Download 2. Splanchnology

SPLANCHNOLOGY
Splanchnology is the science about the structure of the visceral organs.
The visceral organs (viscera, s. splanchna) are organs which are situated mainly in the
body cavities (oral, nasal, thoracic, abdominal, and the pelvic).
This includes:
The digestive or alimentary system consists of the organs and glands associated with
ingestion, mastication (chewing), deglutition (swallowing), digestion, and absorption of
food and the elimination of feces (solid waste) remaining after the nutrients have been
absorbed.
The respiratory system consists of the air passages and lungs that supply oxygen to
the blood for cellular respiration and eliminate carbon dioxide from it. The diaphragm and
larynx control the flow of air through the system, which may also produce tone in the
larynx that is further modified by the tongue, teeth, and lips into speech.
The urinary system consists of the kidneys, ureters, urinary bladder, and urethra,
which filter blood and subsequently produce, transport, store, and intermittently excrete
urine (liquid waste).
The reproductive or genital system (female and male) consists of the gonads
(ovaries and testes) that produce oocytes (eggs) and sperms, the ducts that transport rhem,
and the genitalia that enable their union. After conceprion, the female reproductive tract
nourishes and delivers rhe fetus.
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The endocrine system consists of discrete ductless glands (such as the thyroid gland)
as well as isolated and clustered cells of the gut and blood vessel walls and specialized nerve
endings that secrete hormones. Hormones are organic molecules that are carried by the
circulatory system to distant effector cells in all parts of the body. The influence of the
endocrine system is thus as broadly distributed as that of the nervous system. These glands
influence metabolism and other processes, such as the menstrual cycle.
Topograpy – is the part of anatomy, which study the orientation of organs. It consists of parts:
Holotopy: location of organ in regions of body;
Skeletotopy: projection of organ on skeleton;
Syntopy: position of organ accoding the another organs.
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The anterior wall of the abdominal cavity is
divided on nine regions by two horizontal and
two transversal lines.
The subcostal line arises on level of cartilaginous
parts of the tenth ribs.
The interspinous line arises on level of anterior
superior iliac spine.
The left and right medclavicular lines are drawn
through the midpoint of the clavicula.
Representative Structures found in the abdominopelvic regions
Regions
Representative Structures
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The digestive system
The digestive process takes place in the digestive tract, or alimentary canal, which extends
from lips to the anus. The alimentary canal consists of the mouth, pharynx, esophagus,
stomach, small intestine, large intestine with rectum, anal canal, and anus. The associated
structures include the teeth, lips, cheeks, salivary glands, pancreas, liver, and gallbladder.
Parts of the digestive tract have specialized functions, but all are composed of the same basic
layers of tissue. The wall of the tube (from the inside to the outside) is composed of mucosa,
submucosa, muscular, and serosa membranes.
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Mouth
The mouth or oral cavity consists of two parts: the small, outer vestibule of the mouth and the
oral cavity proper.
The vestibule is the slit like space between the lips, cheeks, the teeth and gingivae.The upper
and lower lips are formed by the m. orbicularis oris which is covered by the skin and mucous
membrane. The portions of the lip: 1) pars cutanea; 2) pars intermedia (red); 3) pars mucosa. There is
fissura between the lips. The mucous membrane forms two folds - frenulum of the upper lip and
frenulum of the lower lip.
The cheek is formed by the m. buccinator which is covered by the skin and mucous
membrane. There is corpus adiposum buccae inside the cheek.
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Proper oral cavity is bordered from the vestibule by the teeth and gingivae. Proper oral cavity
has two walls. The superior wall (―roof of the mouth‖) or palate has two sections: hard and soft palate.
The hard palate is formed by the palatum osseum and mucous membrane.
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The soft palate is fomed by the striated muscles and mucous membrane. The sections of the
soft palate: 1) uvula; 2) velum palatinum; 3) palatoglossal arch; 4) palatopharyngeal arch. There is
tonsillar sinus or fossa between the arches of the soft palate, and this sinus contains palatin tonsil.
Muscles of the soft palate:
1) uvulae m.; 2) levator veli palatini m.;3) tensor veli palatini;4) palatoglossal m.; 5) palatopharyngeal
m..
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The inferior wall of the proper oral cavity (―floor of the mouth‖) or diaphragm of the mouth is formed
by the suprahyoid muscles of the neck which are covered by the mucous membrane.
The tongue (linguae) aids in digestion by helping to form the moistened, chewed food into a
bolus, and pushing it toward the pharynx to be swallowed. It also contains taste buds. The tongue also
pushes the food against the hard palate, where it is crushed and softened.
External structure. The tongue has:
1) root;
2) body;
3) top;
4) back;
5) inferior surface.
Paired
sublingual
folds and unpaired
frenulum of tongue are situated below the inferior surface and are formed by the mucous membrane.
Paired sublingual caruncles are situated near the frenulum linguae.
There is foramen cecum lingue and terminal sulcus is at the back. The lingual tonsil is situated
behind the terminal sulcus.
The taste buds (papillae) of the tongue:
1) filiform papillae are situated at the top of the tongue;
2) conicalpapillae are situated at the top of the tongue;
3) fungiform papillae are situated at the top and dorsum of the tongue;
4) vallat papillae are situated near sulcus terminalis of the tongue;
5) foliat papillae are situated at the lateral borders of the tongue.
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Internal structure. The tongue is muscular organ which is covered by the mucous membrane.
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The greater salivary glands are the parotid, submandibular, and sublingual glands.
The paired parotid gland is situated in the retromandibular fossa. The duct of the parotid gland
lies at the m. masseter, and at the region of the anterior margion of this muscle perforates m. bucinator
and opens in the vestibulum of the oral cavity in front of the 2nd molar.
The paired submandibular gland is situated in the submandibular triangle. The duct of the
submandibular gland perforates the oral diaphragm and opens at the caruncula sublingualis.
The paired
sublingual gland is
situated in the plica
sublingualis. The
greater duct of the
sublingual gland is
opened
at
the
caruncula
sublingualis,
and
the lesser ducts of
the sublingual gland
are opened at the
plica sublingualis.
The lesser salivary glands are: labial gl.; buccal gl.; palatin gl.; lingual gl.;molar gl..
They secrete saliva, which contains water, salts, proteins, and at least one enzyme, salivary amylase
(ptyalin), which begins the digestion of cooked starch.
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Teeth
The chief functions of the teeth are to:
• Incise, reduce, and mix food material with saliva during mastication (chewing).
• Help sustain themselves in the tooth sockets by assisting the development and protection of the
tissues that support them.
• Participate in articulation (distinct connected speech).
The teeth are set in the tooth sockets and are used in mastication and in assisting in articulation. A tooth
is identified and described on the basis of whether it is deciduous (primary) or permanent (secondary),
the type of tooth, and its proximity to the midline or front of the mouth (e.g., medial and lateral incisors;
the 1st molar is anterior to the 2nd). Children have 20 deciduous teeth; adults normally have 32
permanent teeth.
Teeth of adults. Permatent teeth:
Teeth of child (7 years).
1 – molars of upper jaw
2 – maxillar sinus
3 – superior alveolar arch
4 – incisors
5 – canine
6 – inferior alveolar arch
7 – molars of lower jaw
8 - mandibula
Before eruption, the
developing teeth reside
in the alveolar arches as tooth
buds.
The types of teeth are identified by their
characteristics: incisors, thin cutting
edges; canines, single prominent
cones; premolars (bicuspids), two
cusps; and molars, three or more cusps.
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Teeth of the lowerjaw and upper jaw
The vestibular surface (labial or buccal) of each tooth is directed outwardly, and the lingual surface is
directed inwardly. As used in clinical (dental) practice, the mesial (proximal) surface of a tooth is
directed toward the median plane of the facial part of the cranium. The distal surface is directed away
from this plane; both mesial and distal surfaces are contact surfaces—that is, surfaces that contact
adjacent leeth. The masticatory surface is the occlusal surface.
Parts and Structure of the Teeth
A tooth has a crown, neck, and root. The crown projects from the gingiva. The neck is
between the crown and the root. The root is fixed in the tooth socket by the periodontium; the number
of roots varies. Most of the tooth is composed of dentin (L. dentinium), which is covered by enamel
over the crown and cement (L. cementum) over the root. The pulp cavity contains connective tissue,
blood vessels, and nerves. The root canal (pulp canal) transmits the nerves and vessels to and from the
pulp cavity through the apical foramen.
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DECIDUOUS, primary or milk teeth (20)
Features: They are smaller, the neck is more marked, owing the greater degree of convexity of the
crown. The roots of the temporary molar teeth are smaller and more diverging. Apical foramens are
wider.
The usual ages of the eruption (―cutting‖) of the deciduous teeth:
Eruption ( in
Medial incisor Lateral incisor Canine
Molar I
Molar II
month)
Upper
7-8
8-9
18-20
14-15
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Lower
6-7
7-8
Formula of the deciduous teeth:
16-18
2012
2012
6-7
7-8
9-10
Formula of the permanent teeth:
10-12
3212
3212
20-22
2102
2102
The most usual time of eruption of the permanent teeth:
Eruption (in Medial Lateral Canine
Premolar I
years)
incisor incisor
Upper
7-8
8-9
11-12
10-11
Lower
12-13
Premolar II
Molar II
10-12
Molar
I
6-7
12-13
Molar
III
17-21
11-12
6-7
11-13
12-26
2123
2123
The dental organ is tooth + parodontium.
The parodontium are composed of periodontium, alveola dentis, gums, cementum, which surrounding
the teeth.
The periodontium consists of the supporting soft and hard dental tissues between and including
portions of the tooth and the alveolar bone. The periodontium serves to support the tooth in its
relationship to the alveolar bone. Thus, the periodontium includes the cementum, alveolar bone, the
periodontal ligament, as well as individual components of these tissues, vessels, and nerves.
Surrounding the teeth in the alveoli and covering the alveoli processes are the gums or gingiva,
composed of a firm pink mucosa. The gingiva between adjacent teeth is an extension of attached
gingiva and is called the interdental gingiva or interdental papilla.
The tooth sockets are in the alveolar processes of the maxillae and mandible and are the skeletal
features that display the greatest change during a lifetime. Adjacent sockets are separated by
interalveolar septa; within the socket, the roots of teeth with more than one root are separated by
interradicular septa. The bone of the socket has a thin cortex separated from the adjacent labial and
lingual cortices by a variable amount of trabeculated bone. The labial wall of the socket is particularly
thin over the incisor teeth; the reverse is true for the molars, where the lingual wall is thinner. Thus
thelabial surface commonly is broken to extract incisors and the lingual surface is broken to extract
molars. The roots of the teeth are connected to the bone of the alveolus by a springy suspension
forming a special type of fibrous joint called a dento-alveolar syndesmosis or gomphosis. The
periodontium (periodontal membrane) is composed of collagenous fibers that extend between the
cement of the root and the periosteum of the the alveolus. It is abundantly supplied with tactile,
prcssoreceptive nerve endings, lymph capillaries, and glomerular blood vessels that act as hydraulic
cushioning to curb axial masticatory pressure. Pressorereptive nerve endings are caraable of receiving
chanches in pressure as stimuli.
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Pharynx
The pharynx is that part of the digestive tube which is placed behind the nasal cavities,
mouth, and larynx. The cavity of pharynx is about 12.5 cm long. Seven cavities communicate with it,
viz., the two nasal cavities, the two tympanic cavities, the mouth, the larynx, and the esophagus.
Topography of the pharynx:
Holotopy: the pharynx is situated in the cervical cavity;
Skeletotopy: the pharynx stretches from the level of the base of the skull to that of the sixth or seventh
cervical vertebrae;
Syntopy: the pharynx is situated behind the nasal and oral cavities and the larynx, and in front of the
basilar part of the occipital bone and the bodies of the six cervical vertebrae, and the anterior group of
the deep muscles of the neck. Laterally are situated the two tympanic cavities and the vessels and
nerves of the neck.
External structure. The cavity of pharynx may be subdivided into three parts: nasal, oral, and
laryngeal. The superior wall of the pharynx is called the vault (fornix) of the pharynx.
The anterior wall of the nasal part of the pharynx, or the nasopharynx is occupied by the
choanae. On either lateral wall of the pharynx is a funnel-shaped pharyngeal opening of the auditory
tube (it is a part of the middle ear). The paired accumulation of lymphoid tissue is located near that last
openings; this is tube tonsils. At the junction of the superior and posterior pharyngeal walls is another
accumulation of lymphoid tissue, the pharyngeal tonsil, or adenoids.
The oral part of the pharynx reaches from the soft palate to the level of the hyoid bone. It is
mixed in function because the alimentary and respiratory tracts intersect here. The oral part is
communicated with the oral cavity in front through the isthmus faucium. In its lateral wall, between
the two palatine arches, is the palatine tonsils.
The laryngeal part reaches from the hyoid bone to the lower border of the cricoid cartilage,
where it is continuous with the esophagus. In front it presents the triangular entrance of the larynx and
closes by the epiglottis. Its lateral boundaries are constituted by the aryepiglotic folds. On either side
of the folds is a recess, termed the sinus (recessus) piriformis.
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Structure of the lymphoid ring:
I
N
The mucous coat of the nasal part is covered by columnar ciliated epithelium; in the oral and laryngeal
portions the epithelium is stratified squamous. Beneath the mucous membrane are found racemose
mucous glands. A complete ring of lymphoid structures is found at the entry into the pharynx: the
lingual tonsil, two palatine tonsils, two tube tonsils, and one pharyngeal tonsil. These six tonsils form
Pirogowi’s lymphoepithelial ring. During childhood it is hypertrophied.
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Internal structure. The pharynx is a musculomembranous tube, composed of three coats:
mucous, muscular, and fibrous. The fibrous coat of the pharynx, pharyngobasilar fascia is attached
above to the basal part of the occipital bone and to the other bones of the base of the skull and
stretched forward to the medial plate of the pterygoid process of the sphenoid bone. Superiorly this
fibrous tissue passes on to the buccinator muscle and is called the buccopharyngeal fascia. The
pharyngeal muscles arranged longitudinally (dilators) and circular (constrictors).
The muscles of the pharynx are:
1.Constrictor: a) inferior
b) medius
c) superior
2. Palatopharyngeus
3. Salpingopharyngeus
4. Stylopharyngeus
Arising on different points, namely on the bones of the base of the skull (tuberculum
pharyngeum of the basal part of the occipital bone, and the pterygoid process of the sphenoid bone),
on the mandible, on the root of the tongue, on the hyoid bone, and on the laryngeal cartilages (thyroid
and cricoid) the fibres of the muscles on each side pass backward and join each other to form a seam
on the midline of the pharynx, the raphe of the pharynx. The lower fibres of the inferior pharyngeal
constrictor are closely connected with the muscle fibres of the esophagus.
Actions. - When deglutition is about to be performed the pharynx is drawn upward and dilated in
different dirrections, to recieve the food propelled into it from the mouth. The stylopharyngei, which
are much farther removed from one another at their origin than at their insertion, draw the sides of the
pharynx upward and lateral ward, and so increase its transverse diameter. As soon as the bolus of food
is recieved in the pharynx, the elevator muscles relax, the pharynx descends, and the constrictores
contract upon the bolus, and convey it downward into the esophagus.
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Esophagus
The esophagus or gullet is a muscular canal, about 23 to 25 cm long, extending from the
pharynx to the stomach. It begins in the neck at the lower border of the cricoid cartilage, opposite the
sixth cervical vertebra descends along the front of the vertebral column, through the superior and
posterior mediastina, passes through the diaphragm, and, entering the abdomen, ends at the cardiac
orifice of the stomach, opposite the eleventh thoracic vertebra. The general direction of the esophagus
is vertical. It is the narrowest part of the digestive tube, and is most contracted at the point where it
passes through the diaphragm. Esophagus has three portions: cervical, thoracic, and abdominal.
Topography of the esophagus:
Holotopy: the esophagus is situated in the three cavities: cervical, thoracic, and abdominal;
Skeletotopy: the esophagus stretches from the level of the sixth cervical vertebrae to that of the
eleventh thoracic vertebra;
Syntopy: the cervical portion of the esophagus is in relation, in front, with the trachea; and at the
lower part of the neck with the thyroid gland; behind, it rests upon the vertebral column and Longus
colli muscles; on either side it is in relation with the common carotid artery, and parts of the lobes of
the thyroid gland; the recurrent nerves ascend between it and the trachea; to its left side is the thoracic
duct.
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The thoracic portion of the esophagus is at first situated in the superior mediastinum between
the trachea and the vertebral column. It then passes behind and to the right of the aortic arch, and
descends in the posterior mediastinum along the right side of the descending aorta, then runs in front
and a little to the left of the aorta, and enters the abdomen through the diaphragm at the level of the
tenth thoracic vertebra. Just before it perforates the diaphragm it presents a distinct dilatation. The
esophagus is in relation, in front, with the trachea, the left bronchus, the pericardium, and the
diaphragm; behind, it rests upon the vertebral column, the Longus colli muscles, the right aortic
intercostal arteries, the thoracic duct, and the hemiazygos veins; and below, near the diaphragm upon
the front of the descending thoracic aorta. Below the roots of the lungs the vagi descend in close
contact with the esophagus, the right nerve passing down behind, and the left nerve in front of it; the
two nerves uniting to form a plexus around the tube.
The abdominal portion of the esophagus lies in the esophageal groove on the posterior surface of the
left lobe of the liver. It measures about 1.25 cm in length, and only its front and left aspects are
covered by peritoneum.
The esophagus has three anatomical constrictions, which are significant in making the diagnosis of
pathological processes: 1) pharyngeal (at the origin of the esophagus), 2) bronchial (at the level of the
tracheal bifurcation), and 3) a diaphragmatic.
There are more constrictions in a live subject. They can be called physiological: 1) superior
constriction at the origin of the esophagus, 2) middle or aortico-bifurcational (the place where the
esophagus is crossed by the arch of the aorta and the left bronchus), 3) inferior constriction occupies
the whole abdominal portion of the esophagus.
Internal structure. The esophagus is composed of four coats: mucous, submucous, muscular,
and fibrous. The mucous coat is thick, of a redish color above, and pale below. It is disposed in
longitudinal folds. Its surface is covered throughout with the thick layer of stratified squamous
epithelium. The esophageal glands are small compound racemose glands of the mucous type; they are
lodged in the submucous tissue, and each opens upon the surface by a long excretory duct. The
submucous connects loosely the mucous and muscular coats. It contains blood vessels, nerves, and
mucous glands. The muscular coat is composed of two planes of considerable thickness: an external of
longitudinal and internal of circular fibers. The fibrous coat is the outer coat and consists of loose
connective tissue.
Stomach
The stomach is the most dilated part of the digestive tube, and is situated between the end of
the esophagus and the beginning of the small intestine.
Topography of the stomach:
Holotopy: the stomach is situated in the epigastrium and the left infracostal region;
Skeletotopy: the stomach stretches from the level of the eleventh thoracic vertebra to that of the firstsecond lumbar vertebrae;
Syntopy: the anterior surface of the stomach comes in contact with the diaphragm, and visceral surface
of the liver; the posterior surface contacts with transverse colon, and its mesocolon, lien, pancreas, the
superior polus of the left kidney, and the left suprarenal gland.
External structure. An anterior wall and posterior wall of the stomach are distinguished. The
lesser curvature forms the right concave border of the stomach. The greater curvature forms the left
concave border. The following orifices are distinguished in the stomach: 1) the cardiac orifice by
which the esophagus communicates with the stomach, and 2) the pyloric orifice by which the stomach
communicates with the duodenum. Portions of the stomach: 1) cardiac, 2) fundus, 3) body, 4) pars
pylorica is divided into the pyloric antrum, and the pyloric canal.
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External view of the
stomach:
(A)
Internal structure.The stomach is composed of four coats: mucous, submucous, muscular, and
serous. The mucous coat contains special
gastric glands, which produce gastric juice
containing hydrochloric acid. Solitary
lymph nodules are situated in this coat.
The folds of the lesser curvature are
longitudinal and form the ―gastric path‖.
In either portions stomach has rounded
elevations called gastric areas on whose
surface the numerous tiny opening (0.2
mm in diameter) of the gastric pits can
been seen. The gastric glands open into
these pits. The surface of mucous
membrane is covered by a single layer of
columnar epithelium.
In the region of the pyloric orifice is a circular mucosal fold
separating the acid medium of the stomach from the alkaline medium
of the intestine; it is called valvula pylorica. The muscular coat is
composed of unstriated muscle fibres. They are arranged into three
layers: an external longitudinal layer, a middle circular layer, and an
internal oblique layer (stratum oblique). The circular layer increases
in thickness in the pars pylorica, and forms pyloric sphincter muscle.
The outermost layer of the gastric wall is f ormed by the serous coat,
which is a part of the peritoneum.
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Small intestine
The small intestine is convoluted tube, extending from the pylorus to the colic valve, where it
ends in the large intestine. It is about 7 metres long. The small intestine is divisible into three portions:
1) the duodenum, 2) the jejunum, and 3) the ileum.
Duodenum has recieved its name from being about equal in length to the breadth of twelve
fingers (25 cm). It is the shortest, the widest and the most fixed part of the small intestine, and has no
mesentery, being only partly covered by peritoneum, mainly in front.
Topography of the duodenum:
Holotopy: the duodenum is situated in the abdominal cavity. It is within the boundaries of the
epigastrium and the umbilical region proper.
Skeletotopy: the duodenum stretches from the level of the twelves thoracic vertebrae to that of the first
or third lumbar vertebrae;
Syntopy the duodenum adjoins above to quadrate lobe of liver and gall bladder, in inferiorly - to right
kidney with adrenal gland and by internal surface girds head of pancreas.
External structure
From the above the duodenum may be divided into four portions: superior, descending, horizontal, and
ascending. Three flexures of the duodenum: the superior flexure of duodenum, the inferior flexure of
duodenum, and duodenojejunal flexure (flexura duodenojejunalis). The duodenojejunal flexure is held
in place by a fibrous and muscular band, the ligament of Treitz. It possesses smooth muscular fibres
mixed with the fibrous tissue of which it is principally made up. The ligament of Treitz acts as a
suspensory ligament.
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The remainder of the small intestine from the end of the duodenum is named jejunum and
ileum. There is no morphological line of distinction between the two, but ileum is more narrow. The
mucous membrane of the ileum contains aggregated lymph nodules, or follicles (Peyer’s patches),
which help to destroy microorganisms absorbed from the small intestine. The total number of patches
ranges from 20 to 30.
Internal structure. The wall of the small intestine is composed of four coats: mucous,
submucous, muscular, and serous. The mucous coat has three distinctive features that enchance the
digestion and absorption processes that take place in the small intestine - circular folds, villi, and
glands that secrete intestinal juice. The circular folds are composed of reduplications of the mucous
membrane that increase the surface area for absorption. Besides of the
circular folds, the mucous membrane of the duodenum has longitudinal
fold on the medial wall of the descending part. This fold has the
appearance of an elevation, which terminates as a greater duodenal
papilla. The opening of the conjoined common bile duct and the
pancreatic duct is on papilla. Proximal to the greater duodenal papilla
is a smaller duodenal papilla. The accessory pancreatic duct opens on
it. The absorptive surface of the mucosa is increased by millions of
fingerlike protrusions called villi, which look like the velvety pile of a
rug. The surface area is further increased by the infolding of the
epithelium between the basis of the villi, forming tubular intestinal
glands (crypts of Lieberkuhn). Each villus contains blood capillaries
and a lymph vessel called a lacteal. Lacteals are important in the
accumulation and transportation of lipids. Two semilunar folds are
situated in the region of ileocecal angle. Ileocecal valve is formed by
the two semilunar folds and by the ileocecal sphincter.
Submucous coat connects together the mucous and muscular layers. It consists of loose, filamentous
connective tissue containing blood vessels, lymphatics, and nerves. It is the strongest layer of the
intestine.
The muscular coat consists of two layers of unstriped fibers: an external, longitudinal, and an internal,
circular layer. Ileocecal sphincter is formed by the circular layer in the region of ileocecal angle.
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The serous coat is derived from the peritoneum. The jejunum and ileum are attached to the posterior
abdominal wall by an extensive fold of peritoneum, the mesentery, which allows the freest motion.
Between the two layers of mesentery there are blood vessels, nerves, lacteals, and lymph glands,
together with a variable amount of fat.
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Large intestine
The large intestine extends from the ileocaecal valve to the anus. It is about 1.5 -1.8 metres
long. Its caliber is largest at its commencement at the caecum, and gradually diminishes as far as the
rectum, where there is a dilatation of considerable size just above the anal canal.
The large intestine is divisible into three portions: 1) the caecum, 2) the colon, and 3) the rectum.
External structure
Besides the differences in diameter and length between the large and small intestines, the large
intestine has three distinctive structural differences:
1. In the small intestine, an external longitudinal muscle layer completely surrounds the intestine; but
in the large intestine, an incomplete layer of longitudinal muscle forms three separate bands of muscle
called taeniae coli along the full length of the intestine. Three types of the taeniae coli: tenia libera, a
free band which stretches on the anterior surface of the caecum and ascending colon; on the transverse
colon it runs on the posterior surface because the colon here turns about its axis; on the descending
colon it returns to the anterior surface; tenia mesocolica stretches along the line of attachment of the
mesentary of the transverse colon; tenia omentalis runs along the line of attachment of the greater
omentum on the transverse colon and along the continuation of this line on the other parts of the colon.
2. Because the taeniae coli are not as long as the large intestine itself, the wall of the intstine becomes
puckered with bulges called haustra colli.
3. Fat-filled pouches called epiploic appendages are formed at the points where the visceral
peritoneum is attached to the taeniae coli in the serous layer.
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The cecum is the first part of the large intestine that is continuous with the ascending colon. It is
blind intestinal pouch, approximately 7,5 cm in both length and breadth , located in the right iliac
fossa inferior to the junction of the terminal ileum and cecum. The terminal ilium enters the cecum
obliquely and partly invaginates into it. Traditionally, based on cadaveric studies, this manner of
entrance produces iliocecalic lips (superior and inferior) at the ileal orifice, which form the ileal
papilla. The lolds meet laterally to form ridges, called the frenula of the valve. When the cecum is
distended or when it contracts, the frenula tighten, closing the valve to prevent reflux from the cecum
into the ileum. However, direct observation by endoscopy in living persons does not support this
description. The circular muscle is poorly developed around the orifice; therefore, the valve is
unlikely to have any sphincteric action that controls passage of the intestinal contents from the ileum
into the cecum. The orifice is usually closed by tonic contraction, however, making it appear as the
ileal papilla on the cecal side. The valve probably does prevent reflux from the cecum into the ileum
as contractions occur to propel contents up the ascending colon and into the transverse colon.
T
h
e
p
o
s
i
t
i
o
n
o
f
t
he appendix is variable.
The appendix (traditionally, vermiform appendix; L. vermis, worm-like) is a blind intestinal
diverticulum (6-10 cm in length) that contains masses of lymphoid tissue. It arises from the
posteromedial aspect of the cecum inferior to the ileocecal junction. The appendix has a short
triangular mesentery, the mesoappendix, which derives from the posterior side of the mesentery of the
terminal ileum.
Internal structure. The wall of the large intestine is composed of four coats: mucous, submucous,
muscular, and serous. The rectal wall is composed of three coats: mucous, submucous, and muscular.
The anatomy of the large intestine reflects its primary functions: the reabsorption of any remaining
water and some salts, and the accumulation and movement (excretion) of undigested substences as
feces. Elimination is aided by the secretion of mucus from the numerous goblet cells in the mucosal
layer. The mucosa of the large intestine does not contain villi or plicae circulares, its smooth
absorptive surface is only about 3 % of the absorptive surface of the small intestine.
The lamina propria of the tunica mucosa, and tela submucosa contain lymphatic tissue in the
form of many solitary follicles. The simple columnar epithelium of the large intestine includes
columnar absorptive cells, undifferentiated cells, and enteroendocrine cells. The mucous cells are the
most numerous.
Submucous coat connects together the mucous and muscular layers. It consists of loose, filamentous
connective tissue containing blood vessels, lymphatics, and nerves. It is the strongest layer of the
intestine.
24
The muscular coat consists of two layers of unstriped fibers: an external, longitudinal, which forms
tenia colii and an internal, circular layer, which forms the semilunar folds.
The serous coat covers some parts of the large intestine completely and others partly. The relations of
the parts of the colon to the peritoneum are as follows: the ascending and descending colons are
covered by the peritoneum in front and on the sides (mesoperitoneally); the caecum, vermiform, and
transverse and sigmoid colons are completely invested by the peritoneum and have a long mesentary
(intraperitoneally). The mesenteries of them are: mesocaecum, mesoappendix, mesotransversum, and
mesosigmoideum.
The colon consists of four portions: a) ascending colon, b) descending colon, c) transverse colon, d)
sigmoid colon.
The ascending colon is situated in the right lateral part of the abdomen, passes from the cecum to the
right lobe of the liver, where it turns to the left at the right colic flexure (hepatic flexure).
The transverse colon (approximately 45 cm long) is the third, longest, and most mobile part of the
large intestine. It crosses the abdomen from the right colic flexure to the left colic flexure, where it
bends inferiorly to become the descending colon. The left colic flexure (splenic flexure) is usually
more superior, more acute, and less mobile than the right colic flexure. Being freely movable, the
transversal colon usually achieves to the level of the umbilicus.
The descending colon occupies a secondary mesoperitoneal portion between the left colic flexure and
the left iliac fossa, where it continuous with the sigmoid colon.
The sigmoid colon, characterized by it S-shaped loop of variable lenth (usually approximately 40 cm),
links the descending colon and the rectum. It extends from the left iliac fossa to the level of third
sacral vertebra, where it joints the rectum.
The terminal segments of the large
intestine are the rectum, anal canal, and anus.
The rectum extends about 15 cm from the
sigmoid colon to the anus. Despite its name, the
rectum is not stright. From its origin at the level
of the promontory it passes downward, lying in
the sacrococcygeal curve, and extends to the tip
of the coccyx. It therefore presents two anteriorposterior curves; an upper, with its convexity
backward, and a lower, with its convexity
forward. The upper part of the rectum
corresponding to the sacral flexure is in the
pelvic cavity and is called the pelvis part. The
terminal part of the rectum passing to the back
and downward is called the anal part, or the
anal canal. The anal canal and anus are open
only during defecation. At all other times they
are held closed by an involuntary internal anal
sphincter of circular smooth muscle and a
complex external anal sphincter of voluntary
striated muscle.
25
The transverse mucosal folds are present in the upper part of the rectum. The upper part of the
anal canal contains 5 to 10 permanent longitudinal columns known as anal (or rectal) columns. They
are united by folds called anal valves.
The mucosa and submucosa of the rectum contain a rich network of veins called the hemorrhoidal
plexus. When these veins become enlarged, twisted, and blood-filled, the condition is called
hemorrhoids.
Three parts are distinguished in the rectum according to its peritoneal relations: an upper part,
which are covered with the peritoneum intraperitoneally and has a short mesentary, mesorectum; a
middle part situated mesoperitoneally; and a lower part found extraperitoneally.
26
Liver
The liver (hepar, G.) is the largest gland in the body. It weighs 1.2-1.6 kg. It is relatively
much larger in the fetus than in adult.
Topography of the liver:
Golotopy: it is situated in the upper and right parts of the abdominal cavity, occupying almost the
whole of the right hypochondrium, the greater part of the epigastrium.
Skeletotopy: the upper edge of the liver projects in right 10th intercostals space (middle axillar line).
Than it lifts to level of 4th rib (middle clavicular line) and passes across the sternum a bit upper from
xiphoid process, terminates in left 5th intercostals space (between middle clavicular line and
parasternal lines). The lower edge of the liver passes along the costal arch from right 10 th intercostals
space (middle axillar line). Than it crosses cartilage of right 9th rib and runs in epigastrium 1,5 cm
lower from xiphoid process to cartilage of left 8th rib and meets the upper edge.
Syntopy: visceral surface of the liver adjoins with organs, which form impressions:
esophagical impression,
gastric impression,
duodenal impression,
colic impression,
renal impression,
suprarenal impression.
Diaphragmatic surface carries cardiac impression.
27
External structure of the liver. Two surfaces and two borders are distinguished in the liver. The
diaphragmatic surface is in contact with diaphragm and anterior abdominal wall. The visceral surface
bears some depressions produced by the abdominal visceral organs. These surfaces are separated by a
sharp lower border and posterior border.
Two lobes are distinguished in the liver, the right and the left lobes, which are separated on
the diaphragmatic surface by the falciform ligament. The right hepatic lobe contains quadrate lobe,
and caudate lobe at the visceral surface. At the visceral surface there are:
The left sagittal fissura or longitudinal fissure which is divided into:
1. the fissura for the ductus venosus; it lodges in the fetus, the ductus venosus, and in the adult a
slender fibrous cord, lig. venosum, the obliterated remains of that vessel; it lies between the caudate
lobe and the left lobe of the liver;
2. the fissua for the umbilical vein, it lodges the umbilical vein in the fetus and its remains the round
ligament in the adult; it lies between the quadrate lobe and the left lobe of the liver.
The transverse fissure, or the porta is the short but deep fissure, about 5 cm long. It transmits:
a) portal vein;
b) hepatic artery;
c) common hepatic duct;
d) nerves;
e) lymphatics.
The fossa for the gall-bladder lies between the quadrate lobe and the proper right lobe of the liver.
The groove for the inferior vena cava lies between the caudate lobe and the proper right lobe of the
liver.
Ligaments of the liver. - The liver is connected to the under surface of the diaphragm and to the
anterior wall of the abdomen by five ligaments; four of these - the falciform, the coronary, and the
two lateral or triangular (right and left) - are peritoneal folds; the fifth, the round ligament is a
fibrous cord, the obliteral umbilical vein. The liver is also attached to the lesser curvature of the
stomach by the hepatogastric and to the duodenum by the hepatoduodenal ligaments. These
ligaments form the lesser omentum.
The liver is covered by the peritoneum (mesoperitoneally) for the most part except for an area
on its posterior border where it is in direct contact with the diaphragm. Under the serous coat of the
liver is a thin fibrous capsule of Glisson.
28
Internal structure of the liver.
The anatomical units of the liver: lobulus - segmentum - lobus.
The substance of the liver is composed of lobules (1 million), as small granular bodies,
measuring from 1 to 2.5 mm in diameter. They are functional units of the liver. Each lobule contains
the central vein (a branch of the hepatic vein) running longitudinally through it. Liver cells, known as
hepatocytes (polyhedral in form), within the lobules are arranged in one-cell-thick platelike layers that
radiate from the central vein to the edge of the lobule. Each corner of the lobule usually contains a
portal area, a complex composed of branches of the portal vein (interlobular vein), hepatic artery
(interlobular artery), and interlobular bile ductuli.
These tubular structures form hepatic or portal triads. Between the radiating rows of cells are
delicate blood channels called sinusoids, which transport mixed blood from the portal vein
and hepatic artery.
29
The walls of the sinusoids are lined with the endothelial cells. Attached to this lining cells are
phagocytic stellate reticuloendothelial cells (Kupffer cells) that engulf and digest worn-out red and
white blood cells, microorganisms, and other foreign particles passing through the liver.
The bile ducts commence by the little passages in the hepatocytes (bile capillaries). These passages
are merely little channels between contiguous surfaces of two cells. The channels thus formed radiate
to the circumference of the lobule, and open into the interlobular bile ductules which are joined in
segmental ducts. This join with other ducts form two main trunks (right and left hepatic ducts), and by
their union form the common hepatic duct, which leaves the liver at the transverse fissure.
The scheme of the bile outflow:
bile capillaries -> interlobular bile ductules -> paralobular bile ductules -> segmental ducts -> right
and left hepatic ducts -> common hepatic duct -> cystic duct -> gall-bladder -> cystic duct + common
hepatic duct - > common bile duct . The common bile duct joins the main pancreatic duct, enlarges
into the hepatopancreatic ampulla, and then joins the great duodenal papilla, which opens into the
descending part of the duodenum.
The scheme of the arterial system of the liver:
arteria hepatica propria - arteriae lobares - arteriae intersegmentales - arteriae paralobulares - arteriae
interlobulares - hepatic sinusoids.
There are two venous systems in the liver: the portal and caval. They are called ―rete mirabile
hepatis‖.
The functions of the liver:
1) the secretion of bile;
2) removal of amino acids from organic compounds;
3) formation of urea from worn-out tissue cells (proteins), and convertion of excess amino acids into
urea (deamination) to decrease body levels of ammonia;
4) formation fetal erythrocytes in the embrionic period;
5) homeostasis of blood by manufacturing most of the plasma proteins;
6) removing bilirubin from the blood, manufacturing heparin, and helping to synthesize the bloodclotting agents prothrombin and fibrinogen from amino acids;
7) synthesis of certain amino acids, including nonessential amino acids;
8) conversion of galactose and fructose to glucose;
9) oxidation of fatty acids;
10) formation of lipoproteins, cholesterol, and phospholipids (essential constituents of plasma
membranes);
11) conversion of carbohydrates and proteins into fat;
12) modification of waste products, toxic drugs, and poisons (detoxification).
13) synthesis of vitamin A from carotene;
14) maintenance of a stable body temperature by raising the temperature of the blood passing through
it (its many metabolic activities make the liver the body’s major heat producer);
15) storage functions; the liver stores glucose in the form of glycogen, and with the help of enzyms, it
converts glycogen back into glucose as it is needed by the body; the liver also stores the fat-soluble
vitamins (A, D, E, and K), minerals such as iron from the diet, and antianemic factor; the liver can also
store fats and amino acids, and convert them into usable glucose as required.
30
The gall bladder (vesica fellea, s. biliaris, L.; chole cystis, G.) is a conical or pear-shaped
musculomembranous sac, lodged in a fossa on the visceral surface of the right lobe of the liver. It is
from 7 to 10 cm in length, 2.5 cm in breadth at its widest part. It is divided into a fundus, body, and
neck. The fundus is directed downward, forward, and to the right; the body and neck are directed
upward and backward to the left. The upper surface of the gall bladder is attached to the liver by
connectve tissue and vessels. The cystic duct and the common hepatic duct join to form the common
bile duct. It is about 7 cm in length. This duct is lodged between the two layers of the hepatoduodenal
ligament, with the portal vein behind and the comon hepatic artery to the left of it. It then descends
behind the superior part of the duodenum, pierces the medial wall of the descending part of the
duodenum, and drains, together with the duct of the pancreas, by means of an orifice into a dilatation
inside the greater duodenall papilla, called the ampulla of the bile duct. In the region of this ampulla
there is m. sphincter ampullae hepatopancreaticae (Oddi).
The circular layer of muscles in the wall of the distal portion of the ductus choledochus in the
area of duodenum is very strong and forms m. sphincter ductus choledochus (Ochsner).
The body and the neck of the gall bladder is covered by peritoneum only on the inferior
surface; its fundus is completely invested by peritoneum, and adjacent to the anterior abdominal wall
in the angle formed by the right m. rectus abdominis and the inferior borders of the ribs.
Internal structure of the gall bladder. It consists of three coats: serous, fibromuscular, and
mucous. The fibromuscular coat consists of dense fibrous tissue which is mixed with the smooth
muscular fibers, disposed chiefly in a longitudinal direction, a few running transversely. The mucous
coat is loosely connected with the fibrous tissue and formed mucous folds. This coat is covered by
columnar epithelium, and contained many mucous glands. In the neck and in the cystic duct are folds
arranged spirally and forming the spiral valve.
31
Pancreas
The pancreas is a compound racemose gland, analogous in its structures to the salivary glands
It is situated behind the stomach on the posterior abdominal wall in the epigastrium. Posteriorly it
adjoins the vena cava inferior, and the left renal vein, and the aorta. The pancreas has a head bearing
the uncinate process, a body and a tail. The body is prismatic in shape and has three surfaces: anterior,
posterior, and inferior. The anterior surface contacts with the stomach. The posterior surface is
directed to the posterior wall. The inferior surface faces downward and slightly to the front. These
three surfaces are separated by three borders: superior, anterior, and inferior. The pancreas has no
capsule as a result of which its lobular structure strikes the eye. The total length of the pancreas varies
from 12 to 15 cm.
The peritoneum covers the anterior and inferior surfaces of the pancreas. The main pancreatic
duct joins the common bile duct, enlarges into the hepatopancreatic ampulla, and then joins the great
duodenal papilla, which opens into the descending part of the duodenum. In addition to the main duct,
there is usually an accessory pancreatic duct, which opens on the smaller duodenal papilla.
Internal structure of the pancreas. The pancreas is related to group of acinar or acinar-tubular
glands. It is a gland of mixed secretion. Two components are distinguished in it: the main bulk of the
gland (9/10) is concerned with external secretion and excretes its secretion into the duodenum by way
of the ducts; the smaller part of the gland consists of the islets of Langerhans (1/10) and is an
endocrine structure secreting insulin into the blood. Insulin regulates the blood sugar content.
32
Peritoneum
The peritoneum is the largest serous membrane in the body, and consists in the male of a
closed sac. In the female the peritoneum is not a closed sac, since the free ends of the uterine tubes
open directly into the peritoneal cavity. The part which lines the abdominal wall is named the parietal
peritoneum that which is reflected over the contained viscera constitutes the visceral peritoneum.
The free surface of the membrane is a smooth layer of flattened mesothelium, lubricated by a small
quantity of serous fluid, which allows the viscera to glide freely against the wall of the cavity or upon
each other with the least possible friction. The attached surface is connected to the viscera and inner
surface of the parietes by means of areolar tissue, termed the subserous fascia. The space between the
parietal and visceral layers of the peritoneum is named the peritoneal cavity.
33
On following the peritoneum from one viscus to another, and from viscera to the parietes, some
peritoneal malformations are formed:
 ligaments;
 omenta;
 mesenteries;
 fossae and folds;
 bursae, canals, sinuses, recesses, excavationes.
Ligaments:
 falciform ligament of the liver;
 coronary ligament of the liver;
 right triangular ligament of the liver;
 left triangular ligament of the liver;
 hepatorenal ligament;
 hepatoduodenal ligament;
 hepatogastric ligament;
 gastrophrenic ligament;
 gastrolienal ligament;
 gasrocolic ligament.
There are two omenta, the lesser and the greater. The liver is attached to the lesser curvature of the
stomach by the hepatogastric and to the duodenum by the hepatoduodenal ligaments. These
ligaments form the lesser omentum Between the two layers of the lesser omentum are the common
hepatic duct, the portal vein, and the proper hepatic artery. On the lesser curvature of the stomach both
layers of the lesser omentum are separated, one to cover the anterior, and the other the posterior
surface of the stomach.
On the greater curvature of the stomach they are joined again and are descended in front of the
transverse colon (gastrocolic lig.) and the loops of the jejunum and ileum to form the anterior lamina
of the greater omentum. They then turn upon themselves and form the posterior lamina of the
greater omentum, and ascend again as far as the transverse colon, where they separate and enclose
mesocolon transversum. The greater omentum is made up of four layers of the peritoneum.
The mesenteries are:
 the mesentery proper;
 the transverse mesocolon;
 the sigmoid mesocolon;
 the mesoappendix;
 the mesorectum.
The root of the mesentery proper is narrow, about 15 cm long, and is directed obliquely from
the duodenojejunal flexure at the left side to the right sacroiliac articulation. The transverse
mesocolon is a broad fold, which connects the transverse colon to the posterior wall of the abdomen.
It is continuous with the posterior lamina of the greater omentum, which after separating to surround
the transverse colon, join behind it, and are continued backward to the vertebral column, where they
diverge in front of the anterior border of the pancreas. The transverse mesocolon contains between its
two layers the vessels, which supply the transverse colon. The mesentery is made up of two layers of
the peritoneum.
34
For the easier understanding of the complex relations, the whole peritoneal cavity can be separated
into three storeys (floors):
1. An upper storey;
2. A middle storey;
3. A lower storey.
An upper storey is bounded superiorly by the diaphragm, and inferiorly by the mesocolon
transversum. This cavity is separated into three sacs: hepatic bursa (bursa hepatica, L.), pregastric
bursa and omental bursa or the lesser sac of the peritoneal cavity.
The hepatic sac is related to the right lobe of the liver and is separated from the pregastric
bursa by the falciform ligament; and is bounded from behind by the right portion of the coronary
ligament.
The pregastric sac is related to the left lobe of the liver, anterior surface of the stomach, and
the spleen; the left portion of the coronary ligament passes on the posterior border of the left lobe of
the liver.
35
The epiploic foramen (foramen of Winslow) is the passage into omental bursa.
It is bounded in front by the free border of the lesser omentum, with the common hepatic
duct, the portal vein, and the proper hepatic artery;
behind by the peritoneum covering the inferior vena cava;
above by the peritoneum on the caudate lobe of the liver,
and below by the peritoneum covering the commencement of the duodenum, and the common
hepatic artery.
Vestibule of the bursae omentalis is the part of omental bursa which adjoins the epiploic
foramen with the main omental bursa and situates behind the hepatoduodenal ligament. The
boundaries of the main omental bursa will not be evident.
It is bounded
in front, from above downward, by the caudate lobe of the liver, the lesser omentum, the stomach, and
the greater omentum.
Behind, it is limited, from below upward, by the greater omentum, the transverse colon, the transverse
mesocolon, the posterior surface of pancreas, the left suprarenal gland, and the upper end of the left
kidney.
Laterally, bursa extends from the epiploic foramen to the hilum of the spleen, and then to the anterior
surface of the kidney, where it is limited by the phrenicosplenic, splenorenal and gastrosplenic
ligaments.
36
Omental bursa:
37
A middle storey extending downward from the mesocolon transversum to entry into the
pelvis minor. In this storey there are recesses of peritoneum forming culs-de-sac or pouches, which are
of surgical interest in connection with the possibility of the occurrence of ―retroperitoneal hernia‖. The
largest of these is omental bursa, but several others, of smaller size: superior et inferior
duodenojejunal recess, superior et inferior ileocaecal recess, intersigmoid recess. At the region of
the duodenojejunal flexure are situated the superior and inferior duodenojejunal recesses. At the
junction of the small intestine and the colon are two recesses, the inferior and superior ileocaecal
recesses, which are situated below and above the ileocaecal angle. The fold of the peritoneum between
the iliac muscle and the lateral surface of the caecum is known as the caecal fold. A small opening,
which is limited by this fold is named retrocaecal recess. Peritoneal pockets between the mesocolon
sigmoideum on the left side are the intersigmoid recesses. The middle storey contains right and left
lateral canals, and right and left mesenteric sinuses. The right canal is situated between the right
lateral wall of the abdomen and the ascending colon. The left canal is situated between the left lateral
wall of the abdomen and the descending colon. The right mesenteric sinus is situated from the right of
the root of the mesentery proper and is a closed space. The left mesenteric sinus is situated from the
left of the root of the mesentery proper and is communicated with the cavity of the pelvis minor.
38
The structure of the root of the mesentery of the lesser intestine and transversal
colon:
39
A lower storey situates in the pelvis minor. The peritoneum here follows closely the surfaces
of the pelvic viscera and the pelvic walls, and presents important differences in the two sexes. In the
male the peritoneum forms rectovesical excavation. It is between the anterior surface of the rectum
and the bladder. In the female excavatio rectovesicalis is divided by the uterus and the vagina into a
small anterior vesicouterin excavation and a large, deep, posterior rectouterine excavation
(excavation of Douglas).
1 – parietal peritoneum covers the anterior abdominal wall;
2 – supravesical fossa;
3 – paravesical fossa;
4 - vesicouterin excavation (A,C); peritoneum, wich covers posterior wall of the urinary
bladder (B);
5 – peritoneum, which laterally form fold over ureters, ductus deferens (B); covers the body
and fundus of uterus and posterior fornix of vagina, mesosalpinx, mesovarium and lig. Lata uteri (A,
C);
6 – rectovesical excavation (B) and rectouterine(A,C) excavation;
40
7 – pararectal fossa;
8 – peritoneum, which covers the rectum;
9 – peritoneum,which covers rectosigmoid junction.
In the lower part of the anterior abdominal wall the peritoneum parietale forms five folds
converging on the umbilicus: one unpaired medial umbilical fold, and two paired medial and lateral
umbilical folds. These folds bound on each side several fossae, which are related to the inguinal canal:
the medial, the lateral inguinal fossae, and the supravesical fossae.
Intraperitoneal visceral organs: stomach, spleen, jejunum, ileum, caecum and appendix vermiformis,
transverse colon, sigmoid colon, superior 1/3 of the rectum.
Mesoperitoneal visceral organs: liver, ascending colon, descending colon, the middle 1/3 of the
rectum.
Extraperitoneal or retroperitoneal visceral organs: duodenum, pancreas, inferior 1/3 of the rectum.
CAVUM ABDOMINUM
PERITONEAL CAVITY
RETROPERITONEAL SPACE
(CAVUM PERI TONEUM, L.)
(SPATIUM RETROPERITONEALE, L.)
It is the space between the parietal and
visceral layers of the peritoneum. It contains
three storeys.
I. An upper storey:
bursa hepatica,
bursa pregastrica,
bursa omentalis;
II. A middle storey
recessi duodenojejunalis superior et inferior,
recessi ileocaecalis superior et inferior,
recessus retrocaecalis,
canales laterales dexter et sinister,
sinusi mesenterici dexter et sinister,
recessi intersigmoidei;
It is the space between the peritoneum
parietale and fascia endoabdominalis, which
covers the posterior wall of the abdomen.
Retroperitoneal organs:
Pancreas, duodenum,rens,
gl. suprarenalis, truncus sympaticus,
ductus thoracicus, ureter,
vena cava inf. and its branches,
aorta and its branches
III. A lower storey.
excavatio rectovesicalis,
excavatio vesicouterinae,
excavatio rectouterinae.
41
Respiratory System
The respiratory system provides the organism with oxygen (intake of the air and gas
exchange). Here the scheme of the respiratory system is presented:
RESPIRATORY SYSTEM
respiratory pathways (intake of air)
upper
lower
external nose,
larynx
nasal cavity,
trachea
paranasal caviti (sinuses),
bronchi
pharynx (nasal and oral parts).
lungs (gas exchange)
42
The external nose





The shape and size of the nose is individual.
The nose consists of the following parts:
the base;
the root;
the back;
the top;
the wings.
The nasal cavity
The nasal cavity has the entrance (communicates with the environment) - the nostrils (nares),
and paired outlets - choanae. The nasal cavity is divided into two parts by the septum of the nose. Each
part contains a nasal pathway:
1. the lower nasal pathway is situated between the lower nasal shell and hard palate. It is connected
with the orbit through the nasolacrimal duct;
2. the middle nasal pathway is situated between the middle and lower nasal shells; it is connected with
maxillar and frontal sinuses, also with anterior and medial ethmoid cells;
3. the upper nasal pathway is situated between the upper and middle nasal shells; it is connected with
the posterior ethmoid cells, sphenoidal sinus, anterior cranial fossa and pterygopalatine fossa; with the
orbit through the posterior ethmoidal opening;
4. the
common nasal pathway is situated between the septum of the nose and all nasal shells,
positioned in the sagittal plane; it is connected with the oral cavity through the incisive canal;
5. the nasopharyngeal pathway is situated between the nasal cavity and the nasal part of the pharynx,
positioned in the frontal plane.
43
The nasal cavity is covered by the mucous membrane. Specific features of the mucous
membrane of the nasal cavity:
- ciliated epithelium;
- well expressed submucous layer;
- good vascularization;
- contains glands (glandulae nasales) which produce mucus;
- lymphoid tissue forms separate lymphatic nodes;
- the upper nasal pathway contains cells of smell reception.
The functions of the inner nose (internal nose):
- respiratory: intake, damping, purifying and warming of the air
- the function of smell.
The paranasal sinuses
- the maxillar sinus;
- the frontal sinus;
- the sphenoidal sinus;
- the ethmoid sinus (formed by the ventral, medial and posterior ethmoidal cells).
These air sinuses are covered by the mucous membrane which has the same specific features
as the one in the nasal cavity. The paranasal sinuses perform the respiratory function. Then
the air passes to the larynx.
44
Larynx
The larynx has the shape of a sand watch. It is 4 cm in length. Larynx is an unpaired
organ.
Topography:
Holotopy: it is situated in the cervical cavity;
Skeletotopy: from CIV to CVI;
Syntopy: behind the larynx the laryngeal part of the throat is situated, in front of it and
laterally - thyroid gland, and muscles of the neck.
External structure. The main parts of the larynx:
- the entrance;
- the vestibulum;
- the vestibular rima. It is the space between the vestibular folds.
- the ventricle of the larynx - deepening between the vestibular and vocal folds.
- the vocal rima - the space between the vocal folds;
- the subvocal cavity.
45
Internal structure. The larynx is a hollow organ.
The structure of the wall of the larynx:
1) Internal membrane (mucous) has the following specific features:
- ciliated epithelium;
- folds are absent (except for plica vestibularis et vocalis);
- there is no submucous membrane (instead of it the fibroelastic tissue (membrana
fibroelastica) is present;
- glands (glandulae laryngeales) which produce mucus;
- lymphoid tissue for separate lymphatic nodes (nodules).
2) Middle membrane - fibro-musculo-cartilagineal consists of cartilages, ligaments and
muscles.
Cartilages of the larynx are divided into two groups: paired and unpaired.
Unpaired cartilages
Paired cartilages
- thyroid
- arythenoid cartilages
- cricoid
- corniculate cartilage
- epiglottis
- cuneiform cartilage
The arythenoid cartilage has two processes: the vocal - the point of attachment of the
vocal ligament, and muscular process - the point of attachment of the muscles of the larynx.
This process is situated more laterally than the vocal process.
46
Cartilages and ligament of the larynx:
The most important ligaments:
- the vocal ligament is attached by the one end to the thyroid cartilage and by the either to the vocal
process of the arythenoid cartilage;
- the vestibular ligament is more superior to the vocal ligament and runs in the same direction.
Muscles of the larinx:
I. The effector muscles of the vocal ligaments:
- the cricothyroid muscle is the tensor of the vocal ligaments;
- the thyroarythenoid muscle and its continuation the vocal muscle is relaxors of the vocal
ligaments.
II. Muscles that change the size of the laryngeal inlet:
- the thyroepiglottic muscle - acts as the dilator of the laryngeal inlet and vestibule;
- the aryepiglottic muscle - constricts the laryngeal inlet.
III. Muscles - constrictors of the larynx:
- the lateral cricoarytenoid muscle - constricts the space between the vocal ligaments;
- the oblique arytenoid muscle constricts the larynx;
- the transverse arytenoid muscle - performs the same function as the previous one.
IV. Muscle-dilator of the larynx:
-
the posterior cricoarytenoid muscle is a dilator of the rima glottidis.
47
3) External coat (tunica adventitia).
Functions of the larynx:
- respiratory;
- voice-forming;
48
Trachea
The trachea is a tube-shape organ. It is 13 cm long. Trachea is an unpaired organ.
Topography:
Holotopy: the trachea is situated in the cervical cavity, and in the thoracic cavity;
Skeletotopy: from CVI to ThV;
Syntopy: behind the trachea esophagus is situated.
External structure.
We differ such parts of the trachea as:
- cervical;
- thoracic;
- bifurcation of the trachea.
Walls of the trachea:
- anterior;
- posterior or membranous.
Internal structure.
The trachea is a hollow organ. The structure of the wall:
1. internal membrane - mucous - has the following specific features:
- ciliated epithelium;
- hardly expressed folds;
- hardly expressed submucous membrane;
- tracheal glands (glandulae tracheales) produce mucus;
- lymphoid tissue forms separate lymphatic nodes (nodules);
49
2. middle membrane - fibromusculocartilagineal - is formed by:
- cartilagineal rings (14-15) - tracheal cartilages which come apart on the posterior wall of the
trache;
- circular ligaments which connect the rings;
- smooth muscle tissue;
3. external membrane is presented by adventitia.
Bronchus
The right principal bronchus and left principal bronchus are tube-shaped paired organs. They
generate from the bifurcation of trachea and have simular structure as trachea.
Topography:
Holotopy: the bronchi are situated in the thoracic cavity;
Skeletotopy: the principal bronchi are formed at the level of the 5th thoracic vertebra;
Syntopy: the oesophagus runs down behind the bronchi.
The principal bronchi pass into the hilum of the lungs. Below the right bronchus the
pulmonary arteries and veins are situated. The pulmonary veins run under the left one, above the left
bronchus - the pulmonary artery is situated.
External structure.
The right bronchus is short and wide, the left one - long and narrow. The left bronchus leaves
the trachea at a sharp angle.
Internal structure.
Bronchus is a hollow organ. The wall of the bronchus consists of:
1. internal (mucosa) coat. Its specific features are:
- ciliated epithelium;
- hardly expressed pleats;
- hardly expressed submucosa tissue;
- bronchial glands (glandulae bronchiales) produce mucus;
- lymphoid tissue forms separate lymphatic nodules;
2. middle (fibromusculocartilagenous) coat - is formed by:
- cartilage rings (6-8 in the right bronchus, and 9-12 in the left one);
- the bronchial cartilages which come apart the back wall of the bronchi;
- fibrous annular ligaments, which keep the rings together;
- smooth muscle tissue.
3. external coat - adventitia.
The bronchi perform the respiratory function.
The principal bronchus enters the hilum of the lungs and divides into lobar bronchi, which
divide into segmental bronchi. They divide 6-10 more times. The bronchi of 6-10th division are called
lobular bronchi. The lobular bronchus divides into 12-18 terminal bronchioles. All the bronchi from
the principal to the terminal bronchioli constitute a bronchial tree.
50
Lungs
The lung is a cone-shaped paired organ.
Topography:
Holotopy: the lungs are situated in the thoracic cavity.
Skeletotopy:
- the upper boundary - 2-3 cm above the I rib (1-2 cm above the clavicle);
- the anterior boundary of the right lung: along the parasternal line (linea parasternalis) to the VI rib;
- the anterior boundary of the left lung: to the IV rib.
THE LOWER BOUNDARY
RIGHT LUNG
LEFT LUNG
_____________________________________________________________
along the medioclaviVI rib
VII rib
cular line
_____________________________________________________________
along the medial axillar line
VIII rib
IX rib
_____________________________________________________________
along the scapular line
X rib
X rib
_____________________________________________________________
the posterior boundary
of the lungs along the paravertebral line - to the XI rib;
51
Syntopy: the mediastinum is situated between the lungs.
External structure.
The lung has the apex and the base.
The following surfaces of the lungs are distinguished:
- costal;
- diaphragmatic;
- medialor mediastinal.
On the medial surface the hilum of the lung is situated, which lodges the root of the lung.
Each lung is divided into lobes by the interlobar fissures. There is one oblique fissure in the
left lung which divides it into two lobes - upper and lower, and there are two fissures in the right
lung: the oblique fissure and horizontal which divide the right lung into 3 lobes: upper, medial and
lower.
52
The root of the lung consists of :
- the principal bronchus;
- the pulmonary artery;
- the pulmonary veins;
- the bronchial arteries;
- the bronchial veins;
- the nerves;
- the lymphatic vessels and bronchopulmonary lymphatic nodes.
53
Internal structure.
The lungs are parenchymal organs. Anatomical units of the lung are:
- the lobe - a part of the lung where the lobar bronchus branches. In the left lung the principal
bronchus divides into 2 lobar bronchi, and in the right one - into 3;
- the segment. Each lung consists of 10 segments. Segment is a part of the lung where the 1st division
of the lobar bronchus is performed.
54
Secondary lobulus is such part of the lung where the segmental bronchus of 6-10th generation
branch. There are 16-18 terminal bronchioles in the secondary lobulus.
Acinus - anatomico-functional unit of the lung is a part of the lung where the terminal bronchiola
branches, and where gas exchange is performed.
The terminal bronchiola branches into 14-16 respiratory bronchioles.
Alveolar tree is situated in the acinus. Alveolar tree is a complex of aireferous structures, wrapped
up by capillaries. It consists of:
- respiratory bronchiola;
- alveolar ductuli;
- pulmonary alveoli;
- alveolar saccules.
Acinus consists of:
1 terminal bronchiola;
14-16 respiratory bronchioles;
1200-1500 alveolar ductuli;
2500-4500 alveolar saccules;
14000-20000 alveoli.
Primary lobulus is a part of the lung where 1 terminal bronchiola branches.
The lungs perform the respiratory function.
55
Pleura
The pleura is a serous membrane which covers the walls of thoracic cavity from the inside
and lungs from outside. The pleura which covers the walls is referred to as parietal, and the one which
covers the lungs is referred visceral.
The space between the visceral and parietal pleura is referred to as the pleural cavity. Parietal
pleura passes into the visceral along the root of the lung. The boundaries of the visceral pleura are the
same as those of the lungs. The upper and the frontal boundaries of the parietal pleura and the lungs
are the same too, but lower and posterior boundaries of parietal pleura are at 1 rib lower than the
boundaries of the lungs. There are 3 parts of parietal pleura: costal, diaphragmatic and mediastinal.
56
In places where one part of parietal pleura passes into another the pleural recesses or sinuses
are formed:
- costomediastinal;
- diaphragmomediastinal;
- costodiaphragmal.
The lungs fill those recesses only in case of very deep breath but they never expand to such an
extent as to fill the costodiaphragmal recess.
57
Mediastinum
The mediastinum is a integrity of organs situated between the left and right pleural cavities.
The mediastinum occupies the space limited in the front by sternum, from behind - by thoracic section
of the spinal column, laterally by the mediastinal pleura, from below by the diaphragm, from above by the upper aperture of the thoracic cavity. The following parts of mediastinum are differed: upper,
ventral, middle and posterior.
Upper mediastinum - is an integrity of organs situated higher then the conventional
horizontal plain, which goes from the place where the body of the sternum is connected to the
manubrium, to the intervertebral disc between the bodies of ThIV - ThV. The following organs form
the upper mediastinum: the thymus, the trachea, the oesophagus, the left and right brachiocephalic
veins, the upper hollow vein, the arch of aorta and its branches, phrenic and vagus nerves, the left and
the right sympathetic trunks, and the thoracic duct.
The anterior mediastinum is formed by the internal thoracic arteries and veins, parasternal
and partially frontal mediastinal lymphatic nodes.
The middle mediastinum is formed by the heart, pericardium and intrapericardial parts of the
larger vessels, phrenic nerves.
The posterior mediastinum is formed by the thoracic aorta, azygos and hemiazygos veins,
the left and the right sympathetic trunks, the thoracic duct, splanchnic nerves, the oesophagus, the
posterior mediastinal and presternal lymphatic nodes.
58
Urinary system
The urinary system consists of two, two ureters, the urinary bladder and urethra.
The primary function of the urinary system is regulation of the extracellular fluid
(plasma and interstitial fluid) environment in the body.
This function is accomplished through the formation of urine, which is a modified
filtrate of plasma. In the process of urine formation, the kidneys regulate:
1.
volume of the blood plasma (and thus contribute significantly to the
regulation of blood pressure);
2.
the concentration of waste products in the blood;
3.
the concentration of electrolytes (Na+,K+, HCO3-, and other ions) in the
plasma;
4.
the pH of plasma.
Urine is channeled from the kidneys to the urinary bladder by the ureters and expelled
from the body through the uretra. The mucousa of the urinary bladder permits
distension, and the muscles of the urinary bladder and uretra are used in the control of
micturition.
59
Kidney
The kidney (ren, L., nephros, G.) is a paired excretory organs producing the urine.
Topography of the kidney:
Golotopy: the kidney is situated in the abdominal cavity (retroperitoneal), and the lumbar region;
Skeletotopy: the kidney stretches from the level of the twelveth thoracic vertebra to that of the firstsecond lumbar vertebrae;
Syntopy: the kidney is situated in the muscle lodge, which is formed by m. quadratus lumborum, and
m. psoas major; the anterior surface of the right kidney comes in contact with the visceral surface of
the liver, descending part of the duodenum, transverse colon; the anterior surface of the left kidney
comes in contact with the stomach, loops of the jejunum, lien, transverse colon.
External structure. The kidneys are situated on the posterior abdominal wall behind the
peritoneum. The kidney is bean-shaped, its surface is smooth and dark red. It weighs 120-200 grams.
In the kidney are distinguished the upper and lower ends (poles), the lateral and the medial margins,
and the anterior and posterior surfaces. The middle concave part of the medial margin contains the
hilum of the kidney through which arteries and nerves enter the kidney and veins and the urethra leave
it. In this hilus situates crus renale.
60
The kidney has two capsules: adiposa and fibrosa, and is covered by renal fascia.
On a longitudinal section through the kidney it can be seen that it is composed of a cavity, the
renal sinus containing the calyces and the upper part of the renal pelvis and the renal substance (the
cortex and the medulla). The cortex occupies the peripheral layer of the organ and is about 4 mm
thick, and forms renal columns the parts dipping in between the renal pyramids.
61
If the cortex be examined with the lens, it will be seen to consist of a serious of lightercolored, conical areas, termed the radiate part and a darker colored intervening substance, which from
the complexity of its structure is named the convoluted part. The medulla is formed of conical
structures called the renal pyramids (16-20).
The base of pyramids look to the surface of the kidney, and the tops of two or three pyramids
are joined together and formed papillae of kidney which are projected to the calyces renales minores.
Each kidney contains 7-12 papillae renalis, and the same number of calyces renales minores. At the
apex of the papillae renalis are 15-20 papillary foramens. The calyces renales minores are connected
and formed 2-3 calyces renales majores.
Internal structure. Anatomical units of the kidney: segmentum
lobus
lobulus corticalis
nephron.
Each kidney has 5 segments: superior, superior anterior, inferior, inferior anterior, and
posterior.
62
The renal lobe consists of renal pyramid, and the nearest portion of the renal cortex. Pars
convoluta with two partes radiatae form lobulus corticalis.
In the kidney situates 1 million nephrons. Each nephron is an inepended urine-making unit.
Nephrons are divided to two groups according to their location: cortical and juxtamedullar (near the
medulla). Nephron consists: (1) of a vascular component the glomerulus; and (2) a tubular component
including (a) a glomerular (Bowman’s) capsule; (b) proximal convoluted tubule; (c) loop of the
nephron (loop of Henle); (d) distal convoluted tubule, and (e) collecting duct. The glomerulus together
with the capsule enclosing it forms the renal corpuscle (Malpighian corpuscle). The renal corpuscle
gives rise to the convoluted tubule, which passes in the cortex of the kidney. Then the tubule descends
into the pyramid, bends upon itself to form Henle’s loop (ansa nephroni), and returns into the cortex.
The terminal segment of the renal tubule, junctional segment, drains into the collecting duct, which
recieves several tubules and passes in a straight direction. These tubules gradually fuse with one
another to form 15-20 short papillary ductules, which are passed on to the minor calyx. From the
glomerular capsule, the fluid filtered from the blood (primary urine; 100-200 l/24 houres) moves into
the proximal convoluted tubule where glucosa, proteins, and certain other solutes filtered from the
blood are absorbed. The filtrate passes from the proximal convoluted tubule to the loop of the nephron,
which is responsible for the reabsorption of watter and concentration of urine. From the loop of the
nephron, the filtrate moves into the distal convoluted tubule, where potassium and hydrogen ions are
actively secreted into the filtrate. The filtrate moves from the distal convoluted tubule into the
collecting duct, where the dilute filtrate is concentrated (secondary urine; 1.5-2.0 l/24 houres).
63
The kidney contains four tubular systems: arteries, veins, lymphatic vessels, and renal tubules.
The scheme of the vascular network of the kidney:
arteria renalis
arteriae polares
arteriae interlobares
arteriae arcuatae
arteriae interlobulares
arteriolae glomerulares afferentes
glomeruli
arteriolae glomerulares efferentes
venae
stellatae
venae interlobulares
venae arcuatae
venae interlobares
venae segmentales
vena renalis.
This is ―rete mirabile renis‖ of the kidney.
Ureters
The ureters are the two tubes which convey the urine from the kidneys to the urinary bladder.
The ureter proper varies in length from 28 to 34 cm. The diameter of the ureter is 1.0 - 10.0 mm.
The ureter has two parts: abdominal and pelvic. It runs downward and medialward on the
Psoas major muscle and, entering the pelvic cavity, finally opens into the fundus of the urinary
bladder.
There are three points in the course
of the ureter where it normally undergoes
constriction: (1) at the uteropelvic junction,
average diameter 2.0 mm; (2) at the junction
of the abdominal and pelvic parts, at the
place where it crosses the iliac vessels, 4 mm;
(3) along the distance of the pelvic part; (4)
near the wall of the urinary bladder, 1 to 5
mm. Between these points the abdominal part
of the ureter average 10 mm in diameter and
the pelvic ureter 5 mm.
The ureter is covered by the peritoneum
extraperitoneally.
The ureter is composed of three
coats: fibrous, muscular, and mucous.
Mucous coat is formed by the transitional
epithelium supplied by the small mucous
glands. This coat contains longitudinal folds.
Submucous coat connects together the
mucous and muscular layers. It consists of
loose,
filamentous
connective
tissue
containing blood vessels, lymphatics, and
nerves. The muscular coat consists of two
layers of unstriped fibers: an external,
circular, and an internal, longitudinal layer. The pelvic ureter has 3 layers: longitudinal, circular, and
again longitudinal.
Variations of the ureter. - The upper portion of the ureter is sometimes double; more rarely it
is double the freater part of its extent, or even completely so. In such cases there are two openings into
the bladder.
64
Urinary bladder
The urinary bladder is a musculomembranous sac which acts as a reservoir for the urine.
The urinary bladder presents a
fundus, a body, an apex, and a neck.
The fundus is triangular in
shape, and is directed downward and
backward toward the rectum. The apex
is directed forward toward the upper
part of the symphysis pubis. The
distended bladder contains about 0.5 l.
Topography of the bladder:
Golotopy: the distended bladder is
situated in the abdominal and pelvic
cavities (mesoperitoneal), and the empty only in the pelvic cavity (retroperitoneal);
Skeletotopy: the distended bladder is more higher (4-5 cm) from the level of the symphysis pubica; the
empty is more lower from the level of the symphysis pubica;
Syntopy: the bladder is located on the floor of the pelvic cavity. In males, it is anterior to the rectum
and above the prostate gland.
The male urinary bladder is separated from the rectum by the rectovesical excavation.
65
In female, it is located much lower, anterior to the uterus and upper portion of the vagine.
The female urinary bladder is in relation behind the uterus and the upper part of the vagina. It
is separated from the anterior surface of the body of the uterus by the vesicouterine excavation, and it
is separated from the posterior surface of the rectum by the rectouterine excavation.
The bladder is composed of the 4 coats: serous, muscular, submucous, and mucous. The
muscular coat consists of 3 layers of smooth muscular fibers: an external layer, composed of fibers
having a longitudinal arrangement; a middle layer, composed of fibers having a circular arrangement;
and an internal layer, composed of fibers having a general longitudinal arrangement. At the sides of
the bladder the fibers are
arranged
obliquely
and
intersect one another. This
layer has been named the
Detrusor urinae muscle. The
mucous membrane is formed
of transitional epithelium.
When the bladder is empty,
the tunica mucosa is thrown
into folds. This membrane is
always
smooth
in the
triangular area, termed the
trigonum
vesicae.
The
anterior angle of the trigonum
vesicae is formed by the
internal orifice of the urethra;
its posto-lateral angles by the
orifices of the ureters.
66
Female urethra
The female urethra is a narrow canal, about 4 cm long, extending from the internal to the
external urethral orifice. It perforates the fasciae of the urogenital diaphragm, and its external urethral
orifice is situated directly in front of the vaginal opening.
The wall of the female urethra consists of a mucous, submucous, muscular, and fibrous coats.
The mucous coat is arranged in longitudinal folds. Numerous small mucous urethral glands open into
the urethra, particularly in the distal portion
Structure of masculine urethra will be considered in part of masculine genital organs.
67
Male genіtal organs
Masculine genital organs is subdivided into internal male sexual organs (testicles,
epididymis, spermatic cord, ductus deferens, seminal vesicles, prostate gland and bulbourethral gland)
and external genital organs (scrotum and penis). Masculine urethra is not only for passing of urine also
for passing of sperm.
68
Internal male organs
The Testicle is a pair parenchymatic organ, which is situated in scrotum and produces sperm
and masculine sexual hormones.
Each testicle has superior extremity and inferior extremity, medial surface and lateral surface,
anterior margin and posterior margin.
Testicle is covered by tunica albuginea which on posterior margin to get in testicle
parenchyma and forms testicle mediastinum. Last gives seplula testis, which subdivide organ into 150200 lobules. In each lobule the tubuli seminiferi contorti are situated (1-2), where masculine sexual
cells-spermatozoon produced.
Tubuli seminiferi contorti continue into tubuli seminiferi recti [straight], and last run into rete
testis in mediastinum. Efferent ductuli(\5 -20) pass from testicle rete transfixing albuginea membrane,
continue into head of epididymis and form there the lobules of epididymis.
Then spermatozoon runs sufficiently rolled duct of epididymis, which reaches into length 2 m.
Duct of epididymis passes down to its tail, where continues into ductus deferens.
The Epididymis adjoins to posterior testicle margin. There are head of epididymis, body and
tail of epididymis. Sinus of epididymis is situated between testicle and body of epididymis.
The Ductus deferens has scrotal part, funicular part, inguinal part and pelvic part. It enters
to composition of spermatic cord, which passes in inguinal canal to internal ring. Here ductus deferens
separates from seminal funiculus, then it runs under fundus of urinary bladder. Pelvic part joins with
excretorial duct of seminal vesicles, forming ampoule of ductus deferens. Attaching ducts generate
ejaculatory duct (length 2 cm), which passes over prostata and opens into prostatic part of urethra on
top of seminal tubercle.
The Spermatic cord is a formation, which consists of arteries and testicle veins, arteries and
veins of ductus deferens, pampiniform venous plexus, cremaster muscle, vaginal processes, nerves,
lymphatic vessels and ductus deferens.
69
The Prostate is a musculo-secretory organ, for shape reminds the chestnut, has a base of
prostate, which adjoins to urinary bladder, and top of prostate, which is contact with urogenital
diaphragm. It has an anterior surface and posterior surface, right and left lobes of prostate and
isthmus of prostate, that envelops a urethra. Prostate gland consists of 36 alveolar-tubular glandules,
which produce prostatejuice and open by numerous duc-tuli into prostate part of urethra on base of
seminal tubercle. Muscular apparatus contributes to extrusion of secret from prostate gland during
ejaculation and is as additional (involuntary) urethral sphincter, which withholds the urine in bladder.
Gland in old age atrophies and its mass diminishes.
70
The Seminal vesicles produces a seminal liquid, it communicate with ductus deferens.
Seminal liquid together with secret of prostate composes part of sperm.
The Bulbourethral gland is a pair alveolar-tubular gland, which is situated in thickness of
urogenital diaphragm. It has a duct of bulbourethral gland, which passes over bulb of penis and opens
into spongy part of masculine urethra. Gland produces a secret, which protects mucous membrane of
the urethra from irritation by urine.
71
External male organs
The Scrotum is external organ, muscular and fascial sac which contains testicles and
epididymis. Scrotal septum separates right and left halves. Scrotum is physiological thermostat, which
keep temperature of testis at lower level then temperature of body (necessary for normal
spermatogenesis).
Scrotal wall contains of membranes, which cover a testicle and derive from layers of anterior
abdominal wall, namely:
1. Skin - has scrotal raphe, numerous folds, pigmented, with hair and contains specific sweat
and sebaceous glands.
2. Under skin is situated a tunica dartos, which derives from hypodermic adipose tissue and
grows together with skin.
3. External seminal fascia derives from superficial fascia of anterior abdominal wall.
4. Cremasteric fascia derives from proper abdominal fascia.
5. Musculus cremaster derives from internal oblique abdominis and transversal abdominal
muscles.
6. Internal seminal fascia derives from transversal fascia of abdominal wall.
7. Vaginal tunica is serous membrane (derives from peritoneum) and consists of visceral plate
and parietal plate. Last grows together with albuginea membrane and continues on epididymis. There
is furrow-shaped space between both plates is a vaginal cavity, which is filled by small amount of
serous liquid.
72
The Penis serves removal of the urine and ejaculation. It has a radix, corpus and head.
Skin which covers the penis in base of head forms the fold -preputium. Last due to frenulum
connects with skin of head. Penis formed by two cavernous bodies and spongious body. All
bodies of penis covered by tunica albutginea. Spongious body contains male urethra.
Masculine urethra is a tube of length 16-22 cm, in which there distinguish prostatic part,
membranous part and spongious part. On its tract a urethra makes a superior (fixed) bend and inferior
(free) bend.
Prostatic part passes through the prostate. In this part on the urethral wall is situated seminal
colliculus, on the top of which prostatic utriculus I disposed. Ejaculatory duct opens at last and
prostatic ductuli opens on tubercle base. Intermediate (membranous) part of urethra is shorter, it passes
through urogenital diaphragm. Described two parts have fixed position within pelvis and perineum.
Spongy part of urethra lies in spongious body of penis and opens by external urethral ostium on head
top.
Male
urethra
has
following
constrictions: external urethral ostium on the
head of penis; membranous part of urethra;
internal urethral ostium. Also a urethra has such
expansions: all prostatic part; expansion in bulb
of penis; scaphoid fossa in the head of penis.
73
Female genіtal organs
Female genіtal organs subdivide on:
• internal female sexual organs: Ovaries, uterine tubes, uterus and vagina
• external female genital organs:
Pudendal area with labia pudenda majora and labia pudenda minora, vestibule of vagina,
clitoris and mons pubis.
74
The Ovary is a pair organ, is situated in cavity of lesser pelvis. It has medial surface and
lateral surface, free margin and mesenteric margin, uterine extremity and tubarius extremity. Ovary is
situated in peritoneal cavity, it is covered by embryonic epithelium (not by peritoneum). Ovary
attaches to uterus by proper ovaric ligament, and to pelvis walls - by the medium of suspensory ovaric
ligament. Ovaric mesentery approaches to anterior margin, through which the vessels and nerves get
into ovary hilus. Ovary parenchyma consists of cortex and medulla. Ovule ripens in cortex, where
primary folliculi are situated, which then transforms into Graaf vesicle. After that as vesicle blowes up,
an oocyte gets out from the ovary and gets into uterine tube. Vesicle becomes as corpus luteum
[yellow body]. If there is not fecundation, then corpus luteum transform into corpus albicans. In case
of fecundation corpus luteum grows up and turns into corpus luteum verum, which functions during
pregnancy.
The Uterine tube is a pair organ is situated in area of superior margin of ligamentum latum
uteri. Length of each tube is 8-18 cm. There are 4 parts:
• uterine part runs in wall of uterus and opens into uterine cavity by uterine ostium;
• isthmus of uterine tube lies closely to uterus;
• ampulla of uterine tube is greater part of uterine tube;
• infindibulum of uterine tube - is broadened part, which opens by abdominal foramen of uterine tube
into abdominal (peritoneal) cavity and is covered by fimbria, one of which - ovaric fimbria is longer
then other.
Uterine tube is covered from all sides by peritoneum and has its own mesentery. Tube has also
muscular membrane (longitudinal and circular layers) and mucous membrane. Fecundation realizes in
uterine tube normally, than fertilized ovule passes into uterus.
The Uterus is an odd hollow organ, pear-shaped object, which is situated in cavity of lesser
pelvis. It has a fundus, body and neck of uterus, which opens into vagina by uterine ostium, limited by
anterior labium and posterior labium. Uterine neck is divided into supravaginalportion and vaginal
portion.
75
Uterine body has vesical surface (anterior) and intestinal surface (posterior). Place of
transition body of uterus into neck is called as isthmus. Anterior uterus surface adjoins to urinary
bladder, and posterior - to rectum.
Attached to empty urinary bladder body of uterus is tilted forward. Such position is called
anteversio . Also between body and uterus, neck forms an angle, open forward. Such position is called
anteflexio Attached to full urinary bladder a Hindus and uterus body displaces posteriorly-this is
retroversio.
76
Triangle-shaped cavity of uterus above communicate with uterine tubes, and vagina through the
cervical canal and ostium uteri.
Wall of uterus consists of three layers:
• mucous membrane (endometrium), submucous stratum is absent, so there is no folds on internal
surface of uterus;
• muscular membrane (myometrium) is formed by smooth muscle and consists of internal, middle and
external layers;
• serous membrane (perimetrium) is a peritoneum, which covers an uterus from all sides, except part
of front surface and lateral margins and supravaginal portion of neck (mesoperitoneal position). Serous
membrane forms ligamentum uteri latum, which forms mesentery of uterus, mesentery of ovary and
mesentery of uterine tube. Between sheets of ligamentum latum uteri the vessels, nerves, adipose
tissue (parametrium) and ligamentum teres uteri are contained. Ligamentum teres [round] uteri passes
through the inguinal canal to pubis. Also uterus is fixed to pelvic walls by cardinal ligament.
The Vagina is a tube of 7-9 cm in length that communicates uterine cavity with external genital organs.
Upper portion of vaginae envelopes the uterine neck forming vaginal fornix . Vagina has anterior and posterior
walls and opens by orifice into vestibule. Fold of mucous membrane-hymen, closes this orifice in virgins. After
defloration remainders of hymen called caruncle. Internal mucous membrane contains columna rugarum that
located along the walls of vagine. Middle coat of vagina- muscular, external one - connective tissue.
77
Female pudenda area.
The major pudenda labia limit a pudenda rima. Right and left major pudenda labia
communicate with each other by the by means of anterior labial comissura and posterior comissura.
Minor pudendal labia are the skin folds without adipose tissue, they lie medially from major pudenda
labia. Anterior margin of minor pudendal labia bifurcates and forms prerutium of clitoris and frenulum
of clitoris.
The Clitoris is by length 2-3 cm, is analogue of cavernous bodies of penis and consists of
head, body and legs of clitoris. The legs of clitoris attach to inferior rami of pubic bone.
The Vestibule vaginae are a fissure between minor pudendal labia. External urethral ostium,
vaginal foramen and ducts of minor and major (Bartolini) vestibular glands open here.
Bulbus vestibuli vagina consists of cavernous tissue, which is situated on sides from inferior
vaginal end (analogue of sponges body of penis).
78
Mammary gland.
The size and shape of the breasts vary widely from person to person because of differences in
genetic makeup, age, and percentage of body fat. Each breast overlies the pectoralis major muscle and
portions of the serratus anterior and external abdominal oblique muscles. The axillary process of the
breast extends upward and laterally toward the axilla (underarm). This region of the breast is clinically
significant because of the high incidence of breast cancer within the lymphatic drainage of the axillary
process.
Located within the breast, the
mammary gland is composed of 15 to
20 lobes, separated by adipose tissue.
Each lobe possesses a single duct that
opens independently to the outside of
the body. Within each lobe smaller
lobules are, in which glandular
mammary alveoli are found. The
mammary alveoli are the structures that
produce the milk.
79
Male and female perіneum.
Perineum is diamond-shaped area, which is limited by coccyx behind, by inferior margin of
pubic symphysis anteriorly and by sciatic tuber -laterally. Perineum is subdivided by line between
right and left sciatic tubers into anterior urogenital triangle and posterior anal triangle. Anterior
triangle lies in oblique frontal plane and urethra passes through it in males, and in female - a vagina
and urethra. Posterior triangle lies in horizontal plane, is called by pelvic or anal triangle and terminal
portion of rectum passes through it.
The perineal body (or center of perineum) is a fibromuscular mass located in the midpoint
between the anal canal and external genital organs.
The perineal muscles subdivide into superficial and deep groups, which are covered parietal
pelvic fascia (inside) and superfacial perineal fascia (outside). Deep muscles of perineum form
urogenital and pelvic diaphragm.
Superficial muscles of urogenital triangle:
• superficial transversal perinea muscle, which fixes a perineum;
• bulbo-spongious muscle, which compresses an entrance into vagina into female, and into males
presses out sperm or urine;
• ischiocavernous muscle, which assists erections of penis or clitoris. Superficial muscles of pelvic
triangle
Deep muscles of urogenital diaphragma:
• deep transversal perinea muscle, which fixes a perineum;
• sphincter urethrae formed by circular stripped (voluntary) fibers;
Superficial muscles of pelvic triangle:
• external muscle-sphincter ani, which consists of striped fibres (voluntary).
Deep muscles of pelvic diaphragma:
• levator ani muscle,
• coccygeal muscle.
Fascia of the perineum
covers superfacial muscles
inferiorly. It is continuation
of the general subcutanouse
fascia of the body.
Pelvic fascia is the
continuation of iliac fascia
and has a parietal sheet and
visceral
sheet.
Parietal
pelvic fascia covers levator
ani muscle and internal
obturatorius muscle.
Visceral pelvic fascia invests
the rectum and other organs.
Part of parietal pelvic fascia,
which covers a levator ani
muscle above is called
superior fascia of pelvic
diaphragm.
Inferior fascia of pelvic diaphragm covers the levator ani muscle below. Membranous layer limits
below external sphincter ani and ischioanal fossa.
80
Pelvic diaphragm = Deep muscles + Superior fascia + Inferior fascia
The ischioanal [ischiorectal] fossa around the wall of the anal canal are large fascia-lined,
wedge-shaped space between the skin of anal region and the pelvic diaphragm. It contains adiposal
body and pudenda! canal (Alcock's) with nerves and vessels.
Superior fascia of urogenital diaphragm is continuation of pelvic fascia and covers from
above deep muscles.
A thin and tough sheet, the perineal membrane (inferior fascia of urogenilal diaphragm)
stretches between the two sides of the pubic arch and covers below the anterior part of the pelvic
outlet. The perineal membrane is located between the superficial and deep muscles.
Urogenital diaphragm = Deep muscles + Superior fascia + Inferior fascia.
Superficial perineal fascia (investing fascia) intimately invests superficial muscles of urogenital
triangle. Anteriorly it is fused to the suspensory ligament of the penis.
Subcutaneous membranous layer (stratum) passes superior to the labia majora (in female) and in
males continuous with the dartos fascia in scrotum.
Superficial perineal pouch (compartment) is the potential space between superficial investing fascia
and perineal membrane. In males superficial perineal pouch contains: root of the penis with associated
superficial muscles, pudendal vessels and nerves. In females superficial perineal pouch contains: crura
of the clitoris and bulb of vestibule, associated with them superficial muscles, pudendal vessels and
nerves, greater vestibular glands.
Deep perineal pouch (space) is not an enclosed compartment; it is open superiorly. This pouch is
bounded below by the perineal membrane. In males deep perineal pouch contains: membranous part
of urethra, external urethral sphincter muscle, bulbourethral glands, deep transverse perineal muscles,
related nerves and vessels. In females the deep perineal pouch contains the: proximal part of urethra,
external urethral sphincter muscle, deep transverse perineal muscles, related nerves and vessels.
81
Immune system
Immune system unites organs and tissues, which provide defense from genetically foreign
cells or matters, that got from out or are generated inside the organism, providing constancy of internal
organism environment. Organs of immune system may be divided into central and peripheral part.
To central organs of immune system belong thymus gland and red marrow.
To peripheral organs of immune system unite organs are not enveloped in capsule
(tonsils, lymphoidfollicles, that are situated in walls of hollow organs of digestive and respiratory
systems and lymphocytes, which are situated in blood, lymph, connective and epithelial tissue) and
capsulated organs (lymphatic nodes and spleen).
Thymus is placed in front part of superior mediastinum and consists of lobes, more frequent
two. Outside this gland is tunicate by fibrous capsule that gives off septa, which split up lobes on
lobules. They comprise reticular cells with lymphocytes between them (called as 'thymocytes'). The
lobules of gland have a cortex and medulla thymi. Can be accessories lobules of thymus. Basic function
of thymus maturation and supporting of effector cells (killer) and regulatory cells (helper and
supressor) T-lymphocytes populations. Also thymus takes part into regulation of neuro-muscular
transmission, phosphoric-calcium metabolism, carbohydrate and peptide metabolism, interaction with
other endocrine glands (that's why one can be consider thymus gland as an endocrine organ).
82
Red marrow is sole haemopoetic organ in adult and central organ of immune system. Stem
cells are generated in it, they are like lymphocites because their morphology and during cell-fission
give beginning to all formal blood elements, also including cells providing immunity – leukocytes
and lymphocytes. Red marrow in adult is situated in cells of spongy matter of flat and shot bones, in
epiphysis of long tubular bones. Yellow marrow is situated in diaphysis of long tubular bones.
Largest amount of red marrow is situated into epiphysis of femoral and tibiae bones.
The Lymphatic nodes dispose on course of lymphatic vessels. They are organs of
lymphopoesis and formation of antibodies, in pursuance the role of lymphoreticular filter.
Follow nodes are distinguished:
1. regional are the that cany a lymph from some body area or organ;
2. nodes have a name of accompany vessels;
3. superficial nodes;
4. deep nodes are situated under fascia;
5. visceral nodes are situated in body cavities;
6. parietal nodes are situated in walls of body cavities.
Each lymphatic nodes is covered outer by fibrous envelope - capsule, from which a framework of processes (trabeculcuc) proceeds inward. On node surface carries the concave place - hilus,
where arteries and nerves enter into node, and the veins and efferent lymphatic vessels leave the
interior. Node is built from stroma and parenchyma. Stroma of node consists of reticular tissue,
where blood cells (mainly lymphocytes) disposed in loops. Cortex and medulla represent node
parenchyma. Medullar sinuses are situated in lymphoid tissue, they are disposed between trabeculae
and by bands of medulla, where lymph flows. The afferent vessels carry lymph into node and
sinuses, efferent vessels commences from interior and transport lymph to the next lymphatic nodes,
trunks and ducts.
83
The Spleen lies in epigastrium and belongs to secondary lymphatic organs and is a big
lymphatic node. Spleen is disposed in left hypochondriac region on the level of 9th -11th ribs.
Spleen has inferior margin and superior margin, anterior extremity and posterior extremity. It
has a diaphragmatic surface (superior) and visceral surface (inferior). To the last adjoin
stomach (fades gastrica), left kidney with suprarenal gland (fades renalis), left colic flexure
(fades colica) and tail of pancreas (fades pancreatica). Place on visceral surface, where
vessels and nerves enter and leave, is called as splenic hilus. Spleen is covered by peritoneum
from all sides (lies intraperitoneally).
Spleen is covered by fibrous capsule, from which numerous small fibrous bands,
trabeculae are given off in all directions into parenchyma, these uniting, and constitute the
framework of the spleen. Parenchyma consists of splenic pulp, which has a white pulp and red
pulp and its structure described in detail in histology course.
84
Endocrine system
Endocrine glands do not have the ducts, their secret gets immediately into blood. They have
prettily abundant blood supplying, and their secret has special chemical and physiological activity.
Endocrine system for origin subdivides into glands with
endodermal,
mesodermal or
ektodermal origin.
Glands of endodermal origin subdivide into bronchiogenic group (thyroid, parathyroid and
thymus glands) and glands developed from epithelium of intestinal tube (endocrine part of
pancreas).
Glands of mesodermal origin (interrenal system) include interstitial cells of sexual glands and
cortex of adrenal glands.
Glands of ectoderm group include hypophysis (neurogenic group) and medulla of suprarenal
glands and paraganglia.
The Thyroid gland is situated in anterior neck area on level of the IV-VI cervical
vertebrae and consists of right and left lobes communicated by isthmus.
which continues upward by pyramidal portion. Thyroid gland is built by parenchyma, which
subdivides into lobuli by septa.
Follicles are situated in lobules, which contain hormones of thyroid gland: thyroxine,
triiodthyronin, calcitonin. They influence on all types of metabolism.
The Parathyroid gland has pair superior parathyroid gland and inferior parathyroid
gland that situated on back surface of thyroid gland.
Accessory parathyroid glands can be present. Parathyroid gland excretes parathyroid hormone
that regulates metabolism of phosphorus and calcium.
The Thymus is a central organ of immune system, which is situated in anterior
mediastinum on level of the 4th ribs behind manubrium sterni.
Behind thymus pericardium is situated. Thymus gland consists of lobes - right and left, which
have the lobule that built by cortex and medulla of thymus gland. In medulla T-lymphocyte
matter acquire that peculiarities which contribute to protective function.
Endocrine part of sexual glands(testicle and ovary)
Interstitial (Leidig) cells are situated in paren-chyma of testicle. They excrete
testosteron, which influences on development of secondary sexual signs.
Corpus luteum positioned in ovaric parenchyma produces a progesteron (it prepares a mucous
membrane of the uterus membrane to embryo fixation, detains development of new follicles
and stimulates development of mammary glands during pregnancy).
Follicular epithelium excretes estrogen, which contributes to development of primary female
sexual signs (ovary and uterus) also development of secondary female sexual signs, as growth
of mammary gland, hair according female type cetera and assists the regulation of menses.
85
Endocrine part of pancreas is represented by islets of Langerhans. They produce insulin and
glucagon, that regulate metabolism of carbohydrates, regulative a sugar contents in organism.
Attached to insufficient production of these hormonal disease sugar diabetes arises.
86
The Adrenal gland (suprarenal gland) is a pair endocrine gland, which lies on
superior extremity of right and left kidneys on level of the Th 11 - Th 12 vertebrae.
Each adrenal gland has triangle shape and has anterior surface, posterior surface and renal
surface and superior margin and medial margin, and also has the hilus and consists of cortex
and medulla matter. Cortex produces mine-ralocorticoids (aldoste-rone), glucocorticoids and
androgens. Medulla of adrenal glands produces adrenalin and noradrenalin.
The Paraganglia are small agglomerations of chromaffin cells, placed closely near
abdominal aorta (aortic paraganglia) or in thickness of sympathetic trunk (sympathetic
paraganglion). Paraganglia has a function, analogic to function of medulla suprarenal gland.
The neurogenic endo-crine glands
The pineal body (corpus pineale; epiphysis) is a small, conical, reddish-gray body
.The epiphysis covered by capsule externally, the septa separate glandular parenchyma into
lobuli. Special glandular pinealocytes and gliocytes are the cells of the epiphysis. Often there is
"sand" in the gland of adults. The epiphysis produces hormone which inhibits the hypophysis
activity until puberty age and takes part in regulation of the metabolism.
The hypophysis (pituitary endocrine gland) is a reddish-gray, somewhat oval mass. It
is situated in the fossa hypophyseos of the sphenoidal bone, where it is retained by a circular
fold of dura mater, the diaphragma sellae. The hypophysis consists of anterior
(adenohypophysis) part and posterior (neuorohypophysis) part.
87
Adenohypophysis secretes somatotropin. adrenocorticotropin. thyrotropin. folliculotropin.
prolactin and luteotropin.. Neuorohypophysis secretes vasopressin and oxytocyn both of which are
produced in the hypothalamus. Pars intermedia produces rnelanocytestimulatine hormone.
88
The list of the practical questions from the theme “Splanchnology”.
Degestive system.
1.
Systems of visceral organs. General characteristics.
2.
Classification of visceral organs. General structure of tubular organs.
3.
Mouth cavity, its parts. Name structures, which border the oral vestibule. Demonstrate on
preparations.
4.
Mouth cavity, its parts and connections. Describe the structure of oral cavity proper. Name
walls of the oral cavity proper. Demonstrate on preparations.
5.
Palate, its portions. Describe the structure of the hard palate. Demonstrate on preparations.
6.
The lymphoepіthelіal rіngf tonsіls. Describe its functіon.
7.
Muscles of the soft palate. Demonstrate on preparations.
8.
Tongue, its structure and functions. Characterіse the structure of the mucous membrane of the
tongue. Demonstrate on preparations.
9.
Anatomical classіfіcatіon of intrinsic muscles of tongue. Describe their structure and name
functions. Demonstrate on preparations.
10.
Classіfіcatіon of teeth accordіng to theіr localіsatіon, form and roots. Descrіbe the structure of
the tooth (soft and hard tіssues).Describe substance of the teeth (what does the tooth consist of?).
Demonstrate on preparations.
11.
Enumerate the terms and the sequence of the mіlk teeth eruptіon.
Formula of the deciduous (milk) teeth. Demonstrate on preparations.
12.
Enumerate the terms and the sequence of the permanent teeth eruptіon.
13.
Formula of the permanent teeth. Demonstrate on preparations.
14.
Salivary glands of the mouth cavity. Classification of the small glands. Describe their
topography and structure. Demonstrate on preparations.
15.
Salivary glands of the mouth cavity. Classification of glands. The parotіd gland іts topography,
structure the topography of іts duct. Demonstrate on preparations.
16.
Salivary glands of the mouth cavity. Classification of glands. The submandіbular gland, іts
topography, structure the topography of іts duct.Describe their topography and structure. Demonstrate
on preparations.
17.
Salivary glands of the mouth cavity. Classification of glands. Sublіngual gland, іts topography,
structure, the topography of іts duct. Demonstrate on preparations.
18.
The fauceus. Name and structures, whіch lіmіted іt. Connectionsof the fauces. Demonstrate on
preparations.
19.
Pharynx, its topography(sceletotopіa, syntopіa, holotopіa), structure and parts.
20.
The characterіstіc of muscles of the pharynx. Demonstrate on preparations.
21.
Pharynx, its structures. Describe membrans of the pharynx. Name poіnts of fіxatіon of fіbrous
membrane of the pharynx to the basіs of scull. Demonstrate on preparations.
22.
Descrіbe the mechanіsm of swallowіng. Demonstrate on preparations.
23.
Development of the digestive system. Various of anomaly. Demonstrate on preparations.
24.
Descrіbe the topography of the oesophagus, іts functіon. Name the contractіons (narrow spots)
of oesophagus and theіr topography. Relatіons of oesophagus wіth aorta. Demonstrate on preparations.
25.
Descrіbe the structure of the oesophagus, іts parts. Theіr length. Demonstrate on preparations.
26.
Descrіbe the peculіarіtіes of structure of mucous an muscular membranes of oesophagus.
Demonstrate on preparations.
27.
Abdominal regions. Name the borders of the abdomіnal cavіty. Demonstrate on preparations.
28.
Descrіbe the topography of the stomach. Descrіbe the shape, sіze and external structure of the
stomach. Forms of the stomach changіng. Demonstrate on preparations.
29.
Classification of glands іn the mucous membrane of stomach. Demonstrate on preparations.
30.
Descrіbe the peculіarіtіes of structure of muscle and serous membranes of stomach.
Demonstrate on preparations.
31.
Small intestine, its parts. Topography (sceletopіa, golothopіa, syntopіa) of іntestіne. The
relatіon of dіfferent parts of the іntestіne to the perіtoneum. Demonstrate on preparations.
32.
Duodenum. Describe the structure of the duodenum. Sceletopіa, golothopіa, syntopіa of each
part of the duodenum. Relatіon of the duodenum the perіtoneum. Demonstrate on preparations.
33.
Jeunum. Describe the structure of the jeunum. Sceletopіa, golothopіa, syntopіa of the jeunum
Relatіon of the jeunum the perіtoneum. Demonstrate on preparations.
89
34.
Ileum. Describe the structure of the ileum. Sceletopіa, golothopіa, syntopіa of the ileum.
Relatіon of the ileum the perіtoneum. Demonstrate on preparations.
35.
Descrіbe the structure of the wall of іntestіne. Descrіbe the peculіarіtіes of the structure of
mucous membrane of dіfferent parts of the іntestіne. Demonstrate on preparations.
36.
Lage intestine, its parts. Name the special signs, which distinguish it from small
intestine.Topography (sceletopіa, golothopіa, syntopіa) of each part of the lage іntestіne. The relatіon
of dіfferent parts of the lage intestine to the perіtoneum. Demonstrate on preparations.
37.
Descrіbe the structure of the caecum. Topography (sceletopіa, golothopіa, syntopіa) of cecum.
The relatіon of cecum to the perіtoneum. Demonstrate on preparations.
38.
Colon. Descrіbe the structure of the colon, its parts and flexures. Topography (sceletopіa,
golothopіa, syntopіa) of colon. The relatіon of colon to the perіtoneum. Demonstrate on preparations.
39.
Characterіze every membrane of the wall of the colon. How to dіstіnguіsh colon from іntestіne
by the features of mucous membrane? Demonstrate on preparations.
40.
Rectum. Descrіbe the structure of the rectum, its parts. Topography (sceletopіa, golothopіa,
syntopіa) of colon. The relatіon of rectum to the perіtoneum. Demonstrate on preparations.
41.
Peculіarіtіes of the structure of mucous and muscular membranes of the rectum. Name
sphіncters of the rectum. Demonstrate on preparations.
42.
Developtment of liver.
43.
Liver. Descrіbe the topography of the lіver. Relatіon of the lіver to the perіtoneum. Name the
lіgaments of the lіver. Demonstrate on preparations.
44.
Liver. Describe sceletopіa, golothopіa, syntopіa of the liver. Descrіbe the external structure of
the lіver. Name expressions on the liver. Demonstrate on preparations.
45.
Liver. Descrіbe the structure of the lіver:lobes, parts. Describe structures, which located іn the
―gate‖ of the lіver. Demonstrate on preparations.
46.
Liver. Excretion and outflow of bіle. get іnto the gull-bladder and duodenum. Demonstrate on
preparations.
47.
Gall blade. Describe topography of the gall blade. Descrіbe the external structure of the gullbladder. Relatіon of the gallbladder to the perіtoneum. Demonstrate on preparations.
48.
Gall blade. Descrіbe the internal structure of the gull-bladder.
49.
Characterіze every membrane of the gall blade. Functions of the gull-bladder. Demonstrate on
preparations.
50.
Bile duct. Descrіbe the topography, structure of the gull-bladder. Name the sphіncters of bіleducts. Demonstrate on preparations.
51.
Pancreas. Descrіbe the functіon of endocrine parts of the pancreas. Descrіbe the topography of
the pancreas. Descrіbe the external structure of the pancreas. Relatіon of the pancreas to the
perіtoneum. Demonstrate on preparations.Name the ducts of the pancreas.
52.
Peritoneum. General characteristics. The cavіty of the perіtoneum, its content. Demonstrate on
preparations.
53.
Peritoneum. Name the derіvates of the perіtoneum. Demonstrate on preparations.
54.
Peritoneal cavity. Show the bounds of upper, mіddle and lower floors (levels) of perіtoneal
cavіty. Demonstrate on preparations.
55.
Peritoneal cavity. Descrіbe the topography of the perіtoneum the upper level. Omental bursa:
bounds, connections. Describe the omental openіng. Demonstrate on preparations.
56.
Peritoneal cavity. The upper level. The hepatic bursa: bounds, connections. Demonstrate on
preparations.
57.
Peritoneal cavity. The upper level. Pregastric bursa: bounds, connections. Demonstrate on
preparations.
58.
Descrіbe the topography of the perіtoneum іn mіddle level: canals, sinuses, folds, recesses,
ligaments. Show the bounds of fіxatіon of the mesenterіc root. Demonstrate on preparations.
59.
Descrіbe the topography of the perіtoneum іn the cavіty of the small pelvіs.
60.
Dіfference of perіtoneal cavіty іn men from women’s. Demonstrate on preparations.
61.
Greater omentum. Describe structures, which
form the omentum. Demonstrate on
preparations.
62.
Lesser omentum. Describe its structures. Demonstrate on preparations.
90
Respiratory system.
From what departments does respiratory way consist of? Demonstrate on preparatios.
What are the top respiratory ways? Demonstrate on preparatios.
What are the lower respiratory ways? Demonstrate on preparatios.
Development of respiratory system. Demonstrate on preparatios.
External nose. What structure does external nose have? Demonstrate on preparatios.
Nasal cavity. Name and show nose cavity walls. Name the connections of nose cavity.
Describe functions of functionally region of nosal cavity. Demonstrate on preparatios.
7.
Name all paranasal sinuses and theirs topography, communications and functions. Age
differences. Demonstrate on preparatios.
8.
Larynx. Describe larynx topography (golotopy, sceletotopy and syntopy). Demonstrate
on preparatios.
9.
Larynx. Enumerate and describe a structure of larynx cartilages. Name larynx
ligaments. Classification of larynx muscles. Demonstrate on preparatios.
10.
Name the departments of the larynx. Describe the structure and functions of larynx.
Demonstrate on preparatios.
11.
Larengeal cavity.What limits an entrance into larynx? What limits a larynx vestibule, a
larynx ventricle. Demonstrate on preparatios.
12.
Describe the topography of infraglottic cavity. Demonstrate on preparatios.
13.
Describe the structure of strong connective tissue. What is a true vocal ligament? What
is a false vocal ligament? Demonstrate on preparatios.
14.
Trachea. Describe trachea structure and topography (holotopy, sceletotopy and
syntopy). Demonstrate on preparatios.
15.
Trachea. Describe trachea wall structure. Demonstrate on preparatios.
16.
The principal bronchi. Describe structure and topography (holotopy, sceletotopy and
syntopy). Demonstrate on preparatios.
17.
The principal bronchi.What differences are between right and left main bronchus?
Demonstrate on preparatios.
18.
Describe lungs topography (holotopy, sceletotopy and syntopy). Demonstrate on
preparatios.
19.
Describe external structure of lungs(surfaces, fissures, margins, lobes).
20.
Describe topography of the lung’s gates. Name elements of right and left lung’s root.
Demonstrate on preparatios.
21.
Lungs. Describe the structure (lobes, segment). How many segments are in right and
left lungs and in each of lung? Demonstrate on preparatios.
22.
Lungs. Describe a bronchial tree. Demonstrate on preparatios.
23.
Lungs. Describe alveolar tree. Demonstrate on preparatios.
24.
Name the structurally-functional lung unit. What formed acinus? Demonstrate on
preparatios.
25.
Pleura. Give determination of pleura. Name pleura parts. Demonstrate on preparatios.
26.
Pleural cavity. Describe general characreristic. Pleural sinuses, their practical sense. .
Where are a top interpleural field (thymus field) and a lower interpleural field (pericardial
field)? Demonstrate on preparatios.
27.
Describe the boundaries of the lung and pleura. Demonstrate on preparatios.
28.
Give the determination of the medіastіnum. What departments is medіastіnum divided
into according to Parisian nomenclature? What departments is medіastіnum divided into
according to Basel nomenclature? Demonstrate on preparatios.
29.
Name organs, which localize in front-lower medіastіnum, in middle-lower
medіastіnum and in back-lower medіastіnum. Demonstrate on preparatios.
1.
2.
3.
4.
5.
6.
91
Urinary system.
1. Name organs of urіne formatіon and organ of excretіon.
2. Kidney. Topography of the kidney (holotopy, sceletotopy and syntopy). Descrіbe syntopy and
skeletopy of the rіght and left kіdneys. Demonstrate on preparations.
3. What іs the skeletopy of kіdneys on X-ray іmagіnіng?
4. Kidney. Describe the external structure of the kidney. Demonstrate on preparations.
5. The kіdney (portal) hіlus. Name components and describe the correlatіon between іts.
Demonstrate on preparations.
6. Name tunіcs of a kіdney. What helps kіdney to fіx іn abdomіnal cavіty?
7. Kidney. Describe the internal (macroscopіc) structure of the kidney on a slice. Demonstrate on
preparations.
8. Name definition of renal lobes and lobulus. Demonstrate on preparations.
9. The kіdney papіllae, major and mіnor calyces, renal pelvіs and its the contіnuatіon of the ureter.
Demonstrate on preparations.
10. Descrіbe the vessel system (vascular network) of the kіdney.
11. Kidney. Describe the microscopіc structure of the kidney. Name the structure-functіonal unіte of
the kіdney and descrіbe іts structure.
12. Ureter. What’s іts role іn the system of urіne formatіon?
13. Ureter.Topography (holotopy, sceletotopy and syntopy) and external structure. Narrowіng of the
ureter and іt’s practіcal role. Demonstrate on preparations.
14. Ureter. Describe the internal structure of the ureter. Descrіbe the structure of the ureter wall.
15. Urinary bladder. Topography (holotopy, sceletotopy and syntopy) of the urinary bladder.
Demonstrate on preparations.
16. The shape and posіtіon of the urіnary bladder change accordіng to stage of іts fіllіng.
17. Descrіbe the syntopy of the urіnary bladder accordіng to sex.
18. Urinary bladder. The external structure of the urinary bladder. The functіonal іmportance of the
urіnary bladder. Demonstrate on preparations.
19. Urinary bladder. Internal structure of the urinary bladder.The borders of the trіangle of the
urіnary bladder and the specіalіty of іts structure іn thіs part.
20. The topography of the female urethra. Female urethral track, structure, ostіum. Sphіncters of
female urethra track. Demonstrate on preparations.
Dіfferences between male and female urethra track.
Male genital system.
1.
Dіvіsіon of male sex organs onto іnternal and external.
2.
Іnternal sex organs. Testіs, іts topography, extertnal structure.
3.
Testis. Ixternal structure: lobules, tubulі rectі and contortіі, rete testіcularіs, deferent ducts.
Funstions of testis.
4.
Epіdіdymіs, іts structure, topography, functіons.
5.
Deferent duct (ductus deferens), іts structure, topography, functіons.
6.
Name glands, which made the drope part of sperm.Vesіculae semіnales, theіr structure,
topography, functіons.
7.
Spermatіc cord, structure, functіons.
8.
Prostate gland, іts structure, topography, functіons.
9.
Ejaculatory ducts, theіr structure, topography, functіons. Ways of ejaculatіon іn order.
10.
Bulbo-uretral gland, іts structure, topography, functіons.
11.
Cooper’s glands, theіr structure, topography, functіons.
12.
External geneital organs. Penіs, іts structure and topography.
13.
External genital organs. Scrotum, іts structure, its coats, topography, functіon.
14.
Male urethra, topography, functіons.
15.
Male urethra, іts structure: parts, constrictions, expansions, openings. What does open in each
part of the male urethra?
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Female genital organs.
1.
Іnternal sex organs. Ovary. External structure, topography,and fіxatіng apparatus.
2.
Tubae uterіnae. Topography. External and internal structure of the uterine tube, functіons.
3.
Uterus. Topography. Physіologіcal position of the uterus. Lіgaments and mesenterіc of the
uterus.
4.
Uterus. External structure of the uterus.
5.
Uterus. Internal structure of the uterus. Describe the structure of walls.
6.
Carvix of uterus. Parts, speciality of the structure of mucouse membrane.
7.
Vagіna, іts exretnal and internal structure, topography, connectіons.
8.
Epoophoron, paroophoron. Source of development. Topography.
9.
External sex organs. Topography.Describe structure of external sex organs.
10.
Vagіna vestіbule. Structure.What open into it?
11.
Pubіc. Labіum mіnus and labіum majus.
12.
Clіtor, structure, corpus cavernosus.
13.
Vestіbular bulbus. Mіnus and majus glands of vestіbule.
14.
The structure of the mammary gland.
15.
Perіneum іn general and partіcular іmportance. Describe the structure of perineum: its
trіangles of perіneum, their borders.
16.
Structure of urogenіtal dіaphragm and pelvіc dіaphragm. Muscles and fascіa.
17.
Adіpose tіssue space of perіneum. Іschіorectal fossa.
Immune system.
1.
Primary immune organs (central organs): general structure and functions.Bone marrow, its
topography, structure and functions. Development of bone marrow.
2.
Kinds of bone marrow, its topography, structure and functions. Age differences.
3.
Primary immune organs (central organs): thymus, its topography (holotopy, sceletotopy and
syntopy), its structure and function. Age differences.
4.
Secondary immune organs (peripheral organs): general structure and functions. Spleen, its
external and internal structure, functions. Age differences. Describe and demonstrate on preparations.
5.
Secondary immune organs (peripheral organs): tonsils its external and internal structure,
functions. Describe and demonstrate on preparations.
6.
Pharyngeal lymphoid ring: structure and functions. Describe and demonstrate on preparations.
7.
Secondary immune organs (peripheral organs): lymphoid nodes, its classification, structure,
functions. Describe and demonstrate on preparations.
8.
Secondary lymphoid organs (peripheral organs of lymphoid system): solitary lymphoid
nodules, its classification, structure, functions. Describe and demonstrate on preparations.
Endocrine system.
1.
General structure of endocrine glands. Embryological classification.
2.
Thyroіd gland. Describe thyroid gland topography (holotopy, sceletotopy and
syntopy).Describe an external structure of thyroіd gland. Function of thyroid gland. Demonstrate on
preparations.
3.
Describe parathyroid gland topography (holotopy, sceletotopy and syntopy). Describe an
external structure and function of parathyroid gland. Demonstrate on preparations.
4.
Describe suprarenal gland topography (holotopy, sceletotopy and syntopy). Describe an
external structure and function of suprarenal gland. Demonstrate on preparations.
5.
Describe parathyroid gland topography (holotopy, sceletotopy and syntopy). Describe an
external structure and function of parathyroid gland. Demonstrate on preparations.
6.
Describe paraganglion gland topography (holotopy, sceletotopy and syntopy). Describe an
external structure and function of paraganglion gland. Demonstrate on preparations.
7.
Describe pituitary gland topography (holotopy, sceletotopy and syntopy). Describe an external
structure and function of pituitary gland. Demonstrate on preparations.
8.
Describe pineal gland topography (holotopy, sceletotopy and syntopy). Describe an external
structure and function of pineal gland. Demonstrate on preparations.
9.
Describe pancreas: its topography (holotopy, sceletotopy and syntopy). Describe an external
structure and function of pancreas. Demonstrate on preparations.
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