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Normal human anatomy. Lecture notes: briefly, the most important

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Table of contents

1. Osteology (General information about osteology. The structure of the cervical, thoracic and lumbar vertebrae. The structure of the sacrum and coccyx. The structure of the ribs and sternum. The girdle of the upper limbs. The skeleton of the free upper limb. The structure of the humerus and bones of the forearm. The structure of the bones of the hand. The girdle of the lower limbs. Structure skeleton of the free part of the lower limb. Structure of the femur, patella and leg bones. Structure of the bones of the foot. Structure of the skull. Sphenoid bone. Occipital bone. Frontal bone. Parietal bone. Temporal bone. Ethmoid bone. Structure of the bones of the facial part of the skull. Upper jaw. Small nose bones)
2. Arthrology (General information about arthrology. Movements in the joints. Classification of joints. Joints of the upper limb girdle. Joints of the free upper limb. The structure of the joints of the lower limb girdle. The structure of the joints of the free lower limb. Joints of the foot. Joints of the skull bones. Joints of the vertebrae. Joints of the ribs with the vertebral pillar. Chest)
3. Myology (Structure and classification of muscles. Muscle function. General information about the auxiliary apparatus of the muscles. Muscles of the shoulder girdle. Muscles of the shoulder. Muscles of the forearm. Muscles of the hand. Accessory apparatus of the muscles of the upper limb and hand. Pelvic muscles. Thigh muscles. Calf muscles. Foot muscles. Accessory apparatus of the muscles of the lower limb. Facial muscles of the head. Muscles of the auricle. Masticatory muscles. Accessory apparatus of the muscles of the head. Superficial muscles of the back. Deep muscles of the back. Muscles of the deep layer. Muscles of the chest. Accessory apparatus of the muscles of the chest. Abdominal muscles. Muscles of the abdominal walls. Accessory apparatus of the abdominal muscles. Muscles of the neck. Deep muscles of the neck. Accessory apparatus of the neck muscles)
4. Respiratory system (Structure of the nasal region (regio nasalis). Structure of the larynx. Structure of the cartilage of the larynx. Structure of the trachea. Structure of the lungs and main bronchi. Structure of the pleura. Pleural cavity. Mediastinum)
5. Genitourinary system (General information about the kidneys. Topography of the kidneys. Microscopic structure of the kidneys. Blood supply and innervation of the kidney. Structure, blood supply and innervation of the ureters. Structure, blood supply and innervation of the bladder)
6. Female genital organs (Structure, blood supply and innervation of the vagina. Structure, blood supply and innervation of the uterus. Structure, innervation and blood supply of the fallopian tubes. Structure, blood supply and innervation of the ovaries. Ovarian appendages)
7. Male genital organs (Structure, blood supply and innervation of the prostate gland. Structure, blood supply and innervation of the testicles and their appendages. Structure, blood supply and innervation of the penis and urethra. Structure, blood supply and innervation of the scrotum)
8. Digestive system (Structure of the vestibule of the mouth and cheeks. Structure of the oral cavity. Structure of the teeth. Structure of the tongue. Structure of the hard and soft palate. Glands of the mouth. Structure of the pharynx. Structure of the wall of the pharynx (muscular apparatus of the pharynx). Structure of the esophagus. Structure of the stomach. Structure of the wall of the stomach. The structure of the small intestine. The structure, anatomical features and physiology of the jejunum and ileum. The structure of the large intestine. The structure of the cecum. The structure of the colon. The structure of the wall of the cecum and colon. The structure of the rectum. The structure of the liver)
9. Cardiovascular system (Structure of the heart. Structure of the heart wall. Conducting system of the heart. Structure of the pericardium. Blood supply and innervation of the heart. Pulmonary trunk and its branches. Structure of the aorta and its branches. Brachiocephalic trunk. External carotid artery. Branches of the internal carotid artery. Branches of the subclavian arteries. Brachial artery. Ulnar artery. Branches of the thoracic aorta. Branches of the abdominal aorta. Structure of the branches of the common iliac artery. Branches of the femoral, popliteal, anterior and posterior tibial arteries. System of the superior vena cava. Veins of the head and neck. Veins of the upper limb. System inferior vena cava. Portal vein system. Veins of the pelvis and lower limb)

1. GENERAL INFORMATION ABOUT OSTEOLOGY

Skeleton (skeleton) - the totality of all the bones of the human body. The skeleton makes up up to 10% of the mass of the human body. The human skeleton performs many different functions. There are more than 200 bones in the human body. The spinal column consists of 26, the skull - of 29 bones. The skeleton of the lower extremities is formed by 62 bones, and the upper extremities - 64.

Human skeleton:

1) performs a supporting function, supporting a variety of soft tissues;

2) protects the internal organs, creating receptacles for them;

3) is a depot organ for many important macronutrients (calcium, phosphorus, magnesium). These substances are essential for normal metabolism.

Bone (os) outside covered with periosteum (periosteum), inside the bone there is a medullary cavity (cavitas medullares), in which red and yellow bone marrow (medulla ossium rubra et flava) is located.

The strength of bone is determined by the content of organic and inorganic compounds in it. Bone is composed of 29% organic, 21% inorganic, and 50% water.

Bone classification:

1) tubular bones (os longum) most often have a triangular or cylindrical shape. The length of the bone can be divided into approximately three parts. The central part, which occupies a large proportion of the length of the bone, is the diaphysis, or the body of the bone, and the epiphyses (epiphysis) - the marginal parts that have a thickened shape. The epiphyses have an articular surface (facies articularis), which is covered with articular cartilage. The junction of the diaphysis and the epiphysis is called the metaphysis.

There are long tubular bones (for example, shoulders, thighs, forearms, lower legs) and short ones (for example, phalanges of fingers, metacarpals and metatarsals);

2) flat bones (ossa plana). These include the bones of the pelvis, ribs, sternum, bones of the roof of the skull;

3) mixed bones (ossa irregularia) have a complex structure and a variety of shapes (an example is a vertebra);

4) spongy bones (os breve) often have the shape of an irregular cube (tarsal and wrist bones);

5) air bones (ossa pneumatica) have in their thickness a cavity lined with epithelium and filled with air (for example, upper, sphenoid, ethmoid, frontal jaws).

Elevations on the surface of the bone, to which ligaments and muscles are attached, are called apophyses. The apophyses include the crest (crista), tubercle (tuber), tubercle (tuberculum) and process (processus). In addition to elevations, there are depressions - a pit (fossula) and a pit (fovea).

Edges (margo) delimit the surface of the bone.

If a nerve or vessel is adjacent to the bone, then a groove (sulcus) is formed as a result of pressure.

When a nerve or vessel passes through a bone, a notch (incisura), a canal (canalis), a tubule (canaliculus) and a fissure (fissure) are formed.

There are nutritional holes (foramina nutricia) on the surface of the bone.

2. STRUCTURE OF THE CERVICAL, THORACIC AND LUMBAR VERTEBRAE

The cervical vertebrae (vertebrae cervicales) have a feature - the opening of the transverse process (foramen processus transverses). On the upper surface of the transverse process there is a groove for the spinal nerve (sulcus nervi spinalis). The process ends with two tubercles: anterior and posterior.

The first cervical vertebra (atlas) does not have a body, but has anterior and posterior arches (arcus anterior et posterior) and a lateral mass (massa lateralis). There is an anterior tubercle on the anterior surface of the anterior arch, and a posterior tubercle on the posterior surface of the posterior arch. On the lateral masses there are upper (connected to the condyles of the occipital bone) and lower (connected to the second vertebra) articular surfaces.

II cervical vertebra (axis) has a distinctive feature - a tooth (dens), located on the upper surface of the body. The tooth has an apex (apex), anterior and posterior articular surfaces.

At the VI cervical vertebra, the posterior tubercle is better developed than on other vertebrae, and is called sleepy (tuberculum caroticum).

VII cervical vertebra is called protruding (vertebra prominens) due to the long spinous process.

The thoracic vertebrae (vertebrae thoracicae) have smaller vertebral foramens compared to the cervical ones. The thoracic vertebrae from II to IX have upper and lower costal fossae (fovea costales superior et inferior) on the posterolateral surfaces on the right and left. On the anterior surface of the transverse processes from I to X vertebrae there is a costal fossa of the transverse process (fovea costalis processus transverse).

Lumbar vertebrae (vertebrae lumbales) have a massive body and additional processes (processus accessories). All upper articular processes have a mastoid process (processus mamillares).

3. STRUCTURE OF THE SACUM AND KOPPIK

The sacrum (os sacrum) consists of five lumbar vertebrae fused into a single bone. It has a base (basis ossis sacri), an apex (apex ossis sacri), a concave pelvic surface (facies pelvia) and a convex posterior surface (facies dorsalis).

On the pelvic surface there are four transverse lines, at the ends of which the anterior sacral openings (foramina sacralia anteriora) open.

On the back surface there are five longitudinal ridges: median (crista sacralis mediana), paired intermediate (crista sacralis intermedia) and paired lateral crests (crista sacralis lateralis). Near the intermediate crests, the posterior sacral foramens open. Outside of the lateral crests is the lateral part, on which the articular surface is located. Next to it is the sacral tuberosity (tuberositas sacralis). The sacrum has a canal ending in the sacral fissure (hiatus sacralis), on the sides of which are the sacral horns (cornu sacrale).

The coccyx (os coccyges) consists of 4-5 coccygeal vertebrae. The coccyx is connected to the sacrum through the body and coccygeal horns.

4. STRUCTURE OF THE RIBS AND BREAST

Ribs (costae) consist of bone (os costale) and cartilaginous parts (cartilago costales). Seven pairs of upper ribs are called true and are connected by a cartilaginous part to the sternum. The remaining ribs are called false or oscillating (costae fluctuantes).

The ribs have a head (caput costae) and a neck (collum costae), between which there is a tubercle. On the top ten pairs of ribs, the tubercle is bifurcated. Behind the neck is the body (corpus costae), which has a rib angle (angulus costae). Throughout the body of the rib in its lower part there is a groove of the rib.

The first rib differs in structure from other ribs. It has medial and lateral edges delimiting the superior and inferior surfaces. On the upper surface there is a tubercle of the anterior scalene muscle (tuberculum musculi scaleni anterioris), anterior to which is the groove of the subclavian vein, and behind it is the groove of the subclavian artery.

The sternum (sternum) consists of three parts: the handle (manubrium sterni), the body (corpus sterni) and the xiphoid process (processus xiphoideus).

The handle has jugular and clavicular notches. The handle and body form the angle of the sternum (angulus sterni). On the edges of the body of the sternum there are costal notches (incisurae costales).

5. BELT OF THE UPPER LIMB

The scapula is a flat bone. The scapula has three angles: upper (angulus superior), lower (angulus inferior) and lateral (angulus lateralis) - and three edges: upper (margo superior), having a notch (incisura scapulae), lateral (margo lateralis) and medial (margo medialis) ).

There are concave - anterior costal (facies costalis) - and posterior - convex - surfaces (facies posterior). The costal surface forms the subscapular fossa. The posterior surface has the spine of the scapula (spina scapulae), which divides it into the supraspinatus and infraspinatus fossa. These pits contain the muscles of the same name. The spine of the scapula ends in the acromion, at the apex of which there is an articular surface.

The lateral angle of the scapula forms the articular cavity (cavitas glenoidalis), which includes the head of the humerus. The articular surface, narrowing, forms supra- and subarticular tubercles. Behind the glenoid cavity is the neck of the scapula (collum scapulae). From the upper edge of the scapula upward and anteriorly, the coracoid process (processus coracoideus) departs.

The clavicle (clavicula) has an S-shape. The clavicle has a body (corpus claviculae), thoracic (extremitas sternalis) and acromial (extremitas acromialis) ends. At the thoracic end there is a sternal articular surface. The acromial end of the clavicle is connected to the acromion of the scapula. The upper surface of the clavicle is smooth, and on the lower there is a cone-shaped tubercle (tuberculum conoideum) and a trapezoid line (linea trapezoidea).

6. SKELETON OF THE FREE UPPER LIMB. STRUCTURE OF THE HUMERUS AND BONES OF THE FOREARM. STRUCTURE OF THE BONES OF THE HAND

The humerus (humerus) has a body (central part) and two ends. The upper end passes into the head (capet humeri), along the edge of which the anatomical neck (collum anatomykum) passes. Behind the anatomical neck are large (tuberculum majus) and small tubercles (tuberculum minus), from which the crests of the same name (cristae tuberculi majoris et minoris) extend. Between the tubercles there is an intertubercular groove (sulcus intertubercularis).

Between the head and the body of the humerus is the thinnest place of the bone - the surgical neck (collum chirurgicum).

In the lower half of the humerus, which has a triangular shape, three surfaces are distinguished: medial, lateral and posterior. On the lateral surface there is a deltoid tuberosity (tuberositas deltoidea), below which there is a groove of the radial nerve (sulkus nervi radialis). The distal end of the humerus ends in a condyle (condilus humeri), the medial part of which is represented by the block of the humerus (trochlea humeri), and the lateral part by the head of the condyle of the humerus (capitulum humeri). Above the trochlea in front there is a coronoid fossa (fossa coronaidea), and behind there is an olecranon fossa (fossa olekrani). Above the head of the condyle is the radial fossa (fossa radialis). Above the condyles there are elevations - the epicondyles: medial and lateral. The medial epicondyle (epicondylus medialis) passes into the medial ridge, which forms the medial edge of the humerus. On its posterior surface there is a groove of the ulnar nerve (sulcus nervi ulnaris). The lateral epicondyle (epicondylus lateralis) passes into the lateral ridge, forming the lateral edge.

The bones of the forearm include the ulna and radius.

The radius has a body and two ends. The proximal end passes into the head of the radius (caput radii), on which there is an articular fossa (fovea artikularis). Under the head is the neck of the radius (collum radii), behind which is the tuberosity (tuberositas radii). The distal end has an ulnar notch (incisura ulnaris) on the medial side, and a styloid process (processus styloideus) on the lateral side. The lower surface of the distal end is represented by the concave carpal articular surface.

Ulna (ulna). At its proximal end there is a block-shaped notch (incisura trochlearis), ending with two processes: the ulnar (olecranon) and the coronal (processus coronoideus). On the coronoid process is the radial notch (incisura radialis), and just below this process is the tuberosity of the ulna (tuberositas ulnae). The distal end ends with a head (caput ulnae), from the medial side of which the styloid process (processus styloideus) departs. The head has an articular circumference (circumferencia articularis).

The hand (manus) consists of the bones of the wrist (ossa carpi), metacarpus (ossa metacarpi) and phalanges (phalanges) of the fingers.

The wrist (carpus) consists of eight bones arranged in two rows. The first row is formed by the pisiform (os pisiforme), trihedral (os triquetrum), lunate (os lunatum) and scaphoid (os scaphoideum) bones. The second row of bones are hook-shaped (os hamatum), capitate (os capitatum), trapezoid bones (os trapezoideum) and bone-trapezium (os trapezium).

There are five metacarpal bones. They distinguish the body (corpus metacarpale), the base (basis metacarpale) and the head (caput metacarpale).

Phalanges of fingers. All fingers, with the exception of the thumb, have three phalanges: proximal, middle and distal. In the phalanx, the body, base and head are distinguished.

7. LOWER LIMB BELT

Pelvic bone (os coxae) consists of three bones fused together: the ilium, pubic and ischium, the bodies of which form the acetabulum (acetabulum). In the center of the depression there is a hole of the same name. The acetabulum is limited by a high edge, which, interrupted on the medial side, forms the notch of the acetabulum (incisura acetabuli). Along the periphery of the cavity (in its lower part) is the semi-lunar surface (facies lunata).

The ischium (ischium) has the body and branches of the ischium. An angle is formed between the body and the branch, in the region of which the ischial tubercle (tuber ischiadicum) is located.

The ilium (os ilium) has a body (corpus ossis illi) and a wing (ala ossis illi). The wing ends with a convex edge - the iliac crest (crista iliaca), on which three lines are distinguished: the outer lip (labium externum), the intermediate line (linea intermedia) and the inner lip (labium internum).

On the crest in front and behind there are symmetrically located protrusions: the upper anterior (spina iliaca anterior superior), the lower anterior (spina iliaca anterior inferior), the upper posterior (spina iliaca posterior superior) and the lower posterior iliac spine (spina iliaca posterior inferior).

Three lines are located on the outer surface of the wing: the anterior, posterior and lower gluteal lines (lineae gluteales anterioris, posterioris et inferioris). On the inner surface of the wing there is an iliac fossa (fossa iliaca), the lower border of which is an arcuate line (linea arcuata), starting from the ear-shaped surface (facies auricularis). Above this surface is the iliac tuberosity (tuberositas iliaca).

Pubic bone (os pubis) has a body from which the upper branches (ramus superior ossis pubis) depart, having an iliac-pubic eminence (eminencia iliopubica). On the upper branches is the pubic tubercle (tuberculum pubicum), from which the crest of the same name begins. The anterior parts of the upper branches bend down and are considered as the lower branches (ramus inferior ossis pubis). The place of transition of the upper branches to the lower ones is called the symphyseal surface.

8. STRUCTURE OF THE SKELETON OF THE FREE PART OF THE LOWER LIMB. STRUCTURE OF THE FEMOR, PATELLET AND SHIN BONES. BONE STRUCTURE OF THE FOOT

The femur (os femoris) has a body and two ends. The proximal end passes into the head (caput ossis femoris), in the middle of which is the fossa of the same name. The transition of the head into the body is called the neck (collum femoris). On the border of the neck and body are large (trochanter major) and small (trochanter minor) skewers, connected in front by an intertrochanteric line (linea intertrochanterica), and behind - by a crest of the same name.

On the posterior surface of the bone body there is a rough line (linea aspera), which is divided into medial and lateral lips. The lateral lip passes into the gluteal tuberosity (tuberositas glutea), and the medial lip into the comb line (linea pectinea). Diverging at the distal end of the bone, the lips form the popliteal surface (facies poplitea). The distal end of the femur is formed by two condyles - medial and lateral, delimited posteriorly by the intercondylar fossa (fossa intercondylaris). Connecting, the articular surfaces of the condyles form the patellar surface (facies patellaris). Above the condyles are the epicondyles of the same name.

In the patella (patella), the base, apex, anterior and articular surfaces are distinguished.

The lower leg consists of the tibia and fibula, between which is located the interosseous space (spatium interossium cruris).

The fibula has a body and two ends. At the proximal end there is a head (caput fibulae), on which there is an apex and an articular surface of the head (facies articularis capitis fibulae). The place where the head meets the body is called the neck (collum fibulae). The body has three surfaces - medial, lateral and posterior, separated by three edges - anterior, posterior and interosseous.

The distal end of the fibula forms the lateral malleolus (malleolus lateralis).

The tibia (tibia) has a body and two ends. The proximal end has a medial and lateral condyles (condylus medialis et lateralis) and an upper articular surface. The articular surfaces of the condyles are separated by the medial and lateral intercondylar tubercles.

On the lateral side of the lateral condyle is the peroneal articular surface (facies articularis fibularis).

The body of the tibia has three surfaces - medial, lateral and posterior, delimited by three edges - medial, anterior and interosseous. On the anterior edge is the tuberosity of the tibia (tuberositas tibiae). The distal end of the bone has a fibular notch (incisura fibularis), and the medial malleolus (malleolus medialis) extends from the medial side.

The bones of the foot (ossa pedis) consist of the bones of the tarsus (ossa tarsi), metatarsal bones (ossa metatarsi) and phalanges (phalanges).

The bones of the tarsus consist of seven bones arranged in two rows.

The first row is the talus (talus) and calcaneus (calcaneus). In the talus, the neck, head, block of the talus are distinguished. The talus has three articular surfaces: superior, medial and lateral. The calcaneus has anterior and posterior talar surfaces.

The second row consists of five bones: the cuboid bone (os cuboideum), the sphenoid bones (medial, lateral and intermediate) (ossa cuneiformia) and the navicular bone (os naviculare).

Metatarsal bones are short tubular bones. They have a body, base and head.

Phalanxes. All fingers, with the exception of the thumb, have three phalanges: proximal, middle, and distal. In the phalanx, the body, base and head are distinguished.

9. STRUCTURE OF THE SKULL. SPHENOID BONE. OCCIPITAL BONE

The skull (cranium) is a collection of tightly connected bones and forms a cavity in which vital organs are located: the brain, sensory organs and the initial sections of the respiratory and digestive systems. In the skull, brain (cranium cerebrale) and facial (cranium viscerale) sections of the skull are distinguished.

The brain part of the skull is formed by the occipital, sphenoid, parietal, ethmoid, frontal and temporal bones.

Sphenoid bone (os sphenoidale) is located in the center of the base of the skull and has a body from which processes extend: large and small wings, pterygoid processes.

The body of the sphenoid bone has six surfaces: anterior, inferior, superior, posterior and two lateral. The upper one has a depression - the sella turcica (sella turcica), in the center of which is the pituitary fossa (fossa hypophysialis). Anterior to the recess is the back of the sella, the lateral parts of which form the posterior inclined processes (processus clinoidei posteriores). At the base of the back there is a carotid groove (sulcus caroticus). The anterior surface of the body is elongated into a wedge-shaped crest (crista sphenoidalis), which continues into the keel of the same name. On the sides of the ridge there are sphenoid conchae, which limit the opening of the sphenoid sinus, leading to the sinus of the same name.

The large wing of the sphenoid bone (ala major) has three holes at the base: round (foramen rotundum), oval (foramen ovale) and spinous (foramen spinosum). The large wing has four surfaces: temporal (facies temporalis), maxillary (facies maxillaries), orbital (facies orbitalis) and brain (facies cerebralis), on which arterial grooves and finger-like depressions are located.

The small wing (ala minor) has an anterior inclined process (processus clinoideus anterior) on the medial side. Between the small and large wing there is a space called the superior orbital fissure (fissura orbitalis superior).

The pterygoid process (processus pterigoideus) of the sphenoid bone has lateral and medial plates fused in front. Behind the plates diverge and form a pterygoid fossa (fossa pterigoidea). At the base of the process passes the canal of the same name.

Occipital bone (os occipitale) has a basilar part, lateral parts and scales. Connecting, these departments form a large occipital foramen (foramen magnum).

The basilar part (pars basilaris) of the occipital bone has a platform - a slope (clivus). On the lateral edge of this part there is a groove of the lower stony sinus (sulcus sinus petrosi inferioris), on the lower surface there is a pharyngeal tubercle (tuberculum pharyngeum).

The lateral part (pars lateralis) of the occipital bone has an occipital condyle (condylus occipitalis) on the lower surface. Above the condyles passes the hyoid canal (canalis hypoglossalis), behind the condyle is the fossa of the same name, at the bottom of which is the condylar canal (canalis condylaris). Laterally from the condyle there is a jugular notch, bounded behind by the jugular process (processus jugularis), next to which the sulcus of the sigmoid sinus passes.

The occipital scales (squama occipitalis) of the occipital bone has an external occipital protrusion (protuberantia occipitalis externa) in the center of the outer surface, from which the crest of the same name descends. From the occiput to the right and left goes the upper nuchal line (linea nuchae superior), parallel to which runs the lower nuchal line (linea nuchae inferior). The highest nuchal line (linea nuchae suprema) can be distinguished. On the cerebral surface there is a cruciform eminence (eminentia cruciformis), the center of which is called the internal occipital protrusion, from which the groove of the transverse sinus (sulcus sinus transverse) extends to the right and left. Above the protrusion is the groove of the superior sagittal sinus (sulcus sinus sagittalis superioris).

10. FRONTAL BONE. PARIETAL BONE

frontal bone (os frontale) consists of the nasal and orbital parts and the frontal scales, which occupy most of the cranial vault.

The nasal part (pars nasalis) of the frontal bone on the sides and in front limits the ethmoid notch. The median line of the anterior part of this part ends with the nasal spine (spina nasalis), to the right and left of which is the frontal sinus aperture (apertura sinus frontalis), which leads to the right and left frontal sinuses.

The right part of the orbital part (pars orbitalis) of the frontal bone is separated from the left ethmoid notch (incisura ethmoidalis). On its brain surface there are finger-like impressions.

The orbital surface forms the upper wall of the orbits, near its medial corner there is a trochlear fossa (fossa trochlearis), and in the lateral corner there is a fossa of the lacrimal gland (fossa glandulae lacrimalis). Next to the trochlear fossa there is an awn of the same name.

The frontal scales (squama frontalis) of the frontal bone has an internal (facies interna), external (facies externa) and temporal surfaces (facies temporales).

In the medial part of the supraorbital margin (margo supraorbitalis) of the frontal bone there is a frontal notch (incisura frontalis). The lateral part of the supraorbital margin ends with the zygomatic process (processus zygomaticus), from which the temporal line (linea temporalis) departs. Above the supraorbital margin is the superciliary arch (arcus superciliaris), which passes into a flat area (glabella). On the inner surface there is a groove of the superior sagittal sinus (sulcus sinus sagittalis superioris), in front of which passes into the frontal crest (crista frontalis), at the base of which there is a blind hole (foramen caecum).

Parietal bone (os parietale) has four edges: occipital, frontal, sagittal and scaly. Four corners correspond to these edges: frontal (angulus frontalis), occipital (angulus occipitalis), wedge-shaped (angulus sphenoidalis) and mastoid (angulus mastoideus).

The parietal bone forms the upper lateral vaults of the skull. In the center of the convex outer surface is the parietal tubercle (tuber parietale), below which are the upper and lower temporal lines (lineae temporales superior et inferior). On the inner concave surface along the upper edge of the parietal bone there is a groove of the superior sagittal sinus (sulcus sinus sagittalis superioris), along which there are dimples of granulations (foveolae granulares). On the entire inner surface there are arterial grooves (sulci arteriosi), and in the region of the mastoid angle there is a groove of the sigmoid sinus (sulcus sinus sigmoidei).

11. TEMPORAL BONE

Temporal bone (os temporale) is a receptacle for the organs of balance and hearing. The temporal bone, connecting with the zygomatic bone, forms the zygomatic arch (arcus zygomaticus). The temporal bone consists of three parts: squamous, tympanic and petrosal.

The squamous part (pars squamosa) of the temporal bone has an external smooth temporal surface (facies temporalis), on which the groove of the middle temporal artery (sulcus arteriae temporalis mediae) passes. From this part (just above the external auditory canal) begins the zygomatic process (processus zygomaticus), at the base of which is the mandibular fossa (fossa mandibularis). In front, this fossa is limited by the articular tubercle (tuberculum articulare). On the inner cerebral surface (facies cerebralis) there are finger-like depressions and arterial grooves.

The tympanic part (pars tympanica) of the temporal bone is fused with its edges with the mastoid process and the squamous part, limiting the external auditory opening (porus acusticus externus) on three sides, the continuation of which is the external auditory canal (meatus acusticus externus). Behind, at the site of fusion of the tympanic part with the mastoid process, a tympanic-mastoid fissure (fissura tympanomastoidea) is formed. In front of the auditory opening there is a tympanic-squamous fissure (fissura tympanosquamosa), which is divided by the edge of the roof of the tympanic cavity into a stony-scaly (fissura petrosquamosa) and a stony-tympanic fissure (fissura petrotympanica).

The stony part, or pyramid (pars petrosa), of the temporal bone has the shape of a trihedral pyramid. In the pyramid, the apex (apex partis petrosae), anterior, posterior and inferior surfaces, superior and posterior margins, and mastoid process are distinguished.

Canals of the temporal bone.

The anterior surface of the temporal bone on the lateral side passes into the medullary surface of the squamosal bone, from which it is separated by the petrosquamosal fissure (fissura petrosquamosa). Next to the stony-scaly fissure lies the opening of the muscular-tubal canal (canalis musculotubaris), which is divided by a septum into two semi-canals. One of them is the hemicanal of the auditory tube, and the other is the tensor tympani muscle.

In the middle of the anterior surface of the temporal bone there is an arcuate elevation (eminencia arcuata), between it and the stony-scaly fissure is the roof of the tympanic cavity (tegmen tympani). Near the top of the anterior surface there is a trigeminal depression, lateral to which is the opening of the canal of the large stony nerve (hiatus canalis nervi petrosi majoris), from which the sulcus of the same name begins. Lateral to this canal is the opening of the canal of the small stony nerve, the sulcus of the same name departs from it.

In the middle of the posterior surface of the pyramid of the temporal bone is the internal auditory opening (porus acusticus internus), which passes into the internal auditory meatus. Lateral to this opening lies the subarc fossa (fossa subarcuata), below and lateral to which there is an external opening of the vestibule water supply (apertura externa aqueductus vestibuli).

The lower surface of the pyramid of the temporal bone has a jugular fossa (fossa jugularis) at the base, on the front wall of which there is a groove ending in a mastoid opening (foramen mastoideus). The posterior wall of the jugular fossa is represented by the notch of the same name. This notch and notch of the occipital bone form the jugular foramen (foramen jugulare). In front of the jugular fossa, the carotid canal (canalis caroticus) begins, in the wall of which there are small pits that continue into the carotid-tympanic tubules. On the crest, which separates the jugular fossa and the external opening of the carotid canal, there is a stony dimple (fossula petrosa), at the bottom of which the lower opening of the tympanic tubule opens. Lateral to the jugular fossa, the styloid process (processus styloideus) begins, posterior to which there is a stylomastoid foramen (foramen stylomastoideum).

The upper edge of the pyramid of the temporal bone separates the anterior surface from the posterior one, and a furrow of the superior petrosal sinus (sulcus sinus petrosi superioris) passes along its surface.

The posterior edge of the pyramid of the temporal bone separates the posterior and inferior surfaces, along it there is a furrow of the lower stony sinus (sulcus sinus petrosi inferioris).

The mastoid process (processus mastoideus) of the temporal bone is separated from the squamous part by the parietal notch (incisura parietalis) from above, and from below the process is limited by the mastoid notch (incisura mastoidea). Medial to the latter is the sulcus of the occipital artery (sulcus arteriae occipitalis). On the inner surface of the process there is a wide groove of the sigmoid sinus (sulcus sinus sigmoidei). The internal structure of the process is represented by cells, the largest of which is called the mastoid cave (antrum mastoideum).

Numerous channels and tubules pass through the temporal bone:

1) mastoid tubule (canaliculus mastoideus);

2) tympanic tubule (canaliculus tympanicus);

3) tubule of the drum string (canaliculus chordae tympani);

4) carotid-tympanic tubules (canaliculus caroticotympanici);

5) carotid canal (canalis caroticus);

6) facial canal (canalis facialis);

7) muscular-tubal canal (canalis musculotubarius).

12. ethmoid bone

Ethmoid bone (os ethmoidale) consists of a lattice labyrinth, lattice and perpendicular plates.

The ethmoid labyrinth (labyrinthus ethmoidalis) of the ethmoid bone consists of communicating ethmoid cells (cellulae ethmoidales). On the medial side are the superior and middle nasal conchas (conchae nasales superior et media). There is the highest nasal concha (concha nasalis suprema). Under the middle nasal concha there is a nasal passage of the same name, the middle nasal concha at the posterior end has a hook-shaped process (processus uncinatus), posterior to which is a ethmoidal vesicle (bulla ethmoidalis). Between the last formations there is a funnel of the same name. The lateral side of the ethmoid labyrinth is covered with a plate, which is part of the orbital plasty (lamina orbitalis).

The cribriform plate (lamina cribrosa) is the upper part of the ethmoid bone. Above the plate there is an elevation - the cockscomb (crista galli), which anteriorly continues into the wing of the cockscomb (ala cristae galli).

The perpendicular plate (lamina perpendicularis) of the ethmoid bone is a continuation of the cockscomb from top to bottom.

13. STRUCTURE OF THE BONES OF THE FACIAL SECTION OF THE SKULL

The bones that form the facial skull include the maxilla, mandible, palatine bone, inferior nasal concha, nasal bone, vomer, zygomatic, lacrimal, and hyoid bones.

Lower jaw (mandibula) has a body and branches.

The body of the lower jaw (corpus mandibulae) has a lower - base (basis mandibulae) - and an upper - alveolar (pars alveolaris) - part, the latter contains the dental alveoli, separated by interalveolar septa (septa interalveolaria). The outer surfaces of the alveolar arches have alveolar elevations.

On the front of the body there is a chin protrusion (protuberantia mentalis), ending with a chin tubercle (tuberculum mentale), posterior to which, at the level of the second premolar, there is a hole of the same name.

On the inner surface of the body there is a chin spine (spina mentalis), to the right and left of which there are digastric fossae (fossa digastrica). Above the upper edge of the spine is the hyoid fossa (fossa sublingualis), under which there is a weakly pronounced maxillo-hyoid line (linea mylohyoidea). Below this line is the submandibular fossa (fossa submandibularis).

When the body passes into the posterior edge of the ramus, the angle of the lower jaw (angulus mandibulare) is formed. On the outer side of the angle of the lower jaw there is a chewing tuberosity (tuberositas masseterica), on the inner surface there is a wing-shaped one (tuberositas pterigoidea).

On the inner surface of the branch of the lower jaw (ramus mandibulae) there is an opening of the lower jaw (foramen mandibulae), limited on the medial side by the tongue of the same name. Behind the uvula is the maxillary-hyoid groove (sulcus mylohyoideus).

The branch of the lower jaw ends with two processes - the coronal and condylar, between which is located the notch of the lower jaw (incisura mandibulae). The coronoid process (processus coronoideus) has a buccal ridge (crista buccinatoria) that goes to the last molar. The condylar process (processus condilaris) ends with the head of the lower jaw (caput mandibulae), continuing into the neck of the same name, on the front surface of which there is a pterygoid fossa (fossa pterigoidea).

14. UPPER JAW

Upper jaw (maxilla) has a body and four processes: zygomatic, alveolar, palatine and frontal.

The zygomatic process (processus zygomaticus) of the upper jaw is connected to the zygomatic bone.

The frontal process (processus frontalis) of the upper jaw on its medial surface has a crib crest (crista ethmoidalis), on the lateral surface - the anterior lacrimal crest (crista lacrimalis anterior).

The palatine process (processus palatinus) departs from the upper jaw on the medial edge has a nasal crest (crista nasalis), takes part in the formation of the hard palate when connected to the process of the same name on the opposite side. When they are connected, a median suture is formed, at the front end of which there is an opening for the incisive canal. In the posterior part of the lower surface of the palatine process there are palatine furrows (sulci palatini).

The lower edge of the alveolar process (processus alveolaris) on the upper jaw has dental alveoli (alveoli dentales), separated by interalveolar septa (septa interalveolaria). On the outer surface of the process there are elevations of the same name.

The body of the upper jaw (corpus maxillae) has a maxillary sinus (sinus maxillaries), which communicates with the nasal cavity through the maxillary cleft. The anterior surface is separated from the orbital surface by the infraorbital margin, under which there is an opening of the same name (foramen infraorbitale). Under this hole is the canine fossa (fossa canina).

On the medial edge of the upper jaw there is a nasal notch, the lower edge of which forms the anterior nasal spine (spina nasalis anterior).

The nasal surface has a lacrimal sulcus (sulcus lacrimalis), in front of which is the shell crest (crista conchalis).

The orbital surface forms the inferior wall of the orbit. On its back, the infraorbital groove (sulcus infraorbitalis) begins, which anteriorly passes into the canal of the same name.

The infratemporal surface has a tubercle of the upper jaw (tuber maxillae), on which alveolar openings (foramina alveolaria) open, leading to the canals of the same name. The greater palatine sulcus (sulcus palatinus major) passes medially to the tubercle.

Inferior turbinate (concha nasalis inferior) has three processes: ethmoid (processus ethmoidalis), lacrimal (processus lacrimalis) and maxillary (processus maxillaris).

Cheekbone (os zygomaticum) has three surfaces: temporal, orbital and lateral - and two processes: temporal and frontal. On the orbital surface there is a zygomatic orbital foramen (foramen zygomaticoorbitale).

15. SMALL BONES OF THE NOSE

Lacrimal bone (os lacrimale) has a posterior lacrimal crest (crista lacrimalis posterior) on the lateral surface, which ends with a lacrimal hook (hamulus lacrimalis). In front of the crest is the lacrimal sulcus (sulcus lacrimalis), which is involved in the formation of the fossa of the lacrimal sac (fossa sacci lacrimalis).

Coulter (vomer) is involved in the formation of the bony septum of the nose and has two wings (alae vomeris) on the upper back edge.

Nasal bone (os nasale) forms the bony back of the nose; has three edges: upper, lower and lateral. On its front surface there is a ethmoidal groove (sulcus ethmoidalis).

Hyoid bone (os hyoideum) has a body (corpus ossis hyoidei), large (cornu majora) and small horns (cornu minora).

Palatine bone (os palatum) consists of perpendicular and horizontal plates connected at right angles; has three processes: wedge-shaped (processus sphenoidalis), orbital (processus orbitalis) and pyramidal (processus pyramidalis).

The perpendicular plate (lamina perpendicularis) of the palatine bone has a large palatine groove (sulcus palatinus major) on the lateral surface, which, with the same grooves of the sphenoid bone and the upper jaw, forms a large palatine canal, which ends with a large palatine opening (foramen palatinum majus). On the medial surface of the perpendicular plate are shell (crista conchalis) and ethmoid crests (crista ethmoidalis).

The horizontal plate (lamina horisontalis) of the palatine bone is involved in the formation of the bony palate (palatum osseum). It has two surfaces: the upper nasal, on which the nasal crest (crista nasalis) is located, passing into the posterior nasal spine (crista nasalis posterior) and the palatine.

LECTURE 2. ARTROLOGY

1. GENERAL INFORMATION ABOUT ARTROLOGY

For the normal functioning of the skeletal system, their functionally beneficial connection is necessary, due to which the normal functioning of the bones of the skeleton as a whole will be.

Classification of bone joints.

1) continuous connections of bone tissue, in which there is no gap between the connecting bones. There are three types of continuous, or fibrous, joints (articulationes fibrosae), which include injections, syndesmoses and sutures:

a) gomphosis is a special compound; so the teeth are connected to the bone tissue of the alveoli, while between the connecting surfaces there is a periodontium (periodontum), which is a connective tissue;

b) syndesmosis (syndesmosis) is represented by bone tissue, the fibers of which are fused with the periosteum of the connecting bones. Syndesmoses include interosseous membranes (membranae interosseae) and ligaments (ligamenta). Interosseous membranes are located between the diaphyses of tubular bones. Ligaments of the spinal column are formed by yellow ligaments (ligamenta flava), formed by elastic connective tissue;

c) with a seam (sutura) there is a small layer of connective tissue between the edges of the connecting bones. There are the following types of seams: flat (sutura plana), serrated (sutura serrata) and scaly (sutura squamosa);

2) discontinuous connections (articulationes synoviales), or joints. The joint has a complex structure, in its formation the articular surfaces of the connecting bones, covered with cartilage, the articular cavity with synovial fluid, the articular capsule and auxiliary formations (articular discs, menisci, articular lips) take part.

Articular surfaces (facies articulares) most often correspond to each other in shape (for example, the articular head and articular cavity).

Articular cartilage (cartilago articularis) consists of three zones: deep (zona profunda), intermediate (zona intermedia) and superficial (zona superficialis). Most often, articular cartilage is represented by hyaline cartilage and has a thickness of up to 6 mm.

The articular cavity (cavum articulare) has a small amount of synovial fluid (synovia) and is limited by the synovial membrane of the joint capsule.

The joint capsule (capsula articularis) has two layers: the inner one - the synovial membrane (membrana synovialis) - and the outer one - the fibrous membrane (membrana fibrosa). Sometimes the fibrous membrane forms ligaments that strengthen the joint capsule - capsular ligaments (ligamentae capsularia). Ligaments located outside the capsule are called extracapsular (ligamentae extracapsularia), and inside the capsule - intracapsular (ligamentae intracapsularia). The synovial membrane has synovial villi (villi synoviales). In places where the articular surfaces do not coincide, the synovial membrane forms folds (plicae synovialis).

The articular lip (labrum articulare) complements and deepens the articular surface, located along the edge of its concave surface.

Articular discs and menisci (disci et menisci articulares). Menisci are represented by discontinuous cartilaginous (connective tissue) crescent-shaped plates. The disks are represented by solid plates. Disks and menisci, shifting during movement in the joint, smooth out the irregularities of the articular articular surfaces.

Synovial bags (bursae synoviales) are protrusions of the synovial membrane in thinned areas of the outer membrane of the joint capsule;

3) symphyses (symphisis), or semi-joints, refer to transitional connections; in them small displacements of the connected bones are possible. Such a connection is found in the pelvis (pubic symphysis), the spinal column (intervertebral symphyses) and the sternum (symphysis of the sternum handle).

2. MOVEMENTS IN THE JOINTS. CLASSIFICATION OF JOINTS

Depending on the configuration of the articular surfaces of the articulating bones, the following movements are possible in the joints.

Flexion (flexio) and extension (extensio) are possible around the frontal axis.

Around the sagittal axis, adduction (adductio) and abduction (abbductio) are possible.

Rotation (ortatio) is possible around the longitudinal axis. Movement around all axes is called circular (circumductio).

Joint Classification:

1) simple joints (articulatio simplex), formed by two articular surfaces;

2) complex joints (articulatio composita), formed by three or more articular surfaces;

3) complex joints, which have discs or a meniscus between the articular surfaces, dividing the joint cavity into two floors, and combined - anatomically isolated joints that act together.

Anatomical and physiological classification of joints:

1) uniaxial joints. These include cylindrical (articulatio trochoidea), blocky (ginglymus) and helical joints (the latter is a type of blocky). Uniaxial joints have one axis of motion;

2) biaxial joints. These include saddle (articulatio sellaris), elliptical (articulatio ellipsoidea) and condylar joints (articulatio bicondylaris);

3) multiaxial joints. These include spherical (articulatio spheroidea), flat (articulatio plana) and bowl-shaped joints (articulatio cotylica).

3. JOINTS OF THE BELT OF THE UPPER LIMB

Joints of the girdle of the upper limb (articulationes cinguli membri superioris) connect the clavicle to the sternum and scapula.

The sternoclavicular joint (articulatio sternoclavicularis) is formed by the clavicular notch of the sternum and the sternal articular surface of the sternal end of the clavicle. This joint has an articular disc (discus articularis), which, growing together with the capsule, divides the articular cavity into two floors.

The articular capsule has anterior and posterior sternoclavicular ligaments (ligg. Sternoclavicularia anterius et posterius). Above the joint and above the jugular notch is the interclavicular ligament (lig interclaviculare), which connects the right and left sternal ends of the clavicles.

The sternoclavicular joint is strengthened by the costoclavicular ligament (lig costoclaviculare). The sternoclavicular joint, by its nature of movement, belongs to multiaxial joints with a limited range of motion.

The acromioclavicular joint (articulatio acromioclavicularis) in 30% of cases has an articular disc. The articular capsule of the joint is supported from above by the acromioclavicular ligament (lig acromioclaviculare). In addition, this joint has a powerful coracoclavicular ligament (lig coracoclaviculare), consisting of a medial bundle - the conical ligament (lig conoideum) - and a lateral bundle - the trapezoid ligament (lig trapezoideum). The acromioclavicular joint is a multi-axial joint with a limited range of motion.

There are three proper ligaments of the scapula that are not related to the joints: coracoacromial (lig coracoacromiale), lower transverse (lig transversum scapulae inferius) and upper transverse (lig transversum scapulae superius).

4. JOINTS OF THE FREE UPPER LIMB

Joints of the free upper limb (articulationes membri superioris liberi).

The structure of the shoulder joint (articulatio humeri). The shoulder joint is the most mobile in the human body. The articular capsule is thin and free, has the shape of a truncated cone and allows the articular surfaces to move away from each other up to 3 cm. The surface of the articular head of the humerus is three times larger than the articular surface of the articular cavity of the shoulder, which has an articular lip (labrum glenoidale).

The shoulder joint belongs to the spherical joints. Such a structure of the joint and the absence of well-developed ligaments are a common cause of its dislocations. The upper part of the articular capsule is thickened and forms the coraco-brachial ligament (lig coracohumerale). In addition, the capsule of the shoulder joint is strengthened by the adjacent muscles: supraspinatus, infraspinatus, teres minor and subscapularis. The synovial membrane of the capsule forms the intertubercular synovial sheath (vagina synoviales intertubercularis) and the bursa subtendia of the subscapularis muscle (bursa subtendia m. Subscapularis).

The elbow joint (articulatio сubiti) is a complex joint, formed by the articular surfaces of three bones - the humerus, radius and ulna, which have a fairly loose common capsule. Movements around the longitudinal and frontal axes are possible in the joint.

Shoulder joint (articulatio humeroradialis) refers to spherical joints. The shoulder joint (articulatio humeroulnaris) belongs to the block joints. The proximal radioulnar joint (articulatio radioulnaris proximalis) refers to cylindrical joints.

The articular capsule of the elbow joint is strengthened by the following ligaments: the ulnar (lig collaterale ulnare) and radial collateral ligaments (lig collaterale radiale), the latter consists of two bundles (the posterior bundle is woven into the annular ligament of the radius) (lig anulare radii) and the square ligament (ligatum quadratum ).

The bones of the forearm are connected by discontinuous and continuous connections. Discontinuous joints include the proximal (articulatio radioulnaris proximalis) and distal (articulatio radioulnaris distalis) radioulnar joints. The distal joint has an articular disc. The articular capsule of the distal radioulnar joint has a medially directed protrusion that forms a sac-like depression (recessus sacciformis) between the bones of the forearm. Together, the proximal and distal radioulnar joints form a combined cylindrical joint. Continuous connections include the interosseous membrane of the forearm (membrana interossea antebrachii) and the oblique chord (chorda oblique), stretched over the upper edge of the interosseous membrane.

The wrist joint (articulatio radiocarpalis) is formed by the articular disc on the medial side, the proximal surfaces of the lunate, trihedral and navicular bones and the carpal articular surface of the radius.

The wrist joint is a complex biaxial joint. The articular capsule of this joint is supported by the ulnar (lig collaterale carpi ulnare) and radial collateral ligaments of the wrist (lig collaterale carpi radiale).

On the palmar and dorsal surfaces of the wrist joint there are ligaments of the same name (palmar (lig radiocarpale palmare) and dorsal radiocarpal ligaments (lig radiocarpale dorsale)).

Intercarpal joints (articulationes intercarpales) are located between the individual bones of the wrist.

The intercarpal joint includes the pisiform joint (articulatio ossis pisiformis), which has two ligaments that are a continuation of the tendon of the ulnar flexor of the hand: the pisiometacarpale (lig pisometacarpale) and the piso-hook ligament (lig pisohamatum).

The mid-carpal joint (articulatio mediocarpalis) has a functional relationship with the wrist joint and is located between the first and second rows of the bones of the wrist.

The above joints are strengthened by ligaments from the palmar and dorsal sides of the radiant ligament of the wrist (ig carpi radiatum), palmar (ligg intercarpalia palmaria), interosseous (lig intercarpalia interossea) and dorsal intercarpal ligaments (lig intercarpalia dorsalis).

The carpometacarpal joint of the thumb (articulatio carpometacarpalis pollicis) is a saddle joint in which movements around the frontal and sagittal axes are possible.

The carpometacarpal joints (articulationes carpometacarpales) are flat, sedentary joints, have a common thin articular capsule, which is reinforced from the back and palmar sides by the palmar (ligg carpometacarpalia palmaria) and dorsal carpometacarpal ligaments (ligg carpometacarpalia dorsalia).

Intermetacarpal joints (articulationes intermetacarpales) have a common joint capsule, strengthened by the dorsal and palmar metacarpal ligaments (ligg metacarpalia dorsalia et palmaria). There are interosseous metacarpal ligaments (ligg metacarpalia interossea).

Metacarpophalangeal joints (articulationes metacarpophalanges) are formed by the articular surfaces of the heads of the metacarpal bones and the bases of the proximal phalanges. The joint capsules are strengthened on the sides by collateral ligaments (ligg collateralia), on the palmar side, the capsule is thickened by palmar ligaments (ligg palmaria). Between the heads of the metacarpal bones there are deep transverse metacarpal ligaments (ligg metacarpalia transversa profunda). Movement around the frontal and sagittal axes is possible in the joint.

The interphalangeal joints of the hand (articulationes interphalangeales manus) are formed by the head and base of the adjacent phalanx. The joints are referred to as block joints. The capsule is free, reinforced on the sides with collateral ligaments (ligg collateralia), thickened on the palmar side due to palmar ligaments (ligg palmaria).

5. STRUCTURE OF THE LOWER LIMB BELT JOINTS

The structure of the joints of the belt of the lower extremities (articulationes cinguli membri inferioris).

The sacroiliac joint (articulatio sacroiliaca) is formed by the ear-shaped articular surfaces of the sacrum and pelvic bone. The sacroiliac joint is a flat joint.

The articular capsule of the joint is very strong and strongly stretched, fused with the periosteum, strengthened in front by the anterior (ligg sacroiliaca anteriora), and in the back by interosseous (ligg sacroiliaca interossea) and posterior sacroiliac ligaments (ligg sacroiliac posteriora). The iliopsoas ligament (lig iliolumbale) is stretched between the transverse processes of the two lower lumbar vertebrae and the iliac crest.

The pubic symphysis (symphisis pubica) connects the right and left pubic bones. The symphyseal surfaces of the pubic bones are covered with cartilage and fused by the interpubic disc (discus interpubicus). The symphysis is strengthened by the superior pubic ligament (lig pubicum superior) and (from below) the arcuate ligament of the pubis (lig arcuatum pubis), which occupies the top of the subpubic angle (angulus). The lower branches of the pubic bones, limiting the subpubic angle, form the pubic arch (arcus pubis).

The pelvic bones are connected to the sacrum with the help of the sacrotuberous ligament (lig sacrotuberale), the continuation of which is the falciform process (processus falciformis), and also with the help of the sacrospinous ligament (lig sacrospinale).

Pelvis.

The sacrum and pelvic bones, connecting with the help of the sacroiliac joints and the pubic symphysis, form the pelvis (pelvis).

The pelvis is divided into two sections: the upper one - the large pelvis (pelvis major) - and the lower one - the small pelvis (pelvis minor).

The large pelvis is separated from the small pelvis by the border line, the arcuate line of the iliac bones, the crests of the pubic bones and the upper edges of the pubic symphysis. The small pelvis is represented by a cavity, the entrance to which is the upper pelvic aperture (apertura pelvis superior), and the exit is the lower pelvic aperture (apertura pelvis inferior).

The upper aperture is located in a state inclined downward and forward, making an angle of up to 60º in women and up to 55º in men with the horizontal plane. On the sides of this cavity there are obturator openings closed by the membrane of the same name (membrana obturatoria), a large (foramen ischiadicum majus) and a small sciatic foramen (foramen ischiadicum minus).

The dimensions of the pelvis are of great importance for the normal course of the birth process, so you need to know the following indicators:

1) the true conjugate (conjugata vera) is the distance between the cape and the most protruding posterior point of the pubic symphysis and is equal to 11 cm;

2) oblique diameter (diameter obliqua) is the distance between the iliac-pubic eminence and the sacroiliac joint and is equal to 12 cm;

3) the transverse diameter (diameter transversa) is the distance between the most distant points of the boundary line and is equal to 13 cm;

4) the direct size of the outlet from the pelvic cavity - the distance between the inner edges of the ischial tuberosities - is 11 cm;

5) distantia spinarum - the distance between the two upper anterior spines of the ilium - equal to 25-27 cm;

6) distantia cristarum - the distance between the most distant points of the wings of the ilium - is 28-30 cm.

6. STRUCTURE OF THE FREE LOWER LIMB JOINTS

The structure of the joints of the free lower limb (articulationes membri inferioris liberi).

The hip joint (articulatio coxae) refers to a variety of spherical joints - cup-shaped type (articulatio cotylica).

The acetabulum (labrum acetabulum) is firmly fused with the edge of the acetabulum and increases the articular surface of the pelvic bone. Part of the acetabular lip forms a transverse ligament of the acetabulum (lig transversum acetabuli), spreading over the notch of the acetabular cavity of the same name.

The joint capsule is attached around the circumference of the acetabulum in such a way that the latter is in the joint cavity.

In the joint cavity there is a ligament of the femoral head (lig capitis femoris). The fibrous membrane of the hip joint forms a bundle of fibers called the circular zone (zona orbicularis), it belongs to the ligaments of this joint. The outer side of the capsule is strengthened by the following ligaments: the ischiofemoral ligament (lig ischiofemorale), the iliofemoral ligament (lig iliofemorale) - this ligament is the most powerful ligament of the hip joint - and the pubofemoral ligament (lig pubofemorale). Due to such structural features (powerful ligaments and muscles that support the joint capsule), dislocations in the hip joint are very rare.

The knee joint (articulatio genus). This joint is the largest joint in the human body; refers to complex condylar joints.

The knee joint is formed by the femur, tibia and fibula; the articular surface of the patella articulates only with the patellar surface of the femur. The knee joint allows movement around the frontal and vertical axes. The articular surfaces of the femur and tibia are supplemented by the medial (meniscus medialis) and lateral (meniscus lateralis) menisci, which are connected in front by the transverse knee ligament (lig transversum genus). The synovial membrane, lining the fibrous membrane of the joint capsule from the inside, forms a large number of folds. The most developed of them are the unpaired infrapatellar synovial fold (plica synovialis infrapatellaris) and paired pterygoid folds (plica alares).

The knee joint has intra-articular and extra-articular ligaments that strengthen the joint. The intraarticular ligaments include the anterior (lig cruciatum anterius) and posterior cruciate ligaments (lig cruciatum posterius).

Extra-articular ligaments include oblique (lig popliteum obliquum) and arcuate popliteal ligaments (lig popliteum arcuatum), peroneal (lig collaterale fibulare) and tibial collateral ligaments (lig collaterale tibiale), patellar ligament (lig patella), lateral and medial supporting ligaments of the patella ( retinaculum patellae mediale et retinaculum patellae laterale). The tendon of the quadriceps femoris strengthens the capsule of the knee joint in front.

The knee joint has several synovial bags (bursae synoviales): patella (bursae suprapatellaris), subpatellar (bursae infrapatellaris), tendon bursa of the sartorius muscle (bursae subtendinea m sartorii), popliteal recess (recessus subpopliteus), subcutaneous prepatellar bursa (bursa subcutanea prepatellaris).

The bones of the lower leg, like the bones of the forearm, are connected by discontinuous and continuous connections.

The discontinuous joints include the tibiofibular joint (articulatio tibiofibularis), formed by the peroneal articular surface of the tibia and the articular surface of the head of the fibula. The capsule of this joint is strengthened by the posterior (lig capitis fibulae posterius) and anterior (lig capitis fibulae anterius) ligaments of the head of the fibula.

Continuous connections include the interosseous membrane of the leg (membrana interossea cruris) and the tibiofibular syndesmosis (syndesmosis tibiofibularis). In this syndesmosis, the synovial membrane of the ankle joint is invaginated, then it is called the lower tibiofibular joint (articulatio tibiofibularis inferior), which is supported by the anterior and posterior tibiofibular ligaments (ligg tibiofibularia anterius et posterius).

The ankle joint (articulatio talocruralis) is a block joint. In the joint, movement around the frontal axis is possible. On the sides, this joint is reinforced with ligaments. On the lateral side, there are three ligaments: anterior (lig talofibulare anterius) and posterior talofibular ligaments (lig talofibulare posterius), calcaneal-fibular ligament (lig calcaneofibulare). On the medial side is the deltoid ligament (lig deltoideum), in which four parts are distinguished: tibiocalcaneal (pars tibiocalcanea), tibial-navicular (pars tibionavicularis), anterior and posterior tibiotalares anterior et posterior).

7. JOINTS OF THE FOOT

The foot consists of 12 bones with little mobility. The foot has one transverse and five longitudinal arches.

The talocalcaneal-navicular joint (articulatio talocalcaneonavicularis) is formed by two joints: the subtalar (articulatio subtalaris) and the talonavicular (articulatio talonavicularis). The talocalcaneal-navicular joint is a ball-and-socket joint, but it can move only around the sagittal axis. The plantar calcaneonavicular ligament (lig calcaneonaviculare plantare) complements the anterior talar articular surface of the calcaneus. The talocalcaneal-navicular joint is strengthened by the talonavicular ligament (lig talonaviculare) and the strong interosseous talocalcaneal ligament (lig talocalcaneum).

The calcaneocuboid joint (articulatio calcaneocuboidea) belongs to the saddle joints. The articular cavity of this joint communicates with the cavity of the talocalcaneal-navicular joint. On the plantar side, the joint capsule is strengthened by the long plantar ligament (lig plantare longum) and the plantar calcaneocuboideum plantare. The calcaneocuboid joint and the talonavicular joint are considered as a single transverse joint of the tarsus - the chopard joint (articulatio tarsi transversa). Common to these joints is the bifurcated ligament (lig bifurcatum), which is divided into the calcaneocuboideum (lig calcaneocuboideum) and calcaneonavicular (lig calcaneonaviculare) ligaments.

The wedge-shaped joint (articulatio cuneonavicularis) refers to flat joints. This joint is reinforced by interosseous intersphenoid ligaments (ligg intercuneiformia interossea), dorsal and plantar cuneonavicular ligaments (ligg cuneonavicularia dorsalia et plantaria), dorsal and plantar intersphenoid ligaments (ligg intercuneiformia dorsalia et plantaria).

The Lisfranc joint, or tarsal-metatarsal joints (articulationes tarsometatarsales), refers to flat joints; formed by the cuboid and sphenoid bones and the bases of the metatarsal bones. The joint capsules are strengthened by the dorsal and plantar tarsal-metatarsal ligaments (ligg tarsometatarsalia dorsalia et plantaria), between the metatarsal and sphenoid bones there are interosseous and cuneiform ligaments (ligg cuneometatarsalia interossea).

Intermetatarsal joints (articulationes intermetatarsales) are formed by the surfaces of the bases of the metatarsal bones facing each other. The joint capsules are strengthened by the dorsal and plantar metatarsal joints (ligg metatarsalia dorsalia et plantaria) and interosseous metatarsal ligaments (ligg metatarsalia interossea).

Metatarsophalangeal joints (articulationes metatarsophalangeales) are formed by the heads of the metatarsal bones and the bases of the proximal phalanges of the fingers; belong to ball-and-socket joints. The articular capsule is strengthened on the sides by collateral ligaments (ligg collateralia), from below by plantar ligaments (ligg plantaria) and the deep transverse metatarsal ligament (lig metatarsale transversum profundum).

The interphalangeal joints of the foot (articulationes interphalanges pedis) belong to the trochlear joints. The articular capsule of these joints is strengthened from below by plantar ligaments (ligg plantaria), and from the lateral and medial sides by collateral ligaments (ligg collateralia).

8. JOINTS OF THE SKULL BONES

All bones of the skull, with the exception of the connection of the temporal bone with the lower jaw, which forms the joint, are connected using continuous connections, represented in adults by sutures, and in children by syndesmoses.

Continuous connections are formed by the edges of the frontal and parietal bones, forming a jagged coronal suture (sutura coronalis); the edges of the belt bones form a serrated sagittal suture; the edges of the parietal and occipital bones are a serrated lambdoid suture (sutura lambdoidea).

The bones that form the facial skull are connected using flat sutures. Some sutures are named after the bones that form the sutures, for example the temporozygomatic suture (sutura temporozigomatica). The scales of the temporal bone are connected to the greater wing of the sphenoid bone and the parietal bone using a scaly suture (sutura squamosa). In addition to sutures, some bones are connected using synchondrosis: the body of the sphenoid bone and the basilar part of the occipital bone - sphenooccipital synchondrosis (synchondrosis sphenooccipitalis), the pyramid of the temporal bone with the basilar part of the occipital bone - petrooccipital synchondrosis (synchondrosis petrooccipitalis). By the age of 20, synchondroses are replaced by bone tissue.

Skull joints.

The temporomandibular joint (articulatio temporomandibularis) is a complex paired elliptical joint. This joint is formed by the mandibular fossa of the temporal bone (fossa mandibularis) and the head of the lower jaw (caput mandibulae). Between these articular surfaces is the articular disc, dividing the articular cavity into two floors.

The movement in the right and left joints is symmetrical, the following movements are possible: lateral movements, lowering and raising the lower jaw and shifting the lower jaw forward and backward (to its original position).

The upper synovial membrane (membrana synovialis superior) covers the entire joint capsule, attaching along the edge of the articular cartilage, and the lower membrane (membrane synovialis inferior), in addition to the capsule, also covers the posterior surface of the articular disc. In the upper floor, the articular surface of the temporal bone articulates with the upper surface of the articular disc, and in the lower floor, the head of the lower jaw articulates with the lower surface of the articular disc.

The joint capsule is strengthened on the lateral side by the lateral ligament (lig laterale), on the medial side there are auxiliary ligaments: stylomandibular (lig stylomandibulare) and sphenomandibular ligaments (lig sphenomandibulare).

9. CONNECTION OF THE VERTEBRAS

Connection of the vertebrae (articulationes vertebrales) is carried out when the bodies, arches and processes of the vertebrae are connected.

The vertebral bodies are connected by intervertebral discs (discus intervertebrales) and symphyses (symphysis intervertebrales). The intervertebral discs are located: the first is between the bodies of the II and III cervical vertebrae, and the last is between the bodies of the V lumbar and I sacral vertebrae.

In the center of the intervertebral disc is the nucleus pulposus (nucleus pulposus), along the periphery there is a fibrous ring (annulus fibrosus), formed by fibrous cartilage. There is a gap inside the nucleus pulposus, which turns this connection into a half-joint - the intervertebral symphysis (symphysis intervertebralis). The thickness of the intervertebral discs depends on the level of location and mobility in a given section of the spinal column and ranges from 3 to 12 mm. The connections of the vertebral bodies through intervertebral discs are strengthened by the anterior (lig longitudinale anterius) and posterior (lig longitudinale posterius) longitudinal ligaments.

The vertebral arches are connected by yellow ligaments (lig flava).

Articular processes form intervertebral joints (articulationes intervertebrales), related to flat joints. The most protruding articular processes are the lumbosacral joints (articulationes lumbosacrales).

The spinous processes are connected by the supraspinous ligament (lig supraspinale), which is especially pronounced in the cervical spine and is called the ligament (lig nuchae), and the interspinous ligaments (lig interspinalia).

The transverse processes are connected by means of intertransverse ligaments (lig intertransversalia).

The atlantooccipital joint (articulatio atlantooccipitalis) consists of two symmetrically located condylar joints, being a combined joint. In this joint, movement around the sagittal and frontal axes is possible. The joint capsule is reinforced by the anterior (membrana atlantooccipitalis anterior) and posterior (membrana atlantooccipitalis posterior) atlantooccipital membranes.

The median atlantoaxial joint (articulatio atlantoaxialis mediana) is a cylindrical joint. It is formed by the anterior and posterior articular surfaces of the tooth of the axial vertebra, the articular surface of the transverse ligament of the atlas, and the fossa of the tooth of the atlas. The transverse ligament of the atlas (lig transversum atlantis) is stretched between the inner surfaces of the lateral masses of the atlas.

The lateral atlantoaxial joint (articulatio atlantoaxialis lateralis) refers to the combined joints, as it is formed by the articular fossa (fovea articularis inferior) on the right and left lateral masses of the atlas and the upper articular surface of the body of the axial vertebra. The paired lateral and median atlanto-axial joints are strengthened by paired pterygoid ligaments (lig alaria) and a ligament of the tooth apex (lig apices dentis). Behind the pterygoid ligaments there is a cruciate ligament of the atlas (lig cruciforme atlantis), which is formed by fibrous longitudinal bundles and the transverse ligament of the atlas. Behind these joints are covered with a wide integumentary membrane (membrana tectoria).

The sacrococcygeal joint (articulatio sacrococcigea) is formed by the top of the sacrum and the XNUMXst coccygeal vertebra. The joint capsule is strengthened by the ventral (lig sacrococcigeum ventrale), superficial dorsal (lig sacrococcigeum dorsale superficiale), deep dorsal (lig sacrococcigeum dorsale profundum), paired lateral sacrococcygeal ligaments (lig sacrococcygeum laterale).

The spinal column (columna vertebralis) is represented by the totality of all vertebrae connected to each other. The spinal column is the seat of the spinal cord, which is located in the spinal canal (canalis vertebralis).

There are five sections in the spine: cervical, thoracic, lumbar, sacral and coccygeal.

The spine has an S-shape due to the presence of physiological curves in the frontal and sagittal planes: thoracic and sacral kyphosis, cervical and lumbar lordosis, as well as pathological: thoracic scoliosis.

10. JOINING THE RIBS WITH THE SPINE COLUMN. RIB CAGE

The ribs are connected to the vertebrae through the costovertebral joints (articulationes costovertebrales), which are combined joints.

The joint of the head of the rib (articulatio capitis costae) is formed by the articular surface of the head of the rib and the articular surfaces of the semi-pits of adjacent thoracic vertebrae. In the joints, with the exception of I, XI and XII, there is an intra-articular ligament of the head of the rib (lig capitis costae intraarticulare). The radiant ligament of the head of the rib (lig capitis costae radiatum) strengthens the articular capsule of the joint from the outside.

The costotransverse joint (articulatio costotransversalia) is formed by the articular surfaces of the costal fossa on the transverse process of the vertebra and tubercle of the rib. The joint capsule is strengthened by the costotransverse ligament (lig costotransversarium).

The ribs are connected to the sternum: the XNUMXst rib is directly fused with the sternum, from the XNUMXnd to the XNUMXth ribs are connected by means of the sternocostal joints (articulationes sternocostales), the false ribs are not connected to the sternum, but are connected to each other, while the cartilage of the XNUMXth rib is connected to the cartilage of the XNUMXth ribs.

The articular capsules of the joints are reinforced in front and behind by radiant sternocostal ligaments (lig sternocostalia radiate), in front of these ligaments fuse with the periosteum of the sternum and form the sternum membrane (membrana sterni). Intercartilaginous joints (articulationes interchondrales) can form between the cartilages of the ribs.

The anterior ends of the ribs are connected by an external intercostal membrane stretched between them (membrana intercostalis externa), and the posterior ends by an internal intercostal membrane (membrana intercostalis interna).

The chest (compages thoracicus) consists of 12 pairs of ribs, 12 thoracic vertebrae and the sternum, interconnected by various types of joints. The thorax forms the chest cavity (cavitas thoracis), in which many internal organs are located.

There are three shapes of the chest: cylindrical, conical and flat. The upper entrance to the chest is called the upper aperture (apertura thoracis superior), the exit is called the lower aperture (apertura thoracis inferior). The ribs are separated by intercostal spaces (spatial intercostalia).

LECTURE 3. MYOLOGY

1. STRUCTURE AND CLASSIFICATION OF MUSCLES. MUSCLE WORK

The muscle (musculus) consists of bundles of striated muscle fibers covered with endomysium (endomysium), represented by a connective tissue sheath. The bundles, in turn, are demarcated by perimysium (perimysium).

Epimysium (epimysium) covers the entire muscle from the outside and continues on the tendons, covers the latter, forming peritendinium (peritendinium). The set of muscle bundles forms the abdomen (venter) of the muscle, which continues into the tendon of the muscle (tendo). Due to the tendons, the muscle is attached to the bones: the proximal tendon is conventionally located closer to the median axis than the distal one.

During muscle contraction, one of its ends moves and the other remains motionless, so a fixed point (punctum fixum), usually coinciding with the beginning of the muscle, and a moving point (punctum mobile), located at the opposite end of the muscle, are distinguished. In certain body positions, these points can change places. The tendons of different muscles differ: in some muscles the tendons are located between the two muscle bellies (m. digastricus), in other muscles the tendon is short and wide - aponeurosis (aponeurosis), sometimes the course of muscle bundles is interrupted by tendon jumpers (intersectionies tendinei), as in the oblique abdominal muscle . Arteriovenous vessels, nerves and lymphatic vessels approach the muscles from the inside.

Muscle classification.

The shape distinguishes between the broad muscles that form the walls of the body, and the fusiform muscles located on the limbs.

The muscle may have several heads, starting from different points and then forming a common abdomen and tendon. Biceps muscle - m. biceps, triceps - m. triceps, four-headed - m. quadriceps.

If the muscle is located on one side of the tendon, then it is called single-pinnate (m. unipenatus), on both sides - double-pinnate (m. bipenatus), on several sides - multi-pinnate (m. multipenatus).

In relation to the joints, single-articular, bi-articular and multi-articular muscles are distinguished. There are muscles that start and end on bones connected by continuous joints.

The name of the muscles depends on:

1) functions: there are flexors (m. flexor), extensors (m. extensor), abductors (m. abductor), adductors (m. adductor), lifters (m. levator), external rotators (m. supinator), internal rotators (m. pronator);

2) the direction of the muscle or its muscle bundles: there is a straight line (m. rectus), oblique (m. obliqus), transverse (m. transversus) muscles;

3) shapes: there are trapezoid, rhomboid, round, square muscles - and sizes: there are long, short, large, small muscles.

Muscles acting on a joint in the opposite direction are called antagonists, while muscles in a concomitant direction are called synergists.

Muscles that perform a particular movement can be divided into main and auxiliary. When contracting, the muscles perform a holding, overcoming, yielding work, the function of levers of the first and second kind.

2. GENERAL INFORMATION ABOUT THE AUXILIARY MUSCLE APPARATUS

Fascia (fasciae) forms a sheath for muscles, separating them from each other, eliminating friction when muscles contract relative to each other. Thanks to the presence of fascia, favorable conditions are created to limit the pathological process - the spread of blood or pus during injuries and diseases, and local anesthesia is possible.

Each anatomical region has its own fascia. There are superficial (fasciae superficiales) and own fascia (fasciae propriae). The superficial fascia is located under the skin, delimiting the muscles from the subcutaneous tissue. If there are several layers of muscles, they are separated by deep fascia. Muscles that perform different functions are separated by intermuscular septa (septa intermuscularia).

In certain cases, there are places of thickening of the fascia (tendon arch (arcus tendineus), which is formed above the underlying neurovascular bundle, and the muscle tendon retinaculum (retinaculum), supporting them in a certain position).

The channels formed by the muscle tendon retainers form the tendon sheath (vagina tendinis), in which the tendon moves with the participation of the synovial sheath of the tendon (vagina synovialis tendinis), formed by the synovial layer (stratum synoviale).

The synovial layer is formed by the outer parietal part (pars parietalis), which is fused with the fibrous layer (stratum fibrosum), and the inner visceral part (pars tendinea). These parts, merging at the ends of the synovial sheath of the tendon, form the mesentery of the tendon (mesotendium).

In places where a muscle or tendon is attached to the bone tissue, the role of the synovial sheath of the tendon is performed by the synovial bursa (bursa synovialis).

3. MUSCLES OF THE SHOULDER

The deltoid muscle (m. deltoideus) starts from the outer edge of the acromion, the anterior edge of the lateral third of the clavicle, the spine of the scapula, attaching to the deltoid tuberosity.

Function: the scapular part unbends the shoulder, lowers the raised arm down; the clavicular part bends the shoulder, lowers the raised arm down; the acromion abducts the arm.

Innervation: n. axillaris.

Small round muscle (m. teres minor) originates from the lateral edge of the scapula and infraspinatus fascia, attaching to the lower area of ​​the large tubercle of the humerus.

Function: supination of the shoulder.

Innervation: n. axillaris.

The large round muscle (m. teres major) originates from the lower angle of the scapula, infraspinatus fascia, the lower part of the lateral edge of the scapula, attaching to the crest of the small tubercle of the humerus.

Function: with a fixed scapula: brings the raised arm to the body, unbends and penetrates the shoulder in the shoulder joint; with a strengthened hand: pulls the lower angle of the scapula outwards with a forward shift.

Innervation: n. subscapularis.

The supraspinatus muscle (m. supraspinatus) originates from the posterior surface of the scapula above the scapular spine and from the supraspinatus fascia, attaching to the upper area of ​​the large tubercle of the humerus.

Function: abducts the shoulder, pulling the joint capsule.

Innervation: n. subscapularis.

The infraspinatus muscle (m. infraspinatus) originates from the posterior surface of the scapula under the scapular spine and from the infraspinatus fascia, attaching to the middle area of ​​the large tubercle of the humerus.

Function: supination of the shoulder when the joint capsule is retracted.

Innervation: n. suprascapularis.

The subscapularis muscle (m. subscapularis) originates from the lateral edge of the scapula and from the surface of the subscapular fossa, attaching to the lesser tubercle and the crest of the lesser tubercle of the humerus.

Function: pronation and bringing the shoulder to the body.

Innervation: n. subscapularis.

4. MUSCLES OF THE SHOULDER

Anterior shoulder muscle group.

The biceps brachii muscle (m. biceps brachii) consists of two heads. The short head (caput breve) starts from the apex of the coracoid process of the scapula, and the long head (caput longum) starts from the supraspinatus tubercle of the scapula. Both heads in the middle of the humerus form a single belly, the tendon of which is attached to the tuberosity of the radius.

Function: flexes the shoulder at the shoulder joint, supinates the forearm turned inward, flexes the forearm at the elbow joint.

Innervation: n. musculocutaneus.

The coracobrachialis muscle (m. coracobrachialis) originates from the top of the coracoid process, attaching below the crest of the small tubercle to the humerus.

Function: flexes the shoulder at the shoulder joint and brings it to the body. With a pronated shoulder, it is involved in turning the shoulder outward.

Innervation: n. musculocutaneus.

The shoulder muscle (m. brachialis) originates from the lower two-thirds of the body of the humerus between the deltoid tuberosity and the articular capsule of the elbow joint, attaching to the tuberosity of the ulna.

Function: flexes the forearm at the elbow joint.

Innervation: n. musculocutaneus.

Posterior shoulder muscle group.

The ulnar muscle (m. anconeus) originates from the posterior surface of the lateral epicondyle of the shoulder, attaching to the lateral surface of the olecranon, the fascia of the forearm and the posterior surface of the proximal part of the ulna.

Function: extends the forearm.

Innervation: n. radialis.

The triceps muscle of the shoulder (m. triceps brachii) has three heads. The medial head originates on the posterior surface of the shoulder between the fossa of the olecranon and the insertion of the teres major muscle. The lateral head originates from the outer surface of the humerus between the groove of the radial nerve and the insertion of the teres minor muscle. The long head starts from the subarticular tubercle of the scapula. The heads unite and form the belly of the muscle, the tendon of which is attached to the olecranon of the ulna.

Function: unbends the forearm at the elbow joint, the long head is involved in extension and bringing the shoulder to the body.

Innervation: n. radialis.

5. MUSCLES OF THE FOREARMS

Anterior forearm muscles.

The anterior muscles of the forearm are arranged in four layers.

The first, or superficial, layer of the muscles of the forearm.

The round pronator (m. pronator teres) originates from the medial epicondyle of the shoulder, the fascia of the forearm, the medial intermuscular septum (this is its large part) and from the coronoid process of the ulna (this is its small part), ending in the middle of the lateral surface of the radius.

Function: rotates the forearm along with the hand to the elbow side, participates in flexion of the forearm in the elbow joint.

Innervation: n. medianus.

The long palmar muscle (m. palmaris longus) originates from the medial epicondyle of the shoulder, adjacent muscle septa and fascia of the forearm, attaching in the middle of the forearm.

Function: participates in flexion of the hand and stretches the palmar aponeurosis.

Innervation: n. medianus.

The brachioradialis muscle (m. brachioradialis) originates from the lateral supracondylar crest of the humerus and the lateral intermuscular septum, attaching to the lateral surface of the distal end of the radius.

Function: flexes the forearm at the elbow joint, sets the hand in the middle position between pronation and supination, rotates the radius.

Innervation: n. radialis.

The radial flexor of the wrist (m. flexor carpi radialis) originates from the medial epicondyle of the shoulder, the medial intermuscular septum and the fascia of the shoulder, attaching to the base of the second metacarpal bone.

Function: flexes the wrist, participates in the abduction of the hand to the lateral side.

Innervation: n. medianus.

The ulnar flexor of the wrist (m. Flexor carpi ulnaris) originates from the medial epicondyle and the medial intermuscular septum of the shoulder (here is its humeral head) and from the posterior edge of the ulna, the medial edge of the olecranon, the deep plate of the fascia of the forearm (here is its ulnar head) attaching to the pisiform bone.

Function: together with the flexor radialis, it flexes the wrist and adducts the hand.

Innervation: n. ulnaris.

The second layer of the muscles of the forearm.

The superficial flexor of the fingers (m. Flexor digitorum superficialis) starts from the proximal two-thirds of the anterior edge of the ulna (here is its radial head) and from the medial epicondyle of the shoulder, the fascia of the forearm, the medial edge of the coronoid process of the ulna and the ulnar collateral ligament (here is its humeroulnar head), attaching to the base of the middle phalanges.

Function: flexes the middle phalanges of the II-V fingers, participates in the flexion of the hand.

Innervation: n. medianus.

The third layer of the muscles of the forearm.

The long flexor of the thumb (m. flexor pollicis longus) originates from the anterior surface of the radius, attaching to the base of the distal phalanx of the thumb.

Function: flexes the distal phalanx of the thumb, participates in flexion of the hand.

Innervation: n. medianus.

Deep finger flexor (m. flexor digitorum profundus).

Function: flexes the distal phalanges of the II-V fingers, takes part in the flexion of the hand in the wrist joint.

Innervation: n. medianus, n. ulnaris.

The fourth layer of the muscles of the forearm.

The square pronator (m. pronator quadratus) originates from the anterior edge and anterior surface of the lower third of the body of the ulna, attaching to the anterior surface of the distal third of the body of the radius.

Function: penetrates the hand and forearm.

Innervation: n. medianus.

Posterior forearm muscles It is located in two layers: superficial and deep.

The superficial layer of the muscles of the forearm.

Extensor of fingers (m. extensor digitorum).

Function: unbends II-V fingers, takes part in the extension of the hand in the wrist joint.

Innervation: n. radialis.

Extensor of the little finger (m. extensor digiti minimi).

Function: extends the little finger.

Innervation: n. radialis.

Elbow extensor carpi (m. extensor carpi ulnaris) originates from the posterior surface of the ulna, the lateral epicondyle of the humerus, the fascia of the forearm, attaching to the posterior surface of the base of the V metacarpal bone.

Function: unbends and leads the brush.

Innervation: n. radialis.

The long radial extensor of the wrist (m. extensor carpi radialis longum) originates from the lateral epicondyle of the humerus, attaching to the base of the second metacarpal bone.

Function: unbends the hand and flexes the forearm.

Innervation: n. radialis.

The short radial extensor of the wrist (m. extensor carpi radialis brevis) originates from the lateral epicondyle of the humerus and the fascia of the forearm, attaching to the base of the III metacarpal bone.

Function: unbends and abducts the hand.

Innervation: n. radialis.

Deep layer of muscles of the forearm.

The short extensor thumb (m. extensor pollicis brevis) originates on the posterior surface of the radius, attaching to the base of the proximal phalanx of the thumb.

Function: unbends the proximal phalanx of the thumb, abducts the thumb.

Innervation: n. radialis.

The long extensor thumb (m. extensor pollicis longus) originates on the lateral side of the posterior surface of the ulna, attaching to the base of the distal phalanx of the thumb.

Function: extends the thumb of the hand.

Innervation: n. radialis.

The long muscle that abducts the thumb of the hand (m. Abductor pollicis longus) originates from the posterior surface of the ulna and the interosseous membrane of the forearm, attaching to the base of the I metacarpal bone on the back side.

Function: abducts the thumb of the hand.

Innervation: n. radialis.

The extensor of the index finger (m. extensor indicis) originates on the posterior surface of the ulna, attaching to the posterior surface of the proximal phalanx of the index finger.

Function: extends the index finger.

Innervation: n. radialis.

Arch support (m. supinator).

Function: supinates the radius along with the hand.

Innervation: n. radialis.

6. MUSCLES OF THE HAND

Middle group of muscles of the hand.

Palmar interosseous muscles (mm. interossei palmares).

Function: lead II, IV and V fingers to III.

Innervation: n. ulnaris.

Dorsal interosseous muscles (mm. interossei dorsales).

Function: abduct II, IV and V fingers from III.

Innervation: n. ulnaris.

Worm-like muscles (mm. lumbricales).

Function: unbend the middle and distal phalanges of the II-V fingers, bend their proximal phalanges.

Innervation: n. ulnaris, n. medianus.

Muscles of the thumb.

A short muscle that removes the thumb of the hand (m. Abductor pollicis brevis).

Function: abducts the thumb of the hand.

Innervation: n. medianus.

Muscle adductor thumb (m. adductor pollicis).

Function: brings the thumb of the hand, participates in its flexion.

Innervation: n. ulnaris.

The muscle that opposes the thumb of the hand (m. opponens pollicis).

Function: contrasts the thumb with the hand.

Innervation: n. medianus.

Short flexor thumb brush (m. flexor pollicis brevis).

Function: participates in adduction of the thumb, flexes its proximal phalanx.

Innervation: n. medianus, n.ulnaris.

Muscles of the little finger elevation.

The muscle that removes the little finger (m. Abductor digiti minimi).

Function: removes the little finger.

Innervation: n. ulnaris.

Short little finger flexor (m. flexor digiti minimi brevis).

Function: bends the little finger.

Innervation: n. ulnaris.

Short palmar muscle (m. palmaris brevis).

Function: forms weakly pronounced folds on the skin of the little finger elevation.

Innervation: n. ulnaris.

The muscle that opposes the little finger (m. opponens digiti minimi).

Function: opposes the little finger to the thumb of the hand.

Innervation: n. ulnaris.

7. AUXILIARY APPARATUS FOR THE MUSCLE OF THE UPPER LIMB AND THE HAND

Auxiliary apparatus of the muscles of the upper limb and hand:

1) fascia of the shoulder (fascia brachii), which forms the lateral intermuscular septum (septum intermusculare brachii laterale) and the medial intermuscular septum (septum intermusculare brachii mediale);

2) fascia of the forearm (fascia antebrachii);

3) deltoid fascia (fascia deltoidei);

4) axillary fascia (fascia axillaries);

5) flexor retinaculum (retinaculum flexorum); spreading over the groove of the wrist, it turns it into a canal (canalis carpi), in which the tendon sheath of the long flexor of the thumb (vagina tendinis musculi flexoris pollicis longi) and the common flexor sheath (vagina communis musculorum flexorum) are located;

6) extensor retinaculum (retinaculum xtensorium);

7) dorsal fascia of the hand (fascia dorsalis manus), consisting of deep and superficial plates;

8) palmar aponeurosis (aponeurosis palmaris).

8. pelvic muscles

Inner pelvic muscle group.

The internal obturator muscle (m. obturator internus) originates from the edges of the obturator foramen, attaching to the medial surface of the greater trochanter.

Upper twin muscle (m. gemellus superior).

Lower twin muscle (m. gemellus inferior).

Function: these muscles rotate the thigh outward.

Innervation: plexus sacralis.

The iliopsoas muscle (m. iliopsoas) consists of the iliac (m. iliacus) and large lumbar (m. psoas major) muscles.

Function: flexes the hip at the hip joint.

Innervation: plexus lumbalis.

The piriformis muscle (m. pisiformis) originates from the pelvic surface of the sacrum, attaching to the top of the greater trochanter.

Function: rotates the thigh outward.

Innervation: plexus sacralis.

External group of pelvic muscles

The tensor fascia latae (m. tensor fascia latae) originates from the superior anterior iliac bone, attaching to the lateral condyle of the tibia; on the border of the upper and middle thirds of the body of the femur passes into the iliac-tibial tract (tractus iliotibialis).

Function: flexes the hip, strains the iliac-tibial tract.

Innervation: n. gluteus superior.

The gluteus maximus muscle (m. Gluteus maximus) originates from the iliac crest, sacrotuberous ligament, dorsal surfaces of the sacrum and coccyx, attaching to the gluteal tuberosity of the femur.

Function: unbends the thigh; the posterior inferior bundles lead and turn the thigh outward, the anterior superior bundles abduct the thigh, keep the knee joint in an extended position.

Innervation: n. gluteus inferior.

The gluteus medius (m. gluteus medius) originates from the gluteal surface of the ilium and fascia lata, attaching to the outer surface and the apex of the greater trochanter.

Function: abducts the thigh, the posterior bundles turn the thigh outward, the anterior bundles inward.

Innervation: n. gluteus superior.

The square muscle of the thigh (m. quadratus femoris) originates from the upper part of the outer edge of the ischial tuberosity, attaching to the upper part of the intertrochanteric crest.

Function: rotates the thigh outward.

Innervation: n. ischiadicus.

The gluteus minimus (m. gluteus minimus) originates from the outer surface of the iliac wing, attaching to the anterolateral surface of the greater trochanter of the femur.

Function: abducts the thigh, the posterior bundles turn the thigh outward, the anterior bundles inward.

Innervation: n. gluteus superior.

The external obturator muscle (m. obturator externus) originates from the branch of the ischium and the outer surface of the pubic bone, attaching to the trochanteric fossa of the femur and the articular capsule.

Function: rotates the thigh outward.

Innervation: n. obturatorius.

9. THIGH MUSCLES

The muscles of the thigh include the medial, anterior and posterior groups.

Medial thigh muscle group.

The long adductor muscle (m. adductor longus) originates from the outer surface of the pubic bone, attaching to the medial lip of the rough line of the thigh.

Function: leads the thigh, turning and bending it outward.

Innervation: n. obturatorius.

Short adductor muscle (m. adductor brevis) originates from the outer surface of the body and the lower branch of the pubic bone, attaching to the rough line on the body of the femur.

Function: adducts and flexes the thigh.

Innervation: n. obturatorius.

The large adductor muscle (m. adductor magnus) originates from the branches and tubercle of the ischium and the lower branch of the pubic bone, attaching to the medial lip of the rough line of the thigh.

Function: leads and unbends the thigh.

Innervation: n. obturatorius and n. ischiadicus.

Thin muscle (m. gracilis) originates from the lower branch of the pubic bone and the lower half of the pubic symphysis, attaching to the medial surface of the upper part of the tibia.

Function: leads the thigh, bends and turns the lower leg inwards.

Innervation: n. obturatorius.

The comb muscle (m. pectineus) originates from the superior branch and crest of the pubic bone, attaching to the site located between the rough line of the thigh and the posterior surface of the lesser trochanter.

Function: adducts and flexes the thigh.

Innervation: n. obturatorius.

Anterior thigh muscle group.

The quadriceps femoris muscle (m. quadriceps femoris) consists of four muscles: medial (m. vastus medialis), lateral (m. vastus lateralis) and intermediate broad thigh muscles (m. vastus intermedius) and rectus femoris (m. rectus femoris) .

Function: unbends the lower leg at the knee joint (the rectus flexes the thigh).

Innervation: n. femoralis.

The sartorius muscle (m. sartorius) originates from the superior anterior iliac spine, attaching to the tuberosity of the tibia and the fascia of the lower leg.

Function: flexes and rotates the thigh outward, flexes the lower leg.

Innervation: n. femoralis.

Posterior thigh muscle group.

The semitendinosus muscle (m. semitendinosus) originates from the ischial tuberosity, attaching to the medial surface of the upper part of the tibia.

Function: flexes the lower leg and extends the thigh.

Innervation: n. tibialis.

The semimembranous muscle (m. semimembranosus) originates from the ischial tuberosity, attaching in three bundles to the posterolateral surface of the medial condyle of the tibia.

Function: flexes the lower leg and extends the thigh.

Innervation: n. tibialis.

The biceps femoris muscle (m. Biceps femoris) consists of a short (caput breve) and long (caput longum) heads.

Function: flexes the lower leg at the knee joint and extends the thigh.

10. SHIN MUSCLES

Lateral leg muscle group.

The short peroneal muscle (m. peroneus brevis) originates from the lower two-thirds of the lateral surface of the fibula, attaching to the base of the fifth metatarsal bone.

Function: raises the lateral edge of the foot, flexes the foot.

Innervation: n. peroneus superficialis.

The long peroneal muscle (m. peroneus longus) originates from the head and the upper two-thirds of the lateral surface of the fibula, the lateral condyle of the tibia, attaching to the base of the I and II metatarsal bones and the medial sphenoid bone.

Function: raises the lateral edge of the foot, flexes the foot, strengthens the longitudinal and transverse arches of the foot.

Innervation: n. fibularis superficialis.

Anterior leg muscles.

The long extensor hallucis longus (m. extensor hallucis longus) originates from the middle third of the anterior surface of the body of the fibula, attaching to the distal phalanx of the big toe.

Function: unbends the big toe.

Innervation: n. fibularis profundus.

Tibialis anterior (m. tibialis anterior) originates from the upper half of the lateral surface of the body and the lateral condyle of the tibia, attaching to the base of the I metatarsal bone and to the plantar surface of the medial sphenoid bone.

Function: strengthens the longitudinal arch of the foot, unbends the foot at the ankle joint with simultaneous supination and elevation of the medial edge.

Innervation: n. fibularis profundus.

The long extensor digitorum longus (m. extensor digitorum longus) originates from the anterior surface of the body of the fibula, the lateral condyle of the tibia and the fascia of the lower leg, attaching to the base of the middle and distal phalanges of the II-V fingers. The third peroneal muscle (m peroneus tertius) departs from the lower part of this muscle.

Function: unbends the II-V fingers in the metatarsophalangeal joints and the foot in the ankle joint (the third peroneal muscle raises the lateral edge of the foot).

Innervation: n. fibularis profundus.

Posterior leg muscles.

Deep layer of muscles.

The long flexor of the fingers (m. flexor digitorum longus) originates from the posterior surface of the body of the tibia, the fascia of the lower leg and the posterior intermuscular septum of the lower leg, attaching to the distal phalanges of the II-V fingers.

Function: flexes and rotates the foot outward and flexes the distal phalanges of the II-V fingers.

Innervation: n. tibialis.

The long flexor of the thumb (m. flexor hallucis longus) originates from the lower two-thirds of the body of the fibula and the intermuscular septum of the lower leg, attaching to the distal phalanx of the big toe.

Function: flexes the big toe, strengthens the longitudinal arch of the foot, participates in supination, flexion and adduction of the foot.

Innervation: n. tibialis.

The popliteal muscle (m. popliteus) originates from the outer surface of the lateral condyle of the thigh, attaching to the posterior surface of the tibia above the soleus muscle line.

Function: flexes the lower leg, stretches the capsule of the knee joint.

Innervation: n. tibialis.

The posterior tibial muscle (m. tibialis posterior) originates from the posterior surface of the body of the fibula, the lower surface of the lateral condyle and the upper two-thirds of the body of the tibia, the interosseous membrane, attaching to all three sphenoid bones, the base of the IV metatarsal bone and tuberosity of the navicular bone.

Function: flexes, supinates and adducts the foot.

Innervation: n. tibialis.

Superficial muscle layer.

The plantar muscle (m. plantaris) originates on the lateral epicondyle of the thigh and from the oblique popliteal ligament, attaching to the calcaneal tubercle.

Function: participates in the flexion of the foot and lower leg, stretches the capsule of the knee joint.

Innervation: n. tibialis.

The triceps muscle of the lower leg (m. triceps surae) consists of soleus and gastrocnemius muscles.

The soleus muscle (m. soleus) originates from the posterior surface of the tibia and the tendon arch, attaching to the calcaneal tuberosity as part of the calcaneal tendon (tendo calcaneus).

The gastrocnemius muscle (m gastrocnemicus) originates above the lateral condyle on the outer surface of the lower epiphysis of the thigh (its lateral head is located here) and the medial femoral condyle (its medial head is located here), attaching as part of the calcaneal tendon to the calcaneal tuberosity.

Function: flexion of the lower leg and foot; with a fixed foot, it holds the lower leg on the talus.

Innervation: n. tibialis.

11. MUSCLES OF THE FOOT

Muscles of the back of the foot.

The short extensor of the big toe (m. extensor hallucis brevis) originates from the upper surface of the calcaneus, attaching to the dorsum of the base of the proximal phalanx of the big toe.

Function: unbends the big toe.

Innervation: n. fibularis profundus.

The short extensor of the fingers (m. extensor digitorum brevis) originates from the upper and lateral surfaces of the calcaneus, attaching to the bases of the middle and distal phalanges along with the tendons of the long extensor of the fingers.

Function: unbends the toes.

Innervation: n. fibularis profundus.

Lateral muscle group of the sole of the foot.

The short flexor of the little finger (m. flexor digiti minimi brevis) originates from the medial side of the plantar surface of the fifth metatarsal bone and the long plantar ligament, attaching to the base of the proximal phalanx of the little finger.

Function: bends the little finger.

Innervation: n. plantaris lateralis.

The muscle that abducts the little toe of the foot (m. abductor digiti minimi) originates from the plantar aponeurosis, tuberosity of the fifth metatarsal bone and the plantar surface of the calcaneal tuber, attaching to the lateral side of the proximal phalanx of the little toe.

Function: flexes the proximal phalanx of the little finger.

Innervation: n. plantaris lateralis.

The muscle that opposes the little finger (m. Opponens digiti minimi) originates from the long plantar ligament, attaching to the V metatarsal bone.

Function: strengthens the lateral longitudinal arch of the foot.

Innervation: n. plantaris lateralis.

Middle group of muscles of the sole of the foot.

The vermiform muscles (m. lumbricales) are four muscles, three of which begin from the facing surfaces of the flexor digitorum longus tendons, and one from the medial side of the flexor digitorum longus tendon; attached to the medial sides of the proximal phalanges of the II-V fingers.

Function: unbend the distal and middle phalanges and bend the proximal phalanges of the II-V fingers.

Innervation: nn. plantares lateralis et medialis.

The square muscle of the foot (m. quadratus plantae) originates from the outer side of the lower surface of the calcaneus, from the lateral edge of the long plantar ligament (its lateral head is located here), from the inner side of the lower surface of the calcaneus and from the medial edge of the long plantar ligament, attaching with lateral side to the tendons of the long flexor of the fingers.

Function: flexes the toes.

Innervation: n. plantaris lateralis.

The short flexor of the fingers (m. flexor digitorum brevis) originates from the plantar aponeurosis and from the anterior part of the plantar surface of the calcaneal tuber, attaching to the middle phalanges of the II-V fingers.

Function: bends II-V fingers, strengthens the longitudinal arch of the foot.

Innervation: n. plantaris medialis.

Interosseous muscles (mm. interossei) are divided into plantar and dorsal.

Plantar interosseous muscles (m. interossei plantares) originate from the base and medial surface of the bodies of the III-V metatarsal bones, attaching to the medial surface of the proximal phalanges of the III-V toes.

Function: bend the proximal phalanges of the III-V fingers, bring these fingers to the II finger.

Innervation: n. plantaris lateralis.

The dorsal interosseous muscles (m. interossei dorsales) originate from the surfaces of adjacent metatarsal bones facing each other, attaching to the base of the proximal phalanges and the tendons of the long extensor of the fingers.

Function: the first interosseous muscle abducts the XNUMXnd finger from the median plane, the rest abducts the XNUMXnd-XNUMXth fingers to the little finger; all these muscles flex the proximal phalanges of the II-V fingers.

Innervation: n. plantaris lateralis.

Medial plantar muscle group.

The adductor hallucis muscle (m. adductor hallucis) originates from the capsules of the metatarsophalangeal joints of the III-V fingers (its transverse head is located here) and from the bases of the II-IV metatarsal bones, the lateral sphenoid and cuboid bones (its oblique head is located here ), attaching to the lateral sesamoid bone and the base of the proximal phalanx of the big toe.

Function: leads to the midline of the foot and flexes the big toe.

Innervation: n. plantaris lateralis.

The muscle that abducts the big toe (m. abductor hallucis) originates from the medial part of the tubercle of the calcaneus, attaching to the medial side of the base of the proximal phalanx of the big toe.

Function: abducts the big toe in the medial direction.

Innervation: n. plantaris medialis.

The short flexor of the big toe (m. flexor hallucis brevis) originates from the sphenoid bones, the medial side of the plantar surface of the cuboid bone, attaching to the proximal phalanx of the big toe and sesamoid bone.

Function: flexes the big toe.

Innervation: nn. plantares lateralis et medialis.

12. AUXILIARY APPARATUS OF LOWER LIMB MUSCLES

Auxiliary apparatus of the muscles of the lower limb:

1) iliac fascia (fascia iliaca); from its medial side it forms the iliopectineal arch (arcus iliopectineus);

2) lumbar fascia (fascia lumbalis);

3) gluteal fascia (fascia glutea);

4) wide fascia (fascia lata); consists of a deep plate, or iliac-comb fascia, and a superficial plate, which has a subcutaneous fissure closed by a cribriform fascia (fascia cribrosa). The medial (septum intermusculare femoris mediale) and lateral (septum intermusculare femoris laterale) intermuscular septa of the thigh depart from the broad fascia deep into the muscle tissue. On the lateral side of the thigh, the fascia lata forms the ilio-tibial tract (tractus iliotibialis);

5) fascia of the lower leg (fascia cruris); passes the anterior (septum intermusculare cruris anterior) and posterior (septum intermusculare cruris posterior) intermuscular septa of the leg;

6) upper retinaculum of the extensor tendons (retinaculum musculorum extensorum superius);

7) inferior retinaculum of the extensor tendons (retinaculum musculorum extensorum inferius); on the inner surface it is divided into three channels by partitions going to the bones of the foot. In the lateral canal lies the sheath of the tendon of the long extensor of the toes, in the middle - the sheath of the tendon of the long extensor of the big toe, in the medial - the sheath of the tendon of the tibialis anterior muscle;

8) flexor tendon retinaculum (retinaculum musculorum flexorum); located behind the medial malleolus and has three canals. In the first canal there is the sheath of the tendon of the tibialis posterior muscle, in the second - the sheath of the tendon of the long flexor of the toes, in the third - the sheath of the tendon of the long flexor of the big toe;

9) upper (retinaculum musculorum peroneum superios) and lower (retinaculum musculorum perineum infrius) tendon retinaculum of the peroneal muscles; are located from top to bottom and behind from a lateral malleolus. Under the upper retainer is the common synovial sheath of the peroneal muscles;

10) plantar sheath of the tendon of the long peroneal muscle (vagina tendinis musculi peronei longi plantaris);

11) dorsal fascia of the foot (fascia dorsalis pedis);

12) plantar aponeurosis (aponeurosis plantaris).

13. MIMIC MUSCLES OF THE HEAD

The facial muscles of the head are divided into the muscles of the cranial vault, the muscles surrounding the nasal openings, the muscles surrounding the oral fissure, the muscles surrounding the palpebral fissure, the muscles of the auricle.

Muscles of the skull formed by the supracranial muscle (m. epicranus), which consists of three parts: the occipital-frontal muscle, the supracranial aponeurosis and the temporo-parietal muscle.

The occipital-frontal muscle (m. occipitofrontalis) consists of the occipital abdomen (venter occipitalis) and the frontal abdomen (venter frontalis), which are connected by means of the supracranial aponeurosis (aponeurosis epicranialis).

The temporoparietal muscle (m. temporoparietalis) originates on the inside of the cartilage of the auricle, attaching to the lateral part of the tendon helmet.

Function: the occipital belly pulls the scalp back, the frontal belly pulls the forehead skin up, raising the eyebrows.

Innervation: n. facialis.

Muscle proud (m. procerus) originates on the outer surface of the nasal bone, ending in the skin of the forehead.

Function: straightens transverse folds on the forehead, forms transverse folds at the root of the nose.

Innervation: n. facialis.

Muscles surrounding the nasal passages.

The muscle that lowers the nasal septum (m. depressor septi) originates above the medial incisor of the upper jaw, attaching to the cartilaginous part of the nasal septum.

Function: lowers the nasal septum.

Innervation: n. facialis.

The nasal muscle (m. nasalis) consists of two parts:

wing part (pars alaris); originates on the upper jaw, weaving into the skin of the wing of the nose. Function: expands the openings of the nose, pulls the wing of the nose laterally and downwards.

2) transverse part (pars transversa); originates in the upper jaw and passes into the muscle of the same name on the opposite side. Function: narrows the openings of the nose. Innervation: n. facialis.

Muscles surrounding the mouth.

The circular muscle of the mouth (m. Orbicularis oris) consists of the labial (pars labialis) and marginal parts (pars marginalis).

Function: participates in the act of chewing and sucking, closes the mouth gap.

Innervation: n. facialis.

The muscle that lowers the lower lip (m. depressor labii inferioris) originates from the base of the lower jaw, attaching to the skin and mucous membrane of the lower lip.

Function: lowers the lower lip down.

Innervation: n. facialis.

The muscle that lifts the upper lip (m. Levator labii superior) originates from the infraorbital edge of the upper jaw, passing into the muscle that raises the corner of the mouth and the wing of the nose.

Function: lifts the upper lip.

Innervation: n. facialis.

The muscle that lowers the corner of the mouth (m. depressor anguli oris) originates from the base of the lower jaw, attaching to the skin of the corner of the mouth.

Function: lowers the corner of the mouth down and laterally.

Innervation: n. facialis.

The muscle that lifts the corner of the mouth (m. Levator anguli oris) originates from the anterior surface of the upper jaw, attaching to the corner of the mouth.

Function: Raises the corner of the mouth.

Innervation: n. facialis.

The large zygomatic muscle (m. zygomaticus major) originates from the zygomatic bone, attaching to the corner of the mouth.

Function: pulls the corner of the mouth up and out.

Innervation: n. facialis.

The small zygomatic muscle (m. zygomaticus minor) originates from the zygomatic bone, attaching to the skin of the corner of the mouth.

Function: Raises the corner of the mouth.

Innervation: n. facialis.

The chin muscle (m. mentalis) originates from the alveolar elevations of the medial and lateral incisors of the lower jaw, attaching to the skin of the chin.

Function: pulls upward and laterally the skin of the chin.

Innervation: n. facialis.

The buccal muscle (m. buccinator) originates from the branch of the lower jaw, the outer surface of the alveolar arch of the upper jaw, passing into the thickness of the base of the lower and upper lips.

Function: presses the cheek to the lips, pulls the corner of the mouth back.

Innervation: n. facialis.

The muscle of laughter (m. risorius) originates from the masticatory fascia, attaching to the skin of the corner of the mouth.

Function: pulls the corner of the mouth laterally.

Innervation: n. facialis.

Muscles surrounding the eye.

The muscle wrinkling the eyebrow (m. corrigator supercilli) originates from the medial segment of the superciliary arch, attaching to the skin of the eyebrow on the same side.

Function: pulls the skin of the forehead down and medially.

Innervation: n. facialis.

The circular muscle of the eye (m. Orbicularis oculi) consists of the orbital (pars orbitalis), lacrimal (pars lacrimalis) and secular parts (pars palpebralis).

Function: is the sphincter of the palpebral fissure. The lacrimal part expands the lacrimal sac, the secular part closes the eyelids, the orbital part forms folds from the outer corner of the eye, pulls the skin of the cheek up, and shifts the eyebrow down.

Innervation: n. facialis.

14. MUSCLES OF THE EAR. CHECKING MUSCLES

The superior auricular muscle (m. auricularis superior) originates from the tendon helmet above the auricle, attaching to the upper surface of the cartilage of the auricle.

Function: pulls the auricle up.

Innervation: n. facialis.

The posterior ear muscle (m. auricularis posterior) originates from the mastoid process, attaching to the posterior surface of the auricle.

Function: pulls the auricle backwards.

Innervation: n. facialis.

The anterior ear muscle (m. auricularis anterior) originates from the tendon helmet and temporal fascia, attaching to the skin of the auricle.

Function: pulls the auricle forward.

Innervation: n. facialis.

Chewing muscle (m. masseter) consists of deep and superficial parts.

Function: raises the lower jaw, pushes the lower jaw forward.

Innervation: n. trigeminus.

The medial pterygoid muscle (m. rterygoideus medialis) originates in the pterygoid fossa of the sphenoid bone, attaching to the tuberosity of the same name on the upper surface of the angle of the mandible.

Function: raises the lower jaw, pushes the lower jaw forward.

Innervation: n. trigeminus.

Lateral pterygoid muscle (m. rterygoideus lateralis) starts from the lateral plate of the pterygoid process of the sphenoid bone (lower head) and from the maxillary surface and infratemporal crest of the large wing of the sphenoid bone (its upper head is located here), attaching to the articular capsule of the temporomandibular joint and the anterior surface of the neck of the mandible.

Function: pushes the lower jaw forward with a symmetrical contraction, with a unilateral contraction, the lower jaw is displaced in the opposite direction.

Innervation: n. trigeminus.

The temporal muscle (m. temporalis) originates from the surface of the temporal fossa and the inner surface of the temporal fascia, attaching to the coronoid process of the lower jaw.

Function: raises the lower jaw, pulls the forward jaw back.

Innervation: n. trigeminus.

15. AUXILIARY APPARATUS OF HEAD MUSCLES. SURFACE MUSCLES OF THE BACK

Auxiliary apparatus of the muscles of the head:

1) chewing fascia (fascia masseterica);

2) buccal-pharyngeal fascia (fascia buccopharyngea);

3) temporal fascia (fascia temporalis); It is divided into deep (lamina profunda) and superficial (lamina superficialis) plates.

Superficial back muscles.

The latissimus dorsi muscle (m. latissimus dorsi) originates from the iliac crest, median sacral crest, from the spinous processes of all lumbar vertebrae and six lower thoracic vertebrae, attaching to the crest of the small tubercle of the humerus.

Function: lowers the raised arm, unbends the shoulder, pronates and brings the arm to the body, with the upper limbs fixed, pulls the body towards them.

Innervation: n. thoracodorsalis.

The muscle that lifts the scapula (m. Levator scapulae) originates from the posterior tubercles of the transverse processes of the four cervical vertebrae, attaching to the medial edge of the scapula.

Function: raises and brings the scapula closer to the spine, with a fixed scapula tilts the cervical spine in its direction.

Innervation: n. dorsalis scapulae.

The trapezius muscle (m. trapezius) originates from the spinous processes of the VII cervical and all thoracic vertebrae, the supraspinatus ligament, the external occipital protrusion, the medial third of the superior occipital bone line, the occipital ligament and is attached to the posterior surface of the outer half of the clavicle (here are its upper bundles), to the scapular spine (here are its lower bundles), to the scapular spine and acromion (here are its middle bundles).

Function: the upper bundles raise the scapula, together with the lower ones, rotate the scapula in the sagittal plane, all bundles with a fixed spine bring the scapula closer to the latter; with a symmetrical contraction, it extends the cervical spine, with a unilateral contraction, it turns the face in the opposite direction.

Innervation: plexus cervicalis, n. accessorius.

The serratus posterior superior muscle (m. Serratus posterior superior) originates from the spinous processes of the I and II thoracic, VI and VII cervical vertebrae, the lower part of the nuchal ligament, attaching to the posterior surface of the II-V ribs.

Function: raises the ribs.

Innervation: nn. intercostals.

Serratus posterior inferior (m. Serratus posterior inferior) originates from the spinous processes of the XI and XII thoracic, I and II lumbar vertebrae, attaching to the four lower ribs with separate muscle teeth.

Function: lowers the ribs.

Innervation: nn. intercostals.

The large and small rhomboid muscles (mm. Rhomboidei major et minor) originate from the spinous processes of the II-V thoracic vertebrae (large rhomboid), from the spinous processes of the VII cervical and I thoracic vertebrae, the lower part of the nuchal ligament, the supraspinous ligament (small rhomboid), attached to the medial edge of the scapula.

Function: brings the scapula closer to the spine.

Innervation: n. dorsalis scapulae.

16. DEEP BACK MUSCLES

Deep back muscles lie in three layers: superficial (belt muscles of the head and neck, the muscle that straightens the spine), middle (transverse spinous muscle) and deep (intertransverse, interspinous and suboccipital muscles).

Muscles of the superficial layer.

The belt muscle of the neck (m. splenius cervicis) originates from the spinous processes of the III and IV thoracic vertebrae, attaching to the posterior tubercles of the transverse processes of the upper three cervical vertebrae.

Function: with symmetrical contraction, it extends the cervical part of the spine, with unilateral contraction, it turns the cervical part of the spine in its direction.

Innervation: posterior branches of the cervical spinal nerves.

The belt muscle of the head (m. splenius capitis) originates from the spinous processes of the VII cervical and upper three thoracic vertebrae, the lower half of the nuchal ligament, attaching to the mastoid process of the temporal bone and the rough area of ​​the occipital bone.

Function: with symmetrical contraction, it extends the cervical part of the spine and head, with unilateral contraction, it turns the head in its direction.

Innervation: posterior branches of the cervical spinal nerves.

The muscle that straightens the spine (m. erector spinae) is divided into three muscles: spinous, iliocostal and longissimus.

The spinous muscle (m. spinalis) is medial, three muscles are distinguished in it.

The spinous muscle of the chest (m. spinalis thoracis) originates from the spinous processes of the last two thoracic and the first two lumbar vertebrae, attaching to the spinous processes of the eight upper thoracic vertebrae.

The spinous muscle of the neck (m. spinalis cervicis) originates from the spinous processes of the VII cervical and I-II thoracic vertebrae, attaching to the spinous processes of the II and III cervical vertebrae.

The spinous muscle of the head (m. spinalis capitis) originates from the spinous processes of the upper thoracic and lower cervical vertebrae, attaching to the occipital bone.

Function: extends the spine.

Innervation: posterior branches of the cervical, thoracic and upper lumbar spinal nerves.

The iliocostalis muscle (m. iliocostalis) is divided into three muscles.

The iliocostal muscle of the lower back (m. iliocostalis lumborum) originates from the iliac crest, attaching to the corners of the lower six ribs.

The iliocostal muscle of the chest (m. iliocostalis thoracis) originates from the six lower ribs, attaching to the upper six ribs and the posterior surface of the transverse process of the VII cervical vertebra.

The iliocostal muscle of the neck (m. iliocostalis cervicis) originates from the corners of the III-VI ribs, attaching to the posterior tubercles of the transverse processes of the VI and VII cervical vertebrae.

Function: extends the spine.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves.

The longest muscle (m. longissimus) is divided into three muscles.

The longissimus capitis muscle originates from the transverse processes of the III-VII cervical and I-III thoracic vertebrae, attaching to the posterior surface of the mastoid process of the temporal bone.

The longissimus cervicis muscle originates from the tops of the transverse processes of the upper five thoracic vertebrae, attaching to the posterior tubercles of the transverse processes of the II-VI cervical vertebrae.

The longissimus chest muscle (m. longissimus thoracis) originates from the transverse processes of the lumbar and lower thoracic vertebrae, the posterior surface of the sacrum, attaching to the tops of the transverse processes of all thoracic vertebrae and the posterior surface of the lower nine ribs.

Function: unbend the spine, tilt it to the side.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves.

Muscles of the middle layer.

The bundles of the transverse spinous muscle (m. transversospinalis) form the following three muscles.

Multifid muscles (mm. multifidi) originate from the transverse processes of the underlying vertebrae, attaching to the spinous processes of the overlying ones.

Function: rotate the spinal column around its longitudinal axis.

Innervation: posterior branches of the spinal nerves.

The rotator muscles of the neck, chest and lower back (mm rotatores cervicis, thoracis et lumborum) are divided into short and long.

Function: rotate the spinal column around its longitudinal axis.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves.

The semispinalis muscle (m. semispinalis) is divided into three parts: the semispinalis muscle of the head (m. semispinalis capitis), the semispinalis muscle of the neck (m. semispinalis cervicis) and the semispinalis muscle of the chest (m. semispinalis thoracis).

Function: unbend the thoracic and cervical sections of the spinal column (eponymous sections), the cervical part throws the head back.

Innervation: posterior branches of the cervical and thoracic spinal nerves.

17. DEEP LAYER MUSCLES

The transverse muscles of the lower back, chest and neck (mm. intertransversarii lumborum, thoracis et cervicis) are divided into lateral and medial in the lumbar and anterior and posterior in the cervical spine.

Function: tilt the eponymous sections of the spinal column in their direction.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves.

Interspinous muscles of the lower back, chest and neck (mm interspinalis lumborum, thoracis et cervicis).

Function: unbend the same-name departments of the spinal column.

Innervation: posterior branches of the spinal nerves.

Suboccipital muscles (mm. suboccipitalis):

Lower oblique muscle of the head (m. obliquus capitis inferior).

Function: tilts to the side, unbends and rotates the head around the longitudinal axis of the tooth of the axial vertebra.

Innervation: n. suboccipitalis.

Upper oblique muscle of the head (m. obliquus capitis superior).

Function: with a symmetrical contraction, it unbends its head, with a one-sided contraction, it tilts its head to its side.

Innervation: n. suboccipitalis.

The large posterior rectus muscle of the head (m. rectus capitis posterior major).

Function: throws back and tilts the head to the side, with unilateral contraction, turns the head to its side.

Innervation: n. suboccipitalis.

Small posterior rectus muscle of the head (m. rectus capitis posterior minor).

Function: throws back and tilts the head to the side.

Innervation: n. suboccipitalis.

Auxiliary apparatus of the back muscles:

1) thoracic fascia (fascia thoracolumbalis), consisting of two plates: deep and superficial;

2) nuchal fascia (fascia nuchae).

18. MUSCLES OF THE CHEST. AUXILIARY DEVICE FOR CHEST MUSCLES

superficial muscles.

The pectoralis major muscle (m. pectoralis major) consists of three parts: clavicular (pars clavicularis), sternocostal (pars sternocostalis) and abdominal (pars abdominalis).

Function: lowers and brings the raised arm to the body, turning it inward.

Innervation: nn. pectorales lateralis et medialis.

Small pectoral muscle (m. pectoralis minor).

Function: Tilts the shoulder blade forward.

Innervation: nn. pectorales lateralis et medialis.

Serratus anterior (m. serratus anterior) originates from the upper nine ribs, attaching to the medial edge and the lower corner of the scapula.

Function: moves the lower angle of the scapula forward and laterally, rotates the scapula around the sagittal axis.

Innervation: n. thoracicus longus.

The subclavian muscle (m. subclavius) originates from the cartilage of the XNUMXst rib, attaching to the lower surface of the acromion.

Function: pulls the collarbone forward and down.

Innervation: n. subclavius.

Deep muscles.

The transverse muscle of the chest (m. transversus thoracis).

Function: lowers the ribs, participates in the act of inhalation.

Innervation: nn. intercostals.

External intercostal muscles (mm. intercostales externi).

Function: raise the ribs.

Innervation: nn. intercostals.

Internal intercostal muscles (mm. intercostales interni).

Function: lower ribs.

Innervation: nn. intercostals.

The muscles that lift the ribs (mm. Levatores costarum) are divided into short and long.

Function: raise the ribs.

Innervation: nn. intercostals.

Subcostal muscles (mm. Subcostales).

Function: lower ribs.

Innervation: nn. intercostals.

The structure of the diaphragm.

The diaphragm (diaphragma) is a mobile muscular-tendon septum that delimits the chest and abdominal cavities.

In the diaphragm, a tendon center (center tendineum) is distinguished, in which there is an opening of the inferior vena cava, and three parts: costal (pars costalis), sternal (pars sternalis) and lumbar (pars lumbalis). In the lumbar part there is an aortic opening (hiatus aorticus), limited by the right and left crus of the diaphragm (crus dextrum et crus sinistrum), and an esophageal opening (hiatus esophageus).

Function: when the diaphragm contracts, the volume of the chest cavity increases and the abdominal cavity decreases; with simultaneous contraction with the abdominal muscles, an increase in intra-abdominal pressure occurs.

Innervation: n. phrenicus.

Auxiliary apparatus of the chest muscles.

1) thoracic fascia (fascia pectoralis);

2) the actual chest fascia (fascia thoracica);

3) intrathoracic fascia (fascia endothoracica);

4) clavicular-thoracic fascia (fascia clavipectoralis);

5) ligaments that support the mammary gland (ligg suspensoria mammaria).

19. ABDOMINAL MUSCLES. MUSCLES OF THE WALLS OF THE ABDOMINAL CAVITY. AUXILIARY DEVICE OF THE ABDOMINAL MUSCLES

The abdomen (abdomen) is the part of the body located between the chest and the pelvis.

In the abdomen, the following areas are distinguished:

1) epigastrium (epigastrium), which includes the epigastric region, right and left hypochondrium regions;

2) the stomach (mesogastrium), which includes the umbilical region, the right and left side regions;

3) hypogastrium (hypogastrium), which includes the pubic region, right and left inguinal regions.

Muscles of the lateral wall of the abdominal cavity.

The transverse abdominal muscle (m. transversus abdominis) is the deepest muscle of the lateral sections; originates from the deep plate of the lumbar-thoracic fascia, the anterior half of the inner lip of the iliac crest, from the inner surface of the six lower ribs, passing into a wide aponeurosis along the semilunar line.

Function: reduces the size of the abdominal cavity, pulls the ribs forward to the midline.

Innervation: nn. intercostales, nn ilioinguinalis et iliohypogastricum.

The external oblique muscle of the abdomen (m. obliquus externus abdominis) originates from the eight lower ribs, passing into a wide aponeurosis, the lower part of which goes to the pubic tubercle and the outer lip of the iliac crest. The lower part of the aponeurosis forms the inguinal ligament (lig. inguinale), stretched between the pubic tubercle and the superior anterior iliac spine.

At the point of attachment to the pubic bone, the aponeurosis of the external oblique muscle of the abdomen divides into the lateral and medial legs.

Function: with symmetrical contraction, it bends the spine and lowers the ribs; with unilateral contraction, it turns the torso in the opposite direction.

Innervation: nn. intercostales, nn. ilioinguinalis et iliohypogastricum.

The internal oblique muscle of the abdomen (m. obliquus internus abdominis) originates from the lumbar-thoracic fascia, the intermediate line of the iliac crest, the lateral half of the inguinal ligament, attaching to the cartilages of the last ribs (here its upper-posterior bundles are located) and continuing into a wide aponeurosis (this is below it located bundles), covering the rectus abdominis in front and behind. The lower part of the muscle and the bundles of the transverse abdominal muscle form in men the muscle that lifts the testicle.

Function: with a symmetrical contraction, it bends the spine, with a one-sided contraction, it turns the body in the opposite direction.

Innervation: nn. intercostales, nn. ilioinguinalis et iliohypogastricum.

Muscles of the anterior abdominal wall.

The pyramidal muscle (m. Pyramidalis) originates from the pubic crest, weaving into the white line of the abdomen (linea alba), which is a fibrous plate running along the midline from the pubic symphysis to the xiphoid process. It is formed by intersecting fibers of the aponeuroses of the broad abdominal muscles on both sides.

Function: tenses the white line of the abdomen.

The rectus abdominis muscle (m rectus abdominis) originates from the fibrous bundles of the pubic symphysis and the pubic crest, attaching to the outer surface of the cartilages of the V-VII ribs and the anterior surface of the xiphoid process.

Function: with a fixed spine and pelvic girdle, lowers the chest, with a fixed chest, raises the pelvis.

Innervation: nn. intercostales, n. iliohypogastricum.

Muscles of the posterior abdominal wall.

The square muscle of the lower back (m. quadratus lumborum) originates from the transverse processes of the lower lumbar vertebrae, the iliac crest and the iliac-lumbar ligament, attaching to the transverse processes of the upper lumbar vertebrae and the lower edge of the XII rib.

Function: with symmetrical contraction, it holds the spinal column in a vertical position, with unilateral contraction, it tilts the spine in its direction.

Innervation: plexus lumbalis.

Auxiliary apparatus of the abdominal muscles:

1) transverse fascia (fascia transversa);

2) own fascia (fascia propria);

3) the vagina of the rectus abdominis muscle (vagina m recti abdominis).

20. MUSCLES OF THE NECK

Among the muscles of the neck, superficial muscles (suprahyoid (mm suprahyoidei) and sublingual (mm infrahyoidei)) and deep muscles (lateral and prevertebral groups) are distinguished.

Superficial muscles of the neck.

The sternocleidomastoid muscle (m. sternocleidomastoideus) originates from the sternal end of the clavicle and the anterior surface of the sternum handle, attaching to the mastoid process of the temporal bone and the lateral segment of the superior nuchal line.

Function: with a symmetrical contraction, he throws his head back, with a unilateral contraction, he tilts his head in his direction, turning his face in the opposite direction.

Innervation: n. accessories.

The subcutaneous muscle of the neck (platysma) originates from the superficial plate of the thoracic fascia, weaving into the masticatory fascia and the corner of the mouth.

Function: pulls the corner of the mouth down and lifts the skin of the neck.

Innervation: n. facialis.

Suprahyoid muscles

The stylohyoid muscle (m. stylohyoideus) originates from the mastoid process of the temporal bone, attaching to the body of the hyoid bone.

Function: pulls the hyoid bone back, up and to its side, while contracting, moves the hyoid bone up and back.

Innervation: n. facialis.

The digastric muscle (m. didastricus) consists of two bellies. The posterior belly originates from the mastoid notch of the temporal bone, passes into the intermediate tendon, the continuation of which is the anterior belly, which is attached to the digastric fossa of the lower jaw.

Function: with a fixed hyoid bone, lowers the lower jaw; with a fixed lower jaw, the posterior abdomen pulls the hyoid bone backwards, up and to its side.

Innervation: n. facialis, n. mylohyoideus.

The geniohyoid muscle (m. geniohyoideus) originates from the chin spine, attaching to the body of the hyoid bone.

Function: with closed jaws, raises the hyoid bone with the larynx, with a fixed hyoid bone, lowers the lower jaw.

Innervation: cervical plexus.

The jaw-hyoid muscle (m. mylohyoideus) originates from the inner surface of the lower jaw, attaching to the anterior surface of the body of the hyoid bone.

Function: with closed jaws, raises the hyoid bone with the larynx, with a fixed hyoid bone, lowers the lower jaw.

Innervation: n. myohyloideus.

Sublingual muscles.

The sternohyoid muscle (m. sternohyoideus) originates from the posterior sternoclavicular ligament, the posterior surface of the sternum handle and the sternal end of the clavicle, attaching to the lower edge of the body of the hyoid bone.

Function: pulls the hyoid bone down.

Innervation: ansa cervicalis.

The sternothyroid muscle (m. sternothyroideus) originates on the posterior surface of the sternum handle, attaching to the oblique line of the thyroid cartilage of the larynx.

Function: pulls the larynx down.

Innervation: ansa cervicalis.

The thyroid-hyoid muscle (m. thyrohyoideus) originates from the oblique line of the thyroid cartilage, attaching to the body and the greater horn of the hyoid bone.

Function: with a fixed hyoid bone, pulls the larynx up, brings the hyoid bone closer to the larynx.

Innervation: ansa cervicalis.

The scapular-hyoid muscle (m. omohyoideus) has two bellies (lower and upper); originates from the upper edge of the scapula and is attached to the hyoid bone.

Function: with a fixed hyoid bone, it stretches the pretracheal plate of the cervical fascia, with unilateral contraction, it moves the hyoid bone down and backwards in the corresponding direction.

Innervation: ansa cervicalis.

21. DEEP NECK MUSCLES. AUXILIARY DEVICE OF NECK MUSCLES

Medial group.

The anterior rectus capitis anterior (m. rectus capitis anterior) originates from the anterior arch of the atlas, attaching to the basilar part of the occipital bone.

Function: Tilts head forward.

Innervation: cervical plexus.

The lateral rectus muscle of the head (m. rectus capitis lateralis) originates from the transverse process of the atlas, attaching to the lateral part of the occipital bone.

Function: acting on the atlantooccipital joint, tilts the head to the side.

Innervation: cervical plexus.

The long muscle of the head (m. longus capitis) originates from the anterior tubercles of the transverse processes of the III-VI cervical vertebrae, attaching to the basilar part of the occipital bone.

Function: Tilts head forward.

Innervation: cervical plexus.

The long muscle of the neck (m. longus colli) consists of three parts: lower and upper oblique and vertical.

Function: flexes the cervical part of the spinal column, with unilateral contraction, tilts the neck to its side.

Innervation: cervical plexus.

lateral group.

The anterior scalene muscle (m. scalenus anterior) originates from the anterior tubercles of the transverse processes of the III and IV cervical vertebrae, attaching to the tubercle of the anterior scalene muscle on the XNUMXst rib.

The middle scalene muscle (m. Scalenus medius) originates from the transverse processes of the II-VII cervical vertebrae, attaching to the I rib.

The posterior scalene muscle (m. scalenus posterior) originates from the posterior tubercles of the IV-VI cervical vertebrae, attaching to the outer surface and upper edge of the II rib.

The function of the scalene muscles: with fixed ribs, the cervical part of the spine is bent forward, with a fixed cervical region, the XNUMXst and XNUMXnd ribs are raised.

Innervation: cervical plexus.

Auxiliary apparatus of the neck muscles.

The cervical fascia (fascia cervicalis) consists of three plates:

1) superficial (lamina superficialis);

2) pretracheal (lamina pretrachelis);

3) prevertebral (lamina prevertebralis).

Between the plates are the spaces:

1) suprasternal interfascial;

2) previsceral;

3) behind the visceral.

LECTURE 4. RESPIRATORY SYSTEM

1. STRUCTURE OF THE REGION OF THE NOSE (REGIO NASALIS)

Respiratory system (systema resoiratorium) is represented by the airways, which in turn are represented by tubes with a constant lumen diameter, which is ensured by the presence of bone or cartilage tissue in their wall, and lungs.

The nasal region includes the external nose and the nasal cavity.

External nose (nasus externus) has a back of the nose (dorsum nasi), passing into the top of the nose (apex nasi), the root of the nose (radix nasi) and the wings of the nose (alae nasi), which limit the lower edges of the nostrils (nares).

The external nose is formed by bone and cartilage tissue.

Cartilages of the nose:

1) lateral cartilage of the nose (cartilago nasi lateralis); paired, participates in the formation of the side wall of the external nose;

2) large cartilage of the wing of the nose (cartilago alaris major); paired, limits the anterolateral sections of the nostrils;

3) small cartilages of the wing of the nose (cartilagines alares minoris); located behind the large cartilage of the alar nose.

Sometimes additional nasal cartilages (cartilagines nasals accessoriae) are located between the lateral and greater cartilage of the wing of the nose.

The osseous skeleton of the external nose is formed by the frontal processes of the maxillae and the nasal bones.

Nasal cavity (cavitas nasi). The nasal cavity is divided by the nasal septum into two relatively equal parts, communicating through the choanae (choanae) with the nasal part of the pharynx and through the nostrils with the environment.

The nasal septum is formed by a movable part, consisting of cartilaginous (pars cartilaginea) and membranous (pars membranacea) tissues, and a fixed part, consisting of a bone part (pars ossea).

The nasal cavity has a nasal vestibule (vestibulum nasi), limited from above by the threshold of the nasal cavity (limen nasi).

The nasal passages occupy most of the nasal cavity and communicate with the paranasal sinuses (sinus paranasales).

In the nasal cavity, the upper, middle and lower nasal passages are distinguished, lying under the nasal conchas of the same name.

In the upper posterior part of the nose of the superior turbinate there is a sphenoid-ethmoid recess (recessus sphenoethmoidalis), which has an opening of the sphenoid sinus. The superior nasal passage communicates with the posterior ethmoid cells.

The middle nasal passage communicates with the frontal sinus through the ethmoid funnel (infundibulum ethmoidale), the maxillary sinus, the upper and middle cells of the ethmoid bone.

Nasal mucosa (tunica mucosa nasi) has a respiratory (regio respiratoria) and olfactory regions (regio olfactoria). The mucous membrane of the respiratory region is covered with ciliated epithelium and has serous and mucous glands.

The mucosa and submucosa of the inferior turbinate are rich in venous vessels that form the cavernous venous plexuses of the turbinates. The mucous membrane is supplied with blood from the ophthalmic and maxillary arteries. Venous outflow is carried out in the pterygoid plexus.

Lymphatic outflow is carried out in the submandibular and submental lymph nodes.

Innervation: from the nasociliary and maxillary nerve.

2. STRUCTURE OF THE LARYNX

The larynx (larynx) is located in the anterior region of the neck; forms a protrusion (prominentia laryngea), which is strongly expressed in men. Above, the larynx is connected to the hyoid bone, below - to the trachea. In front, the larynx is covered by the hyoid muscles, the superficial fascia of the neck and the pretracheal fascia, the isthmus of the thyroid gland, the lobes of which cover the larynx on the sides.

The pharynx communicates with the larynx through the entrance to the larynx (aditus laryngeus), bounded laterally by aryepiglottic folds (plicae aruepigloticae) and the epiglottis in front.

larynx cavity (cavitas laryngis) is conventionally divided into three sections: upper, middle and lower.

The upper section, or vestibule of the larynx (vestibulum laryngis), continues to the folds of the vestibule (plicae vestibulares), between which there is a vestibule gap (rima vestibuli).

The middle section, or interventricular, continues from the folds of the vestibule to the vocal folds (plicae vocales). Between these folds is the ventricle of the larynx (vestibulum laryngis). The vocal folds limit the narrowest point of the larynx - the glottis (rima glottidis).

The anterior part of the glottis is called the intermembranous part (pars intermembranacea), and the posterior part is called the intercartilaginous part (pars intercartilaginea).

The lower part of the larynx is located under the glottis, it is the subglottic cavity (cavitas infraglottica), which continues into the trachea.

The inside of the larynx is covered with a mucous membrane. The submucosa of the larynx has a fibrous-elastic membrane of the larynx (membrana fibroelastica larynges), consisting of a quadrangular membrane (membrana quadrangularis) and an elastic cone (conus elasticus). The quadrangular membrane at the top reaches the aryepiglottic folds, its lower free edge forms the right and left ligaments of the vestibule (ligg vestibulares), and the upper edge of the elastic cone forms symmetrically located vocal cords (ligg vocale).

3. STRUCTURE OF THE CARTILAY OF THE LARYNX

The larynx consists of paired: sphenoid, corniculate, arytenoid - and unpaired cartilages: epiglottis, thyroid and cricoid cartilages.

The thyroid cartilage (cartilago thyroidea) consists of right and left quadrangular plates (lamina dextra et lamina sinistra), connected in front at a right angle in women and under a blunt one in men. On the front of the cartilage there are upper (incisura thyroidea superior) and lower (incisura thyroidea inferior) thyroid notches. On the back surface of the cartilage there are symmetrically located upper (cornu superius) and lower (cornu inferius) horns. An oblique line (linea obliqua) runs along the outer surface of the plates.

The cricoid cartilage (cartilago cricoidea) consists of an arc (arcus cartilaginis cricoideae) located in front and a quadrangular plate (lamina cartilaginis cricoideae) located behind.

The basis of the epiglottis (epiglottis) is the epiglottic cartilage (cartilago epiglottica). The lower narrow end of the epiglottis (petiolus epiglottidis) is connected to the inner lower surface of the thyroid cartilage.

The arytenoid cartilage (cartilago arytenoidea) has a base (basis cartilaginis arytenoideae), an apex (apex cartilaginis arytenoideae) and three surfaces: medial (facies medialis), posterior (facies posterior) and anterolateral (facies anterolateralis). A vocal process (processus vocalis) extends forward from the base, and a muscular process (processus muscularis) extends laterally.

The corniculate cartilage (cartilago corniculata) is located in the thickness of the posterior part of the aryepiglottic fold at the top of the arytenoid cartilage and forms a corniculate tubercle (tuberculum corniculatum).

The sphenoid cartilage (cartilago cuneiformis) is also located in the thickness of the aryepiglottic fold and forms a wedge-shaped tubercle (tuberculum cuneiforme).

Cartilage connection of the larynx.

The structure of the cricothyroid joint (articulatio cricothyroidea). This joint belongs to the combined joints, the movement in it is carried out around the frontal axis. The cricothyroid joint is paired, formed by the articular surface of the anterolateral surface of the plate of the cricoid cartilage and the lower horns of the thyroid cartilage.

The structure of the cricoarytenoid joint (articulatio cricoarytenoidea). The joint can move around a vertical axis. The joint is formed by the articular surfaces of the plate of the cricoid cartilage and the base of the arytenoid cartilage.

In addition to discontinuous connections, cartilage is also connected using continuous connections - ligaments.

The upper edge of the thyroid cartilage is connected to the hyoid bone through the thyrohyoid membrane (membrana thyrohyoidea), which is thickened in the middle part and forms the median thyrohyoid ligament (lig thyrohyoidea medianum), along the edges - the lateral thyrohyoid ligaments (lig thyrohyoidea lateralia).

The epiglottis is connected to the thyroid cartilage by the thyroepiglotticum, and to the hyoid bone by the hyoepiglotticum.

The cricoid cartilage is connected to the first ring of the trachea by the cricotracheal ligament (lig cricatracheale) stretched between them, and to the edges of the thyroid cartilage by the cricothyroid ligament (lig cricothyroideum).

The muscular apparatus of the larynx (musculi larynges).

The muscles of the larynx perform the following functions: expand and narrow the glottis, stretch the vocal folds.

Muscles that narrow the glottis:

1) thyroid muscle (m. thyroarytenoideus); is a steam room, originates from the inner surface of the plate of the thyroid cartilage and ends on the muscular process of the cricoid cartilage;

2) lateral cricoarytenoid muscle (m. cricoarytenoidales lateralis); is a steam room, originates from the lateral section of the cricoid cartilage and ends on the muscular process of the arytenoid cartilage;

3) transverse arytenoid muscle (m. arytenoideus transverses); attached to the posterior surface of the right and left arytenoid cartilages;

4) oblique arytenoid muscle (m. arytenoideus obliqus); is a steam room, originates from the posterior surface of the muscular process of the left cartilage and ends on the lateral side of the right cartilage; the muscle on the other side has a similar course. Part of the muscle fibers of this muscle continues into the aryepiglottic muscle (m. aryepiglotticus).

The muscle that expands the glottis is the posterior cricoarytenoid muscle (m.cricoarytenoideus posterior). It is a steam room, originates from the posterior surface of the plate of the cricoid cartilage and ends on the muscular process of the arytenoid cartilage.

Muscles that tense the vocal cords:

1) vocal muscle (m. vocales); is a steam room, located in the thickness of the fold of the same name; starts from the inner surface of the angle of the thyroid cartilage and ends on the lateral surface of the vocal process;

2) the cricoid muscle (m. cricothyroideus) is a steam room, consists of two bundles that start from the anterior arch of the cricoid cartilage and are attached to the lower edge (pars recta) and the lower horn (pars obliqua) of the thyroid cartilage.

The blood supply to the larynx comes from the superior and inferior laryngeal arteries. Venous outflow is carried out through the veins of the same name.

Lymphatic outflow is carried out in the deep cervical nodes.

Innervation: upper and lower laryngeal nerves and branches of the sympathetic trunk.

4. STRUCTURE OF THE TRACHEA

Trachea (trachea) begins at the level of the lower edge of the VI cervical vertebra and ends at the level of the upper edge of the V thoracic vertebra, at the level of which it is divided into two main bronchi (bronchi principales dexter et sinister): right and left.

The right bronchus is wider and shorter than the left, is located vertically and is a continuation of the trachea. The azygos vein lies above the right bronchus, and the aortic arch lies above the left.

The wall of the main bronchi is represented by cartilaginous half-rings, with the membranous wall facing backwards. The place of transition of the trachea into the main bronchi is the bifurcation of the trachea (bifurcation tracheae). From below, the keel of the trachea (carina tracheae) protrudes into the lumen of the trachea. The trachea is divided into cervical (pars cervicalis) and thoracic parts (pars thoracica). The trachea is covered in front and on the sides in the cervical part by the thyroid gland, on the sides of it lie the neurovascular bundles, and behind the esophagus. In front lies the pretracheal plate of the cervical fascia with the sternothyroid and sternohyoid muscles enclosed in it. In the thoracic part in front of the trachea there are important arterial and venous trunks and the thymus gland, on the sides - the right and left mediastinal pleura.

The basis of the wall of the trachea is made up of cartilaginous semirings (due to which the lumen of the trachea always remains constant). Neighboring cartilages (cartilagines tracheales) are connected by tracheal ligaments (ligg trachealia). These ligaments continue into the membranous wall (paries membranaceus), facing backwards.

From the inside, the wall of the trachea is lined with a mucous membrane covered with stratified ciliated epithelium, which is located on the submucosa. The mucosa and submucosa contain tracheal and mucous glands and single accumulations of lymphoid tissue.

The blood supply to the trachea comes from the internal thoracic artery, branches of the inferior thyroid artery, and the aorta. Venous outflow is carried out in the right and left brachiocephalic veins.

Lymphatic outflow is carried out in the deep cervical lymph nodes (upper and lower tracheobronchial, paratracheal and pretracheal).

Innervation: branches of the right and left recurrent laryngeal nerves, from the sympathetic trunk.

5. STRUCTURE OF THE LUNG AND MAIN BRONCH

The lungs (pulmonalis) are located in the pleural sacs in the chest cavity and are separated by the mediastinal organs.

In the lungs, the following main parts are distinguished: the diaphragmatic (facies diaphragmatica), costal (facies costalis) and mediastinal surfaces (facies mediastinalis) and the apex (apex pulmonis).

On the mediastinal surface just above the middle of the lung there is an oval opening - the hilum pulmonis, into which the root of the lung (radix pulmonis) enters, represented by the incoming main bronchus, nerves and pulmonary artery and the outgoing lymphatic vessels and pulmonary veins.

At the gates, the main bronchi are divided into lobar (bronchi lobales), the latter - into segmental (bronchi segmentales).

The left upper lobar bronchus (bronchus lobaris superior sinister) is divided into upper and lower reed, anterior and apical-posterior segmental bronchi. The left lower lobar bronchus (bronchus lobaris inferior sinister) is divided into upper, anterior, posterior, medial and lateral basal segmental bronchi.

The right upper lobar bronchus (bronchus lobaris superior dexter) is divided into apical, anterior and posterior segmental bronchi. The right middle lobe bronchus (bronchus lobaris medius dexter) is divided into medial and lateral segmental bronchi. The right lower lobar bronchus (bronchus lobaris inferior dexter) is divided into upper, anterior, posterior, medial and lateral basal segmental bronchi.

The front edge (margo anterior) separates the mediastinal and costal surfaces and has a cardiac notch (incisura cordiaca) on the left lung, which is bounded from below by the tongue of the left lung (lingula pulmonis sinistri).

The lower edge (margo inferior) separates the diaphragmatic, costal and mediastinal surfaces. The left lung is divided by the oblique fissure (fissura obliqua) into the upper (lobus superior) and lower lobes (lobus inferior). In the right lung there is a horizontal fissure (fissura horizontalis), which separates a small part from the upper lobe - the middle lobe. Thus, the left lung consists of two lobes, and the right lung consists of three.

The segment of the lung is a section of lung tissue, facing the apex to the root of the lung, and the base - to the surface of the organ.

The segment consists of pulmonary lobules. Segmental bronchi are divided into ten orders: the lobule includes the lobular bronchus (bronchus lobularis), where it is divided into terminal bronchioles (bronchioli terminals), the walls of which no longer contain cartilaginous tissue. The terminal bronchioles are divided into respiratory bronchioles (bronchioli respiratorii), from which alveolar ducts (ductuli alveolares) extend, ending in alveolar sacs (sacculi alveolares), the walls of which consist of pulmonary alveoli (alveoli pulmonis). The totality of all bronchi makes up the bronchial tree (arbor bronchialis), and starting from the respiratory bronchioles and ending with the alveoli of the lung makes up the alveolar tree, or pulmonary acinus (arbor alveolaris). The number of alveoli in both lungs is about 700 million, and their total area is about 160 m2.

The blood supply to the lungs is carried out in the bronchial branches of the thoracic aorta. Venous outflow is carried out into the unpaired and semi-unpaired veins, into the tributaries of the pulmonary veins.

Lymphatic outflow is carried out in the bronchopulmonary, upper and lower tracheobronchial lymph nodes.

Innervation: branches of the pulmonary plexus (plexus pulmonalis), which is formed by the branches of the sympathetic trunk and the vagus nerve.

6. STRUCTURE OF THE PLEURA. PLEURAL CAVITY. MEDIASTINUM

Pleura (pleura), covering the lung, is divided into:

1) visceral pleura (pleura visceralis), which is tightly fused with lung tissue from all sides;

2) parietal pleura (pleura parietalis).

The visceral pleura forms the ligament of the lungs (lig pulmonale).

The parietal pleura is tightly fused with the inner wall of the chest wall, forming a closed bag in which the right and left lungs are located, enclosed in the visceral pleura.

In the parietal pleura, the mediastinal (pars mediastinalis), costal (pars costalis) and diaphragmatic (pars diafragmalis) parts are distinguished.

The costal and mediastinal parts, passing into each other at the level of the upper aperture of the chest, form the dome of the pleura (cupula pleurae).

Between the visceral and parietal pleura there is a slit-like closed space - the pleural cavity (cavitas pleuralis), which contains a small amount of serous fluid that facilitates sliding between the layers of the pleura. In the places where all parts of the parietal pleura transition into each other, small depressions are formed - pleural sinuses (recessus pleurales).

Between the costal and diaphragmatic parts of the parietal pleura there is a deep costodiaphragmatic sinus (recessus costodiaphragmaticus), at the point of transition of the diaphragmatic part into the mediastinal part - the phrenic mediastinal sinus (recessus phrenicomediastinalis), at the transition of the costal part to the mediastinal part - the costomediastinal sinus (recessus costomediastinalis). If absorption processes are impaired, serous fluid can accumulate in the sinuses, as well as - in various diseases of the pleura and lungs - pus and blood.

Mediastinum (mediastinum) - a set of organs located between the right and left pleural cavities.

The horizontal plane passing through the junction of the body of the sternum with the handle, and the intervertebral cartilage lying between the bodies of the IV and V thoracic vertebrae, divide the mediastinum into the upper (mediastinum superius) and lower (mediastinum inferius).

In the lower mediastinum, the anterior (mediastinum anterius), middle (mediastinum medium) and posterior mediastinum (mediastinum posterius) are distinguished.

The upper mediastinum contains the thymus, the aortic arch, the right and left brachiocephalic veins, the trachea, the upper part of the esophagus, the upper parts of the thoracic lymphatic duct, the vagus and phrenic nerves, and the right and left sympathetic trunks.

In the anterior mediastinum are the anterior mediastinal, peristernal and prepericardial lymph nodes, internal mammary arteries and veins.

In the middle mediastinum are the main bronchi, pulmonary arteries and veins, the pericardium with the heart located in it and large blood vessels, phrenic nerves, lateral pericardial lymph nodes.

In the posterior mediastinum there are unpaired and semi-azygous veins, corresponding parts of the esophagus, splanchnic nerves, thoracic lymphatic duct, right and left sympathetic trunks, prevertebral and posterior mediastinal lymph nodes.

LECTURE 5. URINARY SYSTEM

1. GENERAL INFORMATION ABOUT THE KIDNEYS. TOPOGRAPHY OF THE KIDNEYS

The kidney (ren) is a paired organ that produces and excretes urine. The buds have a dense consistency and bean-shaped shape. The kidneys of an adult have the following dimensions: length - up to 13 cm, width - up to 6-7 cm, parenchyma thickness reaches 5 cm. The average weight of one kidney is about 180 g.

The kidneys have a smooth surface of dark red color. External renal fascia (fascia renalis) consists of two leaves. Below it is a fatty capsule (capsula adiposa). It is most developed on the posterior surface of the kidneys, forming the perirenal fat body (corpus adiposum pararenale). Under the fatty capsule is a fibrous capsule (capsula fibrosa).

In the kidneys, two surfaces are distinguished - anterior and posterior (facies anterior et facies posterior), two edges - medial and lateral (margo medialis et margo lateralis), as well as two poles - upper and lower (extremitas superior et extremitas inferior).

The anterior surface is more convex than the posterior, the medial margin is concave, and the lateral margin is convex.

In the center of the medial edge there is a recess called the gates of the kidney (hilum renalis), through which the renal artery and nerve trunks are sent to the kidney, and the ureter, vein and lymphatic vessels exit. The entire set of formations entering and exiting the gate of the kidney is called the renal pedicle. The gates of the kidney pass into a more massive depression called the renal sinus (sinus renalis), the walls of which are formed by the renal papillae and renal columns. The renal sinus contains the renal calyx, pelvis, nerves, lymphatic and blood vessels, and adipose tissue.

The kidneys are located on either side of the lumbar column in the lumbar region, located in the retroperitoneal space. The kidneys are located at a slight angle to each other, so that the distance between the upper poles of the right and left kidneys is about 7-9 cm, and between the lower poles is about 11 cm.

The right kidney is located slightly lower than the left. The upper pole of the left kidney is located at the level of the middle of the body of the XI thoracic vertebra, and the upper pole of the right kidney is located at the level of the lower edge of the same vertebra. The lower pole of the left kidney is located at the level of the upper edge of the third lumbar vertebra, and the right kidney is located at the level of the middle of the same vertebra. This is an example of averaged data, since individual characteristics can introduce quite large fluctuations in these data.

The quadratus lumborum, transversus abdominis, psoas major, and diaphragm form the renal bed, to which the posterior surface of the kidneys is attached. At the upper pole of the kidneys are the adrenal glands.

The liver is adjacent to the upper half of the right kidney, and the colon is adjacent to the lower half. The descending part of the duodenum is adjacent to the medial edge. The stomach is adjacent to the upper third of the anterior surface of the left kidney, the pancreas is to the middle third, and the jejunum is to the lower third.

Due to such proximity to the organs of intra-abdominal pressure, the presence of the renal pedicle and fatty capsule, the kidneys are a sedentary organ.

2. MICROSCOPIC STRUCTURE OF THE KIDNEYS

In the kidney, there are cortical (cortex renalis) and brain (medulla renalis) substances. The cortical substance of the kidney is located superficially and has a thickness of 0,5 to 2,5 cm. The cortical substance is represented by the proximal and distal tubules of the nephrons and renal corpuscles and has a dark red color.

The medulla is located under the cortex and has a lighter color. In the medulla there are collecting ducts, descending and ascending parts of the tubules, papillary tubules.

The cortical substance forms the surface layer of the kidneys, and also adheres between the areas of the medulla, forming the renal columns. The cortical substance has a non-homogeneous structure: it distinguishes between radiant (pars radiata) (lighter areas of the cortical layer) and folded parts (pars convoluta) (darker areas). In the radiant part are the direct renal tubules and the initial sections of the collecting ducts. The folded part contains the proximal and distal portions of the convoluted renal tubules and renal corpuscles.

The medulla consists of renal pyramids (pyramides renales), which get their name due to the shape they are given by the cortical areas penetrating into the medulla. The number of renal pyramids varies and can range from 8 to 15 in each kidney. Each renal pyramid has a base (basis pyramidis) and an apex (apex pyramidis), or renal papilla. Each papilla is surrounded by a small renal calyx (calix renalis minor), which, when connected, form a large renal calyx (calix renalis major). When three large cups merge, they form the renal pelvis (pelvis renalis). In the wall of the small and large cups, as well as in the pelvis, three membranes are distinguished: mucous, muscular and external - adventitia. The renal pyramid consists of straight tubules and collecting ducts, which, merging with each other, form up to 20 papillary ducts that open on the surface of the papilla with papillary openings.

Five segments are distinguished in each kidney: superior, superior anterior, inferior, inferior anterior, and posterior. Several segments form the renal lobe (lobus renalis). The renal lobe is limited by interlobular arteries and veins. The renal lobe has in its composition the renal pyramid with a portion of the cortical substance adjacent to it. The renal lobe consists of more than 500 cortical lobules. The cortical lobule (lobulus corticalis) is limited by the interlobular arteries and veins and includes a radiant part, around which the folded part is located.

The nephron is the structural and functional unit of the kidney. Each kidney contains about 1 million nephrons. The nephron consists of the Bowman-Shumlyansky capsule and tubules. This capsule encloses the capillary network, resulting in the formation of a malpighian body (corpusculum renale).

The proximal convoluted tubule (tubulus contortus proximalis) is a continuation of the Bowman-Shumlyansky capsule, followed by the loop of Henle (ansa nephroni). It passes into the distal convoluted tubule (tubulus contortus distalis), which flows into the collecting duct (tubulus renalis collagens). The collecting ducts pass into the papillary ducts. 1% of nephrons are located in the cortex. 20% of nephrons (juxtaglomerular nephrons) have a long loop of Henle. 80% have a short loop of Henle, which descends only to the outer part of the medulla.

3. BLOOD SUPPLY AND INNERVATION OF THE KIDNEY

The renal artery entering the hilum of the kidney, being a branch of the abdominal aorta, is divided there into two branches: anterior and posterior. Sometimes there are additional branches. The blood flow in the kidneys is very intense: up to 1,5 tons of blood passes through the kidneys per day. The branches of the renal artery, passing behind and in front of the renal pelvis, are divided into segmental arteries. The posterior branch supplies blood only to the posterior segment, while the anterior branch supplies blood to all other segments.

In turn, the segmental arteries are divided into interlobar, which run in the renal columns and between the renal pyramids. The interlobar arteries at the border of the medulla and cortex are subdivided into arcuate arteries. From the interlobar and arcuate arteries to the medulla of the kidney go direct arterioles that supply the renal pyramids with blood.

Numerous interlobular arteries depart from the arcuate arteries into the cortex, giving rise to the afferent glomerular arterioles (arteriola glomerularis afferens). The afferent glomerular arterioles break up into capillaries, the loops of which form a glomerulus (glomerulus).

The efferent glomerular arterioles (arteriola glomerularis efferens) have a smaller diameter than the afferent ones, and, breaking up into capillaries, form a capillary network of the cortical and medulla of the kidneys.

Venous outflow from the kidney is carried out as follows: the capillary network of the cortical substance forms venules, which, when combined, form interlobular veins. These veins flow into the arcuate veins, where the venous vessels of the renal medulla also flow. The arcuate veins pass into the interlobar veins, which merge and flow into large veins, from which the renal vein is formed, which flows into the inferior vena cava.

Lymphatic vessels accompany blood vessels throughout their length.

The kidney has afferent (lower thoracic and upper lumbar spinal nodes), sympathetic (celiac plexus, sympathetic trunk) and parasympathetic - from the vagus nerves - innervation.

4. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE URETER

The ureter emerges from the hilum of the kidney and flows into the bladder. The purpose of the ureter is to remove urine from the kidney to the bladder. The average length of the ureter is 30 cm, the diameter is about 8 mm, and the internal lumen has a diameter of 4 mm.

The ureter has three physiological constrictions: at the exit from the kidney, at the transition from the abdominal part to the pelvis, and at the point of transition to the bladder. The ureters, like the kidneys, are located in the retroperitoneal space.

The ureter has three parts: abdominal (pars abdominalis), pelvic (pars pelvina) and intramural. The abdominal part is located on the psoas major muscle. The left ureter is located behind the junction of the duodenum and the jejunum, and the right ureter is located behind the descending part of the duodenum. Along with the ureter are the ovarian artery and vein in women and the testicular artery and vein in men. The pelvic part of the ureter has a narrower lumen. In this part, the right ureter lies in front of the internal, and the left - the common iliac arteries and veins. In women, the ureter in the pelvic part goes behind the ovary, bending around the outside of the cervix, then located between the bladder and the anterior wall of the vagina. In men, the ureter runs externally from the vas deferens, entering the bladder slightly below the seminal vesicle, after first crossing the vas deferens. The intramural part is the shortest, its length is no more than 2 cm.

The ureter is covered on the outside with adventitia (tunica adventitia), under it is the muscular membrane (tunica muscularis), which has two layers in the upper part and three layers in the lower. The inner shell is mucous (tunica mucosa).

The blood supply to the ureters is carried out from the branches of the renal, rectal and bladder, ovarian and testicular, as well as the common and internal iliac arteries. Venous outflow is carried out in the lumbar and iliac veins. Lymphatic outflow is carried out in the lymph nodes of the same name.

The innervation of the ureter is carried out from the renal and ureteral plexuses, vagus nerves, and the lower hypogastric plexus.

5. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE URINARY BLADDER

The bladder (vesica urinaria) is an unpaired organ in which urine is accumulated and then excreted.

The capacity of the bladder is 300 to 500 ml. In the bladder, the following main parts are distinguished: the body (corpus vesicae), the top (apex vesicae), the bottom (fundus vesicae) and the neck (cervix vesicae). From the apex to the navel goes the median umbilical ligament (lig umbilicale medianum). The lower part of the bladder is connected by ligaments to neighboring organs and the walls of the small pelvis.

The most important is the pubic-prostatic ligament in men and the pubic-vesical ligament in women. In addition to the ligaments, there are muscles (pubic-vesical and recto-vesical) that strengthen the bladder. In addition, the bladder is fixed by the prostate gland in men, the urogenital diaphragm in women. In the lower part of the neck of the bladder is the internal opening of the urethra.

The bladder is located in the pelvic cavity. Between the pubic symphysis and the anterior wall of the bladder there is loose tissue. The filled bladder is in contact with the anterior abdominal wall, rising above the pubic symphysis. In men, the posterior wall of the bladder is in contact with the rectum and seminal vesicles, the bottom is bordered by the prostate gland, in women - with the anterior wall of the vagina and the uterus, the bottom is bordered by the urogenital diaphragm. The uterus is adjacent to the upper part of the bladder in women, and the intestinal loops in men. An unfilled bladder is located retroperitoneally, and a full bladder is located mesoperitoneally.

The structure of the bladder wall is the same in men and women. The bladder consists of adventitia (tunica adventitia), muscular membrane (tunica muscularis), submucosa and mucous membrane (tunica mucosa). When the bladder is full, its wall thickness is negligible, only 2 mm. In the collapsed state (due to the reduced wall) it can be up to 1,5 cm.

At the bottom of the bladder, an anatomical formation is isolated, called the triangle of the bladder (trigonum vesicae), the corners of which are formed by the openings of the ureters (ostium ureteris) and the internal opening of the urethra (ostium urethrae internum).

The mucous membrane in this area is tightly fused with the muscular membrane and does not fold into folds (unlike other areas where the submucosa is well developed).

The muscularis has three layers. The circular layer, well developed at the beginning of the urethra, forms the sphincter of the bladder.

The muscular membrane performs mainly one function: during the contraction of the bladder, it expels urine through the urethra.

The blood supply to the bladder comes from the superior vesical arteries and branches of the inferior vesical arteries. Venous outflow is carried out in the internal iliac veins.

Lymphatic outflow is carried out in the lymph nodes of the same name.

The bladder receives sympathetic (from the inferior hypogastric plexus), parasympathetic (from the pelvic splanchnic nerves), and sensory (from the sacral plexus) innervation.

LECTURE 6. FEMALE GENITAL ORGANS

1. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE VAGINA

The vagina (vagina) is an unpaired tube-shaped organ that is located in the pelvic cavity from the genital slit to the uterus. The vagina is up to 10 cm long, the wall thickness is from 2 to 3 mm.

From below, the vagina passes through the urogenital diaphragm. The longitudinal axis of the vagina, intersecting with the axis of the uterus, forms an obtuse angle, which is open anteriorly.

The opening of the vagina in girls is closed by the hymen (hymen), which is a semilunar plate, which is torn during the first sexual intercourse, forming flaps of the hymen (carunculae hymenalies).

In the collapsed state, the walls of the vagina look like a slit located in the frontal plane.

Three main parts are distinguished in the vagina: the anterior (paries anterior) and posterior walls (paries posterior) and the vaginal fornix (fornix vaginae).

The anterior wall of the vagina, along its greater length, is fused with the wall of the urethra, and on the rest of it is in contact with the bottom of the bladder.

The lower part of the posterior wall of the vagina is adjacent to the anterior wall of the rectum. The vault of the vagina is formed by the walls of the vagina when they cover the vaginal part of the cervix.

The fornix of the vagina has two parts: a deeper posterior and anterior.

The inner shell of the vagina is represented by a mucous membrane (tunica mucosa), which is tightly fused with the muscular membrane (tunica muscularis), since there is no submucosa. The mucous membrane reaches a thickness of 2 mm and forms vaginal folds (rugae vaginales). On the anterior and posterior walls of the vagina, these folds form columns of folds (columnae rugarum).

The column of folds located on the front wall, in its lower part, is the urethral keel of the vagina.

In the vaginal folds, the mucous membrane is thicker. The muscular membrane of the vagina consists of muscle fibers having a circular and longitudinal direction.

In the upper part of the vagina, the muscular membrane passes into the muscles of the uterus, and in the lower part it is woven into the muscles of the perineum. The muscle fibers covering the lower part of the vagina and the urethra form a kind of sphincter.

The outer shell of the vagina is represented by the adventitia.

The blood supply to the vagina comes from the uterine arteries, the internal pudendal arteries, the inferior vesical arteries, and the middle rectal arteries. Venous outflow is carried out in the internal iliac veins.

Lymphatic vessels accompany the arteries along their entire length. Lymph drainage is carried out in the inguinal and internal iliac lymph nodes.

The innervation of the vagina is carried out by the branches of the pudendal nerve and from the lower hypogastric plexuses.

2. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE UTERUS

The uterus (uterus) is a hollow, pear-shaped, unpaired muscular organ in which the development and gestation of the fetus takes place.

The uterus is located in the pelvic cavity, located in front of the rectum and behind the bladder. In accordance with this, the anterior and posterior surfaces of the uterus are distinguished. The anterior surface of the uterus is called the vesical, and the posterior surface is called the rectal. The anterior and posterior surfaces of the uterus are separated by the right and left edges of the uterus. The length of the uterus of an adult woman is about 8 cm, width - up to 4 cm, length - up to 3 cm. The average volume of the uterine cavity is 5 cm3. The weight of the uterus in women who have given birth is twice as large as in women who have not given birth.

There are three main parts in the uterus: the body (corpus uteri), the cervix (cervix uteri) and the fundus (fundus uteri). The fundus of the uterus is represented by a convex section located above the level where the fallopian tubes enter the uterus. The fundus of the uterus passes into the body of the uterus. The body of the uterus is the middle part of this organ. The body of the uterus passes into the cervix. The isthmus of the uterus (isthmus uteri) is the area where the body of the uterus transitions to the cervix. The part of the cervix that protrudes into the vagina is called the vaginal part of the cervix, the rest is called the supravaginal part. On the vaginal part of the cervix there is an opening, or uterine os, which leads from the vagina into the canal of the cervix, and then into its cavity.

The uterine os is limited by the anterior and posterior lips (labium anterior et superior). In nulliparous women, the uterine os is small and has a rounded shape; in women who have given birth, it looks like a gap.

The wall of the uterus consists of three layers.

The inner shell - mucous, or endometrium (endometrium), - has a thickness of up to 3 mm. The mucous membrane does not form folds, only in the canal there is one longitudinal fold, from which small folds extend in both directions. In the mucous membrane there are uterine glands.

The muscular layer, or myometrium (myometrium), has a significant thickness. Myometrium has three layers: inner and outer oblique and middle circular.

The outer shell is called perimetrium (perimetrium), or serous membrane. In the region of the cervix there is a subserous base (tela subserosa). The uterus is a mobile organ.

The peritoneum, covering the uterus, forms two pockets: the vesicouterine cavity (excavatio vesikouterina) and the Douglas, or recto-uterine cavity (excavatio rectouterina). The peritoneum, covering the anterior and posterior surfaces of the uterus, forms the right and left broad ligaments of the uterus. (lig. Latum uteri). In their structure, the wide ligaments of the uterus are the mesentery of the uterus. The part of the broad ligament of the uterus adjacent to the ovary is called the mesentery of the ovary (mesovarium). Round ligament of the uterus (lig. teres uteri) starts from the anterolateral wall of the uterus. Between the cervix and the walls of the small pelvis at the base of the broad ligaments lie the cardinal ligaments of the uterus (ligg. Cardinalia).

The blood supply to the uterus is carried out from paired uterine arteries, which are branches of the internal iliac arteries. Venous outflow occurs through the uterine veins into the venous plexus of the rectum and the ovarian and internal iliac veins.

Lymphatic outflow is carried out in the internal iliac, inguinal and sacral lymph nodes.

The innervation of the uterus is carried out from the lower hypogastric plexus and along the pelvic splanchnic nerves.

3. STRUCTURE, INNERVATION AND BLOOD SUPPLY OF THE UTERINE TUBES

The fallopian tube (tuba uterina) is a paired organ necessary for carrying the egg into the uterine cavity from the abdominal cavity.

The fallopian tubes are oval-shaped ducts that lie in the pelvic cavity and connect the ovaries to the uterus. The fallopian tubes pass through the broad ligament of the uterus at its upper edge. The length of the fallopian tubes is up to 13 cm, and their internal diameter is about 3 mm.

The opening through which the fallopian tube communicates with the uterus is called the uterine (ostium uterinum tubae), and the abdominal cavity opens into the abdominal cavity (ostium abdominale tubae uterinae). Due to the presence of the last opening, the abdominal cavity in women has a connection with the external environment.

In the fallopian tubes, the following parts are distinguished: the uterine part (pars uterine), the isthmus of the fallopian tube (isthmus tubae uterinae) and the ampulla of the fallopian tube (ampulla tubae uterinae), passing into the funnel of the fallopian tube (infundibulum tubae uterinae), which ends with the fringes of the tube (fimbria ovarika ). The uterine part is located in the thickness of the uterus, the isthmus is the narrowest and thickest part of the fallopian tube. The fimbria of the fallopian tube with their movements direct the egg towards the funnel, through the lumen of which the egg enters the lumen of the fallopian tube.

The structure of the wall of the fallopian tube. The inner layer of the fallopian tube is represented by the mucous membrane, which forms longitudinal tubal folds. The thickness of the mucous membrane and the number of folds increases near the abdominal opening. The mucous membrane is covered with ciliated epithelium. The muscular lining of the fallopian tubes consists of two layers. The outer muscle layer is located longitudinally, and the inner layer is circular. The muscular layer continues into the musculature of the uterus. Outside, the fallopian tubes are covered with a serous membrane, which lies on a subserosal base.

The blood supply of the fallopian tubes is carried out from the branches of the ovarian artery and tubal branches of the uterine artery. Venous outflow through the veins of the same name is carried out to the uterine plexus.

Lymphatic drainage is carried out to the lumbar lymph nodes.

The innervation of the fallopian tubes is carried out from the uterovaginal and ovarian plexuses.

4. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE OVARIANS. OVARIAN ADDITIONS

The ovary (ovarium) is a paired gonad lying in the cavity of the small pelvis, in which the maturation of eggs and the formation of female sex hormones that have a systemic effect are carried out.

Ovary dimensions: average length - 4,5 cm, width - 2,5 cm, thickness - about 2 cm. The mass of the ovary is about 7 g. In women who have given birth, the surface of the ovary is uneven due to the presence of scars that formed as a result of ovulation and tel.

In the ovary, the uterine (extermitas uterina) and upper tubal ends (extermitas tubaria) are distinguished. The uterine end is connected to the own ligament of the ovary (lig ovarii proprium). The ovary is fixed by a short mesentery (mesovarium) and a ligament that suspends the ovary (lig suspensorium ovarii). The ovaries are not covered by the peritoneum.

The ovaries have fairly good mobility. The ovary has a medial surface, facing the pelvis, and a lateral surface, which is adjacent to the wall of the pelvis. The surfaces of the ovary pass into the posterior (free) edge (margo liber), and in front - into the mesenteric edge (margo mesovarikus). On the mesenteric edge there is an ovarian gate (hilum ovari), which is represented by a small depression.

The structure of the ovary. The ovarian parenchyma is subdivided into medulla ovari and cortex ovari. The medulla is located in the center of this organ (near the gate), in this substance there are neurovascular formations. The cortical substance is located on the periphery of the medulla, contains mature follicles (folliculi ovarici vesiculosi) and primary ovarian follicles (folliculi ovarici primarii). A mature follicle has an inner and outer connective tissue sheath (theca).

The inner wall contains lymphatic vessels and capillaries. Adjacent to the inner shell is a granular layer (stratum granulosum), in which there is an egg-bearing mound with an egg cell located in it - an oocyte (ovocytus). The oocyte is surrounded by the zona pellucida and the corona radiata. During ovulation, the wall of a mature follicle, which, as it matures, approaches the outer layers of the ovary, bursts, the egg enters the abdominal cavity, from where it is captured by the fallopian tube and carried into the uterine cavity. At the site of the burst follicle, a depression filled with blood is formed, in which the corpus luteum (corpus luteum) begins to develop. If pregnancy does not occur, then the corpus luteum is called cyclic and exists for a short time, turning into a white body (corpus albicans), which resolves. If fertilization of the egg occurs, the corpus luteum of pregnancy is formed, which is large in size and exists throughout the entire period of pregnancy, performing an intrasecretory function. Later it also turns into a white body.

The surface of the ovary is covered with a single layer of germinal epithelium, under which lies a tunica albuginea, formed by connective tissue.

Appendages (epoophoron) are located near each ovary. They consist of a longitudinal duct of the appendage and transverse ducts, which have a convoluted shape.

The blood supply to the ovaries is carried out from the branches of the ovarian artery and the ovarian branches of the uterine artery. Venous outflow is carried out through the arteries of the same name.

Lymphatic drainage is carried out to the lumbar lymph nodes.

The innervation of the ovaries is carried out along the pelvic splanchnic nerves and from the abdominal aortic and lower hypogastric plexuses.

LECTURE 7. MALE GENITAL ORGANS

1. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE PROSTATE

The prostate gland (prostata) is an unpaired glandular-muscular organ, consisting of individual acini, secreting substances that are a component of sperm. The prostate gland has a mass of up to 25 g and the following dimensions: thickness - up to 2 cm, transverse dimensions - up to 4 cm and longitudinal dimensions - up to 3 cm.

The gland is located in the small pelvis under the bladder. The urethra passes through the prostate, entering the base of the gland and exiting through its apex. The prostate is perforated by the vas deferens.

The prostate is divided into the base (basis prostatae), anterior (facies anterior) and posterior surfaces (facies posterior), inferolateral surfaces (facies inferlateralis) and the apex of the prostate gland (apex prostatae). From the prostate there are ligaments - the median and lateral puboprostatic ligaments (lig puboprostaticae) and the puboprostatic muscle (m. Puboprostaticus), fixing the gland to the pubic symphysis.

The posterior surface of the prostate is separated from the ampulla of the rectum by a rectovesical plate (septum rectovesicale).

Outside, the prostate is covered with a dense capsule, from which partitions extend into the gland.

The prostate has a lobular structure, the number of lobules reaches 50. The lobules are mainly located in the lateral and posterior sections of the prostate. The glandular ducts of the acini merge in pairs and form the prostatic ducts (duktuli prostaci), which open into the urethra. In front of the prostate is a smooth muscle tissue located around the urethra and involved in the formation of an involuntary sphincter.

Blood supply to the prostate is carried out by small branches of the inferior vesical and middle rectal arteries. Venous outflow occurs into the venous plexus of the prostate, from which into the internal iliac veins.

Lymphatic drainage is carried out to the internal iliac lymph nodes.

Innervation is carried out from the prostatic plexus.

2. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE TESTICLES AND THEIR ADDITIONS

The testicle (testis) is a paired gonad of mixed secretion; produces spermatozoa and secretes hormones into the blood.

The testicles are located in the scrotum. The testicles are separated by a septum, have an oval shape and a smooth surface. The mass of the testicle is about 25 g, the dimensions are as follows: length - 4 cm, width - up to 3 cm, thickness - up to 2 cm. The testicle has an upper and lower end (extremitas superior et inferior), two edges - posterior and anterior, and two sides - medial and more convex lateral (facies medialis et lateralis). At the upper end you can find the appendix testis.

The testicle is covered with a dense albuginea (tunika albuginea), under which is located the parenchyma of the testis (parenchyma testis).

The inner surface of the tunica albuginea on the back side forms a small outgrowth - the mediastinum of the testicle, from which thin connective tissue septa (septula testis) extend, dividing the testicular parenchyma into lobules (lobuli testis), the number of which reaches about 300. Each lobule has several convoluted tubules (tubuli seminiferi contorti), which, merging, form straight tubules (tubuli seminiferi recti). Straight tubules flow into the rete testis (rete testis), from where up to 15 efferent testicular tubules (ductuli efferentes testis) emerge, flowing into the duct of the epididymis. Only in the convoluted tubules are spermatozoa formed, which are part of the sperm; the remaining tubules are seminiferous.

The epididymis (epididymis) is located along the posterior edge of the testis. In the appendage, a head (caput epididymidis), a body (corpus epididymidis) and a tail (cauda epididymidis) are distinguished. Children have a well-defined appendage of the testicle (paradidymis), located next to the head of the epididymis. The white of the testicle passes to the epididymis. The efferent tubules of the testis form cones of the epididymis (coli epididymidis), of which there are about 15-20.

Blood supply is carried out from the testicular artery and the artery of the vas deferens. Venous outflow goes to the pampiniform venous plexus (plexus venosus pampiniformis).

Lymphatic drainage occurs in the lumbar lymph nodes.

Innervation is carried out from the testicular plexus.

3. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE PENIS AND URINARY CANAL. STRUCTURE, BLOOD SUPPLY AND INNERVATION OF THE SCROTUM

The penis is intended for excretion of urine and ejection of semen.

In the penis, the following parts are distinguished: the body (corpus penis), the head (glans penis), the root (radix penis) and the back (dorsum penis). At the top of the head there is an external opening of the urethra. The penis is covered with easily shifting skin, forming in the anterior part of the foreskin (preputum penis), which has glands on the inside.

The foreskin in the lower part is connected to the head with a frenulum (frenulum penis).

In the penis there are symmetrically located cavernous bodies (corpus cavernosum penis), under which there is an unpaired spongy substance (corpus spongiosum penis), which has the shape of a cylinder. The corpora cavernosa are covered and separated by a tunica albuginea, having fusion only on the medial surface. The posterior ends of the cavernous bodies are called crura penis; they are attached to the pubic bone. The corpus spongiosum is covered with its tunica albuginea and has an extension - the bulb of the penis (bulbus penis). The corpus spongiosum and cavernous bodies have a trabecular structure, delimiting cavities. When the cavities are filled with blood, an erection occurs. The corpus spongiosum and cavernous bodies are surrounded by superficial and deep fascia. The penis is fixed by suspensory ligaments: deep (sling-shaped) and superficial.

Blood supply is carried out from the external and internal genital arteries. Venous outflow is carried out in the internal pudendal vein.

Lymphatic drainage is carried out to the internal iliac and superficial inguinal lymph nodes.

Innervation: pudendal nerve (sensory), inferior hypogastric plexus (sympathetic), pelvic splanchnic nerves (parasympathetic).

The urethra (urethra masculine) begins with an internal opening (ostium urethrae internum) in the wall of the bladder and ends with an external opening (ostium urethrae externum) at the top of the glans penis. The urethra is up to 25 cm long and up to 8 mm in diameter.

The urethra passes through the prostate, the urogenital diaphragm and the corpus spongiosum, and therefore there are three parts: prostatic (pars prostatica), membranous (pars membranacea) and spongy (pars spongiosa). The membranous part is the shortest (1,5 cm), the spongy part is the longest (up to 18 cm). The urethra has an S-shape and three physiological narrowings: in the area of ​​the internal and external openings and in the area of ​​passage through the urogenital diaphragm.

The mucous membrane of the urethra is rich in glands (gll. Urethrales) and lies on the submucosa. Outside of the submucosa lies the muscular membrane, consisting of two layers: longitudinal and circular.

The scrotum (scrotum) is a protrusion of the anterior abdominal wall and consists of two separate chambers in which the testicles are located. The scrotum is located below and behind the root of the penis.

The scrotum has seven layers:

1) skin (cutis);

2) fleshy shell (tunica dartos);

3) external seminal fascia (fascia spermatica externa);

4) fascia of the muscle that lifts the testicle (fascia cremasterica);

5) the muscle that lifts the testicle (m. Cremaster);

6) internal seminal fascia (fascia spermatica interna);

7) the vaginal membrane of the testicle (tunica vaginalis testis), in which two plates are distinguished: visceral and parietal.

Blood supply is carried out in the branch of the external pudendal artery, the branch of the perineal artery and the branch of the inferior epigastric artery. Venous outflow is carried out in the femoral and internal pudendal veins.

Lymphatic outflow is carried out in the superficial inguinal lymph nodes.

Innervation: from the pudendal nerve, branches of the femoral-genital nerve, lower hypogastric plexuses.

LECTURE 8. DIGESTIVE SYSTEM

1. STRUCTURE OF THE MOUTH AND BEEKS

The vestibule of the mouth (vestibulum oris) is a small space bounded in front by the lips and cheeks, and behind by the gums and teeth.

The lips are muscular folds that, when closed, limit the transverse oral fissure (rima oris), the ends of which are called the corners of the mouth (angulus oris). The visible surface of the lips is covered with skin, which passes into the mucous membrane inside the oral cavity. The upper lip is delimited from the cheeks by the nasolabial groove, the lower lip is delimited from the chin by the chin-labial groove.

The inner surface of the lips is formed by a mucous membrane that passes into the mucous membrane of the gums.

As a result of this transition, two longitudinal folds are formed - the frenulum of the upper and lower lips (frenulum labii superioris et frenulum labii inferioris). In the submucosa of the lips there are many small labial glands, the ducts of which open on the mucous membrane of the lips.

The cheeks (buccae) are covered with skin on the outside, with a mucous membrane on the inside. The basis of the cheek is the buccal muscle (m buccinator). Subcutaneous fat is very well developed only in childhood, as it is necessary for a full act of sucking.

In the submucosa of the cheeks there is a small amount of buccal glands. Above the upper second molar on the mucous membrane of the cheek on both sides, the excretory duct of the parotid gland opens, forming the papilla of the parotid gland (papilla parotidea). The mucous membrane of the cheeks passes into the mucous membrane of the gums (gingivae), which are the alveolar processes of the upper and lower jaws, covered with a dense thick mucous membrane that covers the necks of the teeth.

2. STRUCTURE OF THE MOUTH. STRUCTURE OF THE TEETH

The oral cavity (cavitas oris) with the jaws closed is filled with the tongue. Its outer walls are the lingual surface of the dental arches and gums (upper and lower), the upper wall is represented by the palate, the lower wall is represented by the muscles of the upper neck, which form the diaphragm of the mouth (diaphragma oris).

Teeth (dentes) are located along the upper edge of the gums in the dental alveoli of the upper and lower jaws. Teeth are modified papillae of the oral mucosa. Teeth, through a continuous connection - impaction (gomphosis), are immovably strengthened by their roots in the alveoli; in terms of physico-chemical properties, they are close to bone tissue. The function of teeth is to separate and chew food, form speech, and facilitate the correct pronunciation of individual sounds. Normally, an adult has 32 teeth. The first teeth (baby teeth) appear at 6 months; from the age of five they begin to fall out, and permanent teeth grow in their place.

Each tooth has a crown, neck and root.

The crown of a tooth (corona dentis) is its most massive part, which is a section that rises above the gum. The following surfaces are distinguished in the crown: chewing (facies occusalis) - is the surface of contact between the upper and corresponding lower teeth, lingual (facies lingualis) - facing the tongue, facial (facies vestibularis) - facing the vestibule of the mouth, contact surfaces - facing two neighboring ones teeth

The root of the tooth (radix dentis) is located in the dental alveolus. The number of roots varies - from one to three. Each root ends at an apex (apex radicis dentis), on which there is a small hole of the same name (foramen apicis dentis), through which arteries, veins and nerves enter the tooth, leading to the dental pulp (pulpa dentis), which fills the tooth cavity.

The neck of the tooth (cervix dentis) is a small section of the tooth located between the crown and the apex; which covers the mucous membrane of the gums. The teeth have a cavity (cavitas dentis), which is formed by the cavity of the crown and the canal of the tooth root (canalis radicis dentis).

The main components of the tooth are enamel (enamelum), dentin (dentinum) and cement (cementum). Dentin forms the main part of the dental tissue, cement forms the root, and the crown is covered with enamel on the outside.

A person has four forms of teeth: incisors, canines, small and large molars. The teeth in the oral cavity are arranged symmetrically in the form of the lower and upper rows. Each row has 16 teeth. In the sagittal plane, each row is divided into two symmetrical parts, consisting of eight teeth: two incisors, one canine, two premolars, two molars. Incisors, canines and molars differ from each other in the number of roots and the shape of the crown.

Incisors (dentes incisivi) have a chisel-shaped crown with a narrow edge, a narrow cutting surface, one root. The crowns of the lower incisors are narrower than those of the upper ones.

Fangs (dentes canini) have the shape of a cone with a sharp tip, one very long root. Sometimes the root may be double or forked at the top.

The crown of premolars (dentes premolares) has an oval shape. Its chewing surface has two conical masticatory tubercles. The root can be either single or forked at the top.

The crown of large molars (dentes molares) has a cubic shape. The third large molar (wisdom tooth (dens serotinus)) is distinguished by its small size and late eruption (up to 27 years). On the chewing surface of the molars there are from three to five chewing tubercles.

The meeting of the teeth of the upper and lower jaws is called an overbite. In a normal bite, the teeth of the lower jaw overlap with the teeth of the upper jaw.

3. STRUCTURE OF THE LANGUAGE

The tongue (lingua) is a muscular organ involved in mixing food, swallowing and articulation. The tongue has a large number of taste buds. The front part of the tongue is called the apex of the tongue (apex linguae), the back part is called the root (radix linguae). Between these formations is the body of the tongue (corpus linguae). The upper wall of the tongue is called the back (dorsum linguae) and faces the palate and pharynx. The lower surface (facies inferior linguae) of the tongue is located only at the level of the apex and the initial parts of the body of the tongue. The lateral surfaces of the tongue are called the edges of the tongue (margo linguae). On the back of the tongue there is a median groove (sulcus medianus linguae), ending posteriorly with a fossa - the blind opening of the tongue (foramen caecum linguae). On either side of it runs a boundary groove (sulcus terminalis), which is the boundary between the body and the root of the tongue. The mucous membrane of the tongue (tunica mucosae linguae) is pink in color and has numerous elevations - taste buds of the tongue (papillae linguae).

There are the following types of papillae:

1) conical and filiform papillae (papillae conicae et papillae filiformis); are the most numerous and are located on the back of the tongue;

2) mushroom papillae (papillae fungiformis); located on the sides and at the top of the tongue. They are second in number to the filiform and cone-shaped papillae;

3) foliate papillae (papillae foliatae); located on the edges of the tongue;

4) grooved papillae (papillae vallatae); are the fewest and largest (up to 12), located anterior to the border furrow in the form of a Roman numeral V.

Only the mucous membrane of the root of the tongue does not have papillae; in its thickness there is an accumulation of lymphoid tissue - the lingual tonsil (tonsilla lingualis).

The mucous membrane of the lower surface of the tongue is smooth, has two longitudinal folds, which, when moving to the bottom of the oral cavity, form the frenulum of the tongue (frenulum linguae). Near the frenulum of the tongue there are symmetrically located sublingual papillae (caruncula sublingualis), on which the excretory ducts of the sublingual and submandibular salivary glands open. Behind this elevation there is a sublingual fold (plica sublingualis), corresponding to the location of the sublingual salivary gland.

The tongue has the following muscles:

1) skeletal muscles of the tongue:

a) hyoid-lingual muscle (m. hyoglossus); pulls tongue back and down;

b) styloglossus muscle (m. styloglossus); pulls the tongue up and back, with unilateral contraction - to the side;

c) genio-lingual muscle (m. genioglossus); pulls tongue down and forward;

2) own muscles of the tongue:

a) transverse muscle of the tongue (m. transversus linguae); raises the back of the tongue and reduces its transverse dimensions;

b) vertical muscle of the tongue (m. verticalis linguae); makes the tongue flat;

c) the upper longitudinal muscle of the tongue (m. longitudinalis superior); raises the tip of the tongue and shortens the tongue;

d) upper longitudinal muscle of the tongue (m longitudinalis inferior); lowers the tip of the tongue and shortens the tongue.

The blood supply is carried out in the lingual artery.

Venous outflow is carried out through the vein of the same name into the internal jugular vein.

Lymphatic outflow is carried out in the submental, submandibular and lateral deep cervical lymph nodes.

Innervation: XII pair of cranial nerves - motor, V, IX and X pairs of cranial nerves - sensitive, VII and IX pairs of cranial nerves - gustatory.

4. STRUCTURE OF THE HARD AND SOFT PALATE

The palate (palatum) is the upper wall of the oral cavity and is divided into two parts: the hard palate, formed by bone tissue, and the soft palate. The mucous membrane covers the entire sky, densely growing together with the hard palate, continuing to the soft palate, on the sides passes to the alveolar processes of the upper jaw, forming the gums.

The hard palate (palatum durum) is formed by the palatine processes of the maxillary bones and the horizontal plates of the palatine bones. It occupies the anterior 2/3 of the palate. A palatine suture (raphe palati) runs along the midline of the hard palate, from which several transverse folds extend, which are most pronounced in children.

The soft palate (palatum molle) is 1/3 of the palate and is located behind the hard palate. The soft palate is formed by the palatine aponeurosis and muscles. Participates in the formation of the pharynx. The mucous membrane of the soft palate is a continuation of the mucous membrane of the nasopharynx, below it passes into the mucous membrane of the hard palate.

The soft palate consists of two sections: the anterior one, located horizontally, and the posterior one, which hangs freely and forms the velum palatinum. The back of the soft palate has a small process in the middle - the uvula. Two arches extend from the lateral edges of the velum palatine: the anterior - palatoglossus (arcus palatoglossus) - and the posterior - velopharyngeus (arcus palatopharyngeus). Between the arches there is a small fossa (fossa tonsillaris), in which the palatine tonsil (tonsilla palatina) is located. A special feature of the structure of this tonsil is the presence of a fibrous lining and crypts that penetrate deeply into the tissue of the gland. This structure causes frequent inflammatory processes in it. The internal carotid artery passes 1 cm posterior to the palatine tonsil. The tonsil reaches its maximum size by the age of 17.

Muscles of the soft palate:

1) palatoglossal muscle (m. palatoglossus); lowers the palatine curtain and reduces the opening of the pharynx;

2) palatopharyngeal muscle (m. palatopharyngeus); lowers the palatine curtain and reduces the opening of the pharynx;

3) the muscle that lifts the palatine curtain (m. Levator veli palatini); raises the soft palate;

4) muscle straining the palatine curtain (m. tensor veli palatini); strains the palatine curtain and expands the lumen of the auditory tube;

5) tongue muscle (m. uvulae); shortens and elevates the tongue.

5. MOUTH GLANDS

The glands of the mouth (glandulae oris) produce saliva; are divided into paired large (parotid, sublingual, submandibular) and small salivary glands. Large salivary glands are located outside the oral cavity.

Minor salivary glands (glandulae salivariae minores) are located in the mucous membrane and submucosa of the oral cavity. These glands are small in size - up to 5 mm.

These glands are named according to their location:

1) buccal (glandulae buccales);

2) labial (glandulae labiales);

3) palatine (glandulae palatinae);

4) lingual (glandulae linguales);

5) molar (glandulae molares).

The first two groups are the most important. Depending on the nature of the secretion produced, the glands are divided into serous (lingual), mucous (lingual and palatine) and mixed (buccal, molar, labial and lingual).

Major salivary glands (glandulae salivariae majores).

parotid gland (glandula parotidea) - the largest salivary gland; is a complex alveolar gland that secretes a serous secretion. It is located under the skin on the outer surface of the branch of the lower jaw (anterior and downward from the auricle) and the posterior edge of the masticatory muscle. At the top, the gland reaches almost to the zygomatic arch. Has a capsule. With its deep part (pars profunda), the parotid gland is in contact with the styloid process and the muscles of this process. The facial and ear nerves, the carotid artery, and the mandibular vein pass through the gland. The excretory duct of the gland emerges from its anterior margin and opens in front of the mouth at the level of the second molar. An additional parotid gland (glandula parotis accessoria) is sometimes located on the surface of the masticatory muscle.

Blood supply is carried out in the branches of the temporal artery.

Venous outflow is carried out in the mandibular vein.

Lymphatic outflow is carried out in the deep and superficial parotid lymph nodes.

sublingual gland (glandula sublingualis) belongs to the alveolar tubular glands, secretes a mucous secretion. It is located on the upper surface of the mylohyoid muscle, under the mucous membrane of the floor of the mouth. The anterior edge of the gland approaches the inner surface of the body of the lower jaw, and the posterior edge approaches the submandibular gland. Its minor excretory ducts (ductus sublingualies minores) open in the oral cavity on the surface of the mucous membrane along the sublingual fold. Sometimes there is a large sublingual duct (ductus sublingualis major), which opens on the sublingual papilla along with the excretory duct of the submandibular gland.

Blood supply is carried out in the branches of the lingual and facial arteries.

Venous outflow is carried out in the veins of the same name.

Lymphatic outflow is carried out in the submental and submandibular lymph nodes.

submandibular gland (glandula submandibularis) is located in the submandibular triangle and belongs to the complex alveolar-tubular glands. It is covered with a thin capsule. With its upper part the gland is in contact with the inner surface of the lower jaw, the lower part comes out from under the lower jaw, the medial part of the gland is in contact with the muscles of the tongue. From the front of the gland, its excretory duct emerges - the submandibular duct (ductus submandibularis), which opens with a small hole on the sublingual papilla (near the frenulum of the tongue).

Blood supply is carried out in the branches of the facial artery.

Venous outflow is carried out in the vein of the same name.

Lymphatic outflow is carried out in the submandibular lymph nodes.

6. STRUCTURE OF THE pharynx

The pharynx (pharynx) connects the oral cavity and the esophagus.

The pharynx is part of the respiratory system, conducting air from the nasal cavity to the larynx and vice versa. The pharynx communicates with the nasal cavity through the choanae and with the oral cavity through the pharynx. The structure of the pharynx resembles a funnel with an average length of up to 13 cm, flattened in the anteroposterior direction. Between the back wall of the pharynx and the cervical spine there is a small space (spatium retropharyngeum), filled with loose connective tissue, in which the pharyngeal lymph nodes are located.

The pharynx has a complex holding apparatus: at the top it is attached to the base of the skull, on the sides to the temporal bones, and at the back to the occipital bone. At the level of the IV-VI cervical vertebrae, the pharynx passes into the esophagus. The most important nerves and vessels of the neck pass from the lateral side of the pharynx: the internal jugular vein, the carotid artery, and the vagus nerve.

The pharynx has four walls: the upper, or pharyngeal vault (fornix pharyngis), is part of the base of the skull, the front, which is actually absent, since it contains the anatomical openings of the pharynx (the entrance to the larynx of the choana, pharynx), as well as the back and side.

In accordance with the organs located in front of the pharynx, three parts are distinguished in it: the nasopharynx (pars nasalis pharyngis), the oropharynx (pars oralis pharyngis) and the laryngopharynx (pars laryngea pharyngis).

The nasopharynx refers only to the respiratory tract, the oropharynx - to the respiratory and digestive tracts, and the hypopharynx - only to the digestive tract. The nasopharynx is constantly gaping. During the act of swallowing, the nasopharynx is separated from the oropharynx by the palatine curtain, the epiglottis closes the entrance to the larynx, due to this the food bolus passes only into the esophagus.

The laryngopharynx is bounded above by the epiglottis, on the sides by the aryepiglottic folds, and below by the arytenoid cartilages of the larynx. In the hypopharynx there is a small protrusion into the pharynx - a pear-shaped pocket (recessus piriformis).

On the inner surface of the border of the transition of the upper wall of the pharynx to the lower one there is a small elevation - an accumulation of lymphoid tissue, or the palatine tonsil (tonsilla pharyngealis), or adenoid. It has its maximum development in childhood. On the side walls of the pharynx there is a funnel-shaped pharyngeal opening of the auditory tube (ostium pharyngeum tubae auditivae), through which the auditory tube connects the pharyngeal cavity with the middle ear cavity. The pharyngeal opening is limited by a small elevation - the tubal ridge (torus tubarius), in the thickness of which there is an accumulation of lymphoid tissue - the tubal tonsil (tonsilla tubaria). The accumulation of tonsils in the upper digestive tract plays a protective role. There are six total tonsils: lingual, pharyngeal and paired tubal and palatine tonsils. These tonsils are arranged in a ring called the Pirogov-Waldeyer lymphoid ring.

7. STRUCTURE OF THE WALL OF THE PHARYNGEA (MUSCULAR APPARATUS OF THE PHARYNGEA)

Mucous membrane (tunica mucosa). In the lower parts of the pharynx, this plate is very similar in structure to the submucosa, and in the upper parts it is very dense and does not form folds, for which it received the name pharyngobasilar fascia (fascia pharyngobasilaris). The mucous membrane of the nasopharynx is covered with ciliated epithelium, and in the oropharynx and laryngopharynx it is covered with stratified squamous epithelium. The mucous membrane of the pharynx contains a large number of mucous glands. On the outside, the connective tissue plate is covered with a muscular membrane (tunica muscularis), on top of which lies the adventitia membrane (adventitia). All muscles of the pharynx are represented by striated muscle tissue.

Muscular apparatus of the pharynx:

1) constrictors of the pharynx:

a) superior pharyngeal constrictor (m constrictor pharyngis superior);

b) middle constrictor of the pharynx (m constrictor pharyngis medius);

c) lower pharyngeal constrictor (m constrictor pharyngis inferior);

2) pharynx lifters:

a) tubal-pharyngeal muscle (m salpingopharyngeus);

b) stylopharyngeal muscle (m stylopharyngeus).

Blood supply is carried out in the pharyngeal branches of the external carotid artery, facial and subclavian arteries.

Venous outflow is carried out in the pharyngeal plexus.

Lymphatic outflow is carried out to the internal jugular and pharyngeal lymph nodes.

Innervation: pharyngeal plexus.

8. STRUCTURE OF THE ESOPHAGUS

The esophagus connects the pharynx to the stomach. The esophagus resembles a tube in structure (up to 30 cm long), compressed in the anteroposterior direction. The place of transition of the pharynx into the esophagus in an adult corresponds to the VI cervical vertebra, the place of transition of the esophagus to the stomach corresponds to the level of the XI thoracic vertebra. The esophagus enters the abdominal cavity from the chest through the esophageal opening of the diaphragm.

((i) There are three parts to the esophagus.

The cervical part (pars cervicalis) of the esophagus starts from the VI cervical and ends at the level of the II thoracic vertebra. It is located between the spinal column and the trachea.

The thoracic part (pars thoracica) of the esophagus ends at the level of the X thoracic vertebra and has the greatest length. This part of the esophagus is located in the upper mediastinum up to the IV thoracic vertebra, in front of the esophagus is the trachea, behind is the pericardium. At the level of the IV thoracic vertebra, the esophagus is crossed by the aorta; at the level of the V thoracic vertebra, it is crossed by the left main bronchus. The lower part of the thoracic esophagus borders the right mediastinal pleura.

The abdominal part (pars abdominalis) of the esophagus has a small length, the left lobe of the liver is adjacent to its posterior wall.

The esophagus has three physiological constrictions: the first is at the level of the passage of the pharynx into the esophagus, the second is at the level of the intersection of the left main bronchus, the third is at the level of the passage of the esophagus through the diaphragm.

The esophagus has four main walls: mucosa (tunica mucosa), submucosa (tunica submucosa), muscularis (tunica muscularis) and serosa (adventitia).

The mucous membrane of the esophagus is quite thick, has a well-defined muscular plate. In its thickness, as well as in the submucosa, there are single lymphatic nodules and mucous glands of the esophagus, secreting a secret into the lumen of the esophagus.

The muscular layer consists of two layers: inner circular and outer longitudinal. In the upper part of the esophagus, the muscles are represented by striated muscle tissue, which in the middle part is replaced by smooth muscles, and in the lower sections it is represented only by smooth muscles. Outside, the muscular membrane is covered with an adventitial membrane.

Blood supply is carried out in the esophageal branches of the inferior thyroid artery, the thoracic aorta and the left gastric artery.

Venous outflow is carried out in the veins of the same name.

Lymphatic outflow is carried out in the jugular, posterior prevertebral, left gastric and posterior mediastinal lymph nodes.

Innervation: esophageal nerve plexus.

9. STRUCTURE OF THE STOMACH

The stomach (ventriculus) is a sac-shaped organ located in the upper left part of the abdominal cavity and located between the esophagus and the duodenum.

The stomach has a different shape and size, depending on the degree of its filling and the state of its muscles.

The shape of the stomach changes during the maturation of the organism. There are three forms of the stomach: the shape of a horn, the shape of a stocking and the shape of a hook. The latter is the most common. The left side of the stomach is located under the diaphragm, and the right side - under the liver; a small part of the stomach is in direct contact with the anterior abdominal wall. Most of the stomach is located in the left hypochondrium, the smaller one is in the epigastric region. The cardial opening is located to the left of the body of the X thoracic vertebra, and the outlet is to the right of the body of the XII thoracic or I lumbar vertebra.

The stomach is inactive due to the presence of a ligamentous apparatus with the peritoneum and low mobility of the inlet and outlet. In addition to the ligamentous apparatus with the peritoneum, the stomach has ligaments with the liver, spleen and colon. The stomach contains glands that secrete gastric juice rich in digestive enzymes, hydrochloric acid, and many other physiologically active substances. The mucous membrane of the stomach produces the Castle factor, which is necessary for the absorption of vitamin B12, which in turn is necessary for normal blood formation.

In the stomach, the fundus (fundus ventriculi), the body (corpus ventriculi), the cardiac (pars cardiaca) and pyloric parts (pars pylorica), the anterior (paries anterior) and posterior (paries posterior) walls, the greater curvature (curvatura ventriculi major) and the lesser curvature (curvatura ventriculi minor).

The esophagus enters the stomach through the opening of the lesser curvature - the cardiac opening.

The part of the stomach surrounding the esophagus that flows into it is called the cardiac part. To the left of it there is a dome-shaped protrusion - the bottom of the stomach. On the lesser curvature of the stomach there is an angular notch, which is a slight retraction.

The pyloric part is represented by the narrow right part of the stomach, in which several parts are distinguished: the pylorus cave (antrum pyloricum) and the pylorus canal (canalis pyloricum).

The pylorus canal passes into the duodenum; the boundary between them is a circular furrow.

The fundus of the stomach, the cardial and pyloric parts form the body of the stomach. The hepatic-gastric ligament (lig hepatogastricum) approaches the lesser curvature of the stomach, and the gastro-splenic (lig gastrolienale) and gastrocolic (lig gastrocolicum) ligaments depart from the greater curvature.

10. STRUCTURE OF THE WALL OF THE STOMACH

The stomach has all four main walls, represented by the mucous membrane, submucosa, muscular and external serous membranes.

The mucous membrane (tunica mucosa) of the stomach reaches a thickness of up to 0,5 mm, covered with a single-layer cylindrical epithelium. In the thickness of the mucous membrane, arterial and venous vessels, nerves pass, there are small accumulations of lymphoid tissue.

Due to the presence of the submucosa (tela submucosa) and a well-developed muscular plate, the mucous membrane forms numerous folds. In the area of ​​the fundus and body of the stomach, these folds are located longitudinally, obliquely and transversely, and in the area of ​​the lesser curvature - only longitudinally. At the junction of the stomach and the duodenum there is a valve (valvula pylorica), which, when the pyloric sphincter contracts, completely separates the stomach cavity from the initial part of the small intestine. On the surface of the gastric mucosa there are gastric fields (arae gastricae), on the surface of which there are ventricular dimples (foveolae gastricae) - the mouths of the gastric glands that secrete gastric juice.

The muscular layer (tunica muscularis) of the stomach is represented by three main layers: internal, middle circular and longitudinal outer layers of oblique fibers. The outer muscle layer is a continuation of the longitudinal muscles (stratum longitudinale) of the esophagus and is located mainly around the lesser curvature and greater curvature of the stomach. The layer of circular muscles (stratum circulare) is more developed than the longitudinal one in the region of the pylorus, and there forms the pyloric sphincter (m sphincter pylori) around the outlet of the stomach. The third layer of the muscle wall - oblique fibers - is found only in the stomach and performs a supporting function.

The outer serous membrane (adventitia) lies on the subserous basis and covers the stomach from almost all sides; the stomach is located intraperitoneally.

Blood supply is carried out in the left and right gastric arteries, the right and left gastroepiploic arteries.

Venous outflow is carried out in the veins of the same name.

Lymphatic outflow is carried out to the right and left gastric, right and left gastroepiploic lymph nodes, the lymphatic ring of the cardia.

Innervation: gastric plexus.

11. STRUCTURE OF THE SMALL INTESTINE

The small intestine (intestinum tenue) is the next section of the digestive system after the stomach; ends with an ileocecal opening at the site of its transition to the large intestine.

The small intestine is the longest part of the digestive system. It consists of three main sections: the duodenum, jejunum and ileum.

The jejunum and ileum form the mesenteric part of the small intestine, which occupies almost the entire lower floor of the abdominal cavity.

In the small intestine, food is exposed to intestinal juice, liver bile, pancreatic juice, and the main components of food are absorbed in it.

Duodenum (duodenum) - the initial section of the small intestine, its length is 20 cm. It starts from the pylorus and goes around the head of the pancreas. The duodenum has four parts: superior, descending, horizontal, and ascending.

The upper part (pars superior) of the duodenum starts from the pylorus, departing from it on the right at the level of the XII thoracic or first lumbar vertebra, forms the upper bend (flexura duodeni superior), then passing into the descending part. The length of this section is about 4 cm.

The descending part (pars descendens) originates at level I of the lumbar spine, goes down to the right of the spinal column and at level III of the lumbar spine turns to the left, forming the lower bend of the duodenum (flexura duodeni inferior). The length of this section is about 9 cm. Behind the descending part is the right kidney, the common bile duct passes to the left, and the liver is in front.

The horizontal part (pars horizontalis) originates from the inferior flexure of the duodenum and runs horizontally at level III of the lumbar spine, touching its posterior wall with the inferior vena cava. Then she turns up and goes into the ascending part.

The ascending part (pars ascendens) originates at level II of the lumbar spine and ends with the duodenal lean bend (flexura duodenojejunalis), passing into the jejunum. The muscle that suspends the duodenum (m. suspensoris duodeni) fixes this bend to the diaphragm. Behind the ascending part is the abdominal part of the aorta, next to it are the mesenteric artery and vein, which enter the root of the mesentery of the small intestine.

The duodenum is almost completely located in the retroperitoneal space, with the exception of the ampulla (ampulla), all other parts of the small intestine are covered by the peritoneum on all sides.

The wall of the duodenum consists of three membranes: mucous, muscular and serous.

The mucous membrane (tunica mucosa) is located on the muscle plate and a layer of loose adipose tissue. In the upper sections it forms longitudinal folds (plica longitudinalis duodeni), and in the lower sections it forms circular folds (plicae circulares), which are permanent. In the lower half of the descending part of the duodenum there is a longitudinal fold ending with the major duodenal papilla (papilla duodeni major). Above it is the small duodenal papilla (papilla duodeni minor), on which additional pancreatic ducts open. The mucous membrane has numerous leaf-shaped intestinal villi, in their center there is a lymphatic capillary, and the vessels entering the villi form a capillary network. Around the base of the villi there are small depressions (crypts) into which the ducts of the intestinal glands open. In the thickness of the mucous membrane there are single accumulations of lymphoid tissue.

The muscular membrane (tunica muscularis) of the duodenum consists of two layers: the inner circular and the outer longitudinal.

The serous membrane (adventitia) covers only the initial part of the duodenum, represented by the ampulla.

Blood supply is carried out in the upper anterior and posterior pancreatoduodenal arteries.

Venous outflow is carried out in the veins of the same name.

Lymphatic outflow is carried out in the lumbar, superior mesenteric, pancreatoduodenal and celiac lymph nodes.

Innervation: direct branches of the vagus nerves.

12. STRUCTURE, ANATOMICAL FEATURES AND PHYSIOLOGY OF THE LEAN (JEJUNUM) AND ILEUM (ILEUM) GUT

The structure, anatomical features and physiology of the jejunum (jejunum) and ileum (ileum) intestines will be considered together, since these organs have the same structure and belong to the mesenteric part of the small intestine.

The jejunum is a continuation of the duodenum, its loops lie in the upper left part of the abdominal cavity. Anteriorly, the loops of the jejunum are covered with the greater omentum; posteriorly, they are adjacent to the parietal peritoneum.

The ileum is a continuation of the jejunum, its loops lie in the lower right part of the abdominal cavity. In the cavity of the small pelvis lie the last loops of the small intestine, they are located in two layers, adjacent to the front of the bladder, and behind - to the rectum (in men) or the uterus (in women). This entire part of the small intestine is covered on all sides by the peritoneum, located intraperitoneally (with the exception of a small area in the area of ​​​​attachment of the peritoneum). In the mesenteric part of the small intestine, two edges are distinguished: free and mesenteric, by which the intestine is connected with the mesentery.

The mucous membrane (tunica mucosa) consists of the muscularis mucosa and the submucosa. The mucous membrane of the mesenteric part of the small intestine has similar formations to that in the duodenum (with the exception of the duodenal glands). The main difference lies in the different number of circular folds, the number of which is greater in the mesenteric part. In the jejunum and ileum there are group accumulations of lymphoid tissue (noduli lymphatici aggregati), located on the opposite edge from the mesentery and having a length of up to 10 cm and a width of up to 3 cm.

The place where the small intestine enters the cecum - the ileocecal opening (ostium ileocaecale) - has a valve of the same name, with its convex part facing the large intestine. This valve is formed by folds protruding from above and below into the cavity of the cecum. Anteriorly and posteriorly, the valve leaflets converge and form the frenulum of the ileocecal valve.

The muscular membrane (tunica muscularis) consists of two layers: the inner circular (stratum circulare) and the outer longitudinal (stratum longitudinale).

The serous membrane (adventitia) of the mesenteric part of the small intestine is represented by the peritoneum.

The blood supply comes from the small intestine arteries.

Venous outflow is carried out through the veins of the same name into the portal vein.

Lymphatic outflow is carried out in the iliac-colon and mesenteric lymph nodes.

Innervation: branches of the vagus nerve.

13. STRUCTURE OF THE COLON. STRUCTURE OF THE CECAQUE

The large intestine (intestinym crassum) is a continuation of the small intestine; is the final section of the digestive tract.

It starts from the ileocecal valve and ends at the anus. It absorbs the remaining water and forms feces that are excreted through the rectum. Its length is on average 1,5 m.

The large intestine is divided into three sections: the caecum with the appendix, the colon, and the rectum. The colon is divided into four parts: ascending, transverse, descending and sigmoid. The large intestine is located in the abdominal cavity of the small pelvis.

The large intestine differs from the small intestine in a number of important ways:

1) larger diameter;

2) the presence of colonic bands (taeniae coli). Distinguish the mesenteric tape (taenia mesocolica), corresponding to the place of attachment of the mesentery to it; free tape (taenia libera) located on the anterior surface of the intestine; stuffing tape (taenia omentalis), located at the place of attachment of the stuffing box. All these ribbons converge, converge at the base of the appendix and surround it with a muscular layer;

3) between the ribbons there are haustras of the colon (haustrae coli), separated from each other by transverse furrows;

4) on the surface of the colon along the omental and free bands there are omental processes (appendices epiploicae), which contain adipose tissue. On the descending colon they are located in one row, on its other parts - in two rows. Sometimes adjacent omental processes merge, forming a fold.

The cecum (caecum) is a sac-like dilated section of the large intestine, starting immediately after the ileocecal valve; located in the right iliac fossa. It has a small length - up to 8 cm - and a maximum diameter of the colon - up to 7 cm. With its posterior wall, the cecum is located on the iliacus and psoas major muscles, and with its anterior wall it is adjacent to the anterior abdominal wall. The large intestine is covered with peritoneum on all sides, but sometimes it can be covered with peritoneum only on three sides, not have a serous covering on the posterior wall, and in rare cases it may have a mesentery.

A vermiform appendix (appendix vermiformis) extends from the cecum at the point where the muscle bands converge. The appendix is ​​an outgrowth of the cecum, its dimensions are very variable: length - from 3 to 20 cm, diameter - up to 1 cm. The vermiform appendix lies intraperitoneally and has a mesentery. Most often, the appendix is ​​located in the right iliac fossa, sometimes it descends into the small pelvis, and can even lie retroperitoneally. For practice, it is very important to know the projection of the appendix onto the anterior abdominal wall. Its base can be located on the border of the outer and middle third of the line connecting the navel and the superior anterior iliac spine, or McBurney's point. But this location of the appendix is ​​extremely rare; more often it is projected at Lanz’s point, which corresponds to the border between the outer and middle thirds of the line connecting the left and right iliac spines.

The caecum (caecum) is a continuation of the ileum. They are separated by the ileocecal valve (valva ileocaecalis). The valve flaps form a frenulum or ocecal valve (frenulum valvae ileocaecalis). Having the form of a funnel, the narrow part of the valve faces the lumen of the caecum, freely passing food from the small intestine into the large intestine. With an increase in pressure in the colon (overeating, increased gas formation), the valve flaps close, and no reverse movement of food is observed. Below this valve is the opening of the appendix (ostium appendix vermiformis).

14. STRUCTURE OF THE COLON

The colon is located around the loops of the small intestine, which are located in the middle of the lower floor of the abdominal cavity. The ascending colon is on the right, the descending colon on the left, the transverse colon on top, and the sigmoid colon on the left and bottom.

The ascending colon (colon ascendens) is a continuation of the cecum. Rising vertically, it is first located in front of the quadratus lumborum muscle, then in front of the right kidney and reaches the lower surface of the right lobe of the liver. At this level, it bends to the left, forming the right flexure of the colon (flexura coli dextra) and passing into the transverse colon. The length of this section of the colon is about 20 cm. The free band is located on the anterior surface of the intestine, the omental band on the posterolateral surface, and the mesenteric band on the posteromedial surface.

The transverse colon (colon transversum) originates from the right flexure of the colon and continues to the left flexure of the colon (flexura coli sinistra), which is located in the left hypochondrium at a higher level compared to the right flexure of the colon. Its length is about 50 cm, being the longest section of the large intestine. The colon is located in the form of an arc and sags downwards. The transverse colon is located intraperitoneally and has its own mesentery, originating from the parietal peritoneum. Along the entire length of the omental band, a ligament extending from the stomach, called the gastrocolic ligament, is attached. Topography of the transverse colon: above and to the right of it are the liver, stomach and spleen, behind - the duodenum and spleen, below - the loops of the small intestine.

The left flexure of the transverse colon is the transition section to the descending colon (colon descendens), which goes down to the level of the left iliac fossa and passes into the sigmoid colon. Its posterior wall is not covered by the peritoneum and lies in front of the left kidney, located on the square muscle of the lower back and the iliac muscle in the left iliac fossa. The length of the intestine is on average 17 cm. The descending colon is located mesoperitoneally. From this section of the colon, a decrease in the number of haustra and their depth begins.

The sigmoid colon (colon sigmoideum) lies in the left iliac fossa, its continuation is the rectum. The sigmoid colon forms two loops: the proximal loop lies on the iliacus muscle, and the distal loop lies on the psoas major muscle. The length of the sigmoid colon is very variable. The sigmoid colon is mobile thanks to the mesentery, which is attached to the posterior abdominal wall; lies intraperitoneally.

15. STRUCTURE OF THE WALL OF THE CECIUS AND COLON

The mucous membrane (tunica mucosa) of the wall of the caecum and colon consists of epithelium lying on the basement membrane, muscularis lamina and submucosa, it has no villi. Its epithelium consists of cylindrical cells and a large number of goblet glands and intestinal glands. Throughout the mucous membrane there are single lymphatic nodules, and in the appendix there are multiple accumulations of lymphoid tissue.

Between the muscle bands, the mucous membrane forms semilunar folds (plicae semilunares coli). On the border between the ileum and the large intestine, there are two permanent mucosal folds, which are formed mainly by the muscular layer. These folds form the ileocecal valve.

The muscular membrane (tunica muscularis) throughout the entire length consists of two layers: the inner circular and the outer longitudinal. The longitudinal muscles form ribbons. The appendix has a continuous muscular cover.

The peritoneum covers the following sections from all sides: the caecum, transverse and sigmoid colon. The sections of the ascending and descending colons on the back wall have a section up to 3 cm wide, not covered by the peritoneum. In rare cases, these departments can be covered with peritoneum from all sides and even have their own mesentery.

Blood supply is carried out by branches of the superior mesenteric artery.

Venous outflow is carried out in the superior and inferior mesenteric veins.

Lymphatic outflow is carried out in the mesenterocolic, iliac-colic nodes, appendicular, pre- and post-intestinal lymph nodes.

Innervation: branches of the vagus nerves, from the superior and inferior mesenteric plexuses.

16. STRUCTURE OF THE RECTUM

The rectum (rectum) is the final section of the large intestine and is located at its posterior wall of the pelvic cavity, which is formed by the muscles of the pelvic floor, coccyx and sacrum.

In the rectum, feces accumulate and are removed from the body, and water is also absorbed. The length of the rectum is 16 cm, the diameter is about 4-5 cm. In front of the rectum in men are the prostate, seminal vesicles and bladder, and in women - the uterus and vagina.

The rectum has two bends: perineal (flexura perinealis) and sacral (flexura sacralis). In the rectum, two parts are distinguished: the pelvic, located above the pelvic diaphragm, and the perineal, located in the perineum and representing the anal canal (canalis analis), ending with the anus (anus). In the pelvic region there is a narrow, supramullary section and a wide part - the rectal ampulla (ampulla recti). The length of the pelvic part reaches 14 cm, the perineal part - up to 4 cm.

The mucous membrane of the rectum is rich in mucous and goblet glands, forms longitudinal and transverse folds. The mucosa is devoid of villi, has single lymphatic nodules. There are usually three transverse folds, they cover half the circumference of the rectum, there are non-permanent folds. There are up to 10 longitudinal folds, they are called anal columns (columnae anales) and expand from top to bottom.

The upper border of the longitudinal folds is the rectal-anal line (linea anorectalis). Distal to the longitudinal folds is an intermediate zone, the protruding part of which closes the recesses between the pillars from below, forming the anal sinuses (sinus anales).

Transverse folds (plicae transversae recti), closing the sinuses from below, are called anal flaps (valvulae anales), their combination forms the anal crest.

In the submucosa of the anal column area there is adipose tissue in which the rectal venous plexus (plexus venosus rectalis) lies. The mucous membrane in the area of ​​the pillars is represented by squamous epithelium, in the area of ​​the sinuses - by multilayered epithelium. The anal line is the boundary between the rectal mucosa and the skin. The skin of the anus is lined with stratified keratinizing epithelium.

The muscular membrane throughout the entire length consists of two layers: the inner circular and the outer longitudinal, and the inner layer is better expressed. Longitudinal muscle bundles are a continuation of the muscle bands of the colon: they expand and completely cover the rectum; better expressed on the anterior and posterior walls. Part of the longitudinal muscles is part of the muscle that lifts the anus (m. Levator ani). The anterior bundle of longitudinal muscles in men forms the rectourethral muscle, which passes into the tendon and is attached at the site of passage of the membranous part of the urethra.

In addition to this muscle, men have a rectovesical muscle that connects the rectum to the bladder. The circular layer of muscle tissue thickens at the anus and forms the internal sphincter of the anus (m. sphincter ani interni). Part of its muscles is part of the muscles of the vagina and the membranous part of the urethra. In the subcutaneous tissue around the anus, there is an external anal sphincter (m. sphincter ani externi).

In the interval between the external and internal sphincters, the muscle that lifts the anus passes. The anterior portion of this muscle is called the pubococcygeus muscle.

The serous outer membrane is represented by the peritoneum, which covers the upper section of the rectum from all sides, the middle section - from three sides. The lower portion of the rectum is not covered by the peritoneum.

17. STRUCTURE OF THE LIVER

The liver (hepar) is the largest gland of the digestive tract; located mainly in the right upper abdominal cavity subphrenic; is a complex branched tubular gland.

The liver is involved in the processes of metabolism and hematopoiesis.

The liver has an irregular shape: the upper - convex - and the lower - concave - parts; surrounded on all sides by the peritoneum (with the exception of small areas: the place of attachment of the ligaments and the attachment of the gallbladder).

The upper part of the liver is called diaphragmatic (facies diaphragmatica), and the lower part is called visceral (facies visceralis).

The diaphragmatic surface of the liver corresponds in shape to the dome of the diaphragm. To this surface from the diaphragm and the anterior abdominal wall is the supporting (crescent) ligament of the liver (lig falciformis). It divides the surface of the liver into two lobes: the right (lobus hepatis dexter) and the left (lobus hepatis sinister), connecting behind with the coronary ligament (lig coronarium), which is a duplication of the peritoneum. The coronary ligament has right and left edges, forming the right and left triangular ligaments (ligg triangularis). On the upper part of the liver there is a small depression called cardiac (impressio cardiaca), resulting from the pressure of the heart through the diaphragm on the liver.

There are three grooves on the visceral surface of the liver, dividing it into four parts. The middle section between the right and left sagittal sulci is divided by the transverse sulcus into two sections. The anterior one is called the quadrate lobe (lobus quadratus), the posterior one is called the caudate lobe (lobus caudatus). The left sagittal groove is located at the level of the falciform ligament and separates the left lobe of the liver from the right lobe.

Along its length, the liver has two slits: in the anterior part for the round ligament (fissura ligamenti teretis), in the posterior part for the venous ligament (fissura ligamenti venosi). The round ligament of the liver is an overgrown umbilical vein, the venous ligament is an overgrown ductus venosus. The right sagittal groove is wider than the left. In its anterior section it forms a fossa for the gallbladder (the gallbladder is located there), in the posterior part it forms a groove for the inferior vena cava, where the vessel of the same name passes. The right and left sagittal grooves are connected by the porta hepatis, which is a deep transverse groove.

The portal vein, nerves, hepatic artery enter the gates of the liver, and the lymphatic vessels and the common hepatic duct exit. There are four main impressions on the visceral surface of the liver: renal (impressio renalis), adrenal (impressio suprarenalis), colonic (impressio colica) and duodenal (impressio duodenalis).

The square lobe of the liver has a small depression formed by the duodenum (impressio duodenalis).

The caudate lobe of the liver forms a papillary process (processus papillaris) on its anterior surface, and a caudate process (processus caudatus) on the right.

The left lobe of the liver has a slight elevation on the visceral surface - the omental tubercle facing the lesser omentum. There is an esophageal depression on the back square, to the left of which there is a gastric depression.

Outside, the liver is covered with a serous membrane (tunica serosa), which lies on the subserous basis. Beneath it lies a fibrous sheath (tunica fibrosa).

Inside the liver there is a connective tissue frame, in the cells of which the structural and functional units of the liver are located - hepatic lobules (lobulus hepatis).

The liver lobules are made up of hepatocytes. In the center of the lobule passes the central vein, along the periphery of the lobule there are interlobular arteries and veins, from which interlobular capillaries begin, passing into sinusoidal vessels. In sinusoidal vessels, mixing of venous and arterial blood occurs. Sinusoidal vessels drain into the central vein. The central veins of the hepatic lobules enter the collecting veins, which enter the hepatic veins.

Between the hepatocytes are bile canaliculi (ductulus bilifer), flowing into the bile ducts, which are connected to the interlobular bile ducts.

Based on the location of blood vessels in the liver parenchyma, this organ is divided into: two lobes, five sectors and eight segments, with three sectors and four segments in the left lobe, two sectors and also four segments in the right lobe.

Sector - a section of the liver, which includes a branch of the portal vein of the second order and the hepatic artery, nerves and the sectoral bile duct.

The blood supply is carried out in the hepatic artery.

Venous outflow is carried out in the portal vein.

Lymphatic outflow is carried out in the hepatic, right lumbar, celiac, upper diaphragmatic and parasternal lymph nodes.

Innervation: from the hepatic plexus, branches of the vagus nerves.

LECTURE 9. CARDIOVASCULAR SYSTEM

1. STRUCTURE OF THE HEART

The heart (cor) is a hollow four-chamber muscular organ that pumps oxygenated blood into the arteries and receives venous blood.

The heart consists of two atria that receive blood from the veins and push it into the ventricles (right and left). The right ventricle supplies blood to the pulmonary arteries through the pulmonary trunk, and the left ventricle supplies blood to the aorta. The left half of the heart contains arterial blood, and the right half contains venous blood; the right and left halves of the heart do not normally communicate.

In the heart, there are: three surfaces - pulmonary (facies pulmonalis), sternocostal (facies sternocostalis) and diaphragmatic (facies diaphragmatica); apex (apex cordis) and base (basis cordis). The boundary between the atria and ventricles is the coronary sulcus (sulcus coronarius).

The right atrium (atrium dextrum) is separated from the left by the interatrial septum (septum interatriale) and has an additional cavity - the right ear (auricula dextra). There is a depression in the septum - an oval fossa, surrounded by an edge of the same name, formed after the fusion of the foramen ovale.

The right atrium has openings of the superior vena cava (ostium venae cavae superioris) and the inferior vena cava (ostium venae cavae inferioris), delimited by the intervenous tubercle (tuberculum intervenosum) and the opening of the coronary sinus (ostium sinus coronarii). On the inner wall of the right ear there are pectinate muscles (mm pectinati), ending in a border crest that separates the venous sinus from the cavity of the right atrium.

The right atrium communicates with the ventricle through the right atrioventricular orifice (ostium atrioventriculare dextrum).

The right ventricle (ventriculus dexter) is separated from the left by the interventricular septum (septum interventriculare), in which the muscular and membranous parts are distinguished; has in front the opening of the pulmonary trunk (ostium trunci pulmonalis) and in the back - the right atrioventricular opening (ostium atrioventriculare dextrum). The latter is covered by a tricuspid valve (valva tricuspidalis), which has anterior, posterior and septal valves. The valves are held in place by chordae tendinae, which prevent the valves from everting into the atrium.

On the inner surface of the ventricle there are fleshy trabeculae (trabeculae carneae) and papillary muscles (mm. papillares), from which tendon chords begin. The opening of the pulmonary trunk is covered by the valve of the same name, consisting of three semilunar valves: anterior, right and left (valvulae semilunares anterior, dextra et sinistra).

The left atrium (atrium sinistrum) has a cone-shaped extension facing anteriorly - the left ear (auricular sinistra) - and five openings: four openings of the pulmonary veins (ostia venarum pulmonalium) and the left atrioventricular opening (ostium atrioventriculare sinistrum).

The left ventricle (ventriculus sinister) has behind the left atrioventricular opening, covered by the mitral valve (valva mitralis), consisting of the anterior and posterior valves, and the aortic opening, covered by the valve of the same name, consisting of three semilunar valves: posterior, right and left (valvulae semilunares posterior, dextra et sinistra). There are sinuses between the valves and the wall of the aorta. On the inner surface of the ventricle there are fleshy trabeculae (trabeculae carneae), anterior and posterior papillary muscles (mm. papillares anterior et posterior).

2. STRUCTURE OF THE HEART WALL. CONDUCTION SYSTEM OF THE HEART. STRUCTURE OF THE PERICARD

The wall of the heart consists of a thin inner layer - the endocardium (endocardium), the middle developed layer - the myocardium (myocardium) and the outer layer - the epicardium (epicardium).

The endocardium lines the entire inner surface of the heart with all its formations.

The myocardium is formed by cardiac striated muscle tissue and consists of cardiac cardiomyocytes, which ensures complete and rhythmic contraction of all chambers of the heart. The muscle fibers of the atria and ventricles start from the right and left (anuli fibrosi dexter et sinister) fibrous rings, which are part of the soft skeleton of the heart. Fibrous rings surround the corresponding atrioventricular openings, forming a support for their valves.

The myocardium consists of three layers. The outer oblique layer at the apex of the heart passes into the curl of the heart (vortex cordis) and continues into the deep layer. The middle layer is formed by circular fibers. The epicardium is built on the principle of serous membranes and is a visceral sheet of the serous pericardium. The epicardium covers the outer surface of the heart from all sides and the initial sections of the vessels extending from it, passing along them into the parietal plate of the serous pericardium.

The normal contractile function of the heart is provided by its conducting system, the centers of which are:

1) sinoatrial node (nodus sinuatrialis), or Keyes-Fleck node;

2) the atrioventricular node (nodus atrioventricularis), or the Fshoff-Tavara node, passing downwards into the atrioventricular bundle (fasciculus atrioventricularis), or the His bundle, which is divided into the right and left legs (cruris dextrum et sinistrum).

Pericardium (pericardium) is a fibrous-serous sac in which the heart is located. The pericardium is formed by two layers: the outer (fibrous pericardium) and the inner (serous pericardium). The fibrous pericardium passes into the adventitia of the large vessels of the heart, and the serous one has two plates - parietal and visceral, which pass into each other at the base of the heart. Between the plates there is a pericardial cavity (cavitas pericardialis), it contains a small amount of serous fluid. The pericardium is divided into three sections: the anterior, or sternocostal, right and left mediastinal sections, and the lower, or diaphragmatic section.

The blood supply to the pericardium is carried out in the branches of the superior phrenic arteries, the branches of the thoracic aorta, and the branches of the pericardiophrenic artery.

Venous outflow is carried out in unpaired and semi-unpaired veins.

Lymphatic outflow is carried out in the anterior and posterior mediastinal, pericardial and prepericardial lymph nodes.

Innervation: branches of the right and left sympathetic trunks, branches of the phrenic and vagus nerves.

3. BLOOD SUPPLY AND INSERTION OF THE HEART

The arteries of the heart originate from the bulb of the aorta (bulbus aortae).

The right coronary artery (a coronaria dextra) has a large branch - the posterior interventricular branch (ramus interventricularis posterior).

The left coronary artery (a. coronaria sinistra) is divided into a circumflex (r. circumflexus) n anterior interventricular branch (r. interventricularis anterior). These arteries combine to form the transverse and longitudinal arterial rings.

Small (v. cordis parva), middle (v. cordis media) and large veins of the heart (v. cordis magna), oblique (v. oblique atrii sinistri) and posterior veins of the left ventricle (v. posterior ventriculi sinistri) form the coronary sinus ( sinus coronarius). In addition to these veins, there are the smallest (vv. cordis minimae) and anterior veins of the heart (vv. cordis anteriores).

Lymphatic outflow is carried out in the anterior mediastinal and one of the lower tracheobronchial lymph nodes.

Innervation:

1) cardiac nerves originating from the cervical and upper thoracic nodes of the right and left lymphatic trunks;

2) superficial extraorganic cardiac plexus;

3) deep extraorganic cardiac plexus;

4) intraorganic cardiac plexus (formed by branches of extraorganic cardiac plexuses).

4. PULMONARY TRUNK AND ITS BRANCHES. STRUCTURE OF THE AORT AND ITS BRANCHES

The pulmonary trunk (truncus pulmonalis) is divided into the right and left pulmonary arteries. The place of division is called the bifurcation of the pulmonary trunk (bifurcatio trunci pulmonalis).

The right pulmonary artery (a. pulmonalis dextra) enters the portal of the lung and divides. In the upper lobe there are descending and ascending posterior branches (rr. posteriores descendens et ascendens), apical branch (r. apicalis), descending and ascending anterior branches (rr. anteriores descendens et ascendens). In the middle lobe there are medial and lateral branches (rr. lobi medii medialis et lateralis). In the lower lobe there is the upper branch of the lower lobe (r. superior lobi inferioris) and the basal part (pars basalis), which is divided into four branches: anterior and posterior, lateral and medial.

The left pulmonary artery (a. pulmonalis sinistra), entering the gate of the left lung, is divided into two parts. The ascending and descending anterior (rr. anteriores ascendens et descendens), reed (r. lingularis), posterior (r. posterior) and apical branches (r. apicalis) go to the upper lobe. The upper branch of the lower lobe goes to the lower lobe of the left lung, the basal part is divided into four branches: anterior and posterior, lateral and medial (as in the right lung).

The pulmonary veins originate from the capillaries of the lung.

The right lower pulmonary vein (v. pulmonalis dextra inferior) collects blood from five segments of the lower lobe of the right lung. This vein is formed by the confluence of the superior vein of the lower lobe and the common basal vein.

The right upper pulmonary vein (v. pulmonalis dextra superior) collects blood from the upper and middle lobes of the right lung.

The left lower pulmonary vein (v. pulmonalis sinistra inferior) collects blood from the lower lobe of the left lung.

The left upper pulmonary vein (v. pulmonalis sinistra superior) collects blood from the upper lobe of the left lung.

The right and left pulmonary veins empty into the left atrium.

The aorta (aorta) has three sections: the ascending part, the arch and the descending part.

The ascending part of the aorta (pars ascendens aortae) has an extension in the initial section - the aortic bulb (bulbus aortae), and at the location of the valve - three sinuses.

The aortic arch (arcus aortae) originates at the level of articulation of the II right costal cartilage with the sternum; has a slight narrowing, or isthmus of the aorta (isthmus aortae).

The descending part of the aorta (pars descendens aortae) begins at the level of the IV thoracic vertebra and continues to the IV lumbar vertebra, where it divides into the right and left common iliac arteries. In the descending part, the thoracic (pars thoracica aortae) and abdominal parts (pars abdominalis aortae) are distinguished.

5. SHOULDER HEAD. EXTERNAL CAROTID ARTERY

The brachiocephalic trunk (truncus brachiocephalicus) is located in front of the trachea and behind the right brachiocephalic vein, moving away from the aortic arch at level II of the right costal cartilage; at the level of the right sternoclavicular joint, it divides into the right common carotid and right subclavian arteries, which are its terminal branches. The left common carotid artery (a. carotis communis sinistra) departs from the aortic arch itself.

The external carotid artery (a. carotis externa) is one of the two branches of the common carotid artery, which gives off many branches.

Anterior branches of the external carotid artery.

The superior thyroid artery (a. thyroidea superior) at the upper pole of the thyroid lobe is divided into anterior and posterior branches. This artery has lateral branches:

1) sublingual branch (r. infrahyoideus);

2) sternocleidomastoid branch (r. sternocleidomastoidea);

3) superior laryngeal artery (a. laryngea superior);

4) cricothyroid branch (r. cricothyroideus).

(The lingual artery (a. lingualis) departs at the level of the large horn of the hyoid bone, gives off dorsal branches, and its final branch is the deep artery of the tongue (a. profunda linguae); before entering the tongue, it gives two more branches: the hyoid artery (a. sublingualis ) and the suprahyoid branch (ryu suprahyoideus).

The facial artery (ayu facialis) originates just above the lingual artery. On the face gives the following branches:

1) superior labial artery (a. labialis inferior);

2) inferior labial artery (a. labialis superior);

3) angular artery (a. angularis).

On the neck, the facial artery gives the following branches:

1) tonsil branch (r. tonsillaris);

2) mental artery (a. submentalis);

3) ascending palatine artery (a. palatine ascendens).

((bi) Posterior branches of the external carotid artery.

The posterior ear artery (a. auricularis posterior) gives the following branches:

1) occipital branch (r. occipitalis);

2) ear branch (r. auricularis);

3) stylomastoid artery (a. stylomastoidea), which gives off the posterior tympanic artery (a. tympanica posterior).

The occipital artery (a. occipitalis) gives the following branches:

1) ear branch (r. auricularis);

2) descending branch (r. descendens);

3) sternocleidomastoid branches (rr. sternocleidomastoidea);

4) mastoid branch (r. mastoideus).

The ascending pharyngeal artery (a. pharyngea ascendens) gives the following branches:

1) pharyngeal branches (rr. pharyngealis);

2) lower tympanic artery (a. tympanica inferior);

3) posterior meningeal artery (a. meningea posterior).

Terminal branches of the external carotid artery.

The maxillary artery (a. maxillaries), in which there are three sections - the jaw, pterygoid, pterygo-palatine, from which their branches depart.

Branches of the jaw:

1) anterior tympanic artery (a. tympanica anterior);

2) deep ear artery (a. auricularis profunda);

3) middle meningeal artery (a. meningea media), giving the superior tympanic artery (a. tympanica superior), frontal and parietal branches (rr. frontalis et parietalis);

4) lower alveolar artery (a. alveolaris inferior).

Branches of the pterygoid department:

1) pterygoid branches (rr. pterigoidei);

2) masticatory artery (a. masseterica);

3) buccal artery (a. buccalis);

4) anterior and posterior temporal arteries (rr. temporales anterioris et posterioris);

5) posterior superior alveolar artery (a. alveolaris superior posterior).

Branches of the pterygopalatine:

1) descending palatine artery (a. palatine descendens);

2) sphenopalatine artery (a. sphenopalatina), giving back septal branches (rr. septales posteriores) and lateral posterior nasal arteries (aa. nasales posteriores laterales);

3) infraorbital artery (a. infraorbitalis), giving the anterior superior alveolar arteries (aa. alveolares superiores anteriores).

6. BRANCHES OF THE INTERNAL CAROTID ARTERY

The internal carotid artery (a. carotis interna) supplies blood to the brain and organs of vision. The following parts are distinguished in it: cervical (pars cervicalis), stony (pars petrosa), cavernous (pars cavernosa) and cerebral (pars cerebralis). The cerebral part of the artery gives off the ophthalmic artery and divides into its terminal branches (anterior and middle cerebral arteries) at the inner edge of the anterior clinoid process.

Branches of the ophthalmic artery (a. ophthalmica):

1) central retinal artery (a. centralis retinae);

2) lacrimal artery (a. lacrimalis);

3) posterior ethmoid artery (a. ethmoidalis posterior);

4) anterior ethmoid artery (a. ethmoidalis anterior);

5) long and short posterior ciliary arteries (aa. ciliares posteriores longae et breves);

6) anterior ciliary arteries (aa. ciliares anteriores);

7) muscular arteries (aa. musculares);

8) medial arteries of the eyelids (aa. palpebrales mediales); anastomose with the lateral arteries of the eyelids, form the arch of the upper eyelid and the arch of the lower eyelid;

9) supratrochlear artery (a. supratrochlearis);

10) dorsal artery of the nose (a. dorsalis nasi).

In the middle cerebral artery (a. cerebri media) there are wedge-shaped (pars sphenoidalis) and insular parts (pars insularis), the latter continues into the cortical part (pars corticalis).

The anterior cerebral artery (a. cerebri anterior) is connected to the artery of the same name on the opposite side through the anterior communicating artery (a. communicans anterior).

The posterior communicating artery (a. communicans posterior) is one of the anastomoses between the branches of the internal and external carotid arteries.

Anterior villous artery (a choroidea anterior).

7. BRANCHES OF THE SUBCLAVIAN ARTERY

There are three sections in this artery: the vertebral, internal thoracic arteries and thyrocervical trunk depart from the first, the costocervical trunk from the second, and the non-permanent transverse artery of the neck from the third.

Branches of the first department:

1) vertebral artery (a. vertebralis), in which four parts are distinguished: prevertebral (pars prevertebralis), cervical (pars cervicalis), atlantic (pars atlantica) and intracranial (pars intracranialis).

Neck branches:

a) radicular branches (rr. radiculares);

b) muscular branches (rr. musculares).

Branches of the intracranial part:

a) anterior spinal artery (a. spinalis anterior);

b) posterior spinal artery (a. spinalis posterior);

c) meningeal branches (rr. meningei) - anterior and posterior;

d) posterior inferior cerebellar artery (a. inferior posterior cerebri).

The basilar artery (a. basilaris) is located in the sulcus of the same name of the bridge and gives the following branches:

a) labyrinth artery (a. labyrinthi);

b) middle cerebral arteries (aa. mesencephalicae);

c) superior cerebellar artery (a. superior cerebelli);

d) anterior inferior cerebellar artery (a. inferior anterior cerebelli);

e) pontine arteries (aa. pontis).

The right and left posterior cerebral arteries (aa. cerebri posterior) close the arterial circle from behind, the posterior communicating artery flows into the posterior cerebral artery, resulting in the formation of an arterial circle of the brain (circulus arteriosus cerebri);

2) the internal thoracic artery (a. thoracica interna) gives:

a) bronchial and tracheal branches (rr. bronchiales et tracheales);

b) sternal branches (rr. sternales);

c) mediastinal branches (rr. mediastinales);

d) perforating branches (rr. perforantes);

e) thymic branches (rr. thymici);

e) pericardial phrenic artery (a. pericardiacophrenica);

g) muscular-diaphragmatic artery (a. musculophrenica);

h) superior epigastric artery (a. epigastrica superior);

i) anterior intercostal branches (rr. intercostals anteriores);

3) the thyroid trunk (truncus thyrocervicalis) is divided into three branches:

a) lower thyroid artery (a. thyroidea inferior), giving tracheal branches (rr. tracheales), lower laryngeal artery (a. laryngealis inferior), pharyngeal and esophageal branches (rr. pharyngeales et oesophageales);

b) suprascapular artery (a. suprascapularis), giving acromial branch (r. acromialis);

c) the transverse artery of the neck (a. transversa cervicis), which is divided into superficial and deep branches.

Branches of the second department.

The costal-cervical trunk (truncus costocervicalis) is divided into the deep cervical artery (a. cervicalis profunda) and the highest intercostal artery (a. intercostalis suprema).

Axillary artery (a. axillaris) is divided into three sections, is a continuation of the axillary artery.

Branches of the first department:

1) superior thoracic artery (a. thoracica superior);

2) subscapular branches (rr. subscapulares);

3) thoracoacromial artery (a. thoracoacromialis); gives four branches: thoracic (rr. pectorales), subclavian (r. clavicularis), acromial (r. acromialis) and deltoid (r. deltoideus).

Branches of the second department:

1) lateral thoracic artery (a. thoracica lateralis). Gives lateral branches of the mammary gland (rr .mammarii lateralis).

Branches of the third department:

1) anterior artery, circumflex humerus (a. circumflexa anterior humeri);

2) posterior artery, envelope of the humerus (a. circumflexa posterior humeri);

3) subscapular artery (a. subscapularis), dividing into the artery, circumflex scapula (a. circumflexa scapulae), and thoracic artery (a. thoracodorsalis).

8. BRACHERIC ARTERY. ULCAN ARTERY. BRANCHES OF THE THORACIC AORTA

Brachial artery (a. brachialis) is a continuation of the axillary artery, gives the following branches:

1) superior ulnar collateral artery (a. collateralis ulnaris superior);

2) lower ulnar collateral artery (a. collateralis ulnaris inferior);

3) deep artery of the shoulder (a. profunda brachii), giving the following branches: middle collateral artery (a. collateralis media), radial collateral artery (a. collateralis radialis), deltoid branch (r. deltoidei) and arteries feeding the humerus ( aa. nutriciae humeri).

The radial artery (a. radialis) is one of the two terminal branches of the brachial artery. The terminal section of this artery forms a deep palmar arch (arcus palmaris profundus), anastomosing with the deep palmar branch of the ulnar artery. Branches of the radial artery:

1) superficial palmar branch (r. palmaris superficialis);

2) radial recurrent artery (a. reccurens radialis);

3) dorsal carpal branch (r. carpalis dorsalis); participates in the formation of the dorsal network of the wrist (rete carpale dorsale);

4) palmar carpal branch (r. carpalis palmaris).

The ulnar artery (a. ulnaris) is the second terminal branch of the brachial artery. The terminal section of this artery forms the superficial palmar arch (arcus palmaris supreficialis), anastomosing with the superficial palmar branch of the radial artery. Branches of the ulnar artery:

1) ulnar recurrent artery (a. reccurens ulnaris), dividing into anterior and posterior branches;

2) muscular branches (rr. musculares);

3) common interosseous artery (a. interuossea communis), dividing into the anterior and posterior interosseous arteries;

4) deep palmar branch (r. palmaris profundus);

5) palmar carpal branch (r. carpalis palmaris).

In the system of the subclavian, axillary, brachial, ulnar and radial arteries, there are many anastomoses that provide blood supply to the joints and collateral blood flow.

The branches of the thoracic aorta are divided into visceral and parietal.

Visceral branches:

1) pericardial branches (rr. pericardiaci);

2) esophageal branches (rr. oesophageales);

3) mediastinal branches (rr. mediastinaes);

4) bronchial branches (rr. bronchiales).

Parietal branches:

1) superior phrenic artery (a. phrenica superior);

2) posterior intercostal arteries (aa. intercostales posteriores), each of which gives off a medial cutaneous branch (r. cutaneus medialis), a lateral cutaneous branch (r. cutaneus lateralis) and a dorsal branch (r. dorsalis).

9. BRANCHES OF THE ABDOMINAL AORTA

The branches of the abdominal aorta are divided into visceral and parietal.

Visceral branches, in turn, are divided into paired and unpaired.

Paired visceral branches:

1) ovarian (testicular) artery (a. ovarica (a testicularis). The ovarian artery gives tubal (rr. tubarii) and ureteric branches (rr. ureterici), and the testicular artery gives adnexal (rr. epididymales) and ureteral branches (rr. ureterici);

2) renal artery (a. renalis); gives ureteral branches (rr. ureterici) and inferior adrenal artery (a. suprarenalis inferior);

3) middle adrenal artery (a. suprarenalis media); anastomoses with the superior and inferior adrenal arteries.

Unpaired visceral branches:

1) celiac trunk (truncus coeliacus). Divides into three arteries:

a) splenic artery (a. lienalis), gives branches to the pancreas (rr. pancreatici), short gastric arteries (aa. gastricae breves) and left gastroepiploic artery (a. gastroepiploica sinistra), giving omental and gastric branches;

b) common hepatic artery (a. hepatica communis); is divided into its own hepatic artery (a. hepatica propria) and gastroduodenal artery (a. gastroduodenalis). Own hepatic artery gives off the right gastric artery (a. gastrica dextra), the right and left branches, the gallbladder artery (a. cystica) departs from the right branch. The gastroduodenal artery is divided into the superior pancreaticoduodenal arteries (aa. pancreaticoduodenales superiores) and the right gastroepiploic artery (a. gastroepiploica).

c) the left gastric artery (a. gastrica sinistra), gives off esophageal branches (rr. oesophagealis);

2) superior mesenteric artery (a. mesenterica superior). Gives the following branches:

a) right colic artery (a. colica dextra); anastomoses with branches of the middle colon artery, a branch of the iliac colon artery;

b) middle colic artery (a. colica media); anastomoses with the right and left colonic arteries;

c) iliocolic artery (a. ileocolica); gives the artery of the appendix (a. appendicularis), colonic branch (r. colicus), anterior and posterior cecal arteries (aa. caecalis anterior et posterior);

d) lower pancreaticoduodenal arteries (aa. pancreaticoduodenalies inferiors);

e) ileal-intestinal (aa. ileales) and jejunal arteries (aa. jejunales);

3) inferior mesenteric artery (a. mesenterica inferior). Gives the following branches:

a) sigmoid arteries (aa. sigmoidei);

b) left colic artery (a. colica sinistra);

c) superior rectal artery (a. rectalis superior).

Parietal branches:

1) four pairs of lumbar arteries (aa. lumbales), each of which gives off the dorsal and spinal branches;

2) the lower phrenic artery (a. phrenica inferior), giving the upper adrenal arteries (aa. suprarenales superiores).

At the level of the middle of the body of the IV lumbar vertebra, the abdominal part of the aorta is divided into two common iliac arteries, and itself continues into the median sacral artery (a. sacralis mediana).

10. STRUCTURE OF THE BRANCHES OF THE COMMON ILIAC ARTERY

The common iliac artery (a. iliaca communis) is divided into internal and external iliac arteries at the level of the iliac sacral joint.

The external iliac artery (a. iliaca externa) gives the following branches:

1) deep artery, circumflex ilium (a. circumflexa iliaca profunda);

2) the lower epigastric artery (a. epigastrica inferior), which gives the pubic branch (r. pubicus), the cremaster artery (a. cremasterica) in men and the artery of the round ligament of the uterus (a. lig teretis uteri) in women.

The internal iliac artery (a. iliaca interna) gives the following branches:

1) umbilical artery (a. umbilicalis), presented in an adult by the medial umbilical ligament;

2) superior gluteal artery (a. glutealis superior), which is divided into deep and superficial branches;

3) lower gluteal artery (a. glutealis inferior); gives the artery that accompanies the sciatic nerve (a. comitans nervi ischiadici);

4) iliac-lumbar artery (a. iliolumbalis), giving iliac (r. iliacus) and lumbar branches (r. lumbalis);

5) uterine artery (a. uterine), giving tubal (r. tubarius), ovarian (r. ovaricus) and vaginal branches (rr. vaginales);

6) lower vesical artery (a. vesicalis inferior);

7) lateral sacral arteries (aa. sacrales laterales), giving spinal branches (rr. spinales);

8) internal genital artery (a. pudenda interna); gives the lower rectal artery (a. rectalis inferior) and in women: the urethral artery (a. urethralis), the dorsal and deep arteries of the clitoris (aa. dorsalis et profunda clitoritidis) and the artery of the vestibule bulb (a. bulbi vestibule); in men: urethral artery (a. urethralis), dorsal and deep arteries of the penis (aa. dorsalis et profunda penis), artery of the bulb of the penis (a. bulbi penis);

9) middle rectal artery (a. rectalis media);

10) obturator artery (a. obturatoria); divides into anterior and posterior branches. The latter gives off the acetabular branch (r. acetabularis). The obturator artery in the pelvic cavity gives off the pubic branch (r. pubicus).

11. BRANCHES OF THE FEMORAL, POPliteal, Anterior, and Posterior Tibial Arteries

The femoral artery (a. femoralis) is a continuation of the external iliac artery and gives off the following branches:

1) deep artery of the thigh (a. profunda femoris), giving perforating arteries (aa. perforantes); lateral artery, circumflex femur (a. circumflexa femoris lateralis), giving ascending, transverse and descending branches (rr. ascendens, transversus et descendens); medial artery, circumflex femoral (a. circumflexa femoris medialis), giving the acetabular branch (r. acetabularis) to the hip joint, deep and ascending branches (rr. profundus et ascendens);

2) superficial artery, circumflex ilium (a. circumflexa iliaca superficialis);

3) superficial epigastric artery (a. epigastrica superficialis);

4) descending knee artery (a. genus descendens); participates in the formation of the knee articular network (rete articulare genus);

5) external genital arteries (aa. pudendae externae).

Popliteal artery (a. poplitea) is a continuation of the femoral and gives the following branches:

1) medial lower knee artery (a. genus inferior medialis); participates in the formation of the knee articular network (rete articulare genus);

2) lateral lower knee artery (a. genus inferior lateralis);

3) medial superior knee artery (a. genus superior medialis);

4) lateral superior knee artery (a. genus superior lateralis);

5) middle knee artery (a. genus media).

The anterior tibial artery (ayu tibialis anterior) departs from the popliteal artery in the popliteal fossa and gives the following branches:

1) anterior tibial recurrent artery (a. reccurens tibialis anterior);

2) posterior tibial recurrent artery (a. reccurens tibialis posterior);

3) medial anterior ankle artery (a. malleolaris anterior medialis);

4) lateral anterior ankle artery (a. malleolaris anterior lateralis);

5) muscular branches (rr. musculares);

6) dorsal artery of the foot (a. dorsalis pedis); gives off the lateral and medial tarsal arteries (aa. tarsales lateralis et medialis), the arcuate artery (a. arcuata) and is divided into terminal branches: the deep plantar artery (a. plantaris profunda) and the first dorsal metatarsal artery (.a metatarsalis dorsalis I).

The posterior tibial artery (a. tibialis posterior) is a continuation of the popliteal artery and gives the following branches:

1) medial plantar artery (a. plantaris medialis), dividing into deep and superficial branches;

2) lateral plantar artery (a. plantaris lateralis); forms a deep plantar arch (arcus plantaris profundus), from which four plantar metatarsal arteries depart (aa. metatarsales plantares I-IV). Each metatarsal artery passes into the common plantar digital artery (a. digitalis plantaris communis), which (except I) are divided into two own plantar digital arteries (aa. digitalis plantaris propriae);

3) a branch that wraps around the fibula (r. circumflexus fibularis);

4) peroneal artery (a. peronea);

5) muscular branches (rr. musculares).

12. SYSTEM OF THE SUPERIOR CAVA VEIN

The superior vena cava (v. cava superior) collects blood from the veins of the head, neck, both upper extremities, veins of the thoracic and partially abdominal cavities and flows into the right atrium. The azygos vein flows into the superior vena cava on the right, and the mediastinal and pericardial veins flow into the left. It has no valves.

The unpaired vein (v. azygos) is a continuation into the chest cavity of the right ascending lumbar vein (v. lumbalis ascendens dextra), has two valves at the mouth. The semi-azygous vein, esophageal veins, mediastinal and pericardial veins, posterior intercostal veins IV-XI and the right superior intercostal vein flow into the unpaired vein.

The semi-unpaired vein (v. hemiazygos) is a continuation of the left ascending lumbar vein (v. lumbalis ascendens sinistra). The mediastinal and esophageal veins flow into the semi-unpaired vein, the additional semi-unpaired vein (v. hemiazygos accessoria), which receives I-VII superior intercostal veins, posterior intercostal veins.

Posterior intercostal veins (vv. intercostales posteriores) collect blood from the tissues of the walls of the chest cavity and part of the abdominal wall. The intervertebral vein (v. intervertebralis) flows into each posterior intercostal vein, into which, in turn, the spinal branches (rr. spinales) and the vein of the back (v. dorsalis) flow.

The veins of the spongy substance of the vertebrae and spinal veins flow into the internal anterior and posterior vertebral venous plexuses (plexus venosi vertebrales interni). Blood from these plexuses flows into the accessory semi-unpaired and unpaired veins, as well as into the external anterior and posterior vertebral venous plexuses (plexus venosi vertebrales externi), from which blood flows into the lumbar, sacral and intercostal veins and into the additional semi-unpaired and unpaired veins.

The right and left brachiocephalic veins (vv. brachiocephalicae dextra et sinistra) are the roots of the superior vena cava. They do not have valves. Collect blood from the upper extremities, organs of the head and neck, upper intercostal spaces. The brachiocephalic veins are formed by the confluence of the internal jugular and subclavian veins.

The deep cervical vein (v. cervicalis profunda) originates from the external vertebral plexuses and collects blood from the muscles and auxiliary apparatus of the muscles of the occipital region.

The vertebral vein (v vertebralis) accompanies the artery of the same name, receiving blood from the internal vertebral plexuses.

The internal thoracic vein (v. thoracica interna) accompanies the artery of the same name on each side. The anterior intercostal veins (vv. intercostales anteriores) flow into it, and the roots of the internal thoracic vein are the muscular-diaphragmatic vein (v. musculophrenica) and the superior epigastric vein (v. epigastrica superior).

13. VEINS OF THE HEAD AND NECK

The internal jugular vein (v. jugularis interna) is a continuation of the sigmoid sinus of the dura mater, has an upper bulb (bulbus superior) in the initial section; above the confluence with the subclavian vein is the lower bulb (bulbus inferior). There is one valve each above and below the lower bulb. The intracranial tributaries of the internal jugular vein are the ophthalmic veins (vv. ophthalmicae superior et inferior), labyrinth veins (vv. labyrinthi) and diploic veins.

By diploic veins (vv. diploicae): posterior temporal diploic vein (v. diploica temporalis posterior), anterior temporal diploic vein (v. diploica temporalis anterior), frontal diploic vein (v. diploica) and occipital diploic vein (v. diploica occipitalis ) - blood flows from the bones of the skull; have no valves. With the help of emissary veins (vv. emissariae): mastoid emissary vein (v. emissaria mastoidea), condylar emissary vein (v. emissaria condylaris) and parietal emissary vein (v emissaria parietalis) - diploic veins communicate with the veins of the outer integument of the head.

Extracranial tributaries of the internal jugular vein:

1) lingual vein (v. lingualis), which is formed by the deep vein of the tongue, the hyoid vein, the dorsal veins of the tongue;

2) facial vein (v. facialis);

3) superior thyroid vein (v. thyroidea superior); has valves;

4) pharyngeal veins (vv. pharyngeales);

5) mandibular vein (v. retromandibularis).

The external jugular vein (v. jugularis externa) has paired valves at the level of the mouth and the middle of the neck. The transverse veins of the neck (vv. transversae colli), the anterior jugular vein (v. jugularis anterior), and the suprascapular vein (v. suprascapularis) flow into this vein.

Subclavian vein (v. subclavia) unpaired, is a continuation of the axillary vein.

14. VEINS OF THE UPPER LIMB. SYSTEM OF THE LOWER CAVA VEIN. PORTAL VEIN SYSTEM

These veins are represented by deep and superficial veins.

The superficial palmar venous arch (arcus venosus palmaris superficialis) drains into the palmar digital veins.

Paired palmar metacarpal veins flow into the deep palmar venous arch (arcus venosus palmaris profundus). The superficial and deep venous arches continue into the paired radial and ulnar veins (vv. radiales et vv palmares), which belong to the deep veins of the forearm. From these veins, two brachial veins (vv. brachiales) are formed, which merge and form the axillary vein (v. axillaries), which passes into the subclavian vein.

Superficial veins of the upper limb.

The dorsal metacarpal veins, together with their anastomoses, form the dorsal venous network of the hand (rete venosum dorsale manus). The superficial veins of the forearm form a plexus, in which the lateral saphenous vein of the arm (v. cephalica), which is a continuation of the first dorsal metacarpal vein, and the medial saphenous vein of the arm (v. basilica), which is a continuation of the fourth dorsal metacarpal vein, are distinguished. The lateral saphenous vein flows into the axillary vein, and the medial vein flows into one of the brachial veins. Sometimes there is an intermediate vein of the forearm (v. intermedia antebrachii). The intermediate vein of the elbow (v. intermedia cubiti) is located in the anterior ulnar region (under the skin) and has no valves.

There are parietal and visceral tributaries of the inferior vena cava (v. cava inferior).

Visceral tributaries:

1) renal vein (v. renalis);

2) adrenal vein (v. suprarenalis); does not have valves;

3) hepatic veins (vv. hepaticae);

4) ovarian (testicular) vein (v. ovarica (testicularis)).

Parietal tributaries:

1) lower phrenic veins (vv. phrenicae inferiors);

2) lumbar veins (vv. lumbales).

The portal vein (v. portae) is the largest visceral vein, its main tributaries are the splenic vein, superior and inferior mesenteric veins.

The splenic vein (v. lienalis) merges with the superior mesenteric vein and has the following tributaries: the left gastroepiploic vein (v. gastroepiploica sinistra), short gastric veins (vv. gastricae breves) and pancreatic veins (vv. pancreaticae).

The superior mesenteric vein (v. mesenterica superior) has the following tributaries: the right gastroepiploica vein (v. gastroepiploica dextra), the iliocolic vein (v. ileocolica), the right and middle colic veins (vv. colicae media et dextra), pancreatic veins (vv. pancreaticae), vein of the appendix (v. appendicularis), veins of the ileum and jejunum (vv. ileales et jejunales).

The inferior mesenteric vein (v. mesenterica inferior) flows into the splenic vein, is formed by the confluence of the sigmoid veins (vv. sigmoideae), the superior rectal vein (v. rectalis superior) and the left colonic vein (v. colica sinistra).

Before entering the portal of the liver, the right and left gastric veins (vv. gastricae dextra et sinistra), prepyloric vein (v. prepylorica) and gall bladder vein (v. cystica) flow into the portal vein. Having entered the portal of the liver, the portal vein is divided into right and left branches, which in turn are divided into segmental, then into interlobular veins, which give off sinusoidal vessels into the lobules, flowing into the central vein. Sublobular veins emerge from the lobules, which merge and form the hepatic veins (vv. hepaticae).

15. VEINS OF THE PELVIC AND LOWER LIMB

The right and left common iliac veins (vv. iliacae communes) form the inferior vena cava.

The external iliac vein (v. iliaca externa) combines with the internal iliac vein at the level of the sacroiliac joint and forms the common iliac vein. The external iliac vein receives blood from all veins of the lower limb; has no valves.

The internal iliac vein has visceral and parietal tributaries.

Visceral tributaries:

1) vaginal venous plexus (plexus venosus vaginalis), passing into the uterine venous plexus (plexus venosus uterinus);

2) prostatic venous plexus (plexus venosus prostaticus);

3) vesical venous plexus (plexus venosus vesicalis);

4) rectal venous plexus (plexus venosus rectalis);

5) sacral venous plexus (plexus venosus sacralis).

Parietal tributaries:

1) iliac-lumbar vein (v. ilicolumbalis);

2) superior and inferior gluteal veins (vv. glutealis superiores et inferiors);

3) lateral sacral veins (vv. sacrales laterales);

4) obturator veins (vv. obturatoriae).

Deep veins of the lower limb:

1) femoral vein (v. femoralis);

2) deep vein of the thigh (v. femoris profunda);

3) popliteal vein (v. poplitea);

4) anterior and posterior tibial veins (vv. tibiales anteriores et posteriores);

5) peroneal veins (vv. fibulares).

All deep veins (with the exception of the deep vein of the thigh) accompany the arteries of the same name; have many valves.

Superficial veins of the lower limb:

1) great saphenous vein of the leg (v. saphena magna); flows into the femoral vein, has many valves. Collects blood from the soles of the feet, the anteromedial surface of the lower leg and thigh;

2) small saphenous vein of the leg (v. saphena parva); flows into the popliteal vein, has many valves. Collects blood from the lateral part of the foot, heel region, saphenous veins of the sole and dorsal venous arch;

3) plantar venous arch (arcus venosus plantares); collects blood from the plantar digital veins; from the arc, blood flows into the posterior tibial veins along the plantar veins (lateral and medial);

4) dorsal venous arch (arcus venosus dorsalis pedis); collects blood from the dorsal digital veins; from the arc, blood flows into the large and small saphenous veins.

There are numerous anastomoses between the systems of the superior and inferior vena cava and the portal vein.

BIBLIOGRAPHY

1. Sapin M. R. Human anatomy: In 2 vols. T. 1-2. M.: Medicine, 1997 /

2. Sinelnikov R. D., Sinelnikov Ya. R. Atlas of human anatomy: In 2 vols. T. 1-4. M.: Medicine, 1989.

Author: Yakovlev M.V.

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