The disease is divided into several types and goes away different stages. A competently chosen specialist will help you cope with an ailment, the prognosis of which without medical intervention can be disappointing.

Types

You can find melanoma under a toenail just as often as on your hands. Doctors use two main classifications for these tumors. The first is by origin.

Depending on the original source, there are:

• damage to the tissues of the nail plate;
• involvement of nail bed tissues;
• damage to the periungual fold.

As doctors note, the source of the pathology does not affect either the treatment tactics or the further prognosis. They remain unchanged regardless of the original source of the pathological cells.

Has a big role clinical form diseases. There are:

• superficial, which grows in the horizontal direction;
• nodular, tending to grow deeper;
• acrolentiginous, which can affect not only the nail, but also the tips of the fingers, lips, soles, palms (patients often confuse the acrolentiginous and classical forms);
• achromatic, in which the neoplasm is not dark, as usual, but whitish.

Most dangerous doctors considered the second type of tumor. The first form of melanoma under the nail is relatively safe thumb or any other. The third type is rare in patients with fair skin. The latter type is extremely rare.

Stages and symptoms

Melanoma under the nail, like any tumor, goes through 4 main stages in its development:

1. The disease is difficult to diagnose. The speck is small in size (less than 1 mm), while the nail plate or itself is undamaged.
2. Damage to the big toe or any other toe is accompanied by the appearance of nodules and ulcers. At the same time, obvious changes occur on and around the nail.
3. The tumor begins to metastasize to The lymph nodes. The patient notes involvement in pathological process tissue next to the nail.
4. The neoplasm affects not only the lymph nodes, but also organs. The primary zone has been greatly altered.

Symptoms of nail melanoma may not appear for a long time. The patient detects negative changes only when the nail on the affected finger has already turned partially or completely black. As the disease progresses, pain appears when pressing on the affected area. Over time, tissue ulceration joins the pain, and blood or pus begins to ooze from the wounds.

Nail melanoma often contributes to the development of secondary infections. The patient's skin becomes ulcerated and an open gate appears for penetration. pathogenic microorganisms. In this case, the temperature may rise and general malaise appears. Symptoms characteristic of general intoxication occur.

Some patients develop melanoblastoma. This tumor differs from the classic one in its rapid and aggressive development.

As doctors note, the disease cannot be detected by signs alone. Some new growths do not change the color of the surface. And when a patient visits a doctor for later, then a painful lump or nodule has already formed under the affected nail.

Symptoms of the disease on late stage often accompanied by:

• decrease or total loss appetite;
• rapid loss of body weight;
• deterioration of general health;
• high fatigue.

Which doctor should I contact?

Many patients are interested in the question of which doctor prescribes treatment if nail melanoma has developed. Before starting medical measures, you should visit a dermatologist. This is the doctor who specializes in diseases skin of various origins.

If the tumor nature of the disease is confirmed, the patient will be referred for consultation to an oncologist. It is the oncologist who will deal with further treatment. If necessary, surgeons, therapists, infectious disease specialists, and immunologists may be involved in therapy.

Diagnostics

Before starting to treat a patient with a suspected illness, the doctor conducts a thorough diagnosis to eliminate errors. To do this, collect anamnesis, specifying whether the patient is at risk, whether he has received injuries to his nails or fingers in Lately. They also identify symptoms and conduct a thorough examination of the pathology site.

Nail melanoma is a disease that is not diagnosed by symptoms alone. The doctor must perform a dermatoscopy procedure. Problem area inspected using a magnifying glass or a more modern device.

During dermatoscopy it is often possible to detect a tumor that has jagged edges, asymmetrical shape. The doctor will be alerted to a heterogeneous structure or color. If the tumor is located under the nail plate, it can be difficult and sometimes impossible to conduct a full dermatoscopy.

To definitely confirm the diagnosis, the doctor prescribes a biopsy. During this study, a part of the presumably affected tissue is taken and examined using a microscope or other methods. Testing for tumor markers may also be recommended. Additional research includes inspection abdominal cavity or chest using ultrasound or computed tomography.

Until the diagnosis is confirmed by histology, it is impossible to judge whether the patient suffers from melanoma.

Treatment

Nail melanoma is a disease characterized by frequent malignancy. Surgical intervention becomes the main method of therapy.

It can be done in several different ways:

• A classic operation in which only the affected tissue is removed, the entire nail plate or the entire nail phalanx, depending on the size of the lesion and its neglect.
• Cryotherapy, in which pathological cells are treated with liquid nitrogen(only applies to early stages).
• Laser removal can be performed in the early stages of the disease.

Treatment before surgery always begins with chemotherapy. In this case, the drugs are designed to stop the growth of the tumor and prevent its metastasis. However, it is important to remember that treatment does not stop after surgery. The patient will have to undergo a course radiation therapy, which will finally destroy all malignant cells remaining in the body.

IN last years New methods of treating melanoma are being actively developed. One of them is immunotherapy. Its essence is simple: immune system a person is “tuned” to fight the changed cells. However, this type of therapy is in the development stage and is not widely used.

Forecast

If the patient consults a doctor in a timely manner and begins treatment, the disease can be overcome in 85-90% of cases. Nail melanoma of the superficial type, detected at an early stage, responds well to treatment.

The later you see a doctor, the worse the prognosis and five-year survival rate. The type of tumor is of great importance. For example, deep tumors are less responsive to therapy even in the early stages. If you see a doctor too late, your chances of survival will be no more than 50%.

The prognosis is considered worst if the melanoma has already metastasized to nearby lymph nodes or organs. Fight against metastases - difficult task, which often ends in failure. Survival rate when starting treatment at the metastasis stage does not exceed 20%.

Risk groups and prevention

Nail melanoma is a poorly studied disease. To date, there is no reliable information about its etiology. However, a number of circumstances are known that play the role of risk factors.

People who are predisposed to developing the disease:

• abusing being under direct sun rays or a solarium (it is important to remember that not only artificial light can contribute to illness, but also real light);
• With a small amount melanin from birth (fair-skinned and fair-haired, often blue-eyed);
• received various injuries nail plate;
• having periungual nevi or melanomas of other localization;
• A history of sunburn predisposes to the development of a neoplasm, indicating the sensitivity of the skin to ultraviolet radiation.

Unfortunately, no specific prophylaxis exists today to prevent the development of the disease. However, doctors note that the risk of encountering a malignant tumor drops by a third if a person uses sunscreen.

Melanoma located on or under the nail is very dangerous disease. At the first signs of changes in the nail plate, patients should immediately consult a doctor.

Useful video about subungual melanoma

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IN chest cavity There are two pleural sacs containing the lungs. Between the pleural sacs there is a mediastinum, which contains a complex of organs consisting of the heart with the pericardium (3rd serous sac), the thoracic trachea, the main bronchi, the esophagus, vessels and nerves, surrounded by a large amount of fiber.

Topography of the lungs

Lung(pulmo, rpeitop) - paired organ triangular shape. Its apex is located above the 1st rib and projects to the neck area. The lung has three surfaces: costal(lateral), mediastinal(medial) and diaphragmatic(lower). On the mediastinal surface there are the gates of the lung, into which the lung root. Its main structural components are the main bronchus, pulmonary artery and pulmonary veins, bronchial vessels and lymph nodes. The main bronchus is always located posterior and superior to the pulmonary veins. On the left side, the pulmonary artery lies in front and above relative to the main bronchus, and on the right side it is in front and below him. Abbreviation of the main components of the lung root from top to bottom: on the left - ABC, on the right - BAV (A - pulmonary artery, B - main bronchus, C - pulmonary veins). The lung has three edges: front(projected to the region of the costomediastinal sinus), lower(projected onto two ribs above the bottom of the costophrenic sinus) and rear(fills the pulmonary groove - a depression on the side of the spinal column).

Right lung with the help of horizontal and oblique slits it is divided into three lobes. The oblique fissure separates the lower lobe from the middle lobe. This gap is projected along a line that starts from the angle of the 5th rib, along the rib reaches the midaxillary line and then continues to the border between the cartilaginous and bony parts of the 6th rib along the midclavicular line. A horizontal fissure separates the middle lobe from the upper lobe. It is projected along a line that begins with the cartilage of the IV rib in front and ends at the level of the V rib along the midaxillary line. Left lung is divided into only two parts.

The lobes of the lung are in turn divided into bronchopulmonary segments. Each of them, like the lobe, has the shape of a pyramid. Its base faces the surface of the lung, and its apex faces its gate. The number of segments is determined by the number of branches of the lobar bronchus, which are called segmental bronchi. Together with them, a branch of the pulmonary artery enters the bronchopulmonary segment from the apex. Each lung has 10 segments. In the right lung, the upper lobe has 3 segments, the middle lobe has 2, and the lower lobe has 5 segments. In the left lung, the upper and lower lobes are divided into 5 segments.

Lung boundaries:

• the apex protrudes 2.5 cm above the collarbone (from behind it reaches the level of the VII cervical vertebra);
• during exhalation, the lower border in the direction from front to back crosses the VI rib along the midclavicular line, the VIII rib along the mid-axillary line and ends in the area of ​​​​the articulation of the head of the X rib with the spine. The line of transition of the costal part of the parietal pleura into the diaphragmatic part is projected approximately two intercostal spaces below: midclavicular line - VIII rib, middle axillary line - X rib, posterior midline - spinous process of the XII thoracic vertebra.

Blood supply The lung as an organ is carried out by the bronchial arteries (branches of the thoracic aorta). The bronchial veins on the right flow into the azygos vein, on the left into the semi-gypsy vein or into the posterior intercostal veins.

Innervation The lung originates from the pulmonary plexus, located at the hilum of the lung. The plexus is formed by sensory and parasympathetic fibers from vagus nerve, postganglionic fibers from the superior thoracic ganglia of the sympathetic trunk, which are part of the thoracic pulmonary branches. Irritation of parasympathetic fibers causes spasm of the smooth muscles of the bronchi and increases the secretion of the bronchial glands. Sympathetic fibers innervate the wall blood vessels. They have a vasoconstrictor effect, dilate the bronchi and suppress the secretion of glands.

Lymphatic vessels lungs are divided into superficial and deep. On the way out of the lung, lymph passes through several levels of nodes:

• intrapulmonary nodes - located next to the segmental bronchi in the lung parenchyma;
• bronchopulmonary nodes - located at the hilum of the lung, next to the branching site of the main bronchus on lobar bronchi;
• tracheobronchial nodes:

© upper tracheobronchial nodes - located next to the lateral surface of the trachea and main bronchus; to the right on the lateral side of them lies the azygos vein, to the left is the aortic arch;

° lower tracheobronchial nodes - localized below the bifurcation of the trachea.

Endurant lymphatic vessels the right tracheobronchial nodes participate in the formation of the right bronchomediastinal trunk (flows into the right lymphatic duct), the left - the left bronchomediastinal trunk (flows into the thoracic duct). In addition, lymph can enter from the upper tracheobronchial nodes:

• in the pretracheal nodes - located in front of the trachea. On the right side, this group is limited by the posterior wall of the superior vena cava, on the left - by the posterior wall of the brachiocephalic vein;
• peritracheal nodes - located in the upper mediastinum along the trachea (above the pretracheal nodes);
• nodes of the upper mediastinum (highest mediastinal lymph nodes) - localized in the upper third of the thoracic trachea over a length from top edge subclavian artery or apex of the lung to the point of intersection of the upper edge of the left brachiocephalic vein and midline trachea.

The lungs are paired organs located in the cavities of the pleura.

The lung consists of a system of airways - bronchi and a system of pulmonary vesicles, or alveoli, which act as the actual respiratory sections of the respiratory system.

Structural-functional lung unit is the acinus, acinus pulmonis, which includes respiratory bronchioles of all orders, alveolar ducts, alveoli and alveolar sacs, surrounded by a network of capillaries. Gas exchange occurs through the wall of the capillaries of the pulmonary circulation.

Each lung has an apex and three surfaces: costal, diaphragmatic and mediastinal. The sizes of the right and left lungs are not the same due to the higher position of the right dome of the diaphragm and the position of the heart, shifted to the left.

The right lung in front of the hilum, with its mediastinal surface, is adjacent to the right atrium, and above it, to the superior vena cava. Behind the gate, the lung is adjacent to the azygos vein, the thoracic vertebral bodies and the esophagus, as a result of which an esophageal depression is formed on it. Root right lung bends around in the direction from back to front v. azygos. The left lung with its mediastinal surface is adjacent in front of the hilum to the left ventricle, and above it to the aortic arch.

Rice. 6

Behind the hilum, the mediastinal surface of the left lung is adjacent to the thoracic aorta, which forms the lung aortic groove. The root of the left lung goes around the aortic arch from front to back. On the mediastinal surface of each lung there is a pulmonary gate, hilum pulmonis, which is a funnel-shaped, irregular oval shape recess (1.5-2 cm). Through the gate, the bronchi, vessels and nerves that make up the root of the lung, radix pulmonis, penetrate into and out of the lung. Loose tissue and lymph nodes are also located at the gate, and the main bronchi and vessels give off lobar branches here. The left lung has two lobes (upper and lower), and the right lung has three lobes (upper, middle and lower). The oblique fissure in the left lung separates the upper lobe, and in the right - the upper and middle lobes from the lower. An additional horizontal fissure in the right lung separates the middle lobe from the upper lobe.

Skeletotopy of the lungs. Front and back borders the lungs almost coincide with the boundaries of the pleura. The anterior border of the left lung, due to the cardiac notch, starting from the cartilage of the 4th rib, deviates towards the left midclavicular line. The lower borders of the lungs correspond to the right along the sternal line, to the left along the parasternal (parasternal) lines to the cartilage of the VI rib, along the midclavicular line to the upper edge of the VII rib, along the anterior axillary line to the lower edge of the VII rib, along the mid-axillary line to the VIII rib, along the scapular line to X rib, along the paravertebral line - XI rib. When inhaling lung border falls.

Lung segments. Segments are sections lung tissue ventilated by a segmental bronchus and separated from adjacent segments connective tissue. Each lung consists of 10 segments.

Right lung:

• - upper lobe - apical, posterior, anterior segments
• - middle lobe - lateral, medial segments
• - lower lobe - apical, medial basal, anterior basal,

lateral basal, posterior basal segments.

Left lung:

• - upper lobe - two apical-posterior, anterior, upper lingular, lower lingular;
• - lower lobe - apical, medial-basal, anterior basal, lateral basal, posterior basal segments.

On inner surface the lung has a gate.

Right lung root:

at the top - the main bronchus;

below and anteriorly - the pulmonary artery;

even lower is the pulmonary vein.

Left lung root:

at the top - the pulmonary artery;

below and posteriorly is the main bronchus.

The pulmonary veins are adjacent to the anterior and lower surfaces main bronchus and artery.

Projection of the gate to the front chest wall corresponds to the V-VIII thoracic vertebrae in the back and the II-IV ribs in the front.

5. Classification of bone joints, their functional characteristics.

6. Structure of the joint. Classification of joints according to the shape of the articular surfaces, number of axes and function.

7. Structure of the skeleton of the upper limb. Features of the structure of the skeleton, joints and muscles of the upper limb as a tool.

8. Structure of the skeleton of the lower limb. Structural features associated with upright walking. Muscles of the lower limb.

9. General anatomy of muscles. Muscle as an organ. Classification of muscles.

10. Muscles of the head and neck: topography, structure, functions.

11. Muscles of the body: chest, abdomen, back; topography, structure, functions. Anatomy of the abdominal muscles: topography, structural features. Chest muscles

Back muscles

12. Oral cavity: lips, vestibule, hard and soft palate, tongue, teeth, their structure and functions. The act of swallowing. Salivary glands.

13. Pharynx: structure, function, lymphoid ring. Esophagus: topography, structure, functions.

14. Stomach: topography, structure, functions. Small intestine: sections, topography, relationship to the peritoneum, structure, functions. Large intestine: topography, relationship to the peritoneum, structure, functions.

15. Liver: topography, structure, functions. Pathways for excretion of bile. Pancreas: topography, structure, functions.

16. Nasal cavity, larynx, trachea: topography, structure, functions.

17. Lungs: external and internal structure, functions of the “bronchial tree and acinus”

18. Kidneys: development, topography, structure, functions. Morpho-functional features of individual nephron structures. Ureters, bladder, urethra. Their structure and functions.

19. Structure and functions of male and female genital organs

20. General anatomy of blood vessels. Characteristics of the microcircular bed. Factors providing arterial and venous blood flow.

21. Heart: structural features of the walls of the atria and ventricles. Conduction system of the heart. Blood supply and innervation of the heart. Venous drainage.

22. Systemic and pulmonary circulation.

23. Aorta and its parts. Branches of the aortic arch and its thoracic region (parietal and visceral). Parietal and visceral (paired and unpaired) branches of the abdominal region.

24. External and internal carotid arteries, areas of blood supply. Subclavian artery: areas of blood supply. Blood circulation of the upper limb.

25. Common, external and internal iliac arteries, areas of blood supply. Blood supply of the lower limb.

27. Lymphatic system: capillaries, vessels, lymph nodes, ducts; lymph circulation.

28. Nervous system: sections, significance in the body. Structure and classification of nerve and glial cells.

29. Spinal cord: topography, external and internal structure. The concept of a segment. Reflex arc.

30. Development of the nervous system; brain vesicles and their derivatives.

31. General plan of the structure of the brain. Brainstem: structure of the medulla oblongata, pons, midbrain, diencephalon.

32. Structure of the cerebellum. Telencephalon: structure, localization of functions in the cerebral cortex.

33. Cranial nerves: fiber composition, areas of innervation.

34. Spinal nerves: formation, plexuses, areas of innervation.

36. Parasympathetic division of the VNS: central and peripheral parts, their characteristics.

37. Sympathetic division of the ANS: central and peripheral parts, their characteristics.

38. Organ of vision: structure, pathways of the visual analyzer.

39. Organ of hearing and balance

40. Organs of taste and smell: structure, conductive paths of analyzers.

41. Classification of endocrine glands. Regulation of the functions of the endocrine glands. Hormones: properties, features of physiological action.

42. Classification of hormones by chemical structure.

43. Hypothalamic-pituitary neurosecretory system: structural features, hormones, pathology.

44. Morpho-functional characteristics of the thyroid and parathyroid glands; hormones, pathology.

45. Endocrine function of the pancreas; hormones, their role in the regulation of metabolism. Diabetes.

46. ​​Structure and functions of the cortex and medulla of the adrenal glands; hormones, pathology.

17. Lungs: external and internal structure, functions of the “bronchial tree and acinus”

Lungs (pulmones) located in the chest cavity and covered with a serous membrane, forming a pleural sac for each lung; the right lung is shorter and wider than the left, has 3 lobes (upper, middle and lower), the left - two (upper and lower). According to the cone-shaped shape, the apex and base of the lung are distinguished. Surfaces: costal, diaphragmatic and medial, on the latter there are mediastinal (mediastinal) and vertebral parts; The gates of the lung are located in the mediastinal part. On the surfaces there are deep fissures that separate the lobes of the lungs: both lungs have an oblique fissure, which in the left lung is located between the lower and upper lobes, and in the right lung it separates the lower lobe from the upper and middle; The horizontal fissure of the right lung runs between the upper and middle lobes.

At the hilum of the lung are the pulmonary artery, two pulmonary veins and the main bronchus. The bronchi branch sequentially, forming the air-bearing part of the lung - bronchial tree, which includes the main, lobar, segmental bronchi (10 in the lung), branches of the segmental bronchi (9-10 orders of branching), lobular bronchi, as they branch, the amount of cartilaginous tissue in the wall of the bronchi decreases, the lobular bronchus, having a diameter of about 1 mm, also contains cartilaginous fragments; inside the lobule it is divided into 18-20 terminal bronchioles, in the wall of which cartilage tissue absent, smooth muscle fibers present. Each terminal bronchiole is divided into respiratory bronchioles, which have alveoli in their walls, and continue into the alveolar ducts with alveolar sacs and alveoli. bronchial function- is the conduction, purification and regulation of air flow

The structural and functional unit of the lung is acini- part of the alveolar tree, corresponding to the branches of one terminal bronchiole with the vessels and nerves entering it. The alveolar tree forms the gas exchange part of the lung. Part of the lung, corresponding to the branches of the bronchus III order(segmental) with accompanying vessels and nerves is called the bronchopulmonary segment.

18. Kidneys: development, topography, structure, functions. Morpho-functional features of individual nephron structures. Ureters, bladder, urethra. Their structure and functions.

Kidneyn) - a paired organ that produces and removes urine. They are located asymmetrically in the abdominal cavity (the right one is lower than the left one). The upper edge of the kidneys is covered by the adrenal glands and the kidneys are projected at the level of the middle of the 11th vertebra. Upper part of right kidney located at the level of the lower edge of the 11th thoracic vertebra, lower end right the kidneys are projected at the level of the lower edge of the 3rd lumbar vertebra. Upper edge of the left kidney- at the level of the middle of the 11th thoracic vertebra, bottom edge– at the level of the upper edge of the 3rd lumbar vertebra. Adjacent to the anterior surface of the right kidney are the liver, the right flexure of the colon, the jejunum, and along the medial edge - the descending part of the duodenum. The stomach, pancreas, colon and jejunum are adjacent to the anterior surface of the left kidney, and the spleen is located to the alllateral edge. The kidneys are located in the retroperitoneal space - the renal bed. The kidneys do not move downwards thanks to the fixing apparatus:

1) the renal bed, which is formed by the quadratus lumborum muscle and the psoas major muscles.

2) Increased intra-abdominal pressure, which is created by contraction ( increased tone) abdominal muscles.

3) fibrous capsule of the kidney and fatty capsule behind

4) fascia of the kidneys

5) renal vessels located at the hilum of the kidney

The kidney has a bean-shaped shape with a more convex anterior surface and a flattened posterior one, two ends - lower and upper, the adrenal gland is adjacent to the latter, two edges - convex outer and concave inner. Along the inner edge are the renal hilum, which contains the renal vein, renal artery, renal pelvis with the ureter emerging from it, nerves and lymphatic vessels. The gate continues into the organ into the renal sinus, filled with renal calyces and pelvis, blood vessels and fatty tissue. The renal sinus is surrounded by parenchyma, which contains the medulla and cortex. The medulla forms conical renal pyramids, the apices of which protrude into the renal sinus and are called renal papillae. The papillae have numerous openings, 1-3 papillae are surrounded by small renal calyces. Outside the pyramids is the cortex; the processes of the cortical substance separating the pyramids are called renal columns. From the base of the pyramids, thin processes extend into the cortex - the radiate part; the cortical substance adjacent to these processes is called the collapsible part.

The structural and functional unit of the kidney is nephron, the number of which in each kidney is more than a million. The nephron consists of a renal (Malpighian) corpuscle and a tubule. The renal corpuscle is represented by a double-walled goblet capsule (Shumlyansky-Bowman), covering the capillary glomerulus; the capsule cavity continues into the proximal part of the nephron tubule (proximal convoluted tubule), which then passes into the loop of nephron (loop of Henle), consisting of the descending part, the knee and the ascending part, the latter continues into the distal part of the nephron tubule (distal convoluted tubule), which flows into collecting duct.

The length of the tubule of one nephron is from 20 to 50 mm. Blood enters the capillary glomerulus through the afferent arteriole; the efferent arteriole, which has a smaller diameter, leaves the glomerulus and breaks up into a secondary arteriole. capillary network, entwining the nephron tubule.

The collecting ducts successively merge with each other, enlarge and, heading to the renal papillae, unite into papillary ducts, which open through the papillary openings into the small renal calyces. Two or three small renal calyces, connecting, form a large renal calyx, 2-3 large renal calyces continue into the renal pelvis, which in the area of ​​the renal hilum, narrowing, passes into the ureter. The walls of the pelvis, large and small renal calyces have the same structure and include the mucous, muscular and outer adventitia; the muscular layer of the small renal calyces forms the fornical apparatus, which regulates the excretion of urine from the papillary ducts.

On the surface, the kidney is covered with a fibrous capsule, on the outside of which there is a layer of adipose tissue - the adipose capsule; Outside the fatty capsule are the anterior and posterior layers of the renal fascia, fused at the upper end and outer edge of the organ, the space between them is open downwards.

Primary urine 120-170 – 230 liters per day.

The secondary one is formed by the method of reverse suction, i.e. reabsorption of water and substances needed by the body (glucose, amino acids, mineral substances, etc.) from the renal tubules into the secondary capillary network. The hypothalamus regulates ADH.

Ureter (ureter) - a paired tubular organ that starts from the narrowed part of the renal pelvis and ends at the confluence with the bladder. From the hilum of the kidney it goes downwards retroperitoneally along back wall abdominal cavity (abdominal part), then passes along the posterolateral wall of the pelvis to the bottom, goes forward and medially (pelvic part), enters the wall from the side and back Bladder(intrawall part), opening into its cavity. With a length of 30-35cm. has a diameter of up to 8 mm and forms narrowings: at the beginning of its exit from the pelvis, when crossing the border line of the small pelvis and in the intramural part.

Bladder (vesicaurinaria) - hollow organ with a volume of up to 0.5 l; located in the pelvic cavity behind the pubic symphysis, when filled it increases in volume and is also adjacent to the posterior surface of the lower part of the anterior abdominal wall. Parts of the bladder: the apex, facing anteriorly and upward, continues downward into the body; the posterior-inferior part of the wall is called the bottom; continuing downward and somewhat anteriorly, the bladder narrows into a neck, which passes into urethra

The wall has three membranes: 1) mucosa, formed by transitional epithelium with a well-developed submucosa; it forms numerous folds, which straighten as the organ fills; on the mucous membrane there is a section devoid of folds - the vesical triangle, at the apexes of which the orifices of the ureters and the internal opening of the urethra are located; 2) the muscular layer, which has 3 layers - external and internal longitudinal and middle circular, the latter is especially pronounced in the circumference of the internal opening of the urethra; 3) serous membrane (peritoneum) with a well-defined subserosal base. The peritoneum covers part of the wall of the empty bladder (extraperitoneal). When the bladder is filled, the peritoneum stretches and the organ is located mesoperitoneally, while there is no peritoneum between the anterior abdominal wall and the anterior wall of the bladder.

Table of contents of the topic "Topography of the diaphragm. Topography of the pleura. Topography of the lungs.":

Lungs- paired organs located in the cavities of the pleura. Each lung has an apex and three surfaces: costal, diaphragmatic and mediastinal. The sizes of the right and left lungs are not the same due to the higher position of the right dome of the diaphragm and the position of the heart, shifted to the left.

Syntopy of the lungs. Pulmonary gate

Right lung in front of the gate, its mediastinal surface is adjacent to the right atrium, and above it - to the superior vena cava.

Behind gate lung adjacent to the azygos vein, thoracic vertebral bodies and esophagus, as a result of which an esophageal depression is formed on it. The root of the right lung bends around in the direction from back to front v. azygos.

Left lung The mediastinal surface is adjacent in front of the hilum to the left ventricle, and above it to the aortic arch. Behind the hilum, the mediastinal surface of the left lung is adjacent to the thoracic aorta, which forms the aortic groove on the lung. Left lung root The aortic arch bends from front to back.

On the mediastinal surface of each lung there are pulmonary gate, hilum pulmonis, which are a funnel-shaped, irregular oval-shaped depression (1.5-2 cm).

Through gate to the lung and from it penetrate the bronchi, vessels and nerves that make up lung root, radix pulmonis. Loose tissue and lymph nodes are also located at the gate, and the main bronchi and vessels give off lobar branches here.