung provides for respiratory movements permanent shift air in the alveoli and contact of alveolar air with blood. This is achieved by respiratory excursions of the chest, contraction of the respiratory muscles, contraction of the respiratory muscles, including the diaphragm, as well as the elastic properties of the lung tissue itself.
Age characteristics. The lungs of a non-breathing fetus differ from the lungs of a newborn baby in their specific gravity. In the fetus it is above one, and the lungs drown in water. The specific gravity of a breathing lung is 0.49, and it does not sink in water. The lower borders of the lungs in newborns and infants are located one rib lower than in adults. In the lungs, elastic tissue and interlobar septa are well developed, so the boundaries of the lobules are clearly visible on the surface of the lung.
After birth, lung capacity increases rapidly. The vital capacity of a newborn is 190 cm 3 , by the age of 5 it increases five times, by the age of 10 – ten times. Up to 7-8 years, new alveoli are formed and the number of branching orders of the alveolar tree increases. The dimensions of the alveoli are 0.05 mm in a newborn, 0.2 mm in an 8-year-old child, and 0.3 mm in an adult.
In old and senile age, atrophy of the mucous membrane of the bronchi, glands and lymphoid formations occurs, the cartilage in the walls of the bronchi becomes calcified, the elasticity of the connective tissue decreases, and ruptures of the interalveolar septa are observed.
Anomalies of the bronchi and lungs
1. Agenesis and aplasia of the main bronchus and lung.
2. Absence of one of the lobes of the lung along with the lobar bronchus.
3. Bronchial atresia with congenital atelectasis (collapse) of the corresponding part of the lung (lobe or segment).
4. Accessory lobes located outside the lung, not associated with bronchial tree and not involved in gas exchange.
5. Unusual division of the lung into lobes in the absence of a horizontal fissure in the right lung or when the upper part of the lower lobe is separated by an additional fissure.
6. An abnormal lobe of the azygos vein, lobus venae azygos, is formed when the azygos vein passes through the apex of the right lung.
7. The origin of the right upper lobe bronchus directly from the trachea (tracheal bronchus).
8. Broncho-esophageal fistulas. They have the same origin as tracheal-esophageal fistulas.
9. Bronchopulmonary cysts are congenital dilatations of the bronchi (bronchiectasis) with liquid contents.
Pleura
Pleura, pleura , is the serous membrane of the lung, consisting of visceral and parietal plates. Visceral(pulmonary) pleura, pleura visceralis (pulmonalis), fuses with the lung tissue and extends into the interlobar fissures. Forms pulmonary ligament, lig. Pulmonale , which goes from the root of the lung to the diaphragm. It has villi that secrete serous fluid. This liquid adheres the visceral pleura to the parietal pleura, reduces friction of the surfaces of the lungs during breathing, and has bactericidal properties. At the root of the lung, the visceral pleura transforms into the parietal pleura.
parietal pleura, pleure parietalis , fuses with the walls of the chest cavity, it has microscopic openings (stomato), through which serous fluid absorbed into lymphatic capillaries.
The parietal pleura is topographically divided into three parts:
1) costal pleura, pleura costalis , covers the ribs and intercostal spaces;
2) diaphragmatic pleura, pleura diaphragmatica covers the diaphragm;
3) mediastinal pleura, pleura mediastinalis , goes in the sagittal cavity, limiting the mediastinum. Above the apex of the lung, the parietal pleura forms the pleural dome.
In places where one part of the parietal pleura transitions to another, depressions are formed - pleural sinuses, sinus pleuralis . These are reserve spaces into which the lungs enter when deep breath. Serous fluid can also accumulate in them during inflammation of the pleura, when the processes of its formation or absorption are disrupted.
1. Costophrenic sinus, recessus costodiafragmaticus , paired, formed at the transition of the costal pleura to the mediastinal pleura, expressed on the left in the area of the cardiac notch of the lung.
2. Phrenic-mediastinal sinus, recessus phrenicomediastinalis , paired, located at the transition of the mediastinal pleura to the diaphragmatic one.
3. Costomedial sinus , recessus costomediastinalis , located at the point of transition of the costal pleura (in its anterior section) into the mediastinal; poorly expressed.
Pleural cavity, cavitas pleurae, - this is a slit-like space between two visceral or between two parietal layers of the pleura with a minimal amount of serous fluid.
Boundaries of the lungs and pleura
There are upper, anterior, lower and posterior borders of the lungs and pleura.
Upper the border is the same for the right and left lungs and the dome of the pleura is 2 cm above the collarbone or 3-4 cm above the first rib; posteriorly it is projected at the level of the spinous process of the VII cervical vertebra.
Front the border passes behind the sternoclavicular joint to the junction of the manubrium and the body of the sternum and from here descends along the sternum line to the cartilage of the VI rib on the right and the cartilage of the IV rib on the left. On the right, at the level of the cartilage of the sixth rib, the anterior border becomes the lower border.
On the left, the border of the lung runs horizontally behind the IV rib to the midclavicular line, and the border of the pleura is at the same level to the parasternal line. From here, the borders of the left lung and hymen descend vertically down to the VI rib, where they pass into their lower borders.
Two triangular spaces are formed between the anterior borders of the right and left pleura:
1) superior interpleural space field, area interpleurica superior , located behind the manubrium of the sternum, the thymus gland is located here;
2) inferior interpleural field, area interpleurica inferior , located behind the lower third of the sternum, here between the right and left pleura lies the heart with the pericardium.
The lower border of the right lung crosses the VI rib along the midclavicular line, the VII rib along the anterior axillary line, the VIII rib along the middle axillary line, the IX rib along the posterior axillary line, the X rib along the scapular line, and the paravertebral line ends at the level of the neck of the XI rib. (Table 1). The lower border of the left lung is basically the same as on the right, but approximately the width of the rib below (along the intercostal spaces). The lower border of the pleura corresponds to the junction of the costal pleura and the diaphragmatic pleura. On the left it is also located slightly lower than on the right, crossing the VII-XI intercostal spaces along the lines described above.
Table 1
Lower borders of the right lung and pleura
The discrepancy between the lower boundaries of the pleura and lungs is caused by the costophrenic sinuses. The lower borders of the lungs and pleura are individually variable. With a brachymorphic body type with a wide chest, they can be located higher than in people of a dolichomorphic type with a narrow, long chest.
Posterior border in both lungs it goes the same way. The posterior blunt edge of the organ is projected along the spinal column from the neck of the 11th rib to the head of the 2nd rib.
Mediastinum
Mediastinum, mediastinum , is a complex of organs located in the chest cavity between the right and left pleural cavities. In front it is limited by the sternum and costal cartilages; behind – thoracic vertebrae; on the right and left – mediastinal pleura; from below - the diaphragm. At the top, the mediastinum communicates with the neck region through the superior thoracic aperture.
The greatest clinical significance is the division of the mediastinum into front and back, mediastinum anterius et posterius . They are separated by a frontal plane, conventionally drawn through the trachea and roots of the lungs.
To the organs front The mediastinum includes the heart with the pericardial sac and the beginning of large vessels, the thymus gland, phrenic nerves, pericardial-phrenic vessels, internal thoracic blood vessels, and lymph nodes.
IN rear The mediastinum contains the esophagus, the thoracic part of the descending aorta, the thoracic lymphatic duct, the azygos and semi-gypsy veins, the right and left vagus and splanchnic nerves, sympathetic trunks, and lymph nodes.
There is another classification that involves dividing the mediastinum into upper and lower. The boundary between them is a conventional horizontal plane, passing in front through the junction of the manubrium with the body of the sternum, in the back - through the disc between the IV and V thoracic vertebrae, i.e. at the level of the tracheal bifurcation.
IN upper mediastinum, mediastinum superior located: the thymus gland, large pericardial vessels, vagus and phrenic nerves, sympathetic trunk, thoracic lymphatic duct, upper part of the thoracic esophagus.
In the bottom mediastinum mediastinum inferior , in turn, the anterior, middle and posterior mediastinum are distinguished. The border between them runs along the front and back surface pericardial sac:
· anterior mediastinum, mediastinum anterior , contains fatty tissue and blood vessels;
· middle mediastinum,mediastinum medius , corresponds to the location of the heart with the pericardium, large pericardial vessels and roots of the lungs. The phrenic nerves also pass here, accompanied by the phrenic-pericardial vessels, and the lymph nodes of the lung root are located;
· posterior mediastinum, mediastinum posterior , contains the thoracic part of the descending aorta, azygos and semi-gypsy veins, right and left sympathetic trunks, vagus, splanchnic nerves, thoracic lymphatic duct, middle and lower parts of the thoracic esophagus, lymph nodes.
Pleura, pleura, which is the serous membrane of the lung, is divided into visceral (pulmonary) and parietal (parietal). Each lung is covered with pleura (pulmonary), which along the surface of the root passes into the parietal pleura.
Visceral (pulmonary) pleura, pleura visceralis (pulmonalls). Forms downward from the root of the lung pulmonary ligament, lig. pulmonary
Parietal (parietal) pleura, pleura parietalis, in each half of the chest cavity forms a closed sac containing the right or left lung, covered with visceral pleura. Based on the position of the parts of the parietal pleura, it is divided into the costal, mediastinal and diaphragmatic pleura. Costal pleura, pleura costalis, covers the inner surface of the ribs and intercostal spaces and lies directly on the intrathoracic fascia. Mediastinal pleura, pleura mediastindlis, adjacent to the mediastinal organs on the lateral side, fused with the pericardium on the right and left; on the right it also borders with the superior vena cava and azygos vein, with the esophagus, on the left with the thoracic aorta.
Above, at the level of the superior aperture of the chest, the costal and mediastinal pleura pass into each other and form dome of pleura, cupula pleurae, limited on the lateral side by the scalene muscles. The subclavian artery and vein are adjacent to the dome of the pleura anteriorly and medially. Above the dome of the pleura is the brachial plexus. Diaphragmatic pleura, pleura diaphragmatica, covers the muscular and tendon parts of the diaphragm, with the exception of its central sections. Between the parietal and visceral pleura there is pleural cavity, cavitas pleuralis.
Sinuses of the pleura. In the places where the costal pleura transitions into the diaphragmatic and mediastinal pleura, pleural sinuses, recessus pleurdles. These sinuses are the reserve spaces of the right and left pleural cavities.
Between the costal and diaphragmatic pleura there is costophrenic sinus, recessus costodiaphragmaticus. At the junction of the mediastinal pleura and the diaphragmatic pleura there is diaphragmomediastinal sinus, recessus phrenicomediastinalis. A less pronounced sinus (depression) is present at the place where the costal pleura (in its anterior section) transitions into the mediastinal pleura. Here it is formed costomedial sinus, recessus costomediastinalis.
Boundaries of the pleura. On the right is the anterior border of the right and left costal pleura from the dome of the pleura it descends behind the right sternoclavicular joint, then goes behind the manubrium to the middle of its connection with the body and from here descends behind the body of the sternum, located to the left of the midline, to the VI rib, where it goes to the right and passes into the lower border of the pleura. Bottom line The pleura on the right corresponds to the line of transition of the costal pleura into the diaphragmatic pleura.
Left anterior border of the parietal pleura from the dome it goes, just like on the right, behind the sternoclavicular joint (left). Then it is directed behind the manubrium and the body of the sternum down to the level of the cartilage of the IV rib, located closer to the left edge of the sternum; here, deviating laterally and downwards, it crosses the left edge of the sternum and descends near it to the cartilage of the VI rib, where it passes into the lower border of the pleura. Lower border of the costal pleura on the left is located slightly lower than on the right side. In the back, as well as on the right, at the level of the 12th rib it becomes the posterior border. Posterior pleural border corresponds to the posterior line of transition of the costal pleura into the mediastinal pleura.
Visceral pleura (pleura visceralis):
Sources of blood supply: rr. bronchiales aortae, rr. bronchiales art; thoracicae internae;
Venous outflow: vv. bronchiales (in w. azygos, hemiazygos).
Parietal pleura (pleura parietalis):
Sources of blood supply: aa. intercostales posteriores (posterior intercostal arteries) from the aorta, aa. intercostales anteriores (anterior intercostal arteries) from art. thoracica interna;
Venous outflow: in vv. intercostales posteriores (posterior intercostal veins drain) into vv. arygos, hemiazygos, v. thoracica interna.
Pleura visceral:
Sympathetic innervation: rr. pulmonales (from tr. sympathicus);
Parasympathetic innervation: rr. bronchiales n. Vagi.
Pleura parietal:
Innervated by nn. Intercostales, nn. Phrenici
Pleura visceral: nodi lymphatici tracheobronchiales superiores, interiores, bronchopulmonales, mediastinales anteriores, posteriores.
Pleura parietal: nodi lymphatici intercostales, mediastinales anteriores, posteriores.
3.Arteries of the leg and foot.
Posterior tibial artery, a. tibialis posterior, serves as a continuation of the popliteal artery, passes in the ankle-popliteal canal.
Branches of the posterior tibial artery : 1. Muscular branches rr. musculares, - to the muscles of the lower leg; 2. Branch circumflexing the fibula g. circumflexus fibularis, supplies blood to adjacent muscles. 3. peroneal artery, A. regopea, supplies blood to the triceps surae muscle, the long and short peroneus muscles, is divided into its terminal branches: lateral malleolar branches, rr. malleolares laterales, and calcaneal branches, rr. calcanei, involved in the formation of the calcaneal network, rete calcaneum. A perforating branch, the perforans, and a connecting branch, the communicans, also depart from the peroneal artery.
4. Medial plantar artery, a. plantaris medialis, divided into superficial and deep branches, rr. superficidlis et profundus. The superficial branch feeds the abductor hallucis muscle, and the deep branch supplies the same muscle and the flexor digitorum brevis.
5. Lateral plantar artery, a. plantaris lateralis. forms at the base level metatarsal bones the plantar arch, arcus plantaris, gives off branches to the muscles, bones and ligaments of the foot.
The plantar metatarsal arteries, aa, depart from the plantar arch. metatarsales plantares I-IV. The plantar metatarsal arteries, in turn, give off piercing branches, rr. perforantes, to the dorsal metatarsal arteries.
Each plantar metatarsal artery passes into the common plantar digital artery, a. digitalis plantaris communis. At the level of the main phalanges of the fingers, each common plantar digital artery (except the first) is divided into two own plantar digital arteries, aa. digitales plantares propriae. The first common plantar digital artery branches into three proper plantar digital arteries: to the two sides thumb and to the medial side of the II finger, and the second, third and fourth arteries supply blood to the sides of the II, III, IV and V fingers facing each other. At the level of the heads of the metatarsal bones, perforating branches are separated from the common plantar digital arteries to the dorsal digital arteries.
Anterior tibial artery, a. tibidlis anterior, arises from the popliteal artery in the popliteal.
Branches of the anterior tibial artery:
1. Muscular branches rr. musculares, to the muscles of the lower leg.
2. Posterior tibial recurrent artery, A. hesi-rens tibialis posterior, departs within the popliteal fossa, participates in the formation of the knee articular network, supplies blood to the knee joint and popliteal muscle.
3. Anterior tibial recurrent artery, A. recurrens tibialis anterior, takes part in the blood supply to the knee and tibiofibular joints, as well as the tibialis anterior muscle and extensor digitorum longus.
4. Lateral anterior malleolar artery, a. malleold-ris anterior lateralis, begins above the lateral malleolus, supplies blood to the lateral malleolus, ankle joint and tarsal bones, takes part in the formation of the lateral malleolar network, rete malleoldre laterale.
5. Medial anterior malleolar artery, a. malleold-ris anterior medialis, sends branches to the ankle joint capsule, participates in the formation of the medial malleolar network.
6. Dorsal artery of the foot, a. dorsdlis pedis, is divided into terminal branches: 1) the first dorsal metatarsal artery, a. metatarsdlis dorsdlis I, from which three dorsal digital arteries arise, aa. digitdles dorsdles, to both sides of the dorsum of the thumb and the medial side of the second finger; 2) deep plantar branch, a. plantdris profunda, which passes through the first intermetatarsal space onto the sole.
The dorsal artery of the foot also gives off the tarsal arteries - lateral and medial, aa. tarsales lateralis et medialis, to the lateral and medial edges of the foot and the arcuate artery, a. ag-cuata, located at the level of the metatarsophalangeal joints. The I-IV dorsal metatarsal arteries, aa, extend from the arcuate artery towards the fingers. metatarsales dorsales I-IV, each of which at the beginning of the interdigital space is divided into two dorsal digital arteries, aa. digitales dorsales, heading towards the backs of adjacent fingers. From each of the dorsal digital arteries, perforating branches extend through the intermetatarsal spaces to the plantar metatarsal arteries.
On the plantar surface of the foot As a result of the anastomosis of the arteries, there are two arterial arches. One of them - the plantar arch - lies in the horizontal plane. It is formed by the terminal section of the lateral plantar artery and the medial plantar artery (both from the posterior tibial artery). The second arc is located in the vertical plane; it is formed by an anastomosis between the deep plantar arch and the deep plantar artery - a branch of the dorsal artery of the foot.
4.Anatomy and topography of the midbrain; its parts, their internal structure. Position of nuclei and pathways in the midbrain.
Midbrain, mesencephalon, less complicated. It has a roof and legs. The cavity of the midbrain is the cerebral aqueduct. The upper (anterior) border of the midbrain on its ventral surface is optic tracts and mastoid bodies, on the back - the anterior edge of the bridge. On the dorsal surface, the upper (anterior) border of the midbrain corresponds to the posterior edges (surfaces) of the thalamus, the posterior (lower) border corresponds to the level of exit of the trochlear nerve roots.
Roof of the midbrain tectum mesencephalicum, located above the cerebral aqueduct. The roof of the midbrain consists of four elevations - mounds. The latter are separated from each other by grooves. The longitudinal groove is located to form a bed for the pineal gland. A transverse groove separates the superior colliculi, colliculi superiores, from the inferior colliculi, colliculi inferiores. From each of the mounds, thickenings in the form of a roller extend in the lateral direction - the handle of the mound. The superior colliculus of the roof of the midbrain (quadrigeminal) and the lateral geniculate body perform the function of subcortical visual centers. The inferior colliculus and medial geniculate body are subcortical auditory centers.
legs of the brain, pedunculi cerebri, emerge from the bridge. The depression between the right and left cerebral peduncles is called the interpeduncular fossa, fossa interpeduncularis. The bottom of this fossa serves as a place where blood vessels penetrate the brain tissue. On the medial surface of each of the cerebral peduncles there is a longitudinal oculomotor groove, sulcus oculomotorus (medial groove of the cerebral peduncle), from which the roots of the oculomotor nerve, n. oculomotorius (III pair), emerge.
In the cerebral peduncle it is secreted black substance, substantia nigra. The substantia nigra divides the cerebral peduncle into two sections: the posterior (dorsal) tegmentum of the midbrain, tegmentum mesencephali, and the anterior (ventral) section - the base of the cerebral peduncle, basis pedunculi cerebri. The midbrain nuclei lie in the tegmentum and ascending pathways pass through. The base of the cerebral peduncle consists entirely of white matter; descending pathways pass here.
Midbrain plumbing(aqueduct of Sylvius), aqueductus mesencephali (cerebri), connects the cavity of the third ventricle with the fourth and contains cerebrospinal fluid. In its origin, the cerebral aqueduct is a derivative of the cavity of the middle cerebral bladder.
Around the midbrain aqueduct there is a central gray matter, substantia grisea centrdlis, in which the nuclei of two pairs of cranial nerves are located in the area of the bottom of the aqueduct. At the level of the superior colliculi there is a paired nucleus of the oculomotor nerve, nucleus nervi oculomotorii. It takes part in the innervation of the eye muscles. More ventral is the parasympathetic nucleus of the autonomic nervous system- accessory nucleus of the oculomotor nerve, nucleus oculo-motorius accessorius.. Anterior and slightly above the nucleus of the third pair is the intermediate nucleus, nucleus interstitialis. The processes of the cells of this nucleus participate in the formation of the reticulospinal tract and the posterior longitudinal fasciculus.
At the level of the inferior colliculi in the ventral sections of the central gray matter lies the nucleus of the trochlear nerve, nucleus n. trochlearis. In the lateral parts of the central gray matter throughout the entire midbrain there is the nucleus of the midbrain tract of the trigeminal nerve (V pair).
In the tegmentum, the largest and most noticeable in a cross section of the midbrain is the red nucleus, nucleus ruber. The base of the cerebral peduncle is formed by descending pathways. The internal and external sections of the base of the cerebral peduncles form the fibers of the cortical-pontine tract, namely the medial part of the base is occupied by the frontal-pontine tract, the lateral part is occupied by the temporo-parietal-occipital-pontine tract. Middle part The bases of the cerebral peduncle are occupied by pyramidal tracts.
The corticonuclear fibers pass medially, and the corticospinal tracts pass laterally.
In the midbrain there are subcortical centers of hearing and vision, which provide innervation to the voluntary and involuntary muscles of the eyeball, as well as the midbrain nucleus of the V pair.
Ascending (sensory) and descending (motor) pathways pass through the midbrain.
Ticket 33
1. Anatomy of the abdominal cavity. Linea alba, rectus sheath.
2.Lungs, pleura: development, structure, external signs. Boundaries.
3. Development of the superior vena cava. Outflow of blood from the organs of the head. sinuses of the dura mater.
4.Mandibular nerve
1.Anatomy of the abdominal muscles, their topography, functions, blood supply and innervation. Sheath of the rectus abdominis muscle. White line.
External oblique muscle, m. obliquus abdominis externa. Start: 5-12 ribs. Attachment: iliac crest, rectus sheath, linea alba. Function: exhale, rotate the torso, bend and tilt the spine to the side. Innervation Blood supply:aa. intercostals posteriors, a. thoracica lateralis, a. circumflexa iliaca superfacialis.
Internal oblique muscle, m. obliquus abdominis interna. Start: thoracolumbar fascia, crista iliaca, inguinal ligament. Attachment: 10-12 ribs, sheath of the rectus abdominis muscle. Function: exhale, tilts the torso forward and to the side. Innervation:nn. intercostales, n. iliohypogastricus, n. ilioinguinalis. Blood supply
Transverse abdominis muscle, m. transversus abdominis. Start: inner surface of 7-12 ribs, thoracolumbar fascia, crista illiaca, inguinal ligament. Attachment: rectus sheath. Function: Reduces the size of the abdominal cavity, pulls the ribs forward and towards the midline. Innervation:nn. intercostales, n. iliohypogastricus, n. ilioinguinalis. Blood supply:aa. intercostals posteriors, aa. epigastricae inferior et superior, a. musculophrenica.
Rectus abdominis muscle m. rectus abdominis. Start: pubic ridge, fibrous fascicles of the pubic symphysis. Attachment: anterior surface of the xiphoid process, outer surface of the cartilages of the V-VII ribs. Function: bends the torso, exhales, raises the pelvis. Innervation:nn. intercostales, n. iliohypogastricus. Blood supply:aa. intercostals posteriors, aa. epigastricae inferior et superior.
pyramidalis muscle, m. pyramidalis. Start: pubic bone, symphysis. Attachment: linea alba. Function: tightens the linea alba.
Quadratus lumborum muscle, m. quadratus lumborum. Start: iliac crest. Attachment: 12th rib transverse processes of 1-4 lumbar vertebrae. Function: tilts the spine to the side, exhale. Innervation: plexus lumbalis. Blood supply: a. subcostalis, aa. Lumbales, a. iliolumbalis.
Rectus sheath, vagina t. recti abdominis, is formed by the aponeuroses of the three broad abdominal muscles.
The aponeurosis of the internal oblique muscle of the abdomen splits into two plates - anterior and posterior. The anterior plate of the aponeurosis, together with the aponeurosis of the external oblique muscle, forms the anterior wall of the rectus abdominis sheath. The posterior plate, fused with the aponeurosis of the transverse abdominis muscle, forms the posterior wall of the rectus abdominis sheath.
Below this level, the aponeuroses of all three vastus abdominal muscles pass to the anterior surface of the rectus abdominis muscle and form the anterior wall of its vagina.
The lower edge of the tendinous posterior wall of the rectus abdominis sheath is called the arcuate line, linea arcuata (linea semi-circularis - BNA).
White line, linea alba, is a fibrous plate extending along the anterior midline from the xiphoid process to the pubic symphysis. It is formed by intersecting fibers of the aponeuroses of the broad abdominal muscles of the right and left sides.
2. Lungs: development, topography. Segmental structure of the lungs, acinus. X-ray image of the lungs.
lung, pulmo. Highlight: lower diaphragmatic surface lung, faces diaphragmdtica (base of the lung), apex of the lung, apex pulmonis, costal surface faces costalis (the vertebral part, pars vertebrdlis, of the costal surface borders the spinal column), medial surface faces medlis. The surfaces of the lung are separated by edges: anterior, posterior and inferior. On the leading edge margo anterior of the left lung there is a cardiac notch, incisura cardiaca. This notch is limited below uvula of the left lung, lingula pulmonis sinistri.
Each lung is divided into shares, lobi pulmones, of which the right one has three (upper, middle and lower), the left has two (upper and lower).
oblique slit, fissura obliqua, begins at the posterior edge of the lung. It divides the lung into two parts: upper lobe lobus superior, which includes the apex of the lung, and lower lobe, lobus inferior, including the base and most of the posterior edge of the lung. In the right lung, in addition to the oblique, there is horizontal slot, fissura horizontalis. It begins on the costal surface of the lung and reaches the hilum of the lung. A horizontal slit cuts off from the upper lobe middle lobe (right lung), lobus medius. The surfaces of the lung lobes facing each other are called "interlobar surfaces" fades interlobares.
On the medial surface of each lung there are gate of the lung, hilum pulmonis, through which the main bronchus, pulmonary artery, and nerves enter the lung, and the pulmonary veins and lymphatic vessels exit. These formations constitute lung root, radix pulmonis.
At the gate of the lung, the main bronchus breaks up into lobar bronchi, bronchi lobares, of which there are three in the right lung and two in the left. The lobar bronchi enter the gate of the lobe and are divided into segmental bronchi, bronchi segmentales.
Right upper lobar bronchus, bronchus lobdris superior dexter, divided into apical, posterior and anterior segmental bronchi. Right middle lobe bronchus, bronchus lobaris medius dexter, is divided into lateral and medial segmental bronchi. Right lower lobar bronchus, bronchus lobdris inferior dexter, is divided into superior, medial basal, anterior basal, lateral basal and posterior basal segmental bronchi. Left superior lobar bronchus, bronchus lobaris superior sinister, is divided into apical-posterior, anterior, superior lingular and inferior lingular segmental bronchi. Left lower lobar bronchus, bronchus lobaris inferior sinister, is divided into the superior, medial (cardiac) basal, anterior basal, lateral basal and posterior basal segmental bronchi. The pulmonary segment consists of pulmonary lobules.
The bronchus enters a lobe of the lung called the lobular bronchus, bronchus lobularis. Inside the pulmonary lobule, this bronchus is divided into terminal bronchioles, bronchioli terminates. The walls of the terminal bronchioles do not contain cartilage. Each terminal bronchiole is divided into respiratory bronchioles, bronchioli respiratorii, which have pulmonary alveoli on their walls. From each respiratory bronchiole depart alveolar ducts, ductuli alveoldres, which carry alveoli and end in alveolar sacs, sacculi alveolares. The walls of these sacs consist of pulmonary alveoli, alveoli pulmonis. The bronchi make up bronchial tree arbor bronchiatis. The respiratory bronchioles extending from the terminal bronchiole, as well as the alveolar ducts, alveolar sacs and alveoli of the lung form alveolar tree (pulmonary acinus), arbor alveoldris. The alveolar tree is the structural and functional unit of the lung.
Lungs: nodi lymphatici tracheobronchiales superiores, interiores, bronchopulmonales, mediastinales anteriores, posteriores (lymph nodes: lower, upper tracheobronchial, bronchopulmonary, posterior and anterior mediastinal).
Lungs:
Sympathetic innervation: pl. Pulmonalis, branches of the vagus nerve (pulmonary plexus) rr. pulmonate - pulmonary branches (from tr. sympathicus), sympathetic trunk;
Parasympathetic innervation: rr. bronchiales n. vagi (bronchial branches of the vagus nerve).
lung, pulmo:
Sources of blood supply, cities bronchiales aortae (bronchial branches of the aorta), gg. bronchiales art. thoracicae interna (bronchial branches of the internal mammary artery);
Venous outflow: vv. bronchiales (in w. azygos, hemiazygos, pulmonales).
3.The superior vena cava, sources of its formation and topography. Azygos and semi-gypsy veins, their tributaries and anastomoses.
superior vena cava, v. cava superior, formed as a result of the fusion of the moral and left brachiocephalic veins behind the junction of the cartilage of the first right rib with the sternum, flows into the right atrium. The azygos vein flows into the superior vena cava on the right, and small mediastinal and pericardial veins flow into the left. The superior vena cava collects blood from three groups of veins: the veins of the walls of the chest and partially abdominal cavities, the veins of the head and neck, and the veins of both upper limbs, i.e. from those areas that are supplied with blood by the branches of the arch and thoracic part of the aorta.
azygos vein, v. azygos, is a continuation of the right ascending lumbar vein, v. lumbalis ascendens dextra. The right ascending lumbar vein along its path anastomoses with the right lumbar veins flowing into the inferior vena cava. The azygos vein drains into the superior vena cava. At the mouth of the azygos vein there are two valves. On its way to the superior vena cava, the semi-gypsy vein and veins of the posterior wall of the chest cavity flow into the azygos vein: the right superior intercostal vein; posterior intercostal veins IV-XI, as well as veins of the thoracic cavity: esophageal veins, bronchial veins, pericardial veins and mediastinal veins.
Hemizygos vein, v. hemiazygos, is a continuation of the left ascending lumbar vein, v. lumbalis ascendens sinistra. To the right of the hemizygos vein is the thoracic part of the aorta, behind is the left posterior intercostal artery. The hemizygos vein drains into the azygos vein. The accessory hemizygos vein, which runs from top to bottom, flows into the hemizygos vein, and. hemiazygos accessoria, receiving 6-7 superior intercostal veins, as well as esophageal and mediastinal veins. The most significant tributaries of the azygos and semi-gypsy veins are the posterior intercostal veins, each of which is connected at its anterior end to the anterior intercostal vein, a tributary of the internal mammary vein.
Posterior intercostal veins, vv. inlercostales posteridres, are located in the intercostal spaces next to the arteries of the same name and collect blood from the tissues of the walls of the chest cavity. The dorsal vein, v., flows into each of the posterior intercostal veins. dorsalis, and intervertebral vein, v. intervertebralis. A spinal branch, M. spinalis, flows into each intervertebral vein, which is involved in the outflow of venous blood from the spinal cord.
Internal vertebral venous plexuses (anterior and posterior), plexus venosi vertebrates interni (anterior et posterior), are located inside the spinal canal and are represented by veins anastomosing each other. The spinal veins and veins of the spongy substance of the vertebrae flow into the internal vertebral plexuses. From these plexuses, blood flows through the intervertebral veins into the azygos, semi-unpaired and accessory semi-unpaired veins and external venous vertebral plexuses (anterior and posterior), plexus venosi vertebrates externi (anterior et posterior), which are located on the anterior surface of the vertebrae. From the external vertebral plexuses, blood flows into the posterior intercostal, lumbar and sacral veins, vv. intercostdles posteriores, lumbales et sacrales, as well as into the azygos, semi-gyzygos and accessory semi-gyzygos veins. At the level of the upper spinal column, the plexus veins flow into the vertebral and occipital veins, vv. vertebrates et occipitales.