PLEURA, pleura , a closed serous sac consisting of two layers - parietal and visceral layers. Visceral pleura covers the lung itself and grows tightly with the substance of the lung, enters the grooves of the lung and separates the lobes of the lung from each other. The visceral layer passes into the parietal layer at the root of the lung. Parietal pleura, covers the walls of the chest cavity. It is divided into departments: costal, mediastinal and diaphragmatic. Costal pleura, covers the inner surface of the ribs and intercostal spaces. mediastinal pleura, adjacent to the mediastinal organs. Diaphragmatic pleura, covers the diaphragm. Between the parietal and visceral layers is pleural cavity, The pleural cavity contains 1-2 ml of fluid, which, on one side, separates these two layers in a thin layer, and on the other side, the two surfaces of the lung adhere. In the area of the apex of the lung, the pleura forms dome of pleura. In the places where the costal pleura transitions into the diaphragmatic and mediastinal pleura, free spaces are formed, pleural sinuses, where the lungs go when you take a deep breath. The following are distinguished: pleural sinuses: 1. costophrenic sinus,(its largest size is at the level of the mid-axillary line); 2. diaphragm - mediastinal sinus; 3. costomediastinal sinus.
BOUNDARIES OF THE PLEURAH AND LUNGS:
Apex of pleura in front protrudes above the collarbone by 2 cm, and above the first rib by 3 - 4 cm. At the back the apex lung pleura projected at the level of the spinous process VII cervical vertebra. Posterior border of the pleura- walks along spinal column from the head of the II rib and ends at the level of the XI rib.
Anterior border of the pleura– Right- goes from the apex of the lung to the right sternoclavicular joint to the middle of the connection of the manubrium with the body of the sternum, from here it descends in a straight line and at the level of the VI rib passes into the lower border of the pleura . Left- the anterior edge goes from the apex to the left sternoclavicular joint and to the middle of the connection of the manubrium with the body of the sternum, descends down and at the level of the cartilage of the IV rib, the anterior border deviates laterally and descends parallel to the edge of the sternum to the cartilage of the VI rib, where it passes into the lower border.
The lower border of the pleura is represents the line of transition of the costal pleura to the diaphragmatic pleura. On right side it crosses the midclavicular line, linea mammillaris - VII rib, along the anterior axillary line, linea axillaris anterior - VIII rib, along the midaxillary line, linea axillaris media - IX rib; along the posterior axillary line, linea axillaris posterior – X rib; linea scapularis - XI rib; along the vertebral line - XII rib. On the left side the lower border of the pleura is slightly lower than on the right.
Boundaries of the lungs not in all places coincide with the border of the pleura. The apex of the lungs, the posterior borders and the anterior border of the right lung coincide with the border of the pleura. The anterior edge of the left lung at the level of the IV intercostal space retreats to the left from the pleural space. The lower border follows the same lines as the pleura, only 1 rib higher.
AGE FEATURES – the pleura in a newborn is thin, loosely connected to the intrathoracic fascia, mobile when breathing movements lungs. The upper interpleural space is wide (occupied by a large thymus). The boundaries of the lungs also change with age. The apex of the lung in a newborn is at the level of the 1st rib. The lower border of the right and left lungs in a newborn is one rib higher than in an adult. In old age (after 70 years), the lower borders of the lungs are 1-2 cm lower than in people 30-40 years old.
Interim control “Respiratory system”
1. What anatomical structures limit the entrance to the larynx:
a) epiglottis+
b) aryepiglottic folds+
c) cricoid cartilage
d) arytenoid cartilages+
e) thyroid cartilages
2. Indicate the structures between which the glottis is located:
a) vestibular folds
b) between the arytenoid cartilages+
d) between the wedge-shaped cartilages
e) between the corniculate cartilages
3. Specify the parts of the trachea:
a) cervical part +
b) head part
c) chest part +
d) abdominal part
d) pelvic part
4. Specify the visceral branches of the thoracic aorta:
a) bronchial branches +
b) esophageal branches +
c) pericardial branches+
d) mediastinal branches
e) posterior intercostal arteries
5. Indicate the main anatomical structures that make up the root of the lung:
A) pulmonary artery+
b) pulmonary veins +
c) main bronchus +
d) lymphatic vessels+
e) lobar bronchus
6. Indicate the anatomical formation that occupies the highest position at the hilum of the right lung:
a) pulmonary artery
b) pulmonary veins
d) bronchus +
d) lymph node
7. Indicate the anatomical formation that occupies the highest position in the hilum of the left lung:
a) pulmonary artery +
b) pulmonary veins
e) lymph node
8. Indicate the structures involved in the formation of the acinus:
a) lobular bronchi
b) respiratory bronchioles+
c) alveolar ducts +
d) alveolar sacs +
e) segmental bronchi
9. Terminal bronchioles do not contain in their walls
a) cartilage+
c) mucous glands+
d) smooth muscle elements
d) mucous membrane
10. Indicate the sections of the air ducts in the walls of which there are no cartilaginous half-rings:
a) lobar bronchi
b) terminal bronchioles +
c) lobular bronchioles +
d) segmental bronchi+
d) main bronchi
11. How many bronchi does the right upper lobe bronchus branch into:
at four
e) ten
12. How many segments are there in the middle lobe of the right lung:
at four
e) ten
13. How many segments are there in the upper lobe of the left lung:
at four
e) ten
14. How many segments are there in the lower lobe of the right lung:
at four
e) ten
15. Indicate the structural elements of the lungs in which gas exchange occurs between air and blood:
a) alveolar ducts+
b) alveoli+
c) respiratory bronchioles+
d) alveolar sacs +
e) segmental bronchi
16. Specify the mediastinum in which the phrenic nerve passes:
a) superior mediastinum+
b) anterior section of the lower mediastinum
c) posterior part of the lower mediastinum
d) middle section of the lower mediastinum +
e) posterior mediastinum
17. To which mediastinum do the main bronchi belong:
a) back
b) front
c) top
d) average+
e) lower
18. Indicate which parts are distinguished in the parietal pleura:
a) costal+
b) vertebral
c) mediastinal+
d) diaphragmatic+
d) sternal
17. Name the pleural sinuses:
a) costophrenic +
b) phrenic-mediastinal +
c) costomediastinal+
d) phrenic-vertebral
d) costosternal
20. At the level of which rib does the lower border of the right lung pass along the midclavicular line?
a) IX rib
b) VIIth rib
c) VIII rib
d) VIth rib +
e) IV rib
21. At the level of which rib does the lower border of the left lung pass along the anterior axillary line:
a) IX rib
b) VIIth rib+
c) VIII rib
d) VIth rib
e) IV rib
22. Indicate the lower border of the right lung along the midaxillary line:
a) IX rib
b) VIIth rib
c) VIII rib+
d) VIth rib
e) IV rib
21. At the level of which rib does the lower border of the right lung pass along the posterior axillary line:
a) IX rib+
b) VIIth rib
c) VIII rib
d) VIth rib
e) IV rib
22. Lower border of the pleura along the scapular line: a) IX rib
b) VIIth rib
c) VIII rib
d) XIth rib +
e) IV rib
25. Specify the structures through which the horizontal plane passes, separating the superior mediastinum from the inferior:
a) jugular notch of the sternum
b) sternum angle +
c) intervertebral cartilage between the bodies of the III and IV thoracic vertebrae
d) intervertebral cartilage between the bodies of the IV and V thoracic vertebrae +
e) costal arch
26. Specify the anatomical formation located above the left main bronchus at the hilum of the lung:
a) pulmonary artery +
b) azygos vein
c) hemizygos vein
e) superior vena cava
27. Indicate the location of the cardiac notch on the lung:
c) lower edge of the left lung
e) posterior edge of the left lung
28. Identify the parts respiratory system, which are part of the lower respiratory tract:
a) larynx +
b) oropharynx
c) trachea +
d) nasal part of the pharynx
d) nasal cavity
29. Which of the following anatomical structures communicate with the lower nasal meatus:
a) middle cells of the ethmoid bone
b) nasolacrimal duct +
d) posterior cells of the ethmoid bone
d) frontal sinus
30. Which of the following anatomical structures communicate with the middle meatus:
a) frontal sinus +
b) maxillary sinus +
c) sphenoid sinus
d) eye socket
d) cranial cavity
31. Which parts of the nasal mucosa belong to the olfactory region?
a) mucous membrane of the inferior turbinates
b) mucous membrane of the superior turbinates +
c) mucous membrane of the middle turbinates +
d) mucous membrane of the upper nasal septum +
e) mucous membrane of the lower nasal septum
32. What functions does the larynx perform?
b) respiratory +
c) protective +
d) secretory
e) immune
33. Specify the anatomical structures limiting the ventricle of the larynx
a) folds of the vestibule +
c) aryepiglottic folds
d) arytenoid cartilages
e) thyroid cartilages
34. Specify the unpaired cartilages of the larynx:
a) arytenoid cartilage
b) cricoid cartilage +
c) sphenoid cartilage
d) corniculate cartilage
e) epiglottis +
35. Which direction does the arch of the cricoid cartilage face?
a) anterior +
e) laterally
36. Specify the anatomical formation at the level of which the tracheal bifurcation is located in an adult: a) chest angle
b) V thoracic vertebra +
c) jugular notch of the sternum
G) top edge aortic arch
e) II thoracic vertebra
37. Indicate the lobes of the lungs, which are divided into 5 segments:
a) lower lobe of the right lung +
b) middle lobe of the right lung
c) lower lobe of the left lung +
d) upper lobe of the right lung
e) upper lobe of the left lung +
38. At the level of which rib is the lower border of the right lung projected along the midclavicular line?
a) IX rib
b) VIIth rib
c) VIII rib
d) VIth rib +
e) IV rib
39. Which of the following functions are performed by the upper respiratory tract? a) gas exchange
b) moisturizing +
c) warming +
40. What anatomical structures does the larynx come into contact with at the back?
a) hypoglossal muscles
b) thyroid gland
c) pharynx +
d) prevertebral plate of the cervical fascia
e) esophagus
41. Indicate the level of location of the carina of the trachea:
a) vertebra prominens VII
b) vertebra thoracica V +
c) vertebra thoracica VIII
d) lower half of the body of the sternum
e) vertebra thoracica III
42. What positions are typical for bronchus principalis dexter compared to bronchus principalis sinister
a) more vertical position +
b) wider +
c) shorter +
d) longer
e) located horizontally
43. What positions are typical for the right lung compared to the left?
b) longer
d) shorter +
44. Indicate the location of incisura cardiaca on the lung:
a) posterior edge of the right lung
b) anterior edge of the left lung +
c) lower edge of the left lung
d) lower edge of the right lung
e) anterior edge of the right lung
45. Specify the structures involved in the formation of arbor alveolaris (acinus)?
a) terminal bronchioles+
b) respiratory bronchioles+
c) alveolar ducts+
d) alveolar sacs +
e) segmental bronchi
46. Indicate the projection of the apex of the right lung onto the surface of the body
a) above the sternum 3-4 cm higher
b) at the level of the spinous process of the VII cervical vertebra +
c) above the first rib 3-4 cm higher +
d) above the collarbone 2-3 cm higher +
e) at the level of the 1st rib
47. Indicate during the branching of which structures respiratory bronchioles are formed:
a) bronchi segmentales
b) bronchi lobulares
c) bronchi terminales +
d) bronchi lobares
e) bronchi principales
48. How many shares does it have? right lung?
at four
e) ten
49. How many lobes does the left lung have?
at four
e) ten
50. How many segments are there in right lung?
at four
e) ten +
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very necessary
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 general 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 - superior 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:
· The costal pleura (pleuracostalis) covers the inner surface of the 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).
The right and left anterior pleural folds at the level of II-IV costal cartilages closely approach each other and are partially fixed with the help of connective tissue cords. Above and below this level, the upper and lower interpleural spaces are formed.
- · The upper interpleural (thymic) space, area interpleurica superior (area thymica), with its apex facing downwards, is located behind the manubrium of the sternum and has the shape of a triangle. Adjacent to it is the thymus gland or its remains in the form of an accumulation of fiber (in adults).
- · The lower interpleural (pericardial) space, area interpleurica inferior (area pericardiaca) - with its apex facing upward, is located behind the lower half of the sternum and the adjacent anterior sections of the fourth and fifth left intercostal spaces. In this area, the pericardium is adjacent to the wall of the chest cavity. The lower boundaries of the pleural cavities pass along the midclavicular line - along the VII rib, along the midaxillary line - along the X rib, along the scapular line - along the XI rib, along the paravertebral line - along the XII rib. On the left side, the lower border of the pleura is slightly lower than on the right. Within this gap is the anterior part of the pericardium and, due to the absence of pleural cover, it is possible to penetrate through the chest wall directly into the pericardial cavity without opening the cavitas pleuralis (the site of the pericardial puncture).
Rice. 3 Interpleural fields: 1 - upper interpleural field; 2 - lower interpleural field
Rice. 4 Borders of the pleura (front view)
Rice. 5
The posterior boundaries of the pleural cavities descend from the dome of the pleura along the spinal column and correspond to the costovertebral joints. It should, however, be borne in mind that the posterior border of the right pleura often extends onto the anterior surface of the spine, often reaching the midline, where it is adjacent to the esophagus. The boundaries of the lungs do not coincide with the boundaries of the pleural sacs in all places. Where the pulmonary edges do not coincide with the pleural boundaries, spare spaces remain between them, called pleural sinuses, recessus pleurales. The lung enters them only at the moment of the deepest breath. Pleural sinuses form part of the pleural cavity and are formed at the junction of one part of the parietal pleura to another (a common mistake: “the sinuses are formed by the parietal and visceral layers of the pleura”). The walls of the sinuses come into close contact during exhalation and move away from each other during inhalation, when the sinuses are partially or completely filled with the lungs. They also diverge when the sinuses fill with blood or exudate.
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 a plantar arch, arcus plantaris, at the level of the base of the metatarsal bones, giving 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 own plantar digital arteries: to the two sides of the big toe and to the medial side of the second finger, and the second, third and fourth arteries supply blood to the sides of the second, third, fourth and fifth 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 back sides neighboring 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; parts of it, 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 the optic tracts and mammillary bodies, and on the rear - the anterior edge of the pons. On the dorsal surface, the upper (anterior) border of the midbrain corresponds to the posterior edges (surfaces) of the thalami, the posterior (lower) border corresponds to the level of the roots exit trochlear nerve.
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 midbrain roof (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 III ventricle with IV 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 III pairs there is an 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. The nucleus of the midbrain tract is located in the lateral parts of the central gray matter throughout the entire midbrain. 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. The middle part of the base of the cerebral peduncle is occupied by the pyramidal tracts.
The corticonuclear fibers pass medially, and the corticospinal tracts pass laterally.
The midbrain contains the subcortical centers of hearing and vision, which provide innervation to voluntary and involuntary muscles. eyeball, as well as the mesencephalic 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. solid sinuses meninges.
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, outside surface cartilage 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, 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. Respiratory bronchioles extending from the terminal bronchiole, as well as alveolar ducts, alveolar sacs and lung alveoli 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. Each intervertebral vein drains spinal branch, g. spinalis, 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.
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 with a small amount of 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 the root of the lung, 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; the anterior sinus is behind the sternum, the posterior sinus, less pronounced, is in front of the 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. , , , ).
The lower border of 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.
