Download МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ`Я УКРАЇНИ

MINISTRY OF HEALTH OF UKRAINE
Higher State Educational Establishment of Ukraine
“Ukranian Medical Stomatological Academy”
"Approved"
at the meeting of the
Department Human Anatomy
on 26.10. 2016.
Minutes № 7
Head of Department
Professor O. O. Sherstiuk
_____________________
METHODICAL GUIDELINES
For students’ self-directed work when preparing for and during
The practical session
Academic subject
Module №2
Year of study
Faculty
Human Anatomy
«Splanchnology. Central nervous system and
sensory organs»
I
foreign students’ training faculty,
specialty «Medicine»
Ministry of Health of Ukraine
Higher State Educational Establishment of Ukraine
“Ukranian Medical Stomatological Academy”
Department of Human Anatomy
Composed by
N.L. Svinthythka, Associate Professor at the Department of Human Anatomy,
PhD in Medicine, Associate Professor
V.H. Hryn, Associate Professor at the Department of Human Anatomy,
PhD in Medicine, Associate Professor
A.V. Pilugin, Associate Professor at the Department of Human Anatomy,
PhD in Medicine, Associate Professor
K.A. Lazarieva, Lecturer at the Department of Human Anatomy.
Schedule of classes for students of foreign students’
Training faculty, specialty «Medicine» on module № 2
«Splanchnology. Central nervous system and sensory organs»
№
Topic
1
2
3
4
Oral cavity. Palate.
Tongue. Salivary glands.
Teeth.
Pharynx. Esophagus. Stomach.
Instru
ction
Нours
2
2
2
2
5
6
7
8
9
10
Small intestine.
Large intestine.
Liver. Pancreas.
Peritoneum.
Nose. Larynx.
Trachea, bronchi, lungs.
2
2
2
2
2
2
11 Pleura. Mediastinum. The review of the serous membranous of
the inner organs.
12 Kidney: external structure, the topography.
13 Internal structure of the kidney. The segments of the kidney.
Malformations.
14 Ureters, urinary bladder. Male and female urethrae. X-ray
anatomy of the urine voiding organs.
15 Internal male genital organs. External male genital organs.
Malformations.
16 Female genital organs. Malformations. Perineum.
2
17 General principles of the structure of the endocrine glands.
Central part of the endocrine system. The pineal gland. The
pituitary gland.
18 Peripheral part of endocrine system (the thyroid gland, the
parathyroid gland, the pancreatic islets, the suprarenal gland, the
endocrine part of gonads).
19 Submodule on Splanchnology. Situations problems.
20 Introduction in nervous system. Basic principles of the structure
of the reflex arc. White and grey matters of the central nervous
system. Development of the central nervous system. External
structure of the spinal cord. Meninges and blood vessels of the
spinal cord.
2
2
2
2
2
2
2
2
2
21 Internal structure of spinal cord. White and grey matters of the
spinal cord.
22 Medulla oblongata, pons.
2
23 Cerebellum. The isthmus of the rhombencephalon.
24 The fourth ventricle, the rhomboid fossa.
25 Midbrain.
2
2
2
26
27
28
29
Diencephalon, the third ventricle.
External structure of cerebral hemispheres.
The rhinencephalon. Limbic brain. The basal nuclei.
Structure of grey matter and cortex of cerebral hemispheres.
Functional arrangement of the cerebral cortex.
The lateral ventricles. The white matter of the cerebral
hemispheres. The meninges of the brain. Circulation of
cerebrospinal liquid.
General esthesiology. Visual analyzer. Eyeball: layers, chambers,
refracting medias.
Accessory structures of visual analyzer. Nervous pathway of
visual analyzer.
General characteristic of organ for hearing. External and middle
ears. Bones of middle ear, tympanic cavity, its walls.
2
2
2
2
34 Internal ear. Periotic and otic labyrinths. The eights pair of cranial
nervous.
35 Olphactory and taste analyzers. Nervous pathways of taste and
smell.
36 The integumentary system. Derivates of the skin. Mammary
gland.
37 Afferent nervous pathways of cortical direction. Medial
lemniscus. Afferent nervous pathways of cerebellar direction.
38 Efferent pyramidal nervous pathways. Efferent extrapyramidal
nervous pathways.
39 Final module control on module №2 “Splanchnology. The central
nervous system and sense organs”
2
30
31
32
33
2
2
2
2
2
2
2
2
2
Topic 1. Oral cavity.
1. Relevance of the topic.
The digestive system is a combination of different in structure and functions that provide
mechanical and chemical processing and absorption of nutrients. What is needed to meet
the energy and material costs during the life of the organism.
It is important at the rate of 1 course know all bodies. You need to know the topography
of each organ. To know the topography of the body, you need to define it:
1. Skeletopy (projection body on the skeleton).
2. Holotopy (the position of the body in space).
3. Syntopy (the ratio of the neighboring organs).
Knowledge of the anatomy of the students in the study required subjects such as
topographic anatomy, internal and surgical diseases.
2. The specific aims.
To explain the development of the digestive system in ontogenesis, general plan of the
structure;
To analyze the development of the oral cavity;
To explain: as oral cleft formed:
- parts of the mouth;
- the structure of the lips and cheeks;
- the structure of the hard palate;
- muscles of the soft palate and their function;
- departments entodermal primary colon;
- the structure of the wall of the digestive tube;
- features digestive system in children.
Classify malformations of palate and upper lip.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration)
The preceding
The acquired knowledge
subjects
Biology
Phylogeny digestive system;
Anatomy
Ontogeny of the digestive system;
4.The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
4.2. Theoretical questions for the topic:
1. From which embryonic leaf is formed initial gut?
2. Tell us about the development of the oral cavity.
3. How is the mouth slit?
4. What malformations of palate and upper lip, you know?
5. Tell us about the parts of the oral cavity.
6. What structure are the lips and cheeks?
7. What is the structure of the hard palate?
8. Name and show the part of the soft palate.
9. Show on preparation and vestibule part and own oral cavity. What is the structure of its
walls?
10. Show the preparation of the hard palate.
11. Name the muscles of the soft palate. What is their function?
12. Where are the palatine tonsils. What is their structure?
13. What is the fauces? How is it limited?
14. Name the parts entodermal primary gut.
15. What digestive system develop from the front, middle guts?
16. What is the structure of the wall of the digestive tube?
17. Consistently tell the digestive system.
18. What features of the digestive system in children?
4.3. Practical tasks pertaining to the topic and to be completed during the class:
On anatomical preparations, schemes, models and drawings explore and show the
structure of the mouth, abnormalities.
The content of the topic:
The development of the digestive system in ontogenesis.
The Digestive Apparatus.
The apparatus for the digestion of the food consists of the digestive tube and
of certain accessory organs.
The Digestive Tube (alimentary canal) is a musculomembranous tube,about 9
metres long, extending from the mouth to the anus, and lined throughoutits entire extent
by mucous membrane. It has received different names in the various parts of its course:
at its commencement is the mouth, where provision ismade for the mechanical division
of the food (mastication), and for its admixture with a fluid secreted by the salivary
glands (insalivation); beyond this are theorgans of deglutition, the pharynx and the
esophagus, which convey the food into the stomach, in which it is stored for a time and
in which also the first stages of the digestive process take place; the stomach is followed
by the small intestine, which is divided for purposes of description into three parts, the
duodenum, the jejunum, and ileum. In the small intestine the process of digestion is
completedand the resulting products are absorbed into the blood and lacteal vessels.
Finallythe small intestine ends in the large intestine, which is made up of cecum,
colon,rectum, and anal canal, the last terminating on the surface of the body at
theanus.The accessory organs are the teeth, for purposes of mastication; the three pairs
of salivary glands—the parotid, submandibulary, and sublingual—thesecretion
from which mixes with the food in the mouth and converts it into a bolusand acts
chemically on one of its constituents; the liver and pancreas, two large glands in the
abdomen, the secretions of which, in addition to that of numerous minute glands in the
walls of the alimentary canal, assist in the process of digestion.
Alimentary canal embryo is laid in the form of primary intestinal tube is the embryonic
period divided by the mouth, pharynx, esophagus, stomach and intestines. There is a
differentiation in embryogenesis structural elements in the walls of the digestive tract
and digestive glands develop.
The digestive system begins to function during the prenatal period. At the 4th
month in the intestine of the fetus content appears greenish - meconium; it consists of
wapasha epithelial cells, mucus, bile and substances which swallows the fetus. Since that
time in the intestine find digestive enzymes.
By the end of the period of fetal digestive system reaches the stage of development
where it can provide vital functions of the newborn. Most are differentiated structures
provide breastfeeding baby, and, above all, the act of sucking. Changes in the digestive
organs after birth due to a significant degree the composition and quantity of food, which
is used in different age periods. Food is an important formative factor in individual
development of the digestive system.
In the third week of the embryo in the thickness of the endoderm close to the
ventral surface of the pipe is laid. At the caudal (proctodeum) and cranial (stomadeum)
formed by the ends of the bay. Later they break, pharyngeal and rectal membrane,
connected to the tube and thus formed the primary entodermal gut. With endoderm
formed mucosa and cancer of the mesenchymal muscular layer and serous membrane.
On the serous membrane formed primary colon peritoneum, pleura, pericardium.
Primary colon is divided into two sections: the head and trunk. In oral produce
department of oral (oral rear formation) and of pharyngeal (throat and protrusion, which
give rise to the development of the respiratory system).
In the trunk release department foregut (esophagus, stomach, pancreas and upper
duodenum), midgut (thin, blind, ascending and transverse colon), hindgut (descending
colon, sigmoid, rectum).
The digestive system (systema digestorium) consists of the digestive tract and
digestive glands. Digestive tract begins oral and consists of the pharynx, esophagus,
stomach, small and large intestines.
Oral cavity (саvitas oris, stoma) limited front lips, side - cheeks, above - palate,
bottom - hyoid muscles. Oral cavity divided into the vestibule and the actual mouth.
Mouth Vestibule (vestibulum oris) is an oral cleft (rima oris), which is placed
horizontally between the upper and lower lips.
Outside the vestibule limited cheeks and lips separated from the actual oral teeth
and alveolar bone jaws, which are covered with mucous membrane, called a gums
(gingiva). The oral cavity of neonates is smaller, shorter, wider and lower, closer to the
eye socket.
The upper and lower lip (labium superior et inferior) merge and pass each other
and form a mouth angle (angulus oris). The outer surface of the lips - a skin part (pars
sutanea) internal - the mucous membrane (pars mucosa) located between the
intermediate part (pars intermedia). The skin of the upper lip in the midline is upper lip
groove (philtrum), that ending tubercle (tuberculum).
In the thick lips contains circular muscle mouth, and they covered the inner surface
of the mucosa, which continues to cellular processes of the upper and lower jaws, cleft
fused with their periosteum. By the middle line between the lips and gums and mucous
membrane thickens forms two folds - the upper lip frenulum (frenulum labii superioris)
and lower lip frenulum (frenulum labii inferioris).
The lips, together on each side, limit the mouth slit, forming a spike lips
(comissura labiorum).
Newborn upper lip is relatively thick, the midline is a hump that persists for
several weeks after birth. The lower lip seems to come. The transition of the lip in
newborns narrow, so when the mouth is closed, externally visible mucosa. On the
surface of the mucosa of the lips is the villi, which help preserve the nipple. In the thick
lips well developed muscles, through which stays child and squeezes the nipple. These
structural features of the lips kept for infants; while bottle-fed baby are smoothed rather
than when breastfeeding.
The Cheeks (buccae) form the sides of the face, and are continuous in front
with the lips. They are composed externally of integument; internally of mucous
membrane; and between the two of a muscular stratum, besides a large quantity of
fat, areolar tissue, vessels, nerves, and buccal glands.
The Gums (gingivœ) are composed of dense fibrous tissue, closely
connected to the periosteum of the alveolar processes, and surrounding the necks
of the teeth. They are covered by smooth and vascular mucous membrane, which is
remarkable for its limited sensibility. Around the necks of the teeth this membrane
presents numerous fine papillae, and is reflected into the alveoli, where it is continuous
with the periosteal membrane lining these cavities.
Oral vestibule in front and laterally limited by the cheeks (buccae), which consist
of skin, muscle and mucosa. Between the skin and cheek muscles are clusters of fat body fat cheeks (corpus adiposum buccae), which is particularly well developed in
babies.
Of infants fatty body of the cheek leads to thickening of the wall of the oral cavity
and there by reduces the atmospheric pressure on it, which contributes to the process of
sucking.
Actually oral cavity bounded in front and on the sides of the teeth and jaws
alveolar bone. The upper wall of their own oral forms palate (palatum), which are
divided into hard palate (palatum durum) and soft palate (palatum molle). Bone basis
palate are the palatine processes of the maxilla and horizontal plate of the palatine bone.
The mucous membrane covering the hard palate, thickened and tightly adherent to the
periosteum. In front of the palate are several transverse palatine folds (рlісае раlatinae
transversae) incisive papilla (papilla incisiva) and is in the middle palatine suture (raphe
palati).
The soft palate is a continuation of the hard palate and consists of two layers of
mucosa, which is located between palatal aponeurosis (ароnevrosis palatina), and
muscle.
Soft palate has three parts: the blind palate (velum palatinum) uvula (uvula
palatina) and two pairs of brackets. To the muscles of the soft palate include: muscle palatal lifts curtain (m. levator veli palatini), muscle - palatal curtain tensioner (m. tensor
veli palatini), tongue muscle (m. uvulae), palate - lingual muscle (m. palatoglossus)
mouth - pharyngeal muscle (m. palatopharingeus). You need to understand is that in the
process of swallowing muscles - lifts, muscle - tensioner curtain palatal and
velopharyngeal muscle presses the palatal curtain to the rear and side walls of the
pharynx and thus separates the oral part of the pharynx from the nose, which prevents the
entry of food into the nasal cavity. The muscles of the soft palate and pharynx throat
constrict and divide food into small portions. The act of swallowing is complex nervous
mechanism of its regulation center located in the medulla oblongata.
Before the advent of cellular dental arch upper and lower jaws do not close up, and
the gap between them manage mucous cheeks. At the free edge of the gums at incisors
and canines are moving folds of mucous participating in the act of sucking.
The hard palate in newborns, short and wide, arches his poorly marked. Only
after a year long palate begins to exceed its width. In the mucosal surface visible
transverse palatine folds. In the back of the palate to 3 years of age are whitish clusters of
epithelial cells, so-called "epithelial pearls".
The soft palate in newborns located horizontally at the level of the vault of the
pharynx. Tab rickety little, sometimes it forked, which may indicate the covert of cleft
palate. Palatine tonsils newborn small, they do not fill all the holes tonsilis fossa,
resulting in over tonsils formed over tonsils fossa. Anterioinferior of tonsil covered with
triangular fold of mucous, which is expressed to 3 years of age The surface of the tonsils
in young children is relatively plain crypt navagation and shallow. The growth of the
tonsils is uneven. The fastest growth is observed up to a year, and at the age of 4-6 years.
Abnormalities of development.
1. Cleft upper lip ( «cleft lip», labium leporinum);
2. Splitting of palatine (faucis lupinum);
3. Spit crack face;
4. Increased or decreased tongue;
5. Forked tongue;
6. Double tongue.
Materials for self-check:
А. Tasks for self-check: prepare a multimedia presentation of oral abnormalities.
B. Choose the correct answer:
1.What structures can be found on the mucosa of the oral cavity floor?
A.The frenulum of the tongue, the sublingual fold, the sublingual caruncle
B. The geniohyoid and the mylohyoid muscles
C. Oral diaphragm
D.The fauces
E. The palatoglossal and palatopharyngeal arches
2.Which muscle forms the muscle basis of oral cavity diaphragm?
A.Mylohyoid
B.Thyrohyoid
C.Stylohyoid
D.Styloglossus
E.Geniohyoid
3.A man, 30 years old, appealed to a dentist complaining of mastication disorder: painful
backward movement of the mandible. The doctor detected the inflammation of a
masticatory muscle. Which muscle exactly is it?
A.Temporal (posterior fibres)
B.Temporal (anterior fibres)
C.Medial pterygoid
D.Lateral pterygoid
E.Masticatory
4. A boy, 8 years old, cannot put lips round, the angles of the mouth are pulled out and
up, and oral fissure is stretched aside. What muscle is injured?
A.Orbicular muscle of mouth
B.Greater zygomatic
C.Buccinator
D.Risorius
E.Masticatory
5.Examination of a patient’s expression has shown that he cannot put his lips round,
whistle, the oral fissure is stretched to sides. What muscle’s atrophy do these indicate?
A.Orbicular muscle of mouth
B.Greater zygomatic
C.Cheek muscle
D.Masticatory
E.Risorius muscles
6.Patient 45-years-old accidentally drank acetic acid. Burn what department of
alimentary system will occur firstly?
A.Oral cavity, oropharynx
B.Oesophagus
C.Small intestine
D.Pharynx
E.Stomach
7.The examination of the patient revealed hypertrophy and inflammation of the lymphoid
tissue, swelling of the mucous membrane of the soft palate between the arches (acute
tonsillitis). Which of the tonsils is contained in the norm in this place?
A.Tonsilla palatina
B.Tonsilla pharyngealis
C.Tonsilla lingualis
D.Tonsilla tubaria
E.All answers are correct
8.During the first days of a newborn child, a pediatrician detected that milk gets into the
child's nasal cavity. What malformation does this fact indicate?
A.Non-closed palate
B.Diverticulum of esophagus
C.Esophageal atresia
D.Cleft clip
E.Esophagus constriction
9.During a meal, milk gets into the nasal cavity of a newborn child. What is the probable
cause of this pathology?
A.Cleft palate
B.Nasal septum deviation to the right
C.Basal skull fracture
D.Cleft clip
E.Nasal septum deviation to the left
10.On examination, the doctor found a small ulcer on the front left palatine arch. On
what muscle possible spread infection process?
A. m. palatoglossus
B. m. uvulae
C. m. palatopharyngeus
D. m. genioglossus
E. m. hyoglossus
11.Name the upper wall of the oral cavity:
A.The hard palate and soft palate
B.The oral diaphragm
C.The lips
D.The fauces
E.The cheeks
12.Name the inferior wall of the oral cavity:
A.The oral diaphragm
B.The hard palate and soft palate
C.The lips
D.The fauces
E.The cheeks
13.Where does the buccal fat pad lie?
A.Between the masseter muscle and buccinator muscle
B.Between the tensor veli palatini and the levator veli palatini
C.Between the palatoglossal and the tensor veli palatini
D.Between the palatoglossal and the levator veli palatini
E.Between the musculus uvulae and palatopharyngeal
14.Name the frontal and lateral bounds of the oral cavity proper:
A.The teeth and gums
B.The oral diaphragm
C.The lips
D.The fauces
E.The cheeks
15.Name the anterior bound of the oral vestibule:
A.The lips
B.The oral diaphragm
C.The teeth and gums
D.The fauces
E.The cheeks
References:
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 2.
Tongue. Salivary glands.
1. Relevance of the topic.
Knowledge of this section anatomy of the region important to the students for further
learning.
2. The specific aims:
Analyze face development in ontogenesis.
To explain:
- the structure of the tongue;
- part of tongue.
Classify tongue papillae and their functions.
Classify the muscles of the tongue and their functions.
Explain tongue disease.
Classify salivary glands and their functions.
Explain cellular spaces of the mouth and their clinical significance.
3. Basic knowledge and skills necessary to studying the topic (inter-disciplinary
integration):
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system
Anatomy
Ontogeny of the digestive system;
topics for further study
4. Task’s for student’s individual work.
4.1. The list of basic terms, parameters characteristics which the student should
master while preparing for the class:the root of tongue- radix linguae, apex of tongueapex linguae, the dorsum of tongue- dorsum linguae, the middle groove of the tonguesulcus medianus linguae, filiform papillae- papillae filiformes, fungiform papillaepapillae fungiformes.
4.2. Theoretical questions for the class:
1. Share structure and function of the tongue?
2. The development of facial ontogeny?
3. Show and called on the preparations of the tongue?
4. Show and called on the preparations filamentous and mushroom buds? What is their
function?
5. Show the leaf buds and zholobuvati? What is their structure and function?
6. Name the show and on the preparations insertion tongue muscles? What is their
function?
7. Name the preparations for and show their muscles of the tongue?
8. Name the disease tongue?
9. The classification of salivary glands?
10. Topography, structure, function of minor salivary glands?
11. Topography, structure, functions of the parotid salivary gland?
12. Topography, structure, functions under the mandibular salivary gland?
13. Topography, structure, functions sublingual salivary glands?
14. Cellular spaces of the space of the mouth, their clinical significance?
4.3. Practical work (tasks) that are performed in class:
On the preparations, schemes, models and drawings examine the topography, the
structure of the tongue and salivary glands. To identify cellular spaces oral cavity.
Content topics.
Tongue (lingua), (gr. glossa) - a person performs several functions. It is an important
organ of the digestive system, facilitates the processing of food in the mouth and
movement of her throat, performs the function of the organ of taste. One of its most
important features is voice intelligibility.
In the tongue distinguish two parts: front - body language (corpus lingvae) from the tip
(apex lingvae) and back - tongue root (radix lingvae). The back of the tongue (dorsum
lingvae) convex. Along the tongue is the median furrow (sulcus medianus lingvae), which
coincides with the language barrier connective tissue (septum lingvae). This furrow ends at
the back of the tongue, the tongue blind hole (foramen caecum lingvae), which takes place
in both directions separating groove (sulcus terminalis). Behind the boundary of grooves
positioned lingual tonsils (tonsilla lingvalis).
The mucous membrane of the tongue protrusion many forms - tongue papillae
(papillae lingvales). In form they are divided into filiform papillae, mushroom-shaped,
leaf-shaped and papilla vallatae. Filiform papillae (раріllа filiformes) occupy the entire
surface of the tongue, perform a mechanical function, prevent premature movement of
food, catch food on the surface of language and are sensitive receptors that respond to
temperature, touch, pain. The fungiform papillae (papillae fungiformes) placed between
the filamentary and have a round top, size of 0.4 to 1 mm. They are covered by stratified
squamous epithelium and are not keratinizing taste bulbs. The foliate papillae (papillae
foliatae) are located on the edges of the tongue and have the form of vertical folds. Their
surface epithelium are numerous taste bulbs. The vallate papillae (papillae vallatae) the
largest in size from 1 to 3 mm in width and each of them surrounded trough, it is 7-14,
which are located in front of the boundary grooves and blind holes. All papillae except
filiforming have taste (sweet, salty, bitter, sour).
The muscles of the tongue are divided into two groups: the skeletal muscles that
begin from bone and aponeurosis attached to the tongue, and their muscles begin and
attached in the thickness of the tongue. By the skeletal muscles include: genioglossus
muscle (m. genioglossus), the hyoglossus muscle (m. hyoglossus), the styloglossus
muscle (m. styloglossus) and the hondroglossus muscle (m. hondroglossus).
By their own tongue muscles include upper and lower longitudinal muscles (m.
longitudinalis superior et inferior), transverse muscle (m. tranversus lingvae), vertical
muscle of tongue (m. verticalis lingvae).
Tongue neonatal short, wide and thick, it fills the mouth. Its tip is placed in the
space formed tubercles cutters and side edges in contact with mucous cheeks, which can
not in the mouth. Tongue mucosa has all kinds of papillae, which are numerous taste
buds (cup). With age, the number of taste buds decreases.
Oral cavity glands (glandulae oris) divided into large and small. Small salivary
glands (glandulae salivarae minores) are located in the mucosa or submucosal layer of
the walls of the mouth. Lie under the oral cavity mucosa in the area of : lips (the labial
glands, gll. labiales), cheeks (the buccal glands, g1l. buccales), molars (gl1. Molares),
and some are actually in the mouth, palate (the palatine glands, g1l. palatinae) tongue
(the lingual glands, gl1. linguales). The most numerous among them are the lip, palate
and tongue glands.
Among the major salivary glands (glandulae salivarae majores) include hyoid
(glandulae sublingvales), submandibular (gl1. submandibulares), parotid glands (gl1.
parotidea). These paired glands.
Sublingual salivary gland placed on the upper surface of the oral and sublingual muscle
and consists of several parts. The mass of about 5 grams, tubular-alveolar, function mucosa.
Small sublingual ducts (10-15) (ductus sublingvales minores), partially open along sublingual
folds in their own mouth or are connected and form a large hyoid duct (ductus sublinguales
majores), which opens with joint orifice on caruncula sublinguaes.
Submandibular salivary gland located at the angle of the mandible,
submandibular triangle in the area under the jaw-hyoid muscle. The weight of 15 grams,
tubular-alveolar; secretes mucous and serous secretion. Strait submandibular glands
(ductus submandibulares) goes around the back edge of jaw-muscle and sublingual opens
on sublingual papilla.
Parotid salivary gland located in the parotid area face,enfolds the
temporomandibular joint and lies in retromandibularis fossa. Parotid gland is covered by
fascia, from which the thick connective tissue membrane glands away. The weight of 2030 grams, tubular-alveolar, provides serous secretion. Parotid duct (ductus parotideus) is
1-2 cm below the zygomatic arch and at the front edge of chewing muscles, muscle and
permeates the buccal mucosa opens to a vestibule mouth cheek against the top of the
second molar tooth.
Glands mouth - labial, buccal, molar - anatomically formed, but before six months
are functioning poorly, as the child gets liquid food. Major salivary glands - parotid,
submandibular and sublingual - in its topography and structure of childhood was
different from the adult cortex. For infants and young children characterized by weak
development of connective tissue stroma and glands rich vascularization. Weight parotid,
submandibular and sublingual glands in the newborn is under 1.8 g, 0.8 g and 0.4 g to 3
month of weight gland doubles and 2 years increased in 5.6 times, after which the rate of
growth decreases.
Parotid duct opens in early childhood on the mucosa of the cheek backwards 2nd large
molar tooth; the appearance of permanent teeth eye localized at the 1st big molar teeth in
adults is usually shifted to 2nd molar. The diameter of the duct cells in newborns is 0.25
mm, 1 mm in adults. Course parotid duct in infants and children usually arched, rarely
straight.
Submandibular duct and sublingual glands similar to those in adults.
Cellular spaces oral cavity (space formation festering abscesses):
- spacio submaseterica;
- pterygoid spacio (infratemporal fossa);
- fossa pterygopalatina;
- corpus adiposum buccae;
- space floor of the mouth;
- regio parotideomasseterica.
Materials for self-check:
А. Tasks for self-check: Draw pictures and mark the structure of the tongue papillae.
B. Choose the correct answer:
1.A 35-year-old patient complained of pain and edema in the site of oral cavity floor.
After exanimation, the inflammatory process in the site of the excretory duct of
submandibular gland was diagnosed. Where does this duct open to?
A.Caruncula sublingualis.
B.Vestibulum oris.
C.Plica sublingualis.
D.Foramen caecum linguae.
E.Recessus gingivalis.
2.A 40-year-old patient complained of pain and edema in the site of oral cavity floor.
After exanimation, the inflammatory process in the site of the major excretory duct of the
sublingual gland was diagnosed. Where does this duct open to?
A.Caruncula sublingualis
B.Vestibulum oris
C.Foramen caecum linguae
D.Plica sublingualis
E.Recessus gingivalis
3.A 56-year-old patient complained of pain and edema in the site of oral cavity floor.
After exanimation, the inflammatory process in the site of the minor excretory duct of
the sublingual gland was diagnosed. Where does this duct open to?
A.Plica sublingualis
B.Vestibulum oris
C. Foramen caecum linguae
D.Caruncula sublingualis
E.Recessus gingivalis
4.A 53-year-old patient complained of pain and edema in the site of oral cavity floor.
After exanimation, the inflammatory process in the site of the excretory duct of the
parotid gland was diagnosed. Where does this duct open to?
A.Vestibulum oris
B.Recessus gingivalis
C.Foramen caecum linguae
D.Caruncula sublingualis
E.Plica sublingualis
5.After a face injury, a patient has hematoma in the cheek area. What salivary glands
secretion outflow is blocked by the hematoma?
A.Parotid
B.Bucral
C.Submandibular
D.Labial
E.Sublingual
6.Dentist during the inspection of the oral cavity found between the middle and posterior
third of tongue papillae inflammation. Inflammation which papillae doctor found?
A.Papillae vallatae
B.Papillae fungiformes
C.Papillae foliatae
D.Papillae filiformes
E.Papillae conіcae
7.On examination, vestibule of mouth dentist found redness on the buccal mucosa,
opposite to the upper second molar tooth. Which major salivary gland can be damaged
the first place?
A.Parotid
B.Sublingual
C.Palatine
D.Submandibular
E.Lingual
8.Where is located the lingual tonsil?
A.In the root of tongue
B.In the apex of tongue
C.In the inferior surface of tongue
D.In the dorsum of tongue
E.In the tonsil sinus
9.Where is located the anterior lingual gland?
A.In the area of the tip of tongue
B.In the root of tongue
C.In the inferior surface of tongue
D.In the dorsum of tongue
E.In the tonsil sinus
10.Where is located the parotid gland?
A.In fossa retromandibularis
B.In the area of the tip of tongue
C.In the inferior surface of tongue
D.In the root of tongue
E.In the tonsil sinus
11.Where does the sublingual gland lie?
A.Above the mylohyoid along the internal surface of the mandible
B.In the submental triangle
C.Above the stylohyoid along the internal surface of the mandible
D.In the submandibular triangle
E.Above the mylohyoid along the external surface of the mandible
12.Where does the submandibular duct open to?
A.Caruncula sublingualis
B.Vestibulum oris
C.Foramen caecum linguae
D.Recessus gingivalis
E.Plica sublingualis
13.Where does the parotid duct open to?
A.Vestibulum oris
B.Recessus gingivalis
C.Foramen caecum linguae
D.Caruncula sublingualis
E.Plica sublingualis
14.Where does the major sublingual duct open to?
A.Caruncula sublingualis
B.Vestibulum oris
C.Foramen caecum linguae
D.Recessus gingivalis
E.Plica sublingualis
15.Where does the parotid duct open to?
A.Opposite to the upper second molar tooth
B.Recessus gingivalis
C.Foramen caecum linguae
D.Caruncula sublingualis
E.Plica sublingualis
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 3. Teeth.
1. Relevance of the topic.
The science of teeth - odontology (odus, odontus - tooth) is a part of dentistry.
Knowledge of anatomy of the teeth, their development, order and timing of the eruption
of primary teeth necessary for the study of these sections as childhood diseases, diseases
of the teeth and mouth.
Knowledge of anatomy end of this section is important for students to further
studies.
2.The specific aims:
To analyze the development of tooth ontogeny.
Explain:
- tooth, the tooth surface, tooth structure;
- periodontal structure and its function;
- periodontal structure; signs of teeth.
- structure of milk and permanent occlusion;
- structural features of primary teeth;
- formuly tooth eruption dates.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration)
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4.Task’s for student’s individual work.
4.1. The list of basiuc terms, parameters, characteristics which the student should
master while preparing for the class: the teeth- dentes, the crown- corona dentis, the
lingual surface- facies lingualis, the vestibular surface- facies vestibularis, the approximal
surfaces- facies approximalis, the occlusal surfaces- facies occlusialis, the root- radix
dentis, the neck- cervix dentis, the root apex- apex radices dentis, the pulp cavity- cavitas
dentis, the dental pulp- pulpa dentis, the root canal- canalis radices dentis, dentindentinum, enamel- enamelum, cement- cementum, the incisor teeth- dentes incisive, the
canine teeth- dentes canini, the premolar teeth- dentes premolars, the molar teeth- dentes
molars, wisdom tooth- dens serotinus.
4.2. Theoretical questions for the class:
1. Development of tooth ontogeny?
2. Name and tell tooth structure?
3. Name and tell tissue of tooth?
4. Name and show the surface of the tooth?
5. Name and tell the group of teeth?
6. What is periodontal, paradontal, gum?
7. What are the signs of teeth?
8. Tell us about the development of the oral cavity.
9. Name and tell us about the development and bookmark teeth.
10. Describe the general anatomy of teeth.
11.Formula of deciduous teeth.
12. Show and explain some features of the structure of teeth: incisors, canines, molar
teeth.
13. What is the internal structure of the tooth?
14. What are the terms of the eruption of primary teeth.
15. What is a mixed bite?
16. Determine tooth preparation.
17. Name structure of the dental arches?
18. What is a dental arch, alveolar arch, arch of root? Their features on the upper and
lower jaws?
19. What is a articulation?
20. What occlusion, its types?
21. What is the bite, bite types?
22. Describe the physiological bite?
24. Describe the pathological bite?
25. What do you know abnormalities of teeth?
4.3. Practical work (tasks) that are performed in class:
On anatomical preparation, schemes, models and drawings examine the structure of milk
and permanent teeth.
The content of the topic.
Teeth
The teeth are divided into two sets — namely, the temporary, milk, or
deciduous, which belong to early infancy, and the permanent, which replace the
temporary. The temporary teeth are twenty in number — ten upper, five in each
maxilla, and ten lower, five in each half of the mandible. The number of permanent
teeth is thirty-two — sixteen upper, and sixteen lower.
Structure of a Tooth. — The crown of a tooth contains a central cavity,
called the pulp cavity, which is occupied by the dental pulp. The shape of the pulp
cavity corresponds with that of the crown, and it extends into the root, and as many
fangs as compose it, terminating in a small opening on the apex of the fang. The
cavity also extends for a little into the cusps of the premolars and molars, and in
the incisors it is continued into each angle of the crown. The wall of the cavity
presents a number of openings, which lead into the dental canaliculi. The dental
pulp is composed of a matrix of connective tissue, containing bloodvessels, nerves,
cells, and fibres, which latter seem to be processes of the cells. It is destitute of
lymphatics. The cells are scattered throughout the matrix, and at the surface of the
pulp they form a continuous layer, being there known as the odontoblasts. This
layer is sometimes spoken of as the membrana eboris The pulp is very vascular and
sensitive, its vessels and nerves reaching it through the minute openings at the
apices of the roots.
The substance of the tooth is formed of three tissues — namely, ivory or
dentine, enamel, and cement or crusta petrosa. The dentine forms the principal part
of the tooth, surrounding the pulp cavity and its prolongations; the enamel covers
the exposed part or crown; and the cement covers the root.
Tooth surface:
Occlusal surfaces (for cutting tools - cutting, for canines - tearing, for premolars shredding, for molars - chewing);
Vestibular surfaces;
Oral surface (for lower teeth - lingual, for upper - palatine);
Aproksymalni (contact) surface - mesial and distal.
Groups of teeth:
Signs teeth:
incisor;
1. Signs of root.
canine;
2. Signs angle of crown.
premolars;
3. Signs curvature of crown.
molars.
4. Number of roots.
Paradontal (amfodontoz) - tissue surrounding the tooth, periodontal gum, alveoli, jaw.
Clear - the mucous membrane that covers the cellular processes jaws. Has parts:
Fixed;
Free (forms interdental papillae).
Periodontal - a ligament, nerves and blood vessels, placed in the jaw cement between
the tooth and the wall of the cell. Function: Hold, amortization, touch.
Temporary occlusion (deciduous) - 20 teeth.
Specifics:
- No premolars and third molars;
- Smaller;
- On the blue-colored milk;
- The vestibular surface with a roller;
- Flat molars roots diluted.
Permanent bite - 28-32 tooth.
Mixed bite - from 5-6 years to 13-14 years.
Formula teeth.
In the practice of medicine taken to represent the number of teeth dental formula.
Unwrapped letter-numerous:
m2m1c i2i1i1i2c m1m2
m2m1c
i2i1i1i2c
m1m2
Group letter-numerous:
m2c1i2i2c1m2
m2c1i2i2c1m2
Anatomical formula of deciduous bite:
2012 2102
2012 2102
Clinical formula of deciduous bite:
V IV III II I І ІІ ІІІ ІV V
V IV III II I I II III IV V
International clinical formula of deciduous bite:
55…..51
61..65
85......81
71..75
Teeth erupt in the postnatal (after birth) period at a certain time and in a specific order.
Infants appearance of baby teeth reflects the general processes of skeletal bone formation
and absorption of minerals. Missing deadlines eruption of primary teeth can be an
indicator of rickets.
Medium term eruption of primary teeth
Medial incisors
6-9 міс.
The lateral incisors 9-12 міс.
The first molars
12-15 міс.
Canins
17-20 міс.
The second molars 21 -24 міс.
The period from the beginning of the 3rd year of life to the end 6-8 was called a period
of rest - in the years functioning teeth.
Formula permanent teeth.
Unwrapped numerous:
8 7 6
8 7 6
Unwrapped letter-numerous:
M3M2M1P2P1C
M3M2M1P2P1C
Group numerous:
5 4 3 2 1 1 2 3 4 5 6 7 8
5 4 3 2 1 1 2 3 4 5 6 7 8
I2I1I1I2C P1P2M1M2M3
I2I1I1I2C P1P2M1M2M3
3 2 1 2 2 1 2 3
3 2 1 2 2 1 2 3
Group letter-numerous:
M3P2C1I2I2C1P2M3
M3P2C1I2I2C1P2M3
International formula:
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Numbered jaw segments: the first number - the number of segments, the second number
- a serial number of clinical dental formula.
The terms and order of eruption of permanent teeth
Eruption term (years)
Teeth
Mandible
Maxilla
The medial incisor
6-7
7-8
The lateral incisor
7-8
8-9
Canines
9-10
11-12
1 premolar
10-12
10-11
2 premolar
11-12
10-12
1 large molar
6-7
6-7
2 large molar
11-13
12-13
3 wisdom molar
12-26
17-21
Patterns teething:
- Strict mode change;
- Parity;
- First in the mandible (providing faster development mandible).
Teeth are placed in cells to form dental arch. On the upper jaw it has the shape of
an ellipse at the bottom - the shape of a parabola.
The line centered occlusal surface of teeth - dental arch; line of cells jaw - alveolar
arch; line on the tips of the roots of teeth - root arc. At the root mandibular arch more
than tooth on the upper jaw vice versa.
Articulation – any value of the lower jaw to the upper (talking, chewing).
Occlusion – closing the dental arches at maximum contact.
Distinguished:
- Central occlusion - matches medial incisors lines between the upper and lower jaws;
- lateral occlusion - right (lower jaw is shifted to the right) and left.
Bite (mordex) - closing the dental arches in the position of central occlusion,
where each tooth has two antagonists except medial incisors of the lower jaw and upper
third molars. Bite are normal and abnormal. Normal occlusion characterized in that the
upper jaw teeth (incisors) go in front, on the lower and fangs, premolars and molars
merge with corresponding teeth of the lower jaw, but on the side of them.
Types of bite.
1. Physiological (normal) bite:
- Orthognathic;
- Direct.
2. Pathological (main types):
- Prognathic (prognatia);
- Open (hiatodontia);
- Progeny (progenia);
Anomalies of teeth.
1. Violation of eruption:
- Edentulous (partial, full);
- Retention;
- Violation of the terms and order of eruption.
2. Violation of accommodation:
- Diastema;
- Outside the arch (oral or vestibular position);
- Crowding teeth.
3. Anomaly of structure:
- Hypoplasia;
- Hyperplasia;
- Fluorosis;
- Wedge-shaped defect.
4. Changing shape:
- Subulate teeth
- Anomalies roots (length, number, distortion).
Materials for self-check:
А. Tasks for self-check: on the figures mark of teeth.
B. Choose the correct answer:
1.Dentist at examination of oral cavity of child found out the short bridle of upper lip. On
what teeth will render the negative consequences this anomaly of development?
A.Medial upper incisors
B.Lateral upper incisors
C.Lateral lower incisors
D.Medial lower incisors
E.Upper canines
2.A mother appealed for help to the pediatrician. Sick girl 9 months, with a high
temperature, cries, pushes toys in a mouth. What tooth cuts through in this age?
A.Lateral lower incisor
B.Medial lower incisor
C.Canine
D.Lower molar
E.Premolar
3.A mother appealed for help to the pediatrician. Sick girl 16 months with a high
temperature, cries, pushes toys at mouth. What tooth cuts through in this age?
A.Lower canine
B.Upper canine
C.Lower second molar
D.Premolar
E.Medial lower incisor
4.A mother appealed for help to the pediatrician. Sick girl 14 months with a high
temperature, cries, pushes toys in a mouth. What tooth cuts through in this age?
A.First upper molar
B.Medial lower incisor
C.Premolar
D.Canine
E.Lower second molar
5.A mother appealed for help to the pediatrician. Sick girl 19 months with a high
temperature, cries, pushes toys in a mouth. What tooth cuts through in this age?
A.Upper canine
B.Lower canine
C.Medial lower incisor
D.Premolar
E.Lower second molar
6.A tooth in which lingual surface less than a cheek is remote in a patient. Masticatory
surface in the form of oval. A deep transversal fissure divides cheek and language
tubercles. A root is strongly constrained in mesio-distal direction with longitudinal
fissures on aproximal surfaces and bifurcated. Define what tooth is this.
A.First upper premolar
B.Upper canine
C.Lower canine
D.First lower premolar
E.Second upper premolar
7.Paradont includes:
A.Periodont; dental alveolus; gum; cement
B.Periodont; gum; tooth
C.Gum; tooth; dental alveolus; periodont
D.Dental alveolus; gum; cement
E.Periodont; root of tooth; dental alveolus
8.A mother appealed for help to the pediatrician. Sick girl 6 months, with a high
temperature, cries, pushes toys in a mouth. What tooth cuts through in this age?
A.Medial lower incisor
B.Lateral lower incisor
C.Premolar
D.Canine
E.Lower molar
9.While of oral cavity examination, the dentist revealed the formation of the first molar
teeth on the lower jaw of a child. How old is this child?
A.6-7 years old
B.4-5 years old
C.8-9 years old
D.10-11 years old
E.12-13 years old
10.A mother consulted the doctor about her one-year-old child, who has got six teeth
come out. How many teeth should the child of such age have?
A.8
B.10
C.7
D.12
E.6
11.A mother consulted the doctor about her two-year-old child, who has got twenty-one
teeth come out. How many teeth should the child of such age have?
A.20
B.18
C.21
D.24
E.19
12.When processing a molar tooth with a dental cutter the dentist has by accident deeply
wounded the patient's cheek and damaged not only the mucosa but also a muscle. Which
muscle was hurt?
A.Buccinator
B.Orbicular muscle of mouth
C.Risorius
D.Procerus
E.Masseter
13.Specify parts of the tooth.
A.The crown, the root, the neck
B.The root apex
C.The pulp cavity
D.The root canal
E.The apical foramen
14.Specify surfaces of the crown.
A.The lingual, the vestibular, approximal, the occlusal
B.The vestibular
C.The lingual
D.The buccal
E.The palatine
15.Specify tissue structure of the tooth.
A.Dentin, enamel, cement
B.Periodontium
C.The gums
D.The root canal
E.The crown, the root, the neck
16.Periodontium includes:
A.Strong ligaments, which fix the tooth to the dental alveoli
B.Root of tooth; dental alveolus, gum
C.Gum; tooth; dental alveolus
D.Dental alveolus; gum; enamel
E.Dental alveolus; gum; cement
17.How many teeth should the child of one-year-old have?
A.8
B.10
C.7
D.12
E.6
18.How many teeth should the child of two-year-old have?
A.20
B.10
C.8
D.12
E.7
19.Which kind of teeth should the child of 6 month have?
A.Medial lower incisor
B.Lateral lower incisor
C.Premolar
D.Canine
E.Lower molar
20.Which shape of crown must the incisor teeth have?
A.Chisel-shaped
B.Square
C.Cone-shaped
D.Flattened out
E.Rhomboid
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 4. Pharynx. Esophagus. Stomach.
1. Relevance of the topic.
Knowledge of anatomy pharynx, esophagus, stomach, their topography (skeletopy,
holotopy, syntopy), students need to study the topography anatomy, emergency surgery,
propaedeutics internal medicine, childhood diseases.
2. The specific aims:
Explain what is holotopy, syntopy, skeletopy of body. Giving the definition of these
terms.
To explain: - topography, structure and functions of the pharynx.
Make handwriting a table of the structure of the pharynx.
To explain: - topography, structure and function of the esophagus.
Make handwriting a table of the structure of the esophagus.
Explain:
- The topography of the stomach;
- Structure of the stomach.
- Part of the stomach;
- Structure of the stomach wall;
- Connections stomach;
- Stomach field, stomach dimples and transverse, longitudinal and oblique muscles.
To analyze the abnormalities of the pharynx, esophagus, stomach.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
The acquired knowledge
subjects
Biology
genealogy of the digestive system;
Anatomy
ontogeny of the digestive system;
To further explore topics.
4. Task’s for student’s individual work.
4.1.The list of basic terms, paramaters, characteristics which the student should
master while preparing for the class: cavity of pharynx- cavitas pharingis, the
nasopharynx- pars nasalis pharingis, vault of pharynx- fornix pharynges, the
pharyngeal opening of auditory tube- ostium pharyngeum tubae auditivae, the
cervical part- pars cervicalis, the abdominal part- pars abdominalis.
4.2. Theoretical questions for the class (to the topic):
1. Report about the topography, structure, functions pharynx.
2. Report about the topography, structure, functions of the esophagus.
3. What is holotopy, syntopy, skeletopy of pharynx and esophagus? Define these
terms?
4. What do you know abnormalities of the pharynx, esophagus?
5. Report about the topography, structure, functions of the stomach.
6.What is holotopy, syntopy, skeletopy of stomach? Define these terms?
7.What you know abnormalities of the stomach?
4.3. Practical tasks pertaining to the topic and to be completed during the class:
In the preparations, models, tables examine the structure of the pharynx, esophagus and
stomach. Determine their topography and features.
The content of the topic.
Pharynx (рharуnx) located in the front of the neck and starts from the outer base
of the skull to the cervical vertebrae VI.
Pharyngeal cavity (cavitas pharingis) divided into nasal, oral and laryngeal parts.
The nasal part of the pharynx (pars nasalis pharingis) located at the level near
hoan, between the arch and palatal curtain. On the side wall of the nasal pharyngeal
opening paired auditory tube hole (ostium pharingeum tubae auditive). These holes
connect pharyngeal cavity of the tympanic cavity.
Oral part of pharynx (pars oralis pharingis) located at the throat and palate and
tongue curtains or entrance to the larynx. Behind of the tongue mucosa continues on the
front surface of the epiglottis and the midline forms a well-developed middle median
glosso-epiglottic fold (plica glossoepiglotica mediana) and on either side of it - the less
developed the even side of lateral glosso-epiglottic fold (plica glossoepiglottica
laterales). A paired pit, the epiglottic vallecula( vallecula epiglottica) lying between the
aforesaid folds.
Laryngeal part of pharynx (pars pharingis) located between the level of the
entrance to the larynx and pharynx transition into the esophagus and extends to the
bottom of cricoid cartilage. On the side wall of the pharynx laryngeal depression are
s
s
a
e
significant – the piriform fossa (recessus piriformes), which can be delayed, solid food
particles.
The structure of the wall of the pharynx is presented mucous membrane (tunica
mucosa), muscle (tunica muscularis) and adventive (tunica adventitia).
All the muscles of the pharynx is divided into the muscles that constrict the
pharynx and the muscles that lift the pharynx.
To the muscles that elevator the pharynx are stylopharyngeus muscle (musculus
stylopharingeus) and palatopharyngeus muscle (musculus musculus palatopharyngeus).
To narrow pharynx muscles which include the superior constrictor (musculus
constrictor pharingis superior), middle constrictor pharynx muscle (musculus constrictor
pharingis medius) and lower pharynx inferior constrictor muscle (musculus constrictor
pharingis inferior).
Pharynx in newborns is relatively wider, but shorter than in adults. Pharyngeal
arch is almost not expressed. The pharynx passes to the esophagus at the level of 3-4
cervical vertebrae.
The nasal part of the pharynx has a more sagittal size and low height, respectively,
of the weak development of the nasal cavity. A significant increase in nasal part of the
pharynx in height occurs in the first childhood and adolescence. The angle between the
nose and soft palate increases from 25°-30° in the newborn to 40°-45° - adult. The pipe
itself has a horizontal direction, allowing for easier catheterization through the nasal
cavity. The hole pipe is a pipe Mihalik, hypertrophy of the hole which is pressed and
comes hearing loss.
Pharyngeal tonsils poorly developed in newborns, in the 1st year of life and it
increases in thyroid can close choana ratio. Tonsil growth continues during the first and
second child, and then it atrophies. Pharyngeal, trumpet, palatine, lingual tonsils form the
pharyngeal lymphoid ring formations that surrounds the beginning of the digestive and
respiratory tracts. Lymphoid formation are essential for the formation of immunity. This
explains why almonds are poorly developed in newborns who have a natural immunity
that is passed from the mother, and grow rapidly in the first years of life, when
intensified contact with infectious agents and the formation of the immune system.
Before puberty, growth of the tonsils is stopped.
The oral part of the pharynx located higher in newborns than in adults, level I-II
cervical vertebrae, laryngeal part of the pharynx corresponds to II—III cervical
vertebrae. The pharyngeal glands produce only mucous secret, after a year they appear
serous elements.
Esophagus (оеsophagus) - begins at cervical vertebrae VI and XI at left thoracic
vertebra goes into the stomach. There are three esophagus, neck (pars cervicalis),
abdominal (pars abdominalis), thoracic (pars thoracisa).
Cervical portion is at VI to the cervical vertebrae and thoracic vertebrae. On each
side of the esophagus located rotary laryngeal nerve and common carotid artery, the front
- the trachea and behind - the vertebrae.
Thoracic esophagus in the upper back and mediastinum. At the level of IV thoracic
vertebra, the esophagus passes behind the left main bronchus, bears to the rear surface of
the aortic arch lies in the posterior mediastinum at the right side of the descending aorta.
Thus, the aorta is on the left. The esophagus case.
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. inlength, and
only its front and left aspects are covered by peritoneum. It is somewhat conical with its
base applied to the upper orifice of the stomach, and is known as the antrum
cardiacum.The wall of the esophagus has an outer sheath of connective tissue (tunica
adventitia), muscle (tunica muscularis) and mucosa (tunica mucosa).
The lumen of the esophagus has a series of narrowings and extensions that should
be considered in the diagnosis of various pathological conditions.
Anatomical narrowing: 1) pharyngeal - in place of transition throat into the
esophagus, behind the plate persnepodibnoho cartilage (VI cervical vertebra); 2)
bronchial - at the bifurcation of the trachea, a place of intersection of the left main
bronchus (IV thoracic vertebra) 3) diaphragm - the place of passage of the esophagus
through the diaphragm.
Physiological narrowing, which is the only living person: 1) aortic - cross at the
site of the esophagus with thoracic part of the aorta (VII - IX thoracic vertebrae); 2)
cardiac - a place of transition of the esophagus into the stomach (XI thoracic vertebra).
Esophagus at a newborns has a length of 11-16 cm to 1 year increased to 18 cm to
3 years up to 21 cm, 25 cm in adults. Almost essential to know the distance from alveolar
(dental) arch to the entrance to the stomach; this size in infants is 16-20 cm in early
childhood 22-25 cm in the first period of childhood 26-29 cm in the second period of
childhood 27-34 cm, 40-42 cm in adults. At that distance, adding a 3.5 cm, it is necessary
to advance the probe that he was in the stomach.
Newborn marked the beginning of a higher level of the esophagus between the
cartilage III-ed and IV-th cervical vertebrae. At the age of 2 years, the upper limit of the
esophagus drops to IV-V vertebrae, and 12 years is set at the same level as an adult, is at
an altitude of VI-VII cervical vertebrae. The lower end of the esophagus in all age
groups corresponding to X-XI thoracic vertebrae.
The shape of the esophagus in newborns spindle with a small narrowing in the
neck part. Second place is narrowing of the esophagus intersection left bronchus.
Diaphragmatic constriction in young children absent or mild. The diameter of the lumen
of the esophagus at narrowing in infants is 4-9 mm, and in early childhood 12-15 mm, in
the second period of childhood it reaches 13-18 mm.
The second child esophagus loosely connected to surrounding organs and easy
shifting. The mucosa it very gentle, has numerous branched tubular gland. The muscular
coat of the esophagus in infants and children younger ages thin. The development of
muscle continues to 13-14 years.
Stomach (ventriculus) at the top of the abdominal cavity under the diaphragm.
Three quarters of the stomach placed on the left subcostal area, one fourth - in the
epigastric region (erigastrium). Skeletopy: cardiac hole located at the left thoracic
vertebra VI; gate opening - at the right XII thoracic vertebra. The bottom of the stomach
- in the fifth left intercostal space on the 1.5 cm mid midclavicular line. Lesser curvature
located at xiphoid process sternum bone. United curvature may change its position,
depending on the filling of the stomach, in the case of normal filling of the stomach - is
located on the second lumbar vertebra. Syntopy: cardio, bottom and front wall of the
stomach is partially adjacent to the diaphragm; gate to the small curvature of the adjacent
left side of the liver, stomach left of the bottom placed spleen. Part of the front of the
stomach adjacent to the anterior abdominal wall. Behind the stomach bag is placed heart,
pancreas, left kidney upper end of the left adrenal gland. The abdominal portion of the
aorta. Bottom-placed somewhat behind the transverse colon.
The stomach has the following parts: cardiac (pars cardiaca), body (corpus
gastricum), bottom (fundus gastricum), pyloric (pars pilorica) .
Stomach wall is made up of three shells: serous, mucous, muscular. Serous
membrane (tunica serosa) – internal peritoneum that covers the stomach from all sides,
except for narrow strips on the small and large curvature. Between the layers internal
peritoneum are blood vessels and nerves that go to the stomach. The under-developed
subserous layer (tela subserosa) separating serous membrane of muscle. The muscular
coat (tunica muscularis) - is situated immediately beneath the serous covering, with
which it is closely connected. It consists of three sets of
smooth muscle fibers: longitudinal, circular and oblique. The longitudinal fibers (stratum
longitudinale) are the most superficial, and are arranged in two sets. The first set
consists of fibers continuous with the longitudinal fibers of the esophagus; they radiate
in a stellate manner from the cardiac orifice and are practically all lost before the pyloric
portion is reached. The second set commences on the body of the stomach and passes to
the right, its fibers becoming more thickly distributed as they approach the pylorus.
Average, circular layer of muscle layer (stratum circulare) is a continuation of similar
cells of the esophagus, and in the goal area significant thickening - muscle - latches (m.
sphincter pulorius). The inner layer of muscle membrane - oblique fibers (fibrae
obliguae), which are on the front and back walls of the stomach.
Submucosal layer (tela submucosa) quite thick, thus mucosa is going to fold. The
mucosa (tunisa mucosa) is covered with a single layer of columnar epithelium. Gastric
mucosa forms Stomach field (ariae gastricae). On the surface, these fields are stomach
dimples (foveolae gastricae), which opened many gastric cancer (glandulae gastricae)
that secrete gastric juice for chemical processing of food.
Relations stomach internal formed two layers of peritoneum, which goes from
neighboring organs. Relations stomach:
1. hepato-gastric ligament (lig. Hepatogastricum);
2. gastrointestinal orifice (lig. Gastrophenicum);
3. gastro-splenic (lig. Gastrosplenicum);
4. gastro-intestinal colon, (lig. Gastro colicum).
In a living person are three main forms of stomach, according to the constitution.
People brachymorphic type - belly is shaped like a horn. People type mesomorphic
peculiar form of stomach in a fishing hook. People dolihomorfnoho type - stomach has
the shape of stockings.
Stomach newborn filled with meconium. After selecting meconium fallen down
body wall, and it is cylindrical. In infancy wide entrance to the stomach, so little kids
often vomiting. Bottom poorly developed stomach, pyloric part, opposite, has a relatively
greater length than in adults.
Topography stomach in infants and in infancy characterized in that the body is
high and not in contact with the abdominal wall. In this period are marked individual
differences stomach position: in some children it is vertical, the second takes a transverse
position. At the age of 2-3 years, stomach again positioned more vertically. After 7-8
years the shape and topography of the stomach meets the following adult.
The stomach capacity of the newborn when filling on the body is 30 cm3, by the
end of the year it increases to 250-300 cm3, and the child reaches 3 years 575-680 cm3,
almost half of the capacity of the adult stomach (1200-1600 cm3). Physiological
newborn stomach capacity does not exceed 7 cm 3, and the first day it doubles by the
end of the newborn period increased 11 times and becomes equal to 80 cm3.
The walls of the stomach at the time of birth is not quite differentiated, not nany
mucosa forms folds. Mucosal surface is 40-50 cm2, in postnatal life, it increases to 750
cm2, that is 15-20 times. The number of gastric dimples, which opened gland in the
newborn is 200 thousand, an adult increases to 5 million. Gastric cancer and 2.5 years
did not produce hydrochloric acid. The muscular coat of the stomach in infants formed
predominantly circular fibers. Well pronounced sphincter home. In newborns there is
sometimes spasmodic contraction of the goal - pilorospazm. This hypertrophic keeper.
Strongly expressed pilorospazm leads to frequent vomiting, exhaustion, and a child
needs surgery.
Materials for self-check:
А. Tasks for self-check: mark on the tables of the throat, esophagus and stomach.
B. Choos the correct answer:
1.During the X-ray, examination of a 30-year-old patient in vertical position a doctor
detected the presence of air in the stomach. What part of the stomach is it in?
A.At the fundus
B.In the cardial
C.In the body
D.In the pyloric
E.In the area of the lesser curvature
2.During a duodenal intubation, the probe does not pass from the stomach into the
duodenum. What part of the stomach is an obstacle (tumor) in?
A.In the pyloric part
B.In the cardial part
C.In the fundus area
D.In the body area
E.In the area of the lesser curvature
3.A patient has pain in epigastric region. What organs disease can it indicate?
A.Stomach, duodenum
B.Small intestine, liver
C.Spleen, kidney
D.Colon, gallbladder
E.Fundus of stomach, transverse colon
4.During a duodenal intubation, the probe does not pass to the stomach from the gullet.
What part of the stomach is an obstacle (tumor) in?
A.In the cardial
B.In the pyloric
C.In the fundus area
D.In the body area
E.In the greater curvature area
5.Children frequently have nasal breathing affection caused by the overgrowth of the
pharyngeal mucous membrane lymphoid tissue. Which tonsils excrescence may cause
this?
A.Pharyngeal
B.Palatine
C.Lingual
D.Tubal
E.All mentioned
6.A patient has a malignant swelling in the abdominal part of the esophagus. Which
group of lymph nodes is regional for this part of esophagus?
A.Anuluslymphaticuscardiacae
B.Nodiparatracheales
C.Nodiprevertebrales
D.Nodiperecardialeslaterales
E.Nodimediastinales posteriors
7.A 10-year-old child complains of nasal breathing affection. Examination has shown
that the cause of this is lymphoid tissue hypertrophy. Which tonsil is increased?
A.Pharyngeal
B.Palatine
C.Lingual
D.Left tubal tonsil
E.Right tubal tonsil
8.Skeletotopy of stomach.
A.Th10 – L1
B.Th5 – L1
C.Th4 – Th12
D.Th10 – Th11
E.C4 – Th11
9.Skeletotopy of pharynx
A.C1 – C7
B.C6-7 – Th11
C.C4 – Th5
D.C7 – Th7
E.C4 – Th11
10.Where is located the lingual tonsil?
A.In the root of tongue
B.In the apex of tongue
C.In the inferior surface of tongue
D.In the dorsum of tongue
E.In the tonsil sinus
11. Patient '42 cylinder chest x-ray was performed stomach. What form of gastric be
determined?
A. Stomach shaped hook
B. Stomach shaped horn
C. Stomach shaped stockings
D. stomach in the form of an elongated hook
E. oblong stomach.
12.Male 37 years brachymorphic type of constitution the body was carried out x-ray of
the stomach. What form of stomach was determined?
A. Stomach shaped horn
B. Stomach shaped stockings
C. stomach in the form of a hook
D. stomach in the form of an elongated hook
E. oblong stomach.
13.During X-ray in patients 30 years of the doctor ver¬tykalnomu position konsta¬tuye
presence of air in the stomach. In which part of the stomach it contains?
A. In the days.
B. In the body.
C. In cardiac.
D. In the pyloric.
E. In the area of small curvature.
14. The patient - pain in the epigastric region. On whose conditions of this mean?
A. Duodenum, ventriculus.
B. Intestinum tenue, hepar.
C. Ren, lien.
D. Vesica fellae, colon.
E. Fundus gastricus, colon descendens.
15. In conducting duodenalno¬ho sensing probe passes from the stomach into the
duodenum. In which part of the stomach existing obstacles (tumor)?
A. In the pyloric.
B. In cardiac.
C. In the bottom section of the stomach.
D. In the stomach area of the body.
E. In all these areas.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Thopic 5. Small intestine.
1. Relevance of the topic.
Duodenum together with the pancreas and the liver is central to the function of
digestion. In the cavity of the duodenum pancreatic enzymes break down proteins, fats,
carbohydrates, and fat digestion bile promotes the absorption of fatty acids. Furthermore
bile increases the tone of the intestines, increases peristalcis and is involved in parietal
digestion, stimulates pancreatic enzymes. Knowledge of the anatomy of the small
intestine, topography (skeletopy, holotopy, syntopy) required students to study
physiology, internal medicine, infectious diseases, surgery.
2. The specific aims:
Analyze:
- Features of the small intestine;
- The topography of the small intestine;
- Small intestine;
- Functions of the small intestine.
- The structure of the wall of the small intestine.
Explain the differences between the structure and ileum intestines empty.
3.Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration)
The precending
The acquired knowledge
subjects
biology
Phylogeny of the digestive system;
anatomy
Ontogeny of the digestive system;
To further explore topics.
4. Task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class: small intestine- intestinum tenue, the superior
part- pars superior, superior duodenal flexure- flexura duodeni superior, ampuladuodenal cap, the descending part- pars descendens, inferior duodenal flexure- flexura
duodeni inferior.
4.2. Theoretical questions for the class (to the topic):
1. Tell us about the features of the small intestine;
2. Describe the topography of the small intestine.
3. What parts of the small intestine.
4. Share function of the small intestine.
5. Which department is divided mesenteric small intestine?
6. Point to the root of the drug mesentery of the small intestine.
7. Tell the structure of the wall of the small intestine.
8. What are the structural features of the mucous membrane of the small intestine.
9. What are the differences in structure and ileum intestines empty.
4.3. Practical task’s pertaining to the topic and to be completed during the class:
On anatomical preparations, tables, models to study the structure, topography of the
small intestine. Determine their functional significance.
The content of the topic.
Small intestine (intestinum tenue) starts out of the stomach and ends at the
confluence of the colon. The length of the small intestine from a living person 2,5 - 4, 5
meters, and the dead person 5.7 meters. connected to the vertebral column by a fold of
peritoneum, the mesentery. The small intestine is divisible into three portions: the
duodenum, the jejunum, and the ileum.
Duodenum (duodenum) has four parts: top (pars superior), downward (pars
descendes), horizontal (pars horisontalis), rising (pars ascendes). The length of the colon
adults 25-30cm., the upper part starts at XII thoracic vertebra ampoule (ampulla), and
behind it is based portal hepatic vein, common bile duct, and the top square lobe of the
liver. Descending part of duodenum begins from the top bend (flexura duodeni superior)
level and lumbar vertebra and descends along the right edge of the vertebral column to
level III lumbar vertebra, which turns sharply to the left, forming a bottom bend (flexura
duodeni inferior). The length of this 10 cm.
The horizontal portion starts from the bottom bend, go horizontally left and level III
lumbar vertebra crosses the inferior vena cava. The ascending part located under the head
and body of the pancreas at the left edge of level II lumbar vertebra and ends emptyduodenal-intestinal bend (flexura duodenojejunalis). Behind is the abdominal part of the
aorta, the upper mesentery artery and vein. To link duodenal ulcers include: hepatoduodenal-intestinal ligament (lig. hepatoduodenale) and suspensory ligament (lig.
suspensorium duodeni).
Duodenal wall consists of three shells. Serous membrane (tunica serosa) covered on all
sides only the initial section of intestine. In serosa isolated subserosa layer (tela subserosa). The
muscular coat (tunisa muscularis) has longitudinal and circular layers not striated muscle fibers.
The mucous membrane (mucosa tunica) covered with a single layer of epithelium and form a
prismatic circular lines and semicircles (plicae circulares). Mucosal surface is ring-shaped curves
called intestinal villi (villi intestinales), 0,2-1,2 mm long, increasing the suction and excretory
area.
Some differences in the structure and iliac empty guts. In the early parts of the
mesenteric small intestine digestion process is faster and more intense. Jejunum is wider
diameter, wall thickness of, mucous membrane has arranged more densely wrinkles, lint,
more blood vessels per unit area of the bowel wall. Ileum narrower wall of thinner
mucosa is smaller wrinkles, lint less blood supply to worse. In the jejunum mucosa are
rare lymphatic nodules, and ileum accumulation of lymph nodes.
Small intestine in infants and young children is relatively longer than adults, due
to the great need of the child's body in the diet. According B.S.Lebed length of the small
intestine in the newborn is about 3 m and refers to body length as 5.4: 1. In the first year
of life continuing rapid growth of the small intestine, and its relation to body length up to
5.7: 1. Intensive development of the small intestine continues to since years, after which
it slowed growth. New growth acceleration body is between 10 and 15 years.
Duodenum the newborn has a length 7,5-10 cm., of its initial and final parts are
at the 1st lumbar vertebra. The form of bowel most often ring, mild curves and formed
after six months. The provisions of the intestine depends on the filling of the stomach,
with empty stomach it is located transversely when it filled the stomach returns attaining
sagittal plane. With age, shifting the lower boundary of the duodenum to the 2nd lumbar
vertebra in 7years and 3rd lumbar vertebra in 12 years. Form intestine as it is becoming
more volatile growth.
Jejunum and ileum gut amount to about 4/5 the length of the entire digestive
tract. In newborns, they occupy a limited space because the upper half abdominal cavity
occupied by the liver, and in the lower section are the pelvic organs. Mesentery small
intestine in infants and young children and a short loop of intestines are relatively high.
With the extension of ripples and lowering the pelvic viscera small intestine moves to
the underbelly.
The structure of the walls of the small intestine in infants is characterized by the
folds and villi mucosal poorly developed. Circular folds are only in the initial jejunum
and the ileum no. The muscular coat to six months has the same thickness as the mucosa,
whereas in later ages it on thicker mucosa.
Materials for self-check:
А. Tasks for self-check:
At the figures mark the small intestine.
B. Tasks for self-check:
1.Where are located the minor duodenal papilla?
A.Above the major papilla
B.Below the major papilla
C.Beside the major papilla
D.On the circular fold of duodenum
E.The intestinal villi
2.Which anatomical structures are opened on the top of the major duodenal papilla?
A.The bile duct, the pancreatic duct
B.The common hepatic duct
C.The accessory pancreatic duct
D.The right hepatic duct
E.The cystic duct
3.Which anatomical structure is opened on the top of the minor duodenal papilla?
A.The accessory pancreatic duct
B.The bile duct
C.The pancreatic duct
D.The common hepatic duct
E.The cystic duct
4.Peritoneal relations of the duodenum.
A.Extraperitoneally (except for a small upper part)
B.All answers are correct
C.All answers are incorrect
D.Mesoperitoneally
E.Intraperitoneally
5.Peritoneal relations of the jejunum and ileum.
A.Intraperitoneally
B.All answers are correct
C.All answers are incorrect
D.Extraperitoneally (except for a small upper part)
E.Mesoperitoneally
6.Where are lied the aggregated lymphoid nodules?
A.In the ileum opposite to the mesenteric side of the intestine
B.In the duodenum, at the lower end of the longitudinal fold
C.In the jejunum opposite to the mesenteric side of the intestine
D.Above the major papilla of duodenum
E.In the superior part of duodenum
7.Name function of the mesentery.
A.Fixes the intestine to the posterior abdominal wall
B.Provides better contact with chime and effective absorption of nutrients
C.Contains connective and adipose tissues, blood and lymphatic vessels, nerves and
numerous lymph nodes
D.Produces the intestinal juice
E.Produces mucus
8.A patient was admitted to the surgical department with suspected inflammation of
Meckel's diverticulum. What part of bowels should be examined in order to discover the
diverticulum in course of an operation?
A.Ileum
B.Duodenum
C.Jejunum
D.Caecum
E.Colon ascendens
9.A patient complains about impaired evacuatory function of stomach (long-term
retention of food in stomach). Examination revealed a tumour of initial part of
duodenum. Specify localization of the tumour:
A.Pars superior
B.Pars inferior
C.Pars descendens
D.Pars ascendens
E.Flexuraduodeni inferior
10.During the endoscopy the inflammation of a major papilla of the duodenum and the
disturbances of bile secretion were found. In which part of duodenum were the problems
found?
A.Descendent part
B. Bulb
C.Lower horizontal part
D.Upper horizontal part
E.Ascendant part
11.A patient has pain in epigastric region. What organs disease can it indicate?
A.Stomach, duodenum
B.Small intestine, liver
C.Spleen, kidney
D.Colon, gallbladder
E.Fundus of stomach, transverse colon
12.During fibrogastroduodenoscopy, a doctor has to examine the major duodenal papilla.
What anatomic formation can serve as a landmark for its revealing?
A.Longitudinal fold of the duodenum
B.Duodenal glands
C.Duodenal cap
D.Circular folds of the duodenum
E.Hepatoduodenal ligament
13.Where are situated the solitary lymphoid nodules?
A.On the mucosa surface of the entire intestine
B.Longitudinal fold of the duodenum.
C.Duodenal glands.
D.Circular folds of the duodenum.
E.Hepatoduodenal ligament.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 6. Large intestine.
1. Relevance of the topic.
Knowledge of anatomy colon topography (skeletopy, holotopy, syntopy) required
students to study physiology, internal medicine, infectious diseases, surgery.
2. The specific aims:
To explain the topography of the colon;
To analyze the differences of the small and large intestines.
To explain:
- The structure of appendix and call options for its location on the anatomical
preparation;
- Especially the topography of the sigmoid colon;
- Layers of the wall of the colon;
- The topography of the rectum;
- The X-ray colon;
- That the formation of a mucous membrane of the rectum;
- Anomalies of the colon.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration)
The precending subjects
Biology
Anatomy
The acquired knowledge
Phylogeny of the digestive system;
Ontogeny of the digestive system;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class: the ascending colon- colon ascendes, transverse
colon- colon transversum, the descending colon- colon descendes, the sigmoid coloncolon sigmoideum, haustra of colon- haustra coli, omental appendices- appendices
omentales, the right colic flexure- flexura coli dextra.
4.2. Theoretical questions for the class:
1. Describe the topography of the blind and colon.
2. Report on a preparation about the differences of the small and large intestines.
3. Report on a preparation about the appendix and call options for its location.
4. Name and show the features of the topography of the sigmoid colon.
5. Name the layers of the wall of the colon.
6. What is the topography of the rectum?
7. Show the X-ray department of the colon.
8. What is the formation of the mucous membrane of the rectum?
9. Abnormalities of the colon?
4.3. Practical tasks pertaining to the topic and to be completed during the class: on
anatomical preparations, tables, models to study the structure, topography colon.
Determine their functional significance.
The content of the topic.
Colon (intestinum crassum), divided into three main parts: cecum, colon and
rectum. The cecum (saecum) located in the right iliac region. Colon has four parts: the
ascending colon (colon ascendens), the transverse colon (colon transversum), descending
colon (colon descendens), sigmoid colon (colon sigmoideum). The end is a department
of the rectum (rectum).
The colon is different from the small intestine into three main external signs. The
outer surface is 3 longitudinal bands - bands colon (teniae colon). Each tape width of
about 1 cm, mesenteric-intestinal colon-band (taenia mesocolica) omental ribbon (taenia
omentalis) and free ribbon (taenia libera). Between the strips are transverse colon
membrane, resulting in the gut wall forms bursiform flexure (haustrae coli). On the wall
of the colon are under serous membrane accumulation of fat in the form omental
appendant (appendices omentales).
Caecum (саесum) - 6-8 cm segment of bowel and lies below the place of
transition in the thick of the small intestine. In rear centre bottom surface converge at
one point all three bands colon. At this point of the cecum away appendix (appendices
vermiformes) - gut rudiment of 2-20 cm in length. Inflammation of the appendix –
(appendicitis). The provisions of the appendix is not permanent, making it difficult to
diagnose appendicitis.
In most cases the location of the appendix is projected on the border between the
lateral and middle thirds of a line connecting the right and left upper, anterior iliac spine
(point Lanza). In addition, the origin of the process is determined by the point MacBurneo, which is located on the middle line drawn between the navel and right front
upper iliac own.
In 40-45% of cases the appendix is found in the pelvis, and for women it reaches
the right ovary and right fallopian tube (downward position). In addition, the rising
position of the appendix in 13% of cases, and lateral position of 17-20%. The rare cases
include lumbar position - behind the location of the appendix from the cecum.
The colon in fruitful period of slower growing small intestine in the newborn its
length is 66 cm; the ratio between the length of the small and large intestine is 4.5: 1. Up
to 3 years both gut grow equally intense, but in subsequent periods colon characterized
by faster growth in adults and the relationship between the two intestines is 4.3: 1.
The cecum in infants more conical form, moving, sometimes a ripple. Usually it is
located above the iliac crest and within 1 year of falls in the right iliac fossa. Variable for
the position of the appendix in newborns has a length of 2 to 8 cm. Depending on the
position of the cecum it can border on the liver, right kidney, ureter. Girls appendix
sometimes descends to the right ovary. The growth of the appendix is rapid during the
1st year of life and then slows down.
Colon and in newborns in infancy is usually horseshoe shape, bends it had
expressed. The ascending colon is shorter than downward. The transverse colon is short
and slow-moving ripples. In the first 1-1.5 years mesentery of the transverse colon is
extended to 3-4. Already in early childhood, there are differences in the length and
position of the colon, it can be positioned transversely, go in oblique upward direction
and sag in the form of a letter. The structure of the wall of the colon in infants is
characterized by weak development of muscles and protrusion appendant stuffing.
Sigmoid colon in infants has a long mesentery; loop it can be located in different parts of
the abdomen. In the first years of life is based highly gut. After 5 years, it is in large part
falls in the pelvic cavity. Length of intestine in newborns is 20 cm, 5-year-olds 30 cm,
10-year-olds about 40 cm. Mesentery sigmoid colon in the postnatal period is relatively
reduced and the intestine becomes fixed. Features sigmoid children play a role in the
pathology contributing to constipation, bowel distortion etc.
Rectum neonatal relatively long; its mild curves, the walls are thin, colon filled
with meconium and covers almost the entire pelvic cavity. During the first year formed
vial rectum, the extent of which is different. In early childhood rectum poorly fixed,
which creates prerequisites for its loss with increasing abdominal pressure, strong
tension of abdominal press cough, etc.
Materials for self-check:
А. Tasks for self-check:
At the figures mark the colon.
B. Choose the correct answer:
1.An injured person was delivered to the hospital with a penetrating wound in the left
lateral region of abdomen. What part of the large intestine is most likely damaged?
A.Colon descendens
B.Colon ascendens
C.Colon transverses
D.Caecum
E.Rectum
2.A patient has an injury in right lateral area of belly. What part of large intestine is most
likely injured?
A.Ascending colon
B.Transverse colon
C.Descending colon
D.Sigmoid colon
E.Rectum
3.A patient complains about impaired evacuatory function of ileum (long-term retention
of food in ileum). Examination revealed a tumour of initial part of the large intestine.
Specify localization of the tumour:
A.Caecum
B.Colon ascendens
C.Colon descendens
D.Rectum
E.Colon transverses
4.A patient has an injury in the left inguinal region of belly. What part of large intestine
is most likely injured?
A.Sigmoid colon
B.Transverse colon
C.Descending colon
D.Ascending colon
E.Rectum
5.An injured person was delivered to the hospital with a penetrating wound in the right
inguinal region of abdomen. What part of the large intestine is most likely damaged?
A.Caecum
B.Colon transverses
C.Colon descendens
D.Colon ascendens
E.Rectum
6.A patient complains about impaired evacuatory function of ileum (long-term retention
of food in ileum). Examination revealed a tumour of initial segment of the large
intestine. Specify localization of the tumour:
A.Caecum
B.Colon ascendens
C.Colon descendens
D.Rectum
E.Colon transverses
7.Specify the segments of the colon.
A.Colon ascendens, colon transversum, colon descendens, colon sigmoideum
B.Caecum, the colon, the rectum
C.Colon descendens
D.Colon transversum, duodenum
E.Rectum, the anal canal
8.Specify the rectal segments.
A.Rectal ampulla, the anal canal
B.Caecum, the colon, the rectum
C.Colon descendens
D.Colon ascendens, colon transversum, colon descendens, colon sigmoideum
E.Rectum, the anal canal
9.Name the layers of the large intestine.
A.The mucosa, the submucosa, the muscular layer, the serosa
B.The mucosa, the submucosa, the muscular tunic, the adventitia
C.The mucosa, the muscular tunic, the adventitia
D.The mucosa, the pharyngobasilar fascia, the adventitia
E.The mucosa, the pharyngobasilar fascia, the muscular tunic
10.Name the layers of the colon.
A.The mucosa, the submucosa, the muscular layer, the serosa
B.The mucosa, the submucosa, the muscular tunic, the adventitia
C.The mucosa, the muscular tunic, the adventitia
D.The mucosa, the pharyngobasilar fascia, the adventitia
E.The mucosa, the pharyngobasilar fascia, the muscular tunicLiterature.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 7. Liver. Pancreas.
1. Relevance of the topic.
Knowledge of the anatomy of the liver and pancreas, the topography of these
bodies (skletotopy, holotopy, syntopy) students necessary to study the physiology,
histology, topographic anatomy, emergency surgery, internal medicine, endocrinology,
surgery and infectious diseases.
2. The specific aims:
To analyze the development of liver and pancreas.
To explain:
-The topography of the liver;
- External structure of the liver;
- Liver function;
- Of the gallbladder;
- External structure of the pancreas;
- The topography of the pancreas;
- Connections liver;
- The internal structure of the liver;
- Structure of the gallbladder wall;
- The internal structure of the pancreas.
- Links pancreas.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The precending subjects
The acquired knowledge
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny of the digestive system;
To further explore topics.
4. The tasks for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class: the liver- hepar, the fossa for gallbladder- fossa
vesicae feleae, the groove for vena cava- sulcus venae cavae, the fissure for ligamentum
teres- fissure ligament teretis, notch for ligamentum teres, the fissure of ligamentum
venosum- fissure ligament venosi, lobe of liver- lobus hepatis.
4.2. Theoretical questions for the class:
1. What are liver and pancreas produced?
2. Describe the topography of the liver.
3. Show the authorities, which borders liver.
4. Describe the external structure of the liver.
5. Tell about a liver function.
6. Name of the gallbladder.
7. Describe the external structure of the pancreas.
8. Tell the topography of the pancreas.
9. Describe the function of the pancreas.
10. Point on a anatomical preparation authorities, which borders liver.
11. Name and show relationships liver.
12. Point a anatomical preparation gate liver. What anatomical formation out of the gate
and liver are they?
13. What important anatomical structures are located deep in the hepato duodenalintestinal relations? Describe their topography.
14. Describe the internal structure of the liver.
15. What do you know about the structure of segmental liver?
16. What is a liver lobe?
17. Tell the structure of the gallbladder wall.
18.Name and show preparation for extrahepatic bile duct, the common bile duct.
19. Tell the internal structure of the pancreas.
20. What are the relations of the pancreas.
21. Describe the excretory function of the pancreas.
4.3. Practical tasks pertaining to the topic and to be completed during the class: on
anatomical preparation, tables, models to study the structure, topography, liver and
pancreas. To study the formation of bile ducts.
The content of the topics.
Liver - gland digestive system performs excretory function - producing bile. In
bile comprise 40 compounds synthesized in the liver or captured from the blood,
cholesterol, bile acids, bilirubin. Converting fat to emulsify, bile promotes further
splitting them under pancreatic lipase. Bile increases peristalsis intestines. In the adult
overnight liver produces bile 700-800 cm3. Liver inherent barrier function: toxic
products of protein metabolism that are brought to the liver blood neutralized it. The
liver is involved in all types of metabolism: water, protein, fat, carbohydrate, mineral, it
deposited a number of vitamins (A, B, C, P, PP), it is a depot of iron, copper, zinc. In the
embryonic period characteristic of liver function blood formation.
Pancreas secretes pancreatic juice containing enzymes (trypsin, amylase, lipase,
maltose, etc.) that break down proteins into amino acids, fats - to fatty acids and
carbohydrates - to monosaccharides. In the pancreas is a special cluster of glandular cells
pidshlunkovi islets (insulae pancreatisae) interspersed between acini. These islands are
part of the exocrine pancreas.
Liver (hераr) - the largest gland of the human body, its mass of 1500 g newborn
liver occupies most of the abdominal organs and is 1/20 by weight.
The topography of the liver (holotopy). It is located in the upper part of the
abdominal cavity and completely fills the right under the rib area. Syntopy: upper,
diaphragm, liver convex surface and adjacent to the diaphragm. Lower, internal sutfaces,
slightly concave surface and adjacent to the right bend of the colon, transverse colon, gall
bladder, behind them - with the right kidney, right adrenal vial duodenum, inferior vena
cava; left - pyloric part of the body and stomach. Skeletopy: posterior part of the liver is
at IX and VIII vertebrae. The front edge of the liver starts from V intercostal spaces on
the right, then left, along costal arch to the middle of the cartilage, VIII left edge.
In the liver distinguish between two surfaces: diaphragm (facies diafragmatica)
and internal (fasies visceralis). In visceral surface of the liver are two longitudinal and
one transverse grooves. At the junction of the gate grooves are liver (porta hepatis).
These furrows share visceral surface of the liver into four particles: right (lobus hepatic
dexter), left (lobus hepatic sinister), square (lobus quadratus) and caudate (lobus
caudatus).
The liver is almost completely covered by peritoneum, so you should consider that
the liver is relatively peritoneum intraperitoneally. To link the liver include coronary
communication (lig. coronarium), right and left triangular ligament (lig. triangulare
dextrum et sinistrum), sickle connection (lig. falciforme) round ligament (lig. teres
hepatis) and hepato-renal communication (lig. hepatorenale), and links with the stomach
and duodenum.
The liver is one of the complex parenchymal organs. Outside liver parenchyma
covering serous membrane, beneath which is a dense fibrous membrane (tunica fibrosa).
In the liver secrete two parts, five eight sectors and segments. This separation caused by
branching blood vessels of the liver - liver portal vein and the hepatic artery.
The substance of the liver has liver lobules (lobulus hepatis), whose shape
resembles a hexagonal prism, with a diameter of 1-2.5 mm diameter. This formation is
called structural and functional unit of the liver. Particles comprises about 5000000.
Inside hepatic arterial capillaries are particles that are moving away from their own
branches of the hepatic artery and flow into the liver sinusoidal capillaries, giving
oxygen and nutrients. Thus, venous blood is poured and the central vein.
The cells of hepatic lobules produce bile that enters the bile ducts (ductuli biliferi). On
the periphery of these particles fall into protochki interlobular bile protochki (ductuli biliferi
interlobulares), then - in interlobar bile ducts, and then - to the right and left hepatic duct
(ductus hepaticus dexter et sinister). Coming out of the gate of the liver, right and left
hepatic ducts merge and form the common hepatic duct (ductus hepaticus communis).
Liver during the prenatal period covers more than half of the abdominal cavity.
The relative weight of a newborn is 4,5-5% of body weight. In the postnatal period
relative liver weight is reduced by half. The increase in absolute body weight continues
to 21-30 years. The upper limit of the liver in the newborn is at 5th ribs, sometimes it
meets the 4th or 6th edges. Due to the strong development of the left lobe of the liver is
more symmetrical than in adults, and over a large area bordered aperture pushing of her
other organs. The lower limit of the liver after birth stands under the costal arch on the
right papillary line 2-3 cm. Edge liver may be palpable at the navel or iliac crest. At the
age of one, the liver acts from the costal arch 1 cm to 6.7 years lower edge of the liver is
not out of the upper quadrant. At the same time decreases the left lobe, causing the
stomach enters the gap formed by the liver and spleen, coming into greater contact with
the diaphragm. In childhood liver mobile, because its rear surface is covered with
peritoneum.
Gallbladder (vesisa felleae) (гр. cholecystis) inflammation of the gallbladder cholecystitis) has a bottom (fundus vesicae felleae), the body of the gallbladder (corpus
vesicae felleae), the neck of the gallbladder (collum vesicae felleae). Cervix - the narrow
part of the bladder, which gradually turns into cystic duct (ductus cysticus). Cystic duct
goes down between the layers of the peritoneum, forming the hepato-duodenal-intestinal
communications and merged with the common hepatic duct, forms the common bile duct
(ductus choledoctus), which opens at the top of a large papilla duodenum.
Gallbladder wall is composed of three shells: the serous membrane (tunica serosa),
muscle membrane (tunica muscularis), mucous membrane (tunica mucosa).
Gallbladder in infants or spindle has a cylindrical shape. The bottom of it does not act
on the edge of the liver, bladder itself is covered with a thin layer of liver tissue. During
the 1st year of life gallbladder is pear-shaped, length and breadth of it in early childhood
increases by half, and in the first period of childhood doubles.
Pancreas (раncreas) - located in omental, retroperitoneal and takes a left pidrebrovu
area and comes at the right infracostal area. Skeletopy: gland located transverse
relatively to the vertebral column, head level I, II lumbar vertebral body - at the lumbar
vertebrae and tail gate reaches the spleen, which corresponds to XII thoracic vertebra.
Syntopy: gland located in front of the stomach, back from her - body lumbar vertebrae,
inferior vena cava, abdominal portion of the aorta, the left kidney and left adrenal gland.
The pancreas has a head (caput pancreatis), body (corpus pancreatis) and tail (cauda
pancreatis). Iron particles are separated layers of loose connective tissue. These
interlobular septa (septum interlobulare) placed vessels, nerves and interlobular
excretory ducts. Interlobular excretory ducts formed after the merger intraparticle ducts
channels, each of which starts from acinus (asinus pancreaticus) - structural and
functional unit of the gland, which produces digestive enzymes. In the final division
pancreatic duct is muscle - latches pancreatic duct (m. sphincter ductus pancreatici).
Sometimes the pancreas has an additional pancreas duct (ductus pancreaticus
accessorius), which opens on a small duodenal papilla above big papilla duodenum.
Newborn pancreas lies in the retroperitoneal space at IX-XIIth thoracic vertebrae and has
greater mobility than in adults. The gland has a length of 4.6 cm and weighs 2.8 grams in
the first two months gland grows slowly, then accelerates its growth and weight at 6
months gland doubles. At the age of 1-2 years gland weighs 13.5 grams, 2-4 years, 19.4
g This rapid growth is due to a change in the food regime of the child in this period.
Materials for self-check.
А. Tasks for self-check:
At the figures mark a lot and the gate of the liver and pancreas.
B. Choose the correct answer:
1.A patient with cholelithiasis fell ill with mechanic jaundice. Examination revealed that
the stone was in the common bile duct. What bile-excreting ducts make up the obturated
duct?
A.Ductushepaticuscommunisetductuscysticus
B.Ductushepaticusdexteret sinister
C.Ductushepaticusdexteretductuscysticus
D.Ductushepaticus sinister etductuscysticus
E.Ductushepaticuscommunisetductuscholedochus
2.A surgeon has to find the common hepatic duct during the operative intervention on
account of concrements in the gall ducts. The common hepatic duct is located between
the leaves of:
A.Hepatoduodenal ligament
B.Hepatogastric ligament
C.Hepatorenal ligament
D.Round ligament of liver
E.Venous ligament
3.Obturative jaundice developed in a 60-year-old patient because of malignant tumour of
the big papillary of the duodenal. Lumen of what anatomical structure is squeezed with
tumour?
A.Hepatopancreatic ampulla
B.Cystic duct
C.Common hepatic duct
D.Right hepatic duct
E.Left hepatic duct
4.A female patient with a tumour of pancreas has developed mechanic jaundice resulting
from compression of a bile-excreting duct. Which duct is compressed?
A.Ductuscholedochus
B.Ductuscysticus
C.Ductushepaticuscommunis
D.Ductushepaticusdexter
E.Ductushepaticus sinister
5.Dimensioning of liver gave an opportunity to establish that its superior border along
the right middle clavicular line is on the forth intercostal space level; its inferior border
projects from the coastal margin by 4 cm. Evaluate the liver size.
A.Enlarged liver - its lower border dislocated down
B.Reduced liver - its lower border dislocated down
C.Reduced liver - its lover border dislocated upwards
D.Enlarged liver - its upper border dislocated upwards
E.Liver dimensions are normal
6.Dimensioning of liver gave an opportunity to establish that its superior border along
the right middle clavicular line is on the forth intercostal space level; its lower border
does not come out from the costal arch. Evaluate the liver size.
A.Liver dimensions are normal
B.Reduced liver - its lower border dislocated down
C.Enlarged liver - its lower border dislocated down
D.Reduced liver - its lover border dislocated upwards
E.Enlarged liver - its upper border dislocated upwards
7.A patient with cholelithiasis fell ill with mechanic jaundice. Examination revealed that
the stone was in the common hepatic duct. What excreting ducts make up the obturated
duct?
A.Ductushepaticusdexteret sinister
B.Ductushepaticuscommunisetductuscholedochus
C.Ductushepaticusdexteretductuscysticus
D.Ductushepaticuscommunisetductuscysticus
E.Ductushepaticus sinister etductuscysticus
8.A 30-year-old patient complains thirst and dry mouth, which appeared after severe
neurasthenia. Laboratory examination has shown blood sugar increase up to 10
millimoles per litre. Which endocrine gland is affected?
APancreas gland
B.Thyroid gland
C.Sexual gland
D.Adrenal gland
E.Epiphysis
9.During the endoscopy the inflammation of a major papilla of the duodenum and the
disturbances of bile secretion were found. In which part of duodenum were the problems
found?
A.Descendent part
B.Ascendant part
C.Lower horizontal part
D.Upper horizontal part
E.Bulb
10.Peritoneal relations of the liver.
A.Mesoperitoneally
B.All answers are correct
C.All answers are incorrect
D.Extraperitoneally (except for a small upper part)
E.Intraperitoneally
11.Peritoneal relations of the pancreas.
A.Extraperitoneally
B.All answers are correct
C.All answers are incorrect
D.Mesoperitoneally
E.Intraperitoneally
12.Specify surfaces of the liver.
A.Diaphragmatic and visceral
B.Vesical and intestinal
C.Anterior and posterior
D.Interlobar
E.Costal and mediastinal
13.Name the layers of the gallbladder.
A.The mucosa, the submucosa, the muscular layer, the serosa
B.The mucosa, the submucosa, the muscular tunic, the adventitia
C.The mucosa, the muscular tunic, the adventitia
D.The mucosa, the pharyngobasilar fascia, the adventitia
E.The mucosa, the pharyngobasilar fascia, the muscular tunic
14.Peritoneal relations of the gallbladder.
A.Mesoperitoneally
B.All answers are correct
C.All answers are incorrect
D.Extraperitoneally
E.Intraperitoneally
15.A patient has pain in the right hypochondrium region. What organs disease can it
indicate?
A.Gallbladder, liver
B.Stomach, duodenum
C.Spleen, kidney
D.Colon, gallbladder
E.Fundus of stomach, transverse colon
16.During fibrogastroduodenoscopy, a doctor has to examine the major duodenal papilla.
What anatomic formation can serve as a landmark for its revealing?
A.Longitudinal fold of the duodenum
B.Duodenal glands
C.Duodenal cap
D.Circular folds of the duodenum
E.Hepatoduodenal ligament
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 8. Peritoneum.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further
studies.
2. The specific aims:
To explain:
- The structure of the peritoneum, leaves, peritoneal cavity;
- Connections liver, stomach, spleen, duodenum, pancreas;
- Top floor topography peritoneum;
- The limits of the middle and lower floors of the peritoneum;
-Abdominal cavity, covered with peritoneum, intraperitoneally, mezoperytoneal,
ekstraperytoneal;
- Folds and depressions peritoneum.
3. Basic knowledge and skills necessary to study the (inter-disciplinary integration)
The preceding subjects
The acquired knowledge
Biology
Anatomy
Phylogeny of the digestive system;
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
Pеritoneum
Peritoneum
Pеritoneum раrіеtale
Parietal peritoneum
Pеritoneum viscerale
Viscerale leaf
Cаvitas abdominales
Abdominal cavitas
Cavitas peritonealis
Lig. hepatoesophageale
Lig. hepatogastricum
Peritoneal cavity between the sheets
Liver esophageal ligament
Stomach liver ligament
Lig. hepatocolicum
Liver colon ligament
Lig. hepatoduodenale
The liver duodenum ligament
4.2. Theoretical questions for the class:
1. Derivatives peritoneum, its structure, leaves, peritoneal cavity?
2. Retroperitoneal space, its value?
3. Show ligament of liver, stomach, spleen, duodenum, pancreas.
4. How important is omental hole. Show on drug and call the wall of the hole?
5. Topography of the upper floor of the peritoneum?
6. Describe the verge of middle and lower floors of the peritoneum?
7. Name the abdominal cavity, covered with peritoneum, intraperitoneally,
mezoperytoneally, ekstraperytoneally.
8. What is the difference between the abdomen and the peritoneal cavity?
9. Show on preparation mesentery of the small intestine.
10. Share and show folds of peritoneum.
11. Covered by peritoneum pelvic organs in men?
12. Name the pelvic peritoneum depressions in men and women.
13. The functions of the peritoneum?
14. Share the basic methods of internal organs?
4.3. Practical tasks pertaining to the topic and to be completed during the
class: on drugs, tables, examine the abdominal cavity, the line on the anterior
abdominal wall. Examine the peritoneum and its derivatives peritoneal cavity,
bags, ties, gaskets, ripples, sinuses, channels corners. To study the topography
of the upper and lower floors abdomen.
The content of the topic.
Peritoneum (реritoneum) – serous membrane that lines the abdominal
wall and covers organs. Peritoneum is characterized by high sensitivity, it has
a high concentration of nerve cells that form the superficial nerve plexus.
Abdominal (cavitas abdominales) bounded above the diaphragm, the front and
on the sides - the abdominal muscles, back - the lumbar vertebrae, square back
muscles and iliac lumbar muscles.
There are two sheets: parietal (peritoneum parietale) and visceral
(peritoneum viscerale), located between the slit-like space (peritoneal cavity).
Peritoneal cavity (cavum peritonei) is a complex system slit spaces filled with
a small number of serous fluid that moistens the surface of the serous
membrane.
Peritoneal cavity men completely closed. In women, there is a
connection with the environment by means of openings of the fallopian tubes,
which open in the peritoneal cavity. The second open end of the tube into the
uterus.
Numerous peritoneal folds extend between the various organs or
connect them to the parietes; they serve to hold the viscera in position, and, at
the same time, enclose the vessels and nerves proceeding to them. They are
grouped under the three headings of ligaments, omenta, and mesenteries.
There are two omenta, the lesser and the greater.
The lesser omentum (omentum minus; small omentum;
gastrohepatic omentum) is the duplicature which extends to the liver from the
lesser curvature of the stomach and the commencement of the duodenum. It is
extremely thin, and is continuous with the two layers of peritoneum which
cover respectively the antero-superior and postero-inferior surfaces of the
stomach and first part of the duodenum. Between the two layers of the lesser
omentum, close to the right free margin, are the hepatic artery, the common
bile duct, the portal vein, lymphatics, and the hepatic plexus of nerves—all
these structures being enclosed in a fibrous capsule (Glisson’s capsule).
Between the layers of the lesser omentum, where they are attached to the
stomach, run the right and left gastric vessels.
The greater omentum (omentum majus; great omentum; gastrocolic
omentum) is the largest peritoneal fold. It consists of a double sheet of
peritoneum, folded on itself so that it is made up of four layers. The two layers
which descend from the stomach and commencement of the duodenum pass in
front of the small intestines, sometimes as low down as the pelvis; they then
turn upon themselves, and ascend again as far as the transverse colon, where
they separate and enclose that part of the intestine. These individual layers
may be easily demonstrated in the young subject, but in the adult they are
more or less inseparably blended.
Peritoneal Recesses or Fossae (retroperitoneal fossae). In certain
parts of the abdominal cavity there are recesses of peritoneum forming culsde-sac or pouches, which are of surgical interest in connection with the
possibility of the occurrence of “retroperitoneal” herniae. The largest of these
is the omental bursa (already described), but several others, of smaller size,
require mention, and may be divided into three groups, viz.: duodenal, cecal,
and intersigmoid.
The ratio of peritoneal to:
- Intraperitoneally (stomach, spleen, small intestine, blind, transverse, sigmoid,
the upper third of the line);
- Mezoperitoneally (liver, ascending, descending colon rim, the middle third of
the rectum);
- Ekstraperitoneally (duodenum, pancreas, lower third rectum).
Relations peritoneum:
- Sickle, coronary, right and left triangular, round, venous connections liver;
- Hepatonephric;
- Liver-duodenum;
- Hepato-gastric;
- Gastrointestinal diaphragmatic;
- Gastro-splenic;
- Gastro-colon;
- Suspending the duodenum (ligament Treytsa).
Gaskets:
- Small cap, formed hepato-duodenal gastric and hepatic ties
- Large cap, gastrointestinal colon ligament 2 leaf going down to the entrance
to a small basin, then rise up, join the ripples transverse colon and go to the
back wall of the abdominal cavity.
Mesentery:
- Mesentery of the small intestine (duodenum except);
- Appendix mesentery;
- Mesentery of the transverse colon;
- Mesentery of the sigmoid colon.
- Formation parietally peritoneum:
- Fold the front wall: umbilical median, medial (accommodate umbilical
artery), lateral (accommodate lower epigastric arteries and veins);
- Fossa anterior wall: inguinal medial, lateral.
Сap hole, stuffing the hole (foramen epiploicum s. Winslovi), through
which can penetrate slit-like space behind the stomach and small bonnets omental bag (bursa omentalis), limited:
- Front - hepato-duodenal ligament;
- Behind - hepato-renal ligament;
- Top - caudate lobe of the liver;
- From the bottom - the upper part of the duodenum.
In men, the pelvic cavity peritoneum forms a concavity between the
bladder and rectum, while women have two depressions - between the bladder
and uterus and between the rectum and uterus.
The main functions of the peritoneum are:
- Development and absorption of serous fluid;
- Barrier (barrier hematolimfatyco sero-fibrous and serous-type barrier
hematolimfatyco cell type).
The abdominal cavity in infants in the first year of life is relatively high
under the strong development of the liver and small intestine. As the child
grows and increases to a large extent the volume of the chest cavity and the
abdominal cavity is relatively reduced. The spatial relationship of change as a
result of uneven growth, as discussed above. Peritoneum and its formation in
infants and young children are very subtle ripples in the peritoneal relations
and translucent vessels. Large cap short and contains no fat. In the first period
of childhood omentum (omentum) is extended and covers the small intestine,
it appears adipose tissue, but its formation is strong only in puberty. At the
same time deposits of adipose tissue observed in ripples and folds of
peritoneum. In adolescence period abdominal established relationships that are
characteristic of adult.
Materials for self-check.
А. Tasks for self-check:at tables show the peritoneum and its derivatives
peritoneal cavity, bags, ties, gaskets, ripples, sinuses, channels corners. To study the
topography of the upper floor of the abdominal cavity.
B. Choose the correct answer:
1.A 45-year-old patient was admitted to the surgical department with complaints of
abrupt sharp pain in the epigastric region. After examination it was diagnosed: perforated
ulcer of the posterior wall of the stomach. Where did content of the stomach flow out
while perforation?
A.To the omental bursa
B.To the liver bursa
C.To the proventriculus sack
D.To the left mesenteric sinus
E.To the right mesenteric sinus
2.A 53-year-old female patient was diagnosed with liver rupture resulting from a blunt
abdominal injury. The escaped blood will be assembled in the following anatomic
formation:
A.Right mesenteric sinus
B.Vesicouterine pouch
C.Rectouterine pouch
D.Omental bursa
E.Left mesenteric sinus
3.A man with internal abdominal right side injury and suspicion of liver rupture was
admitted to the traumatological department. In what peritonial structure will blood
accumulate?
A.Right mesenteric sinus
B.Bursa omentalis
C.Recessus intersigmoideus
D.Fossa ischio-analis
E.Recessus duodenalis inferior
4.A patient with a stab wound of the anterior stomach wall is in surgical care. What
formation of abdominal cavity did the stomach contents get into?
A.Pregastric bursa
B.Omental bursa
C.Hepatic bursa
D.Left mesenteric sinus
E.Right mesenteric sinus
5.A surgeon should reach the omental bursa to perform an operation on abdominal
cavity. How can he reach this part of peritoneal cavity without affecting the integrity of
lesser omentum?
A.Through the epiploic foramen
B.Through the right paracolic sulcus
C.Through the left paracolic sulcus
D.Through the right mesenteric sinus
E.Through the left mesenteric sinus
6.A 28-year-old woman has been diagnosed with extrauterine pregnancy complicated by
the fallopian tube rupture. The blood is most likely to penetrate the following peritoneal
space:
A.Rectouterine
B.Vesicouterine
C.Right mesenteric sinus
D.Left mesenteric sinus
E.Intersigmoid sinus
7.Necrotic form of acute pancreatitis of a patient is diagnosed. Into what peritoneal
formation does serous fluid exudation spread?
Into the omental bursa
Into the hepatic bursa
Into the pregastric bursa
Into the left paracolic gutter
Into the right paracolic gutter
8.During the examination of a patient, the presence of suppurative exudation in the
straight rectouterine pouch was suspected. Through what anatomic formation is it better
to puncture the pouch?
Posterior vaginal fornix
Anterior vaginal fornix
Rectal ampulla
Pelvic diaphragm
Anterior vaginal wall
9.In case of a penetrating wound of the anterior abdominal wall the wound tract went
above the lesser curvature of stomach. What peritoneum formation is most likely to be
injured?
Ligamentum hepatogastricum
Ligamentum gastrocolicum
Ligamentum hepatoduoduodenale
Ligamentum hepatorenale
Ligamentum triangulare sinistrum
10.A surgeon has to find the common hepatic duct during the operative intervention on
account of concrements in the gall ducts. The common hepatic duct is located between
the leaves of:
Hepatoduodenal ligament
Venous ligament
Hepatorenal ligament
Round ligament of liver
Hepatogastric ligament
11.Peritoneal relations of the duodenum.
A.Extraperitoneally (except for a small upper part)
B.All answers are correct
C.All answers are incorrect
D.Mesoperitoneally
E.Intraperitoneally
12.Peritoneal relations of the jejunum.
A.Intraperitoneally
B.All answers are correct
C.All answers are incorrect
D.Extraperitoneally (except for a small upper part)
E.Mesoperitoneally
13.Specify anatomical structures of the superior level of the peritoneal cavity.
A.The hepatic bursa, the pregastric bursa, the omental bursa
B.The recto-uterine pouch, the vesico-uterine pouch
C.The right paracolic gutter
D.The left paracolic gutter
E.The right and left mesenteric sinuses
14.Specify anatomical structures of the middle level of the peritoneal cavity.
A.The right and left mesenteric sinuses
B.The recto-uterine pouch
C.The vesico-uterine pouch
D.The omental bursa
E.The hepatic bursa, the pregastric bursa
15.Specify anatomical structures of the inferior level of the peritoneal cavity.
A.The recto-uterine pouch, the vesico-uterine pouch
B.The right and left mesenteric sinuses
C.The right paracolic gutter
D.The left paracolic gutter
E.The hepatic bursa, the pregastric bursa, the omental bursa
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 9. Nose. Larynx.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further
studies.
2. The specific aims:
To analyze the development of the respiratory system in ontogenesis.
To explain:
- The external structure of the nose;
- The structure of the nose;
- The nasal passages than they are limited;
- Paranasal sinuses and their connections;
- Structure and topography of the larynx;
- Structure of the cavity of the larynx;
- Joints and muscles of the larynx.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration)
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
SYSTEMA RESPIRATORIUM
Respiratory system
Nasus
Nose
Radix nasi
The root of the nose
Dorsum nasi
Back of the nose
Apex nasi
The top of the nose
Ala nasi
A wing nose
Cartilago alaris major
Great gristle wings
Crus mediale
The middle leg
Pars mobilis septi nasi
Mobile part of nasal septum
Crus laterale
Lateral leg
Cartilagines alares minores
Small cartilage wings
Cartilago septi nasi
The cartilage of the nasal septum
Processus lateralis
Lateral process
Cavitas nasi
Nasal cavity
Choanae
Septum nasi
Pars membranacea
Pars cartilaginea
Pars ossea
Organum vomeronasale
Larynx
Cartilago thyroidea
Cartilago cricoidea
Cartilago arytenoidea
Choanae
Nasal septum
Webbed part
Cartilage part
Bone part
Lemish nasal organ
Larynx
Thyroid cartilage
Shaped gristle ring
Arytenoidea gristle
4.2. Theoretical questions for the class:
1. Development of the respiratory system in ontogenesis?
2. The structure of the external nose?
3. The structure of the nose?
4. The nasal passages than they are limited?
5. Paranasal sinuses, their combination?
6. Structure and larynx topography?
7. The structure of the cavity of the larynx?
8. Joints and muscles of the larynx?
4.3. Practical tasks pertaining to the topic and to be completed during the
class: on drugs, tables, models to study the structure, topography, functions of
the nasal cavity and larynx. To study the formation of phonation.
The content of the topic.
Respiratory system occupies an important place in metabolism: a first gas
exchange, participation in the exchange of water in maintaining acid-base
balance, regulation of temperature balance.
In addition it is the largest depot, the content of DES cells that participate
in the processes of the endocrine and immune system cells. A light stand
volatile substances - alcohol, ether, acetone, ammonia. Respiratory system
performs the function of phonation, in the nasal cavity are the olfactory
receptors.
Development of the respiratory system.
After 3 weeks of development ventral pharyngeal wall department
primary bowel protrusion formed - laryngeal, tracheal outgrowth. At 4-7
weeks outgrowth divided into asymmetrical bags - broncho-pulmonary
kidneys (left - 2, right - 3). At 8-9 weeks formed cartilage of the larynx
(cricoid, then thyroid, then ladlely). 5-16 week - formed the bronchial tree, 4-6
month - formed bronchioles, alveoli 6-9 months. From endoderm develops
mucosal epithelium, glands. From mesenchyme - cartilage, muscles, pleura.
Anomalies of development.
1. Nose: atresia nostrils, nasal septum curvature.
2. Larynx: trachea: narrowing.
3. Lung: atelectasis, underdevelopment, additional shares.
4. Bronchi: bronchiectasis.
Avilable in children.
1. Paranasal sinuses are absent.
2. No lower nostril.
3. Larynx wide, short 3 vertebrae above.
4. Short trachea, bifurcation at 3-4 thoracic vertebra.
5. Bronchi wide.
6. The top of the lung at 1 rib, the lower boundary above. Over 1 year lung
capacity increases by 4 times.
The functions of the respiratory system.
1. Conducting air.
2. Gas exchange.
3. Olfactory.
4. Phonation.
Features of the structure.
1. The walls of the respiratory tube collapse not at the expense of bone and
cartilage walls (except bronchioles).
2. The mucosa has submucosal (excluding nasal cavity).
3. Ciliary epithelium.
4. Lymphoid tissue.
The structure of the respiratory system.
1. respiratory tract (of air).
a) upper, external nose, nasal cavity, paranasal sinuses, nasopharynx,
oropharynx;
b) lower: laryngopharynx, larynx, trachea, bronchi.
2. Lungs (gas exchange).
a) Acinus.
NOSE (nasus, rhinos)
The External Nose (Nasus Externus; Outer Nose)—The external nose is
pyramidal in form, and its upper angle or root is connected directly with the
forehead; its free angle is termed the apex. Its base is perforated by two
elliptical orifices, the nares, separated from each other by an antero-posterior
septum, the columna. The margins of the nares are provided with a number of
stiff hairs, or vibrissae, which arrest the passage of foreign substances carried
with the current of air intended for respiration. The lateral surfaces of the nose
form, by their union in the middle line, the dorsum nasi, the direction of
which varies considerably in different individuals; the upper part of the
dorsum is supported by the nasal bones, and is named the bridge. The lateral
surface ends below in a rounded eminence, the ala nasi.
The Nasal Cavity (Cavum Nasi; Nasal Fossa)—The nasal chambers are situated
one on either side of the median plane. They open in front through the nares,
and communicate behind through the choanae with the nasal part of the
pharynx. The nares are somewhat pear-shaped apertures, each measuring
about 2.5 cm. antero-posteriorly and 1.25 cm. transversely at its widest part.
The choanae are two oval openings each measuring 2.5 cm. in the vertical,
and 1.25 cm. in the transverse direction in a well-developed adult skull. Inside
the aperture of the nostril is a slight dilatation, the vestibule, bounded laterally
by the ala and lateral crus of the greater alar cartilage, and medially by the
medial crus of the same cartilage. It is lined by skin containing hairs and
sebaceous glands, and extends as a small ecess toward the apex of the nose.
Each nasal cavity, above and behind the vestibule, is divided into two parts: an
olfactory region, consisting of the superior nasal concha and the opposed part
of the septum, and a respiratory region, which comprises the rest of the
cavity.
The roof of the nasal cavity is narrow from side to side, except at its
posterior part, and may be divided, from behind forward, into sphenoidal,
ethmoidal, and frontonasal parts, after the bones which form it.
The floor is concave from side to side and almost horizontal anteroposteriorly; its anterior three-fourths are formed by the palatine process of the
maxilla, its posterior fourth by the horizontal process of the palatine bone. In
its anteromedial part, directly over the incisive foramen, a small depression,
the nasopalatine recess, is sometimes seen; it points downward and forward
and occupies the position of a canal which connected the nasal with the buccal
cavity in early fetal life.
The Mucous Membrane (membrana mucosa nasi).—The nasal mucous
membrane lines the nasal cavities, and is intimately adherent to the periosteum
or perichondrium. It is continuous with the skin through the nares, and with
the mucous membrane of the nasal part of the pharynx through the choanae.
From the nasal cavity its continuity with the conjunctiva may be traced,
through the nasolacrimal and lacrimal ducts; and with the frontal, ethmoidal,
sphenoidal, and maxillary sinuses, through the several openings in the
meatuses. The mucous membrane is thickest, and most vascular, over the
nasal conchae. It is also thick over the septum; but it is very thin in the
meatuses on the floor of the nasal cavities, and in the various sinuses.
Features mucosa:
1. Severe submucosa (swelling).
2. Covered ciliary epithelium (cleaning).
3. It has mucous glands (hydration).
4. The lymph nodules (immune protection).
5. Olfactory receptors (smell).
6. Venous plexus on the bottom of the sink (warm, bleeding).
Paranasal sinuses (PNS)
1. maxillary (maxillary).
In the thick body of the upper jaw dimensions are different, the amount of
2,5-30 mm 3.
Walls - medial (hole total of nose);
- Upper (total of orbit);
- Lower (total of alveolar jaw condyles);
- Front - lateral;
- Rear - lateral.
options:
1. The hole is located at the bottom or sinus or above.
2. Value of the roots of teeth:
- Bone layer;
- At the sinus mucosa;
- Measures to sinus form a bay (with tooth extraction - sinus perforation).
Opens the middle nasal passage.
3. Wedge.
In the thick body of sphenoid bone. The form of four-sided pyramid. Opens in
upper nasal passage.
4. Frontal.
In frontal bone thickness, the size is different, divided by a partition,
asymmetrical. Opens the middle nasal passage.
5. lattice.
Formed a maze consisting of front, middle and rear of the WTO. opened:
- The front and the middle cell in the middle of the course.
- Back to top nostril.
The function of sinuses:
1. The warming air.
2. Hydration.
3. Cleaning.
4. The accumulation.
5. Resonant.
External nose newborns with short broad wings small, flattened. The
back and top of the nose underdeveloped in connection with the development
of the facial skull. Standing nose shape is set in puberty.
Neonatal nasal cavity is relatively low and narrow. Turbinate, developed
and limit the narrow nasal passages. The lower nasal passage to 6 months,
almost not expressed as the inferior turbinate touches the bottom of the nose, it
is finally formed to 14-15 years. Middle and upper nasal passages poorly
developed. Average well expressed to 6 months, top - up to 2 years. Paranasal
sinuses are absent, except for maxillary (maxillary) sinuses that finally
acquires the features that are inherent in it, only to 8-9 years. The frontal sinus
and wedge and bone cell lattice appear in the first year of life. The final
formation of the frontal and sphenoid sinuses there for three years, and bone
lattice holes up to 3-6 years. Nasolacrimal channel starts to fully function at 3
years old. Nasal mucosa is rich in blood and lymphatic vessels (possible
swelling in inflammatory processes, leading to breathing difficulties in
children).
Larynx (Larynx)
In the cavity of the neck at the C4-C6, behind - laryngopharynx; front fascia and muscles of the neck, thyroid, skin; on the sides - the neuro-vascular
bundles. The form of sand clock, length 4 cm.
The outer structure.
1. Log in to the larynx.
2. Vestibule of the larynx:
- Vestibule gap between the vestibular folds.
- The ventricles - between the vestibular and vocal folds.
3. The voice part.
- Glottis between the vocal folds.
4. In the voice cavity.
The structure of the walls of the larynx
1. Internal - mucosa.
2. Average - fibrous muscle and cartilage.
3. Exterior - adventive.
The structure of the mucosa
1. No submucosal membrane.
2. No folds (except vestibule and voice).
3. Ciliary epithelium.
4. Glands, lymphoid nodules.
The Cartilages of the Larynx (cartilagines laryngis) are nine in
number, three single and three paired, as follows:
Two:
Arytenoid.
Epiglottis.
Thyroid.
Corniculate.
Cricoid.
Cuneiform.
Ligaments.—The ligaments of the larynx are extrinsic, those connecting the
thyroid cartilage and epiglottis with the hyoid bone, and the cricoid cartilage with the
trachea; and intrinsic, those which connect the several cartilages of the larynx to each
other.
Extrinsic Ligaments.—The ligaments connecting the thyroid cartilage with the
hyoid bone are the hyothyroid membrane, and a middle and two lateral hyothyroid
ligaments.
Intrinsic Ligaments.—Beneath the mucous membrane of the larynx is a broad
sheet of fibrous tissue containing many elastic fibers, and termed the elastic
membrane of the larynx. It is subdivided on either side by the interval between the
ventricular and vocal ligaments, the upper portion extends between the arytenoid
cartilage and the epiglottis and is often poorly defined; the lower part is a well-marked
membrane forming, with its fellow of the opposite side, the conus elasticus which
connects the thyroid, cricoid, and arytenoid cartilages to one another. In addition the
joints between the individual cartilages are provided with ligaments.
Muscles.—The muscles of the larynx are extrinsic, passing between the
larynx and parts around—these have been described in the section on Myology;
and intrinsic, confined entirely to the larynx.
The intrinsic muscles are:
Cricothyreoideus.
Cricoarytaenoideus posterior.
Cricoarytaenoideus lateralis.
Arytaenoideus.
Thyroarytaenoideus.
Actions.—In considering the actions of the muscles of the larynx, they may
be conveniently divided into two groups, vix.: 1. Those which open and close the
glottis. 2. Those which regulate the degree of tension of the vocal folds.
Mucous Membrane.—The mucous membrane of the larynx is continuous
above with that lining the mouth and pharynx, and is prolonged through the trachea
and bronchi into the lungs. It lines the posterior surface and the upper part of the
anterior surface of the epiglottis, to which it is closely adherent, and forms the
aryepiglottic folds which bound the entrance of the larynx. It lines the whole of the
cavity of the larynx; forms, by its reduplication, the chief part of the ventricular
fold, and, from the ventricle, is continued into the ventricular appendix. It is then
reflected over the vocal ligament, where it is thin, and very intimately adherent;
covers the inner surface of the conus elasticus and cricoid cartilage; and is
ultimately continuous with the lining membrane of the trachea. The anterior
surface and the upper half of the posterior surface of the epiglottis, the upper part
of the aryepiglottic folds and the vocal folds are covered by stratified squamous
epithelium; all the rest of the laryngeal mucous membrane is covered by columnar
ciliated cells, but patches of stratified squamous epithelium are found in the
mucous membrane above the glottis.
Larynx newborn occupies a high position, the upper limit - level II cervical
vertebrae, lower at 4 cervical vertebra, the final position of the larynx takes to the
end of the second child, having between 4 and 6 cervical vertebrae, as in adults. The
shape of the larynx newborn cartilage thin, flexible, and highly epiglottis is a tongue
touches the soft palate. When ingested fluid passes laterally through the epiglottis
pear-shaped pockets. Sign in larynx wide vestibule short, glottis placed high. Vocal
folds are thick and short -4-5 mm. Laryngeal ventricles shallow, narrow glottis.
Voice poorly developed muscles. The mucous membrane is thin, rich in blood and
lymphatic vessels. Larynx rejected back from the longitudinal axis, resulting in a
corner of the trachea open toward the spine. Intensive growth of the larynx seen
during the first year of life and during puberty, particularly in boys when changing
the position of the thyroid cartilage plates extended vocal cords, "breaks down"
vote.
Materials for self-check:
А. Tasks for self-check: in tables mark the nasal cavity, nasal passages, sinuses around
the nose, cartilage, muscles of the larynx.
B. Choose the right answer:
1.A patient complains of headache, heavy breathing. X-ray examination confirmed the
diagnosis - frontitis. What nasal meatus may contain purulent discharge?
A.Middle
B.Superior
C.Inferior
D.Common
E.Above the superior nasal concha
2.Because of the carried illness at a man, expansion of glottis was violated. What from
the counted muscles is damaged?
A.Posterior cricoarythenoideus
B.Lateral cricoarythenoideus
C.Cricothyreoideus
D.Thyreoarythenoideus
E.Vocalis muscle
3.A 69-year-old patient has got an abscess of frontal lobe as a result of purulent infection
in nasal cavity. What anatomical formation did the infection penetrate through?
A.Foraminae cribrosae
B.Foramen ovale
C.Foramen ethmoidalae posterior
D.Foramen sphenopalatinum
E.Foramen rotundum
4.X-ray examination revealed an accumulation of suppuration in maxillary sinus. Into
what nasal meatus excretes the suppuration?
A.Median nasal
B.Nasopharyngeal
C.Inferior nasal
D.Superior nasal
E.Common nasal
5.A 18-year-old patient came to the out-patient department with the complaints of
bleeding trauma in the vestibule of his nose. On examination: the mechanical injure of
the mucous layer of the vestibule without continuation into nasal cavity proper. What is
the boundary between the vestibule and nasal cavity proper?
A.Nasal limen
B.Nasal roller
C.Nasal septa
D.Choanes
E.Nostrils
6.A 35-year-old patient applied to a doctor with complaints about having intense rhinitis
and loss of sense of smell for a week. Objectively: nasal cavity contains a lot of mucus
that covers mucous membrane and blocks olfactory receptors. In what part of nasal
cavity are these receptors situated?
A.Superior nasal meatus
B.Median nasal meatus
C.Inferior nasal meatus
D.Common nasal meatus
E.Vestibule of nose
7.Acute inflammatory process of the nasolacrimal duct mucosa of a 28-year-old has been
diagnosed. Influenza was followed by 10-days' discharge from the nose. From that part
of the nasal cavity could the infection get into the nasolacrimal duct?
A.Inferior nasal meatus.
B.Middle nasal meatus.
C.Superior nasal meatus.
D.Vestibule of nose.
E.Frontal sinus.
8.A patient has got a complication after rhinitis. X-ray examination showed pus
accumulation in the maxillary sinus on the left. To what nasal meatus does the pus
release?
A.Left middle nasal
B.Right inferior nasal
C.Right superior nasal
D.Right common nasal
E.Right nasopharyngeal
9.A patient has a tumor in the superior nasal meatus region. Which function can be
affected?
A.Of smell
B.Of salivation
C.Of taste
D.Of hearing
E.Of swallowing
10.During woodwork, a worker accidentally inhaled a bulb nearly 0.5 cm in diameter,
which caused strong cough. Which part of respiratory influence?
A.Larynx above the vocal ligaments
B.Trachea
C.Larynx under the vocal ligaments
D.Right principal bronchus
E. Left principal bronchus
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 10. Trachea. Bronchi. Lungs.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further studies.
2. The specific aims:
To explain the development of the trachea, bronchi ontogeny.
To know:
- The structure and topography of the trachea;
- Bronchial tree;
- Alveolar tree;
- Structure of the lungs;
- Border pleura and lung.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration):
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
Trachea
Trachea
Pars cervicalis
Neck part
Pars thoracica
Chest portion
Cartilagines tracheales
Cartilage tracheal
Bifurcatio tracheae
Bifurcation of the trachea
Bronchus
Bronchі
Bronchus principalis dexter
The right main bronchus
Bronchus principalis sinister
Left main bronchus
Pulmones
Lung
Pulmo dexter
Right lung
Pulmo sinister
The left lung
Basis pulmonis
The basis of the lungs
The top of the lungs
Aрех pulmonis
Rib surface
Facies costalis
Facies mediastinalis
Mediastinal surface
Impressio cardiacа
Heart suppression
4.2. Theoretical questions for the class:
1. Development of the trachea, bronchi ontogeny?
2. The structure and topography of the trachea?
3. What is the bronchial tree?
4. What alveolar tree?
5. The structure of the lungs?
6. Segments lungs, their clinical significance?
7. Limits lung?
4.3. Practical tasks pertaining to the topic and to be completed during the class: on
anatomical preparation, tables, models to study the structure, topography trachea,
bronchi, lungs.
The content of the topic.
TRACHEA.
The trachea or windpipe is a cartilaginous and membranous tube, extending from the
lower part of the larynx, on a level with the sixth cervical vertebra, to the upper border
of the fifth thoracic vertebra, where it divides into the two bronchi, one for each lung.
The trachea is nearly but not quite cylindrical, being flattened posteriorly; it measures
about 11 cm. in length; its diameter, from side to side, is from 2 to 2.5 cm., being always
reater in the male than in the female.
The trachea newborn has a length of 3.5-4.5 cm, is high (between 4 and cervical vertebrae
from December). Cartilage elastic. Membranous part wide. The trachea fixed times, easily
shifting. The upper part of the cervical isthmus thyroid covered at 5-8 tracheal rings, so
can only lower tracheotomy. Bifurcation of the trachea is at 3 thoracic vertebra to 7 years at 4 thoracic vertebra. The right bronchus is a continuation of the trachea that causes hit by
foreign bodies in children. The trachea and main bronchi grow rapidly during the first six
months of life and during puberty.
Bronchus.
The Right Bronchus (bronchus dexter), wider, shorter, and more vertical in direction than
the left, is about 2.5 cm. long, and enters the right lung nearly opposite the fifth
thoracic vertebra. The azygos vein arches over it from behind; and the right pulmonary
artery lies at first below and then in front of it. About 2 cm. from its commencement it
gives off a branch to the upper lobe of the right lung. This is termed the eparterial
branch of the bronchus, because it arises above the right pulmonary artery. The
bronchus now passes below the artery, and is known as the hyparterial branch; it
divides into two branches for the middle and lower lobes.
The Left Bronchus (bronchus sinister) is smaller in caliber but longer than
the right, being nearly 5 cm. long. It enters the root of the left lung opposite the
sixth thoracic vertebra. It passes beneath the aortic arch, crosses in front of the
esophagus, the thoracic duct, and the descending aorta, and has the left pulmonary
artery lying at first above, and then in front of it. The left bronchus has no
eparterial branch, and therefore it has been supposed by some that there is no upper
lobe to the left lung, but that the so-called upper lobe corresponds to the middle
lobe of the right lung.
The muscular tissue consists of two layers of non-striated muscle,
longitudinal and transverse. The longitudinal fibers are external, and consist of a
few scattered bundles. The transverse fibers (Trachealis muscle) are internal, and
form a thin layer which extends transversely between the ends of the cartilages.
Mucous Membrane.—The mucous membrane is continuous above with
that of the larynx, and below with that of the bronchi. It consists of areolar and
lymphoid tissue, and presents a well-marked basement membrane, supporting a
stratified epithelium, the surface layer of which is columnar and ciliated, while the
deeper layers are composed of oval or rounded cells.
Bronchial tree until the birth basically formed. In the first year of life observed its intense
growth. At puberty growth again intensified. Smoothing the alveolar parts occurs in the
first hours of life, but a few days remain areas of so-called "physiological (embryonic)
atelectasis" as a result may be stagnation and pneumonia. Acinus formed to the moment of
birth, the development of alveoli continues to 12-16 years. Segments of lungs in newborns
formed and arranged so as adults.
Lungs.
The lungs (pulmones) are the essential organs of respiration; they are two in
number, placed one on either side within the thorax, and separated from each other
by the heart and other contents of the mediastinum. The substance of the lung is of
a light, porous, spongy texture; it floats in water, and crepitates when handled, owing to
the presence of air in the alveoli; it is also highly elastic.
Each lung is conical in shape, and presents for examination an apex, a base, three
borders, and two surfaces.
Segments of lungs.
Segment - of the lung parenchyma that surrounds segmental (3rd order) bronchus,
artery and vein, and separated from the second segment connective tissue wrap. (The
concept of surgery).
Right lung: - 10 segments.
The left lung: - 10 segments
Structure.—The lungs are composed of an external serous coat, a subserous
areolar tissue and the pulmonary substance or parenchyma.
The serous coat is the pulmonary pleura; it is thin, transparent, and invests
the entire organ as far as the root.
The subserous areolar tissue contains a large proportion of elastic fibers; it
invests the entire surface of the lung, and extends inward between the lobules.
The parenchyma is composed of secondary lobules which, although closely
connected together by an interlobular areolar tissue, are quite distinct from one
another, and may be teased asunder without much difficulty in the fetus. The
secondary lobules vary in size; those on the surface are large, of pyramidal form,
the base turned toward the surface; those in the interior smaller, and of various
forms. Each secondary lobule is composed of several primary lobules, the
anatomical units of the lung. The primary lobule consists of an alveolar duct, the
air spaces connected with it and their bloodvessels, lymphatics and nerves.
The lungs of newborns have a conical shape, weight - 67 -68 g, 6 months doubles
and 1 year -potroyuyetsya. Neonatal lung volume 67 cm3, and vital capacity - 0.15
liters, 5 years - 0,75l, 10 years - 1.5 liters. The tops of the lungs of the newborn are
projected to level 1 rib, lower limit - 5 seredynnoklyuchychniy rib on line 7 edge - on
average axillary line, 9 edge - on pryhrebtoviy line (adults respectively - ribs 6,8,11)
The boundaries of the lungs as an adult set up to 3 years of life.
Materials for self-check:
А. Tasks for self-check:in tables flag segments of the lungs, the bronchial tree to draw.
B. Choose the correct answer:
1.A patient, 50 years old with the tumour of larynx was made tracheotomy. Can you
define, at what level it was made?
A.Between second and third cartilages of trachea
B.Between first and fourth cartilages of trachea
C.Between fourth and fifth cartilages of trachea
D.Between the cricoid cartilage of larynx and first cartilage of trachea
E.Between the first and second cartilages of trachea
2.A patient was admitted to a hospital with a knife wound of the thorax on the right and
pneumothorax. Percussion has shown that the inferior right lung border at the
midclavicular line rose to the III rib level. Where is it located normally?
A.VI rib
B.VII rib
C.VIII rib
D.IX rib
E.V rib
3.A 37-year-old patient has suffered from pulmonary tuberculosis since childhood.
Amputation of the middle lobe of the right lung has been performed. Which segments
have been amputated?
A.Lateral and medial
B.Superior and anterior
C.Medial basal and lateral basal
D.Superior lingular and inferior lingular
E.Posterior and anterior
4. During the examination of a 78-year-old patient, X-ray examination shows a tumor of
the superior lobe of the left lung. What segments located in this lobe?
A.Apicoposterior, anterior, superior lingual, inferior lingual
B.Superior, medial basal, anterior basal, lateral basal, posterior basal
C.Anterior and posterior primary
D.Apical, anterior
E.Medial, lateral
5.A 50-year-old patient with carcinoma of lung had a right-side lobecotomy (ablation of
the superior lobe of the lung) performed. How many segments were ablated during the
operation?
A.Three
B.Four
C.Five
D.Two
E.None
6.A patient has a left-side pulmonectomy performed because of the carcinoma of lung.
After the dissection of the mediastinal pleura pulmonary veins must be ligated first of all
to decrease the possibility of malignant cells metastasis. To avoid mistakes a surgeon
must know the order of the root anatomic of the left lung from top to bottom.
A.Artery, bronchus, veins
B.Bronchus, artery, nerves
C.Bronchus, artery, veins
D.Veins, artery, bronchus
E.Artery, veins, bronchus
7.A 10-year-old patient was admitted to a clinic. The day before he had swallowed a nut
after what continuous cough and signs of heavy breathing appeared. Phonation function
wasn't affected. Where may the foreign body localize?
A.In the right principal bronchus
B.In the left principal bronchus
C.In the vestibular fissure
D.In the trachea
E.In the fissure of glottis
8.During the examination of a 67-year-old patient, X-ray examination shows a tumor of
the middle lobe of the right lung. What segments located in this lobe?
A.Medial, lateral
B.Superior lingular, inferior lingular
C.Anterior and posterior primary
D.Apical, anterior
E.Apical-posterior, anterior
9.Right-side bronchopneumonia of medial and lateral segments of a patient was
diagnosed. To which lobe of lungs do they refer?
A.Middle
B.Superior right
C.Inferior right
D.Superior left
E.Inferior left
10.A 37-year-old patient had a cough, then asphyxia because a foreign body got into the
respiratory tracts. Tracheotomy was made in the neck region limited by the superior
belly of omohyoid muscle, sternocleidomastoid muscle and the median neckline. In what
triangle of neck was the operation performed?
A.Omotracheal.
B.Carotid.
C.Submandibular.
D.Omotrapezoid.
E.Omoclavicular.
11. During the examination of a 65-year-old patient, X-ray examination shows an
inflammation process (pneumonia) of the inferior lobe of the right lung. What segments
located in this lobe?
A.Superior, medial basal, anterior basal, lateral basal, posterior basal.
B.Apicoposterior, anterior, superior lingual, inferior lingual.
C. Anterior and posterior primary.
D.Apical, anterior.
E.Medial, lateral.
12.Point the order of the right lung root component from top to bottom?
A.Bronchus, pulmonary artery, pulmonary veins.
B.Pulmonary artery, bronchus, pulmonary veins.
C.Pulmonary vein, pulmonary artery, bronchus.
D.Bronchus, pulmonary artery, phrenic nerve.
E.Phrenic nerve, bronchus, pulmonary artery and vein.
13.Point the order of the root anatomic component of the left lung from top to bottom.
A.Pulmonary artery, bronchus, pulmonary veins.
B.Bronchus, pulmonary artery, pulmonary veins.
C.Pulmonary vein, pulmonary artery, bronchus.
D.Bronchus, pulmonary artery, phrenic nerve.
E.Phrenic nerve, bronchus, pulmonary artery and vein.
14. A patient was admitted to a hospital with a knife wound of the thorax on the left and
pneumothorax. Percussion has shown that the inferior left lung border at the anterior
axillary line rose to the III rib level. Where is it located normally?
A.VII rib
B.IX rib
C.VIII rib
D.VI rib
E.V rib
15. A 50-year-old patient with carcinoma of lung had a left-side lobecotomy (ablation of
the superior lobe of the lung) performed. How many segments were ablated during the
operation?
A.Four
B.Three
C.Five
D.Two
E.None
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 11. Pleura.Mediastinum. The review of the serous membranous of the inner
organs.
1. Relevance of the topic.
Knowledge of the structure of the lower respiratory tract (trachea, bronchi, lungs)
is necessary for students to study these diseases in the departments of pathological
anatomy, pathological physiology, internal diseases.
2. The specific aims:
To explain the structure of the chest, upper aperture.
To analyze the distinctive lines on the surface of the chest to determine the boundaries
of the lungs.
To explain the structure of the pleura and mediastinum.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration)
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual .
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
Cavitas thoracica
Chest cavity
Cavitas pleuralis
Pleural cavity
Pleura
Pleura
Pleura visceralis
Visceral pleural leaf
Pleura pulmonalis
Pulmonary pleura
Tunica serosa
Serous membrane
Tela subserosa
Under Serous layer
Pleura parietalis
Parietal leaf
Pars costalis
Rib portion
Pars diaphragmatica
Portion diaphragmatic
Pars mcdiastinalis
Portion mediastinum
Recessus costodiaphragmaticus
Costal-diaphragmatic pigeonhole
Rib-mediastinum pigeonhole
Recessus costomediastinalis
Diaphragmatic mediastinal pigeonhole
Recessus phrenicomediastinalis
Mediastinum
Mediastinum
Mediastinum superius
The upper mediastinum
Mediastinum inferius
Lower mediastinum
Mediastinum anterius
Anterior mediastinum
Mediastinum medium
Average mediastinum
Mediastinum posterius
Rear mediastinum
4.2. Theoretical questions for the class:
1. Structure of the pleura, sinuses and their clinical significance?
2. The boundaries of the pleura and pulmonary?
3. What is the mediastinum, give definition?
4. Which organs are located in the lower mediastinum:
- The front
- Average
- Back
4.3. Practical tasks pertaining to the topic and to be completed during the class
that: on anatomical preparations, tables, models to study the structure, the mediastinum
and pleura topography.
The content of the topic.
Pleura.
Each lung is invested by an exceedingly delicate serous membrane, the
pleura, which is arranged in the form of a closed invaginated sac. A portion of the
serous membrane covers the surface of the lung and dips into the fissures between
its lobes; it is called the pulmonary pleura. The rest of the membrane lines the
inner surface of the chest wall, covers the diaphragm, and is reflected over the
structures occupying the middle of the thorax; this portion is termed the parietal
pleura. The two layers are continuous with one another around and below the root
of the lung; in health they are in actual contact with one another, but the potential
space between them is known as the pleural cavity. When the lung collapses or
when air or fluid collects between the two layers the cavity becomes apparent. The
right and left pleural sacs are entirely separate from one another; between them are
all the thoracic viscera except the lungs, and they only touch each other for a short
distance in front; opposite the second and third pieces of the sternum the interval
between the two sacs is termed the mediastinum.
Different portions of the parietal pleura have received special names which
indicate their position: thus, that portion which lines the inner surfaces of the ribs
and Intercostales is the costal pleura; that clothing the convex surface of the
diaphragm is the diaphragmatic pleura; that which rises into the neck, over the
summit of the lung, is the cupula of the pleura (cervical pleura); and that which is
applied to the other thoracic viscera is the mediastinal pleura.
The free surface of the pleura is smooth, polished, and moistened by a serous
fluid; its attached surface is intimately adherent to the lung, and to the pulmonary
vessels as they emerge from the pericardium; it is also adherent to the upper
surface of the diaphragm: throughout the rest of its extent it is easily separable
from the adjacent parts.
The right pleural sac is shorter, wider, and reaches higher in the neck than
the left.
The boundaries of the pleura
Topography
Right lung
Left lung
Top
1 cm above the clavicle
At the sternal line
Midclavicular line
Anterior axillary line
Middle axillary line
Posterior axillary line
Scapular line
Paraspine line
Up to 6 ribs
Up to 4 ribs
Up to 7 ribs
Up to 8 ribs
Up to 9 ribs
Up to 10 ribs
Up to 11 ribs
Mediastinum
Up to 12
heads ribs
Reflections of the Pleura – commencing at the sternum, the pleura passes
lateralward, lines the inner surfaces of the costal cartilages, ribs, and intercostales,
and at the back part of the thorax passes over the sympathetic trunk and its
branches, and is reflected upon the sides of the bodies of the vertebrae, where it is
separated by a narrow interval, the posterior mediastinum, from the opposite
pleura. From the vertebral column the pleura passes to the side of the pericardium,
which it covers to a slight extent; it then covers the back part of the root of the
lung, from the lower border of which a triangular sheet descends vertically toward
the diaphragm. This sheet is the posterior layer of a wide fold, known as the
pulmonary ligament. From the back of the lung root, the pleura may be traced
over the costal surface of the lung, the apex and base, and also over the sides of the
fissures between the lobes, on to its mediastinal surface and the front part of its
root. It is continued from the lower margin of the root as the anterior layer of the
pulmonary ligament, and from this it is reflected on to the pericardium
(pericardial pleura), and from it to the back of the sternum.
Mediastinum - lies between the right and left pleurae in and near the median sagittal
plane of the chest. It extends from the sternum in front to the vertebral column behind,
and contains all the thoracic viscera excepting the lungs. It may be divided for purposes
of description into two parts: an upper portion, above the upper level of the
pericardium, which is named the superior mediastinum; and a lower portion, below
the upper level of the pericardium. This lower portion is again subdivided into three
parts, viz., that in front of the pericardium, the anterior mediastinum; that containing
the pericardium and its contents, the middle mediastinum; and that behind the
pericardium, the posterior mediastinum.
The structure of the mediastinum
1. Upper - separated from the bottom of the imaginary plane of Th 4-5 to connect the
handle and body of the sternum.
Placed: thymus, trachea, esophagus, right and left brachiocephalic veins, superior vena
cava, aortic arch with branches, thoracic lymphatic duct, vagus and phrenic nerves,
sympathetic trunk.
2. Lower:
a) front - between the sternum and pericardium.
Placed: internal mammary arteries and veins, lymph nodes.
b) medium - full of heart in the pericardium.
Placed: diaphragmatic nerve.
c) back - between the pericardium and vertebral column.
Placed: thoracic aorta, esophagus, thoracic duct, lymph trunks, visceral nerves, the
vagus nerve, thoracic duct, lymph node.
The main research methods are respiratory fluoroscopy, radiography, bronchography,
imaging, pnevmodiastenohrafiya, anhiopulmohrafiya and others.
In the study of the bronchi to examine the walls of the main, lobar, segmental bronchi,
their permeability, topography.
On chest X-ray guided in the contours of the bones, heart and lungs. The space between
the ribs is called - lung field. We see the shadow of the root of the lungs, lung bottom
edge.
Pleura Newborn thin, loosely associated with intrathoracic fascia and easily displaced
during respiratory excursions. The upper between the pleural triangle relatively broad.
Pleural dome rises above 0.5 cm and ribs; lower limit corresponds to 6 mid clavicular
edge on line 8 rib on average axillary line, 9 edge - on with spinal line (adults
respectively - 7, 9 and 12 edges). Sinus pleura (costal-diaphragm and costal-
mediastinum) deep in newborns, not breathing, have any sinuses - sterno-sternum and
pericardial-sternum.
Mediastinum newborn has a relatively large size, it is short and wide. The
considerable width in the upper associated with well established zahrudnynnoyu gland.
The upper limit of the mediastinum lies horizontally in the plane of the upper thoracic
aperture, as well as handle the sternum is high. The lower limit - more convex due to
the high standing of the diaphragm. Anteroposterior relatively large dimensions: front
boundary represented by the sternum, the angle between the handle and the body
missing, the back - formed the spine, which has not yet pronounced thoracic syphosis.
The weak development of fiber and locking device results in what authorities
mediastinal shift easily, so the accumulation of effusion in the pleural cavity, leading to
the displacement of the heart and blood vessels, can cause circulatory disorder.
Materials for self-check:
А. Tasks for self-check: on the tables for study, show the structure of the pleura and
mediastinum.
B. Choose the correct answer:
1.A 50-year-old patient with carcinoma of lung had a right-side lobecotomy (ablation of
the superior lobe of the lung) performed. How many segments were ablated during the
operation?
A.Three
B.Four
C.Five
D.Two
E.None
2.A patient has a left-side pulmonectomy performed because of the carcinoma of lung.
After the dissection of the mediastinal pleura pulmonary veins must be ligated first of all
to decrease the possibility of malignant cells metastasis. To avoid mistakes a surgeon
must know the order of the root anatomic of the left lung from top to bottom.
A.Artery, bronchus, veins
B.Bronchus, artery, nerves
C.Bronchus, artery, veins
D.Veins, artery, bronchus
E.Artery, veins, bronchus
3.A 10-year-old patient was admitted to a clinic. The day before he had swallowed a nut
after what continuous cough and signs of heavy breathing appeared. Phonation function
wasn't affected. Where may the foreign body localize?
A.In the right principal bronchus
B.In the left principal bronchus
C.In the vestibular fissure
D.In the trachea
E.In the fissure of glottis
4. During the examination of a 67-year-old patient, X-ray examination shows a tumor of
the middle lobe of the right lung. What segments located in this lobe?
A. Apical-posterior, anterior.
B. Superior lingular, inferior lingular.
C. Anterior and posterior primary.
D. Apical, anterior.
E. Medial, lateral.
5.Right-side bronchopneumonia of medial and lateral segments of a patient was
diagnosed. To which lobe of lungs do they refer?
A.Middle
B.Superior right
C.Inferior right
D.Superior left
E.Inferior left
6.A 37-year-old patient had a cough, then asphyxia because a foreign body got into the
respiratory tracts. Tracheotomy was made in the neck region limited by the superior
belly of omohyoid muscle, sternocleidomastoid muscle and the median neckline. In what
triangle of neck was the operation performed?
A.Omotracheal
B.Carotid
C.Submandibular
D.Omotrapezoid
E.Omoclavicular
7.Specify surfaces of the lung.
A.Costal, mediastinal, interlobar, diaphragmatic
B.Vesical and intestinal
C.Medial and lateral
D.Diaphragmatic and visceral
E.Interlobar
8.Point the order of the right lung root component from top to bottom?
A.Bronchus, pulmonary artery, pulmonary veins
B.Pulmonary artery, bronchus, pulmonary veins
C.Pulmonary vein, pulmonary artery, bronchus
D.Bronchus, pulmonary artery, phrenic nerve
E.Phrenic nerve, bronchus, pulmonary artery and vein
9.Point the order of the root anatomic component of the left lung from top to bottom.
A.Pulmonary artery, bronchus, pulmonary veins
B.Bronchus, pulmonary artery, pulmonary veins
C.Pulmonary vein, pulmonary artery, bronchus
D.Bronchus, pulmonary artery, phrenic nerve
E.Phrenic nerve, bronchus, pulmonary artery and vein
10.Specify organs that are situated in the superior mediastinum.
A.The upper portion of the esophagus
B.Thoracic aorta
C.The heart, pericardium
D.The azygos and hemiazygos veins
E.The internal thoracic arteries
11.Specify organs that are situated in the middle mediastinum.
A.Phrenic nerves
B.Thoracic aorta
C.The trachea, thymus
D.The azygos and hemiazygos veins
E.The internal thoracic arteries
12.A patient was admitted to a hospital with a knife wound of the thorax on the left and
pneumothorax. Percussion has shown that the inferior left lung border at the anterior
axillary line rose to the III rib level. Where is it located normally?
A.VII rib
B.IX rib
C.VIII rib
D.VI rib
E.V rib
13.During the examination of a 78-year-old patient, X-ray examination shows a tumor of
the superior lobe of the left lung. What segments located in this lobe?
A.Apicoposterior, anterior, superior lingual, inferior lingual
B.Superior, medial basal, anterior basal, lateral basal, posterior basal
C.Anterior and posterior primary
D.Apical, anterior
E.Medial, lateral
14.During the examination of a 65-year-old patient, X-ray examination shows an
inflammation process (pneumonia) of the inferior lobe of the right lung. What segments
located in this lobe?
A.Superior, medial basal, anterior basal, lateral basal, posterior basal
B.Apicoposterior, anterior, superior lingual, inferior lingual
C.Anterior and posterior primary
D.Apical, anterior
E.Medial, lateral
15.A patient was admitted to a hospital with a knife wound of the thorax on the left and
pneumothorax. Percussion has shown that the inferior left lung border at the scapular line
rose to the III rib level. Where is it located normally?
A.X rib
B.VII rib
C.VIII rib
D.VI rib
E.V rib
16.A 50-year-old patient with carcinoma of lung had a left-side lobecotomy (ablation of
the superior lobe of the lung) performed. How many segments were ablated during the
operation?
A.Four
B.Three
C.Five
D.Two
E.None
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 12. Kidney: external structure, the topography.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further studies.
2. The specific aims.
To analyze the development of the urinary system in ontogenesis.
To explain:
- Skeletopy right and left kidneys;
- Holotopy right and left kidneys;
- Syntopy right and left kidneys;
- External structure of the kidneys;
- Membrane fascia and kidneys;
- Related to kidney peritoneum;
- Fixing apparatus kidneys.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class: the kidney- ren, the lateral border- margo
lateralis, the hilum of kidney- hilum renalis, the perinefric fat- capsula adipose, the ranal
lobes- lobi renalis, the cortical lobules- lobuli corticales, radiate part- pars radiate, the
glomerular capsule- capsula glomeruli, renal corpuscle- corpusculum renale, the
subscapule nephrons, the intermediate nephrons.
4.2. Theoretical questions for the class:
1. Development of the urinary system in ontogenesis?
2. Skeletopy right and left kidneys?
3. Holotopy right and left kidneys?
4. Syntopy lane and left kidneys?
5. .External structure of kidneys?
6. Share of membranes and fascia kidneys?
7. The ratio of the kidneys to the peritoneum.
8. What created fixing apparatus kidneys?
4.3. Practical tasks pertaining to the topic and to be completed during the class: on
anatomical preparation, tables, models to study the topography and the structure of the
kidney.
The content of the topic.
The urinary organs comprise the kidneys, which secrete the urine, the ureters, or ducts,
which convey urine to the urinary bladder, where it is for a time retained; and the
urethra, through which it is discharged from the body.
Urinary organs (organa urinària).
KIDNEY (ren, nefros)
The kidneys are situated in the posterior part of the abdomen, one on either side of the
vertebral column, behind the peritoneum, and surrounded by a mass of fat and loose
areolar tissue. Their upper extremities are on a level with the upper border of the twelfth
thoracic vertebra, their lower extremities on a level with the third lumbar. The right
kidney is usually slightly lower than the left, probably on account of the vicinity of the
liver. The long axis of each kidney is directed downward and lateralward; the transverse
axis backward and lateralward. Each kidney is about 11.25 cm. in length, 5 to 7.5 cm. in
breadth, and rather more than 2.5 cm. in thickness. The left is somewhat longer, and
narrower, than the right. The weight of the kidney in the adult male varies from 125 to
170 gm., in the adult female from 115 to 155 gm. The combined weight of the two
kidneys in proportion to that of the body is about 1 to 240. The kidney has a
characteristic form, and presents for examination two surfaces, two borders, and an upper
and lower extremity.
Anterior Surface of Right Kidney.—A narrow portion at the upper
extremity is in relation with the right suprarenal gland. A large area just below this
and involving about three-fourths of the surface, lies in the renal impression on the
inferior surface of the liver, and a narrow but somewhat variable area near the
medial border is in contact with the descending part of the duodenum.
Anterior Surface of Left Kidney.—A small area along the upper part of the
medial border is in relation with the left suprarenal gland, and close to the lateral
border is a long strip in contact with the renal impression on the spleen. A
somewhat quadrilateral field, about the middle of the anterior surface, marks the
site of contact with the body of the pancreas, on the deep surface of which are the
lienal vessels. Above this is a small triangular portion, between the suprarenal and
splenic areas, in contact with the posterior-inferior surface of the stomach.
The Posterior Surface (facies posterior).—The posterior surface of each
kidney is directed backward and medialward. It is imbedded in alveolar and fatty
tissue and enterely devoid of peritoneal covering.
Borders.—The lateral border (margo lateralis; external border) is convex,
and is directed toward the postero-lateral wall of the abdomen. On the left side it is
in contact at its upper part, with the spleen.
The medial border (margo medialis; internal border) is concave in the
center and convex toward either extremity; it is directed forward and a little
downward. Its central part presents a deep longitudinal fissure, bounded by
prominent overhanging anterior and posterior lips. This fissure is named the hilum,
and transmits the vessels, nerves, and ureter. Above the hilum the medial border is
in relation with the suprarenal gland; below the hilum, with the ureter.
Kidneys newborn short and thick, developed more than adults, act in the abdominal
cavity. On the surface of kidney visible grooves that correspond to boundaries between
their slices stored for 2-3 years. The left kidney newborn little more human, its weight is
13-15 grams, while the right kidney weight equal to 11-12 g average weight of both
kidneys is 21.5 -24 g at 1 year of age buds grow very quickly and reach their weight 3035 hours after 3-5 years growth slows kidney. The new acceleration of growth observed
in the second childhood and adolescence. Up to 15 years weight reaches 225-250 g
kidney and then slowly increased to 30-40 years, when it becomes equal to 275-310 g
Skeletotopichno kidneys in newborns are lower than in adults. The lower pole of the
kidney at 50% until the year rises above the iliac crest. Therefore, in young children it
can probe. Gates kidneys in children as in adults, are most often at the level of the 2nd
lumbar vertebra. The left kidney in 2/3 cases is slightly above right, 24% is on a level
with it and 13% is lower position. Vascular glomeruli and nephrons are differentiated in
the prenatal period. In fetal kidney produces urine, but its function is not vital that we
have cases of children born with agenesis of both kidneys. In postnatal number
glomerular vascular changes little, but their size, volume and surface area of leakage
increases several times.
Function:
- Excretory (kidney produces excreta - urine);
- Protection (urine output from harmful substances, waste of metabolism).
Materials for self-check:
А. Tasks for self-check:draw the structure of the structural and functional unit kidneys nephron.
B. Choose the correct answer:
1.A patient with a knife wound in the left lumbar part was delivered to the emergency
hospital. In course of operation a surgeon found that internal organs were not damaged
but the knife injured one of muscles of renal bed. What muscle is it?
A.Quadratuslumborum
B.Piriformis muscle
C.Obturatorinternus muscle
D.Iliacus muscle
E.Gluteus maximus muscle
2.A patient with a knife wound in the right lumbal part was delivered to the emergency
hospital. In course of operation a surgeon found that the knife injured one of muscles,
which plays the most important role in support of kidneys. What muscle is it?
A.The transversusabdominis
B.Iliac muscle
C.Erector muscle of spine
D.Abdominal internal oblique muscle
E.Abdominal external oblique muscle
3.After a significant weight loss a 70-year-old man has dull pain in the loin. The
diagnose is a floating kidney. In which part of the kidney fixative apparatus have the
changes taken place?
A.The perinephric fat
B.Capsulafibrosa.
C.m. iliopsoas.
D.lig.hepatorenalis
E.m. quadratuslumborum.
4.During operation on kidneys, a surgeon must select the renal leg (stalk). What
anatomical structures leave a kidney hilum?
A.Renal vein, ureter and lymphatic vessels
B.Renal artery, nerves
C.Renal vessels and nerves
D.Renal artery and vein
E.Renal artery, ureter
5.Ultrasonic examination of a young man of 34 y.o. has shown abnormal kidney descent.
Which vertebrae level is the kidneys' normal position?
A.ThXI - LII
B.ThXI– LIII
C.LIV- LV
D.ThIX- ThXII
E.ThIX– ThX
6.During operation on kidneys, a surgeon must select the leg of kidney. What enters in
the kidney hilum?
A.Renal artery and nerves
B.Renal artery, nerves and lymphatic vessels
C.Renal artery and vein
D.Renal vein, ureter
E.Renal artery, ureter
7.After a significant weight loss, a 56-year-old woman has dull pain in the loin. The
diagnose is a floating kidney. In which part of the kidney fixative apparatus have the
changes taken place?
A.Capsulaadiposa
B.lig.hepatorenalis
C.m. iliopsoas
D.Capsulafibrosa
E.m. quadratuslumborum
8.Ultrasonic examination of a young woman of 20y.o. has shown nephroptosis. Name
the structures that is not responsible for kidney's support.
A.Piriform muscle
B.The perinephric fat
C. The renal stalk
D.m. quadratuslumborum
E.The renal bed
9.Ultrasonic examination of a young man of 34 y.o. has shown abnormal kidney descent.
Treatment of this condition is aimed at suturing the fascial layers inferior to the kidney
and fixation of the organ to the rib. Specify this rib?
A. ThXII
B. ThXI
C. ThIX
D. ThVIII
E. ThX
10.Holotopy of the kidney.
A.Regiolateralis
B.Regiopubica.
C.Regioinguinalis.
D.Regioumbilicalis
E.Regioepigastrica
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 13. The internal structure of the kidney. Segments of the kidney.
Malformations.
1. Relevances of the topic.
Knowledge of anatomy end of this section is important for students to further studies.
2. The specific aims:
To explain the development of the urinary system in ontogenesis.
Analyze: -Internal structure of the kidneys;
- Segments of the kidneys;
- Structure of the nephron.
3. Basic knowledge, skills necessary for studying the subject (interdisciplinary
integration)
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s forstudent’s individual work
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
Segmenta renalia
Segments kidneys
Arteriae intrarenales
Between renal artery
Aa. Interlobares
Interlobular artery
Arteriola glomerularis afferens
Arteriola glomerularis efferens
Pelvis renalis
Calices renales majors
Calices renales minores
Accept glomerular arterioles
Remote glomerular arterioles
Pelvis kidneys
Large kidney calyx
Small renal calyx
4.2. Theoretical questions for the class:
1. Development of the urinary system in ontogenesis?
2. Internal structure kidney?
3. Which segments isolated kidney?
4. What is the nephron, as it is built?
4.3. Practical tasks pertaining to the topic and to be completed during the class: on
anatomical preparation, tables, models to study the internal structure of the kidney,
segments and abnormalities.
The content of the topic.
KIDNEY (ren, nefros)
The kidney is composed of an internal medullary and an external cortical
substance.The medullary substance (substantia medullaris) consists of a series of redcolored striated conical masses, termed the renal pyramids, the bases of which are
directed toward the circumference of the kidney, while their apices converge toward the
renal sinus, where they form prominent papillae projecting into the interior of the
calyces.The cortical substance (substantia corticalis) is reddish brown in color and soft
and granular in consistence. It lies immediately beneath the fibrous tunic, arches over
the bases of the pyramids, and dips in between adjacent pyramids toward the renal sinus.
The parts dipping in between the pyramids are named the renal columns (Bertini), while
the portions which connect the renal columns toeach other and intervene between the
bases of the pyramids and the fibrous tunic are called the cortical arches. If the cortex be
examined with a lens, it will be seento consist of a series of lighter-colored, conical
areas, termed the radiate part, and adarker-colored intervening substance, which from the
complexity of its structure isnamed the convoluted part. The rays gradually taper toward
the circumference ofthe kidney, and consist of a series of outward prolongations from the
base of eachrenal pyramid.The renal tubules, of which the kidney is for the most part
made up,commence in the cortical substance, and after pursuing a very circuitous
coursethrough the cortical and medullary substances, finally end at the apices of the
renalpyramids by open mouths, so that the fluid which they contain is emptied, through
the calyces, into the pelvis of the kidney. If the surface of one of the papillae be
examined with a lens, it will be seen to be studded over with minute openings, theorifices
of the renal tubules, from sixteen to twenty in number, and if pressure bemade on a fresh
kidney, urine will be seen to exude from these orifices. The tubules commence in the
convoluted part and renal columns as the renalcorpuscles, which are small rounded
masses of a deep red color, varying in size,but of an average of about 0.2 mm. in
diameter. Each of these little bodies is composed of two parts: a central glomerulus of
vessels, and a membranous envelope, the glomerular capsule (capsule of Bowman),
which is the small pouch-like commencement of a renal tubule.The glomerulus is a
lobulated net-work of convoluted capillary bloodvessels, held together by scanty
connective tissue. This capillary net-work is derived from a small arterial twig, the
afferent vessel, which enters the capsule; and the resulting vein, the efferent vessel,
emerges from the capsule at the same point.The afferent vessel is usually the larger of the
two. The glomerular or Bowman’s capsule, which surrounds the glomerulus, consists of
a basement membrane, lined on its inner surface by a layer of flattened epithelial cells,
which are reflected from the lining membrane on to the glomerulus, at the point of
entrance or exit of the afferent and efferent vessels. Thus between the glomerulus and the
capsule a space is left, forming a cavity lined by a continuous layer of squamous cells;
this cavity varies in size according to the state of secretion and the amount of fluid
present in it. In the fetus and young subject the lining epithelial cells are polyhedral or
even columnar. The renal tubules, commencing in the renal corpuscles, present, during
their course, many changes in shape and direction, and are contained partly in the
medullary and partly in the cortical substance. At their junction with the glomerular
capsule they exhibit a somewhat constricted portion, which is termed the neck. Beyond
this the tubule becomes convoluted, and pursues a considerable course in the cortical
substance constituting the proximal convoluted tube. After a time the convolutions
disappear, and the tube approaches the medullary substance in a more or less spiral
manner; this section of the tubule has been called the spiral tube. Throughout this
portion of their course the renal tubules are contained entirely in the cortical substance,
and present a fairly uniform caliber. They now enter the medullary substance, suddenly
become much smaller, quite straight in direction, and dip down for a variable depth into
the pyramids, constituting the descending limb of Henle’s loop. Bending on themselves,
they form what is termed the loop of Henle, and reascending, they become suddenly
enlarged, forming the ascending limb of Henle’s loop, and reлnter the cortical substance.
This portion of the tubule ascends for a short distance, when it again becomes dilated,
irregular, and angular. This section is termed the zigzag tubule; it ends in a convoluted
tube, which resembles the proximal convoluted tubule, and is called the distal convoluted
tubule. This again terminates in a narrow junctional tube, which enters the straight or
collecting tube. The straight or collecting tubes commence in the radiate part of the
cortex, where they receive the curved ends of the distal convoluted tubules. They unite at
short intervals with one another, the resulting tubes presenting a considerable increase in
caliber, so that a series of comparatively large tubes passes from the bases of the rays
into the renal pyramids. In the medulla the tubes of each pyramid converge to join a
central tube (duct of Bellini) which finally opens on the summit
of one of the papillae; the contents of the tube are therefore discharged into one of
the calyces.
Process of urine formation
1. Filtration. One day to 200 liters. primary urine in the renal corpuscles
2. Reabsorption. In the convoluted tubules to 2 liters urine.
Supplied with blood kidney renal artery. Venous blood flowing in renal vein into the
inferior vena cava.
"Wonderful net" kidney ( "réte miràbile rénis"). In the kidney, there are 2 capillary net.
"Miracle" is that blood from the artery enters the capillaries and then into the artery.
Formula "wonderful mesh" Kidney: A - C - A (- k).
Sympathetic innervation of the kidney carried renal plexus formed axons
vistseromotoneyron units lumbar sympathetic trunk; parasympathetic vistseromotoneyron parasympathetic axons units, which are interrupted renal branches of
the vagus nerve
Scheme nephron and urine output path:
1 — capillary ball (glomérulus);
2 — glomerular capsule or capsule
Shumlyanskoho-Bowman (cаpsula
gloméruli) —
contains primary urine;
3 — proximal tubule portion
twisted or 1st order (pàrs
proximàlis,);
4 Nephron loop or the loop of Henle
(ansa nephróni);
5 — distal part or twisted tubule
2nd order (pàrs distàlis);
6 — connecting portion (pars
conjùgens) — contains recycled
urine.
7 — collective (straight tubule)
tùbulus colligens, s. réctus);
8 — papillary duct (diictus
papillàris);
9 — renal papilla (papilla renаlis)
↓
small renal calyx
↓
large kidney calyx
↓
pelvis kidney
↓
ureter
↓
bladder
↓
2.6 urethra - of the renal tubule
(Production of urine). 1 + 2 = renal
corpuscles (corpùsculum
rénis Malpighiì).
Scheme kidneys vascular network:
renal artery (artèria renalis) - is the right kidney
↓
polar artery (artériae polares) - segments kidney
↓
interlobar artery (artériae interlobàres) - between pyramids
↓
arch artery (artériae arcuate) - on the edges of the pyramids (on the border between the
brain and the kidney cortex)
↓
interlobular artery (artériae interlobulàres) - between cortical slices
↓
prynosni arterioles of glomeruli (arteriólae glomerulàres afferéntes)
↓
capillary glomeruli (gloméruli) - products of primary urine
↓
remote arterioles of glomeruli (arteriólae giomerulares efferéntes)
↓
capillary nets around the renal tubules where reabsorption occurs and the formation of
secondary urine, kidney trophic
↓
stellate veins (venae stellatae)
↓
interlobular veins (venae interlobulares)
↓
arch veins (venae arcuatae)
↓
interlobar veins (venae interlobares)
↓
segmental vein (venae segmentales)
↓
renal vein (vena renalis) - out of the gate of the kidney.
Newborn number glomerular vascular changes little, but their size, volume and
surface area of leakage increases several times. Accordingly, the developing cortical
substance of the kidney. The thickness of the newborn is 2-4 mm in the first year of
life increased 2 times. The ratio between the cortex and medulla neonatal exactly 1:
4 adult 1: 2. Renal pelvis in infants and children up to 5 years often located inside
the kidney, and in subsequent ages prevails pozanyrkove location and mixed dishes.
In the embryonic period bowls are ampullar form large cups available. At the end of
a fruitful period formed large cups and bowls are dendrytychnymy and after birth,
aged 10-15 years, again increasing.
Anomalies of development:
- Abnormal position - pelvic kidney (kidney did not rise to the development of the
pelvis in the lumbar region, the vessels are thus also low). Pelvic kidney should be
differentiated from floating kidney (kidney risen in development, but dropped due
to disease, while vessels are in a standard location);
- Number of anomalies: double kidney, an additional (third) kidney, horseshoe
kidney.
Materials for self-check:
А. Tasks for self-check:the figures mark the cortical and medulla of the kidneys, small
and large cups.
B. Choose the correct answer:
1.Urography has shown stones in the macroscopic parts of the kidney urinary tracts. It
was detected that they are located in:
A.Minor and major renal calices, renal pelvis
B.Gathering tubules, papillary ducts, minor renal calices
C.Straight tubules, minor and major renal calices
D.Papillary ducts, major renal calices, renal pelvis
E.Papillary ducts, minor renal calices, straight tubules
2.A patient with a knife wound in the right lumbal part was delivered to the emergency
hospital. In course of operation a surgeon found that the knife injured one of muscles,
which plays the most important role in support of kidneys. What muscle is it?
A.The quadratuslumborum
B.Iliac muscle
C.Erector muscle of spine
D.Abdominal internal oblique muscle
E.Abdominal external oblique muscle
3.After a significant weight loss, a 70-year-old man has dull pain in the loin. The
diagnose is a floating kidney. Which part of the kidney fixative apparatus have the
changes taken place.
A.Capsulaadiposa
B.Capsulafibrosa
C.M. iliopsoas
D.Lig.hepatorenalis
E.M. quadratuslumborum
4.During operation on kidneys, a surgeon must select the renal stalk. What goes out from
a kidney gate?
A.Renal vein, ureter and lymphatic vessels
B.Renal artery, nerves
C.Renal vessels and nerves
D.Renal artery and vein
E.Renal artery, ureter
5.Ultrasonic examination of a young man of 19 y.o. has shown nephroptosis. Which
vertebrae level is the kidneys' normal position?
A.ThXI - LII
B.ThXI– LIII
C.LIV- LV
D.ThIX- ThXII
E.ThIX– ThX
6.During operation on kidneys, a surgeon must select the leg of kidney. What enters in
the kidney gate?
A.Renal artery and nerves
B.Renal artery, nerves and lymphatic vessels
C.Renal artery and vein
D.Renal vein, ureter
E.Renal artery, ureter
7.After a significant weight loss, a 67-year-old woman has dull pain in the loin. The
diagnose is a floating kidney. In which part of the kidney fixative apparatus have the
changes taken place?
A.Capsulaadiposa
B.Lig.hepatorenalis
C.M. iliopsoas
D.Capsulafibrosa
E.M. quadratuslumborum
8.Ultrasonic examination of a young woman of 23y.o. has shown nephroptosis. Name
the structures that is not responsible for kidney support.
A.Piriform muscle
B.The perinephric fat
C.The renal stalk
D.M. quadratuslumborum
E.The renal bed
9.Specify surfaces of the kidney.
A.Anterior and posterior
B.Vesical and intestinal
C.Interlobar
D.Diaphragmatic and visceral
E.Costal and mediastinal
10.The renal bed – the excavation bounded by which muscle:
A.The psoas major, the quadratuslumborum, the diaphragm, the transversusabdominis
B.The gluteus maximus, the piriformis
C.The latissimusdorsi, the erector spine
D.Abdominal internal oblique muscle
E.Abdominal external oblique muscle
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 14. Ureters, urinary bladder. Vale and female urethrae. X-ray anatomy of
the urine voiding organs.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further studies.
2.The specific aims:
To analyze the topography of the ureter in the abdomen on the right and left.
To analyze the topography of the ureter in the pelvic cavity in men and women.
To explain: - narrowing of the ureters and their structure;
- External structure of the ureter;
- Structure of a wall of the ureter;
- External structure of the bladder;
- Structure of the bladder wall;
-topohrafiyu bladder in men and women.
To interpret the structural features of the male urethra.
Share bends of the male urethra.
Explain constriction and expansion of the male urethra.
Share structural features of the female urethra.
Share of female urethra wall structure.
Describe the direction of the female urethra function.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class:
Ureter
Ureter
Pars abdominalis
Abdominal part
Pars pelvica
Pelvic portion
Bladder
Vesica urinaria
The top of the bubble
Apex vesicae
The body bubble
Corpus vesicae
The bottom of the bladder
Fundus vesicae
Cervix vesicae
The neck of the bladder
Women urethra
Urethra feminine
Urethra masculine
Male urethra
4.2. Theoretical questions for the class:
1. Share topography ureter abdominal right and left?
2. Share topography ureteral pelvic cavity in men and women?
3. What have narrowing of the ureters and what is their practical value?
4. Describe the external structure of the ureter?
5. What is the structure of the wall of the ureter?
6.Share the external structure of the bladder?
7.What is the structure of the wall of the bladder?
8. Share topography of the bladder in men and women?
9. Avilable male urethra?
10. Share of male urethra bends?
11. Describe the constriction and expansion of the male urethra?
12. avilable female urethra?
13. Share of female urethral wall structure?
14. Describe the direction of the female urethra function?
4.3. Practical tasks pertaining to the topic and to be completed during the class: on
anatomical preparations, tables, models to study the topography, structure ureters,
bladder and examine the structure of the male and female urethra.
The content of the topic.
URETER (uréter).
Ureter - paired organ is shaped like a tube. Ureteral length 30- 35 cm. In diameter - 4-7
mm., Is located behind the peritoneum (ekstraperytonealno).
Topography: ureter is abdominal and pelvic cavities.
The outer structure. There are 3 parts ureter:
- Abdominal (pàrs abdominàlis);
- Pelvic (pàrs pelvina).
- Vnutrishnostinkovu (pàrs intramuralis)
Narrowing of the ureter:
- A place of transition pelvis into the ureter;
- A place of transition abdominal part in pelvic ureter (the whole of the pelvic narrower
than abdominal);
- Place the entrance of the ureter into the bladder.
Internal structure. Ureter - a hollow (tubular) body.
The structure of the wall:
1) The inner shell - mucous - has the following features:
- Transitional epithelium;
- Longitudinal wrinkles;
- Expressed submucosa;
- Glands produce mucus;
- Lymphoid tissue forms a single lymph nodules;
2) the average shell - muscle - consists of two layers:
- Internal - longitudinal;
- External - circular.
But part of the pelvic ureter has 3 layers:
- Longitudinal;
- Circular;
- Longitudinal;
3) outer shell - adventive.
Newborn ureters are tortuous course, easily displaced due to the weak development of
retroperitoneal fat. Their length - 4.7 cm. The left ureter longer than the right. Field
joining with bladder relatively large. Curves are more pronounced at the level of the
lower pole of the kidney and ureter in the intersection of vessels. The wall of the ureter
thin, circular muscle layer poorly developed, especially at the confluence of the bladder.
X-ray anatomy: the X-ray ureter looks like a long narrow shadow that runs from the
kidney to the bladder. Ureter forms bends (curvature) in two planes - sagittal and frontal
(in the abdominal part - medially in pelvic - lateral).
Development. Ureter develops from secondary (intermediate) of the mesoderm (with
legs mesoderm). With caudal part mezonefrychnoyi duct formed metanefrychnyy
diverticulum, which formed the ureter.
Function: holding urine.
Blood supply and innervation. Krovopostachayetsya ureter ureter branches of the renal
artery, internal iliac artery, lower cystic artery, testicular (ovarian) arteries. Venous blood
flowing in the veins of the same name. Lymph flowing in the lumbar and iliac lymph
nodes. Parasympathetic innervation carried parasympathetic axons vistseromotoneyroniv
units, which are interrupted by branches of the vagus nerve and pelvic nerves nutryani.
Sympathetic innervation occurs kidney, ureter, lower pidcherevnym plexus formed axons
vistseromotoneyroniv lumbar and sacral sympathetic trunk assemblies. Sensitive fibers
are composed of sympathetic and parasympathetic nerves.
BLADDER (vésica urinàrìa, s.cystus (rp.).
The filled bladder has ovoid shape, hollow - triangular. Bladder volume - 500 ml.
Bladder - odd body.
Topography:
Holotopiya: full bladder is in the pelvic cavity and abdomen; empty - only in the pelvic
cavity;
Skeletopy: full bladder stands at 4-5 cm above the pubic symphysis, blank - not acting;
Syntopy: the men behind the bladder is placed rectum in women - uterus.
The outer structure. There bladder following parts:
The tip (àpex vésicae urìnàriae);
Body (corpus vésicae urinàriae);
The bottom (fundus vésicae urinàriae);
Neck (cérvix vésicae urinàriae).
The bladder has paired inlet - ureteral orifice (óstium uretéris) i odd outlet - internal
opening of the urethra (óstium uréthrae intémum).
Internal structure. The bladder - a hollow (tubular) body. The structure of the wall:
1) The inner shell - mucous - has the following features:
- Transitional epithelium;
- Pronounced folds (plicae vesicàles), but there is an exception - a triangle bladder
(trigónum vésicae), which is based on the openings of the ureters, and on top - the
internal opening of the urethra;
- Expressed submucosa, but an exception - bladder triangle (a triangle fold and no
submucosa);
- Bladder cancer (glandulae vesicàles) produce mucus;
- Lymphoid tissue forms a single lymph nodules;
2) the average shell - muscle - consists of three layers:
- Internal (stràtum intérnum) - dominated longitudinal fibers;
- Average (stràtum mèdium) - dominated transverse fibers;
- External (stràtum extérnum) - dominated longitudinal fibers;
Transverse fibers in the area of the bladder neck and form potovschuyutsya styskach
bladder muscle (musculus sphincter vésicae).
The muscular coat of the bladder muscle and forms which expels urine (musculus
detrùsor urinae);
3) outer shell - adventive (empty bladder) on three sides, only the top - serous (bubble is
ekstraperytonealno).
Bladder neonatal fusiform or pear-shaped, located above the entrance to a small basin,
its tip is in the middle of the distance between the navel and pubic symphysis. The
bottom of the bladder is located at the upper edge of the pubic symphysis, the holes are
ureter in girls at an altitude of opening of the uterus. The front wall of the bladder not
covered by peritoneum. Girls, in contrast to adults, the bladder is not in contact with the
vagina, the boy does not border the rectum. In the first three years of life is lowering the
bladder in the pelvic cavity. This changes the ratio of body to the pelvic viscera and
peritoneum; bladder gets out and takes cover retroperitoneal in empty state
ekstraperytonialne position. The capacity of the bladder is, in infants 50-80 cm3, children
6 months 135 cm3, aged 1 year 200 cm3, in 3-4 years 400 cm3, in 8-9 years 500 cm3, in
12-13 years 900 cm3. In adults, the maximum capacity of the bladder is an average of
1500-2000 cm3.
Development. The development of the bladder associated with the transformation of
cloaca. Cloaca - a joint cavity, which first opened urinary and genital tract, colon back.
Cloaca looks like a blind sac, closed kloakovoyu membrane. Subsequently there in front
kloatsi membrane that divides the cloaca into two parts: the urogenital sinus and rectum
kloakova membrane breaks. Urogenital sinus continues to urinary bag (allantóis). The
distal portion of the bag sechovoho converted to uric duct (urachus), which
obliteruyetsya the time of birth and remains as the median umbilical ligament. On the
proximal part of the urinary bladder sac develops.
Function:
- Accumulation of urine;
- Urine output.
Blood supply and innervation. Bladder krovopostachayetsya upper and lower cystic
artery. Venous blood flowing in the same vein. Lymph flowing in the lymph nodes of the
pelvis (iliac). Parasympathetic innervation carried parasympathetic axons
vistseromotoneyroniv units, which are interrupted nutryani pelvic nerves. Sympathetic
innervation is lower pidcherevnym plexus (pelvic) formed axons vistseromotoneyroniv
units sacral sympathetic trunk. Sensitive fibers are composed pelvic nerves nutryanyh.
Urethra (uréthra).
Male urethra (uréthra masculina).
Women urethra (uréthra feminina).
The urethra is a tube shape. The length of the female urethra - 3 cm, female - 18-20 cm.
Urethra - odd body.
Development. The development of the urethra associated with the development of
external genitalia. Function: output of urine.
Topography: female urethra is in the pelvic cavity, the male - in the pelvic cavity and
sponge penis.
The outer structure. The urethra is the inlet - the internal opening of the urethra (óstium
uréthrae ìntérnum) i outlet - external opening of the urethra (óstium uréthrae extérnum).
The urethra in women opens in the vestibule of the vagina, men - on the head of the
penis. The male urethra is divided into three parts.
- Prostate (pàrs prostàtica) - passes through the prostate;
- Membranous (pàrs membranàcea) - passes through the urogenital diaphragm, covered
crotch skeletal muscle - muscle-styskachem urethra (musculus sphincter uréthrae);
- Spongy (pàrs spongiósa) - held in the spongy substance of the penis.
Internal structure. The urethra - a hollow (tubular) body.
The wall of the urethra is made up of mucous, muscular and adventive shells.
Urethra baby boy 5-6 cm in length, has a relatively sharp curvature. The prostate and
the membranous part of the channel up about 2 cm of its length, the remaining 3-4 cm
pryhodyatsya on the spongy part. Inside it is a hole at the top third symphysis. Provisions
narrowed urethra and advanced parts correspond to those in adults.
Urethra baby girls wide, arched curved length of 1-3 cm. Folds glands and mild. The
muscular coat of the urethra and sphincter exterior formed to 12-13 years.
And supply and n n e p c in and I did. Urethra krovopostachayetsya sechivnykovymy
arteries (arteries branch vnutrishnoyistatevoyi). Venous blood flowing in the same vein.
Lymph flows club lymph nodes. Parasympathetic innervation carried parasympathetic
axons vistseromotoneyroniv units, which are interrupted nutryani pelvic nerves.
Sympathetic innervation is lower pidcherevnym (pelvic) plexus formed axons
vistseromotoneyroniv sacral sympathetic trunk assemblies, sensitive - the sacral plexus
Materials for self-check.
А. Tasks for self-check: mark on the tables of the ureter, bladder and structure of the
male and female urethra.
B. Choose the correct answer:
1.A 58-year-old woman had her uterus and all appendages completely removed. It
resulted in stoppage of urine excretion. Cystoscopy results: bladder doesn't contain any
urine, urine doesn't come also from ureteric orifices. What part of urinary excretion
system was damaged during the operation?
A.Ureter
B.Uretra
C.Vesica urinaria
D.Pelvis renalis
E.Ren
2.A patient has urolithiasis that was complicated by a renal stone passage. At what level
of ureter is it most likely to stop?
A.Between abdominal and pelvic part
B.In pelvis
C.In the middle abdominal part
D.2 cm above flowing into urinary bladder
E.5 cm above pelvic part
3.During complicated labour, the symphysis pubis ruptured. What organ can be damaged
mostly?
A.Urinary bladder
B.Rectum
C.Ovaria
D.Uterine tubes
E.Uterus
4.During cystoscopy, mucous membrane of urinary bladder normally makes folds except
for a single triangular area with smooth mucosa. This triangle is located in the following
part of urinary bladder:
A.Bladder fundus
B.Bladder cervix
C.Bladder apex
D.Bladder body
E.Bladder isthmus
5.During a urinary bladder catheterization, an abrupt catheter introduction caused
bleeding because of the trauma of the urethral mucous tunic in the external sphincter
muscle area. In which urethral area should the doctor be careful and feel the resistance of
soft tissues as the catheter through?
A.In pars membranacea urethrae
B.In fossa navicularis urethrae area
C.In bulbus urethrae
D.In pars spongiosa urethrae
E.In past prostatica urethrae
6.An elderly man has complicated urination. Which part of urethra becomes narrower
with age the most often?
A.Pars prostatica
B.Glandulae urethrales
C.M. sphincter urethrae externum
D.Pars spongiosa
E.Pars membranacea
7.During a surgery on the small pelvis, there was a need to perform an intraoperative
uterine artery ligation. Which one of the mentioned may be accidentally ligated together
with it?
A.Ureter
B.Uterine tube
C.Round ligament of uterus
D.Internal iliac vein
E.Urethra
8.A 40-year-old man had a ureteral calculus instrumentally removed, which was
complicated by a rupture of the ureter wall in the abdominal part. Where will urine get
through the rupture in the ureter wall?
A.Retroperitoneal space
B.Hepatic bursa
C.Peritoneal cavity
D.Omental bursa
E.Vertebral canal
9.Holotopy of the urinary bladder.
A.Lesser pelvis
B.Regio pubica.
C.Regio inguinalis.
D.Regio umbilicalis
E.Regio epigastrica
10.Peritoneal relations of the ureter.
A.Extraperitoneally
B.All answers are correct
C.All answers are incorrect
D.Mesoperitoneally
E.Intraperitoneally
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 15. Internal male genital organs. External male genital organs.
Malformations.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further studies.
2.The specific aims:
Analyze the classification of male genitalia.
Explain that authorities relating to the internal reproductive organs.
To explain: - the structure of the stroma and the parenchyma of the testes;
- Syim'yavynosnoyi duct components;
- Structure of the prostate gland and urethra bulbs;
- The topography of the prostate;
- The internal structure of the prostate;
- Structure of the spermatic cord;
- The functional significance of the prostate.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. The task’s for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class: the testis-testis, the upper pole- extremitas
superior, the lower pole- extremitas superior, the head of epididymis- caput
epididymidis, the tail of epididymis- cauda epididymis, lobules of testis- lobuli testis, the
seminiferous tubules- tubuli seminiferi contorti, the straight tubules- tubuli seminiferi
recti, the efferent ductile- ductuli efferentes testis, the external spermatic fascia- fascia
spermatica externa.
4.2. Theoretical questions for the class:
1. Name the classification of male genitalia.
2. What authorities relating to the internal reproductive organs?
3. Show the vaginal membrane testicles, leaves the wall and organ.
4. Tell us about the structure of the stroma and the parenchyma of the testes.
5. Draw a diagram of secretion of the male sex gland.
6. Name and show parts syim'yavynosnoyi Strait.
7. What is the structure of the prostate gland and urethra bulbs?
8. Topography of the prostate.
9. Share the internal structure of the prostate.
10. The structure of the spermatic cord?
11. What is the functional significance of prostate cancer?
12. What authorities belong to the external genitalia?
13. The structure of the external genitalia?
14. Share internal and external structure of the corpus cavernosum of the penis?
15. What is spongy body of the penis?
16. What fascia and ligaments have a penis?
17. Share structure purse?
4.3. Practical tasks pertaining to the topic and to be completed during the class:
To study the development of the male reproductive system in ontogenesis. On
anatomical preparations, tables, models to study the structure, function of external and
internal genitalia.
The content of the topic:
In the male reproductive system distinguish external and internal genitalia.
The internal organs.
Testicle, Testis, Orchis, Didimis (гр.)
Doubles body 25g, a scrotal 4-2,5sm
Surface:
- medial
- lateral
land;
- front
- rear
poles:
- Upper (appendage, early cord)
- lower
Options:
- Produce sperm
- Hormonoutvorennya (testosterone)
Shell testicles:
- Leather purse
- Muscle (subcutaneous tissue)
- External seminal fascia (superficial fascia of the abdomen)
- Fascia kremasteryka
- Muscle kremaster
- Internal seminal fascia
- Vaginal membrane:
- Parietalnyy leaf
- Visceral leaf
between the average cavity, pathology accumulation of fluid (edema)
Internal structure:
1 protein shell
2. mediastinum (back edge thickening protein)
3. partition (of the mediastinum, hormones)
4 slices - parenchyma between partitions
5. parenchyma:
- Tubules (products)
- Straight tubules (transport)
Bookmark abdominal descent through a wire to the birth.
Epididymis :
- At the rear edge of the testicles, the transition of the mediastinum:
- head
- body
- Tail (go to the ejaculatory ducts)
Ejaculatory duct :
Shape: tube 40 cm
Parts:
-prydatkova
-kanatykova (from the scrotum to the inguinal canal)
-pahova (channel)
-tazova (for lateral - rear).
Spermatic cord:
- The complex tubular structures in a shell length of 20 cm
- Ejaculatory ducts
- Testicular artery
- Testicular veins (varicocele, usually the left)
- Arteries and veins Strait
- nerves
- Lymphatic vessels.
Ejaculatory duct:
The tube is 1.5 cm from the merger of ejaculatory duct and seminal bladder. Opens in
seminal tubercle urethra.
Seminal vesicles:
Irregular shape, side - behind the bladder, up to 5 cm (15cm tube, in the form of
accordion) function:
- Making the liquid part of semen.
Prostate:
- Muscle - glandular body shape chestnut, 2-5 cm in the pelvic cavity under the bladder,
urethra passes through it. Options:
- Making the liquid part of semen
- Hormone
- Urethral sphincter
- External structure:
- The right of fate
- Left fate
- Isthmus (adenoma)
- the basis of
- top.
Bulbourethral gland (Cooper)
Spherical, 1 cm in promizhnosti opened in the membranous part of the urethra. Grease to
protect the walls of the urethra.
Testicle newborn baby has a relatively large size. The length of the testes is 10.5 mm and
weighs 0.3 grams over 1 year testicles grow rapidly, increasing body weight to 1 g, then
growth slows down before puberty, when there is a rapid increase in the size and weight
of the gonads. The length of the testis is aged 5 years, 15 mm, 15 20 mm to 18 mm 40,
adult 50 mm. Weight testicles in 14 years is only 2 grams, and 15-16 years for 8 hours to
20 years Weight testicle is 20 hours in premature infants testicles not fully descended
into the scrotum, is sometimes observed in term. Spermatic duct in infants and in
children have expressed lumen in 14-16 years due to the start of spermatogenesis tubule
diameter increases, and they formed a clearance. Nadyayechko neonatal relatively large,
its length is 20 mm. In the first 10 years nad'yayechko hardly growing at puberty
increases its size significantly.
Prostate and seminal vesicles in newborns also have relatively large size and are located
in the pelvis above. The prostate gland weighs 0.82 grams at birth, a form of Balloon
Shaped, particles are not differentiated glandular tissue is poorly developed. In the first
10 years of increasing prostate weight in half, and between 10 and 15 years, more than 2
times. At puberty gland gets its characteristic shape chestnut, full development it reaches
for 21-25 years. Seminal vesicles in newborns weigh 0.05 g.
External genitalia.
Penis
* Root (2 parts - pechernysti body)
* Body (2 pechernysti + sponge)
* Head (spongy)
* Leather
* Folds on the head (foreskin)
* Tie
* Sebaceous glands
Penis the newborn has a length of 2-2.5 cm, thickness 1 cm. Front penile skin is almost
completely covers the penis and part of it grows. Spongy body developed more
cavernosum. Up to 4 years penis almost not growing at the age of 7 years, its length is
4.5 cm. In early adolescence penis grows primarily in length, and is increasing its
thickness.
Materials for self-check.
А. Tasks for self-check: draw a diagram of secretion of the male sex glands.
B. Chjjse the correct answer:
1.While performing a man's inguinal canal operation on account of hernia a surgeon
damaged the canal's contents. What exactly was damaged?
A.Funiculus spermaticus
B.Urarchus
C.Lig. teres uteri
D.Lig. inguinalе
E.Broad ligament of uterus
2.A patient complains of having urination disorder. He is diagnosed the hypertrophy of
prostate gland. What part of gland is damaged?
A.Median lobe
B.Left lobe
C.Right lobe
D.Base
E.Apex
3.Patient complains of frequent and difficult urination. Imperfection of what formation
can cause it?
A.Prostate
B.Testicles
C.Bulb-uretic glands
D.Testicle adnexa
E.Sperm bubbles
4.Examination of a newborn boy's genitals revealed a cleft of urethra that opens on the
inferior surface of his penis. What developmental anomaly is meant?
A.Hypospadia
B.Hermaphroditism
C.Epispadia
D.Monorchism
E.Cryptorchism
5.A young man consulted a doctor about disturbed urination. Examination of his external
genitals revealed that urethra is split on top and urine runs out of this opening. What
anomaly of external genitals development is the case?
A.Epispadia
B.Phimosis
C.Hermaphroditism
D.Paraphimosis
E.Hypospadia
6.A boy was diagnosed a scrotal hernia. The underdevelopment of which testicular
membrane caused the hernia?
A.Tunica vaginalis testis.
B.Fascia spermatica externa.
C.Fascia spermatica interna.
D.Fascia cremasterica.
E.Tunica dartos.
7.A man of 35 complains of pain and swelling of the right testicle. Examination has
shown a tumor, the surgery of which requires dissection of testicle tunics. Which tunic
will be dissected the last before tunica albuginea?
A.Tunica vaginalis testis.
B.Tunica spermatica externa.
C.Tunica spermatica interna.
D.Tunica dartos.
E.Cutis orchis.
8.A patient is diagnosed with scrotal hydrocele - an increase of fluid quantity in serous
sac. Between which testicular tunics is the pathologic content located?
A.Between parietal and visceral layers of vaginal tunic
B.Between skin and dartos muscle
C.Between internal spermatic fascia and vaginal tunic
D.Between dartos muscle and internal spermatic fascia
E.Between skin and cremaster muscle
9.A surgeon has detected scrotal hydrocele of a patient. Between the layers of which
testicular tunic has the fluid accumulated?
A.Serous (vaginal tunic)
B.Tunica albuginea
C.Dartos muscle
D.Spermatica externa
E.Spermatica interna
10.A patient has left-side varicocele. Blood outflow disorder has taken place in:
A.V. testicularis sinistra
B.V. testicularis dextra
C.V. renalis sinistra
D.V. renalis dextra
E.V. ovarica
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 16. Female genital organs.Malformations.
1. Relevance of topic.
Knowledge of anatomy end of this section is important for students to further studies.
2. The specific aims:
1. Classify female sex organs.
2. To explain: - part of the uterus;
3.
The structure of the uterus;
4. Layers of the uterus;
5.
Ligament of the uterus;
6.
Part of the fallopian tube;
7.
Links fallopian tube;
8.
Part of the ovary and its appendage;
9.
The vault of the vagina, cervix, uterus mouth;
10. Vulva women;
11. The structure of the vagina;
12. Abnormalities of the female reproductive system.
13. To explain: - the structure of the perineum;
14. Part of the crotch;
15. The pelvic diaphragm is formed;
16. Fascia of the pelvic diaphragm;
17. Muscles that make up the urinary-genital aperture and their structure and function;
18. Fascia has a urinary-genital diaphragm;
19. The limited-vidhidnykova sciatic fossa;
20. Practical value sciatic-holes vidhidnykovoyi.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
The acquired knowledge
subjects
Biology
Phylogeny of the digestive system;
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
To further explore topics.
4. Task’s for student’s individual work.
4.1. The list of basic terms,parameters, characteristics which the student should
master while
ORGANA GENITALIA FEMININA Women's internal genitals
INTERNA
Ovarium
Ovaries
Stroma ovarii
Ovarian stroma
Medulla ovarii
Cerebellum ovary
Folliculi ovarici vesiculosi
Vesicular ovarian follicles
Соrpus luteum
Yellow body
Соrpus albicans
Whitish flesh
Lig. ovarii proprium
Own ovarian ligament
Lig. Uteroovaricum
Utero-ovarian ligament
Tuba uterina; Salpinx
The uterine tube
Uterus
Uterus
Clitoris
Clitoris
4.2. Theoretical questions for the class:
1. Name the classification of female genital mutilation.
2. What authorities relating to the internal reproductive organs of women.
3. Name and show parts of the uterus.
4. What is the structure of the uterus?
5. Name and show the layers of the uterus and the perineum.
6. Name and show ligament of the uterus.
7. Show the pockets of the peritoneum, those related to the uterus.
8. Name and show parts of the fallopian tube.
9. Name and show relationships fallopian tube.
10. Name of the ovary and show his appendage.
11. What can cause female infertility?
12. Show the vault of the vagina, cervix, mouth cancer.
13. What features of blood supply to the uterus?
14. Name the show and the vulva of women.
15. Tell us about the structure of the vagina.
16. What do you know abnormalities of the female reproductive system?
17. Tell us about the structure of the crotch?
18. Name and show of the perineum.
19. What pelvic diaphragm is formed and which is fascia?
20. What muscles are part of the urinary-genital aperture? Their structure and function?
21. What fascia has urinary-genital diaphragm?
4.3. Practical tasks pertaining to the topic and to be completed during the class:
To study the development of the female reproductive system in ontogenesis. On
anatomical preparation, tables, models to study the structure, function of internal and
external genitalia and perineum.
The female genital organs consist of an internal and an external group. The
internal organs are situated within the pelvis, and consist of the ovaries, the
uterine tubes, the uterus, and the vagina. The external organs are placed below
the urogenital diaphragm and below and in front of the pubic arch. They comprise
the mons pubis, the labia majora et minora pudendi, the clitoris, the bulbus
vestibuli, and the greater vestibular glands.
The ovaries are homologous with the testes in the male. They are two
nodular bodies, situated one on either side of the uterus in relation to the lateral
wall of the pelvis, and attached to the back of the broad ligament of the uterus,
behind and below the uterine tubes. The ovaries are of a grayish-pink color, and
present either a smooth or a puckered uneven surface. They are each about 4 cm. in
length, 2 cm. in width, and about 8 mm. in thickness, and weigh from 2 to 3.5 gm.
Each ovary presents a lateral and a medial surface, an upper or tubal and a lower or
uterine extremity, and an anterior or mesovarion and a posterior free border. It lies in a
shallow depression, named the ovarian fossa, on the lateral wall of the pelvis; this
fossa is bounded above by the external iliac vessels, in front by the obliterated
umbilical artery, and behind by the ureter. The exact position of the ovary has been the
subject of considerable difference of opinion, and the description here given applies to
the ovary of the nulliparous woman. The ovary becomes displaced during the first
pregnancy, and probably never again returns to its original position. In the erect posture
the long axis of the ovary is vertical. The tubal extremity is near the external iliac
vein; to it are attached the ovarian fimbria of the uterine tube and a fold of
peritoneum, the suspensory ligament of the ovary, which is directed upward over the
iliac vessels and contains the ovarian vessels. The uterine end is directed downward
toward the pelvic floor, it is usually narrower than the tubal, and is attached to the
lateral angle
of the uterus, immediately behind the uterine tube, by a rounded cord termed the
ligament of the ovary, which lies within the broad ligament and contains some
non-striped, muscular fibers. The lateral surface is in contact with the parietal
peritoneum, which lines the ovarian fossa; the medial surface is to a large extent
covered by the fimbriated extremity of the uterine tube. The mesovarian border is
straight and is directed toward the obliterated umbilical artery, and is attached to
the back of the broad ligament by a short fold named the mesovarium. Between
the two layers of this fold the bloodvessels and nerves pass to reach the hilum of
the ovary. The free border is convex, and is directed toward the ureter. The uterine
tube arches over the ovary, running upward in relation to its mesovarian border,
then curving over its tubal pole, and finally passing downward on its free border
and medial surface.
Epoophoron (parovarium; organ of Rosenmller)—The epoцphoron lies
in the mesosalpinx between the ovary and the uterine tube, and consists of a few
short tubules (ductuli transversi) which converge toward the ovary while their
opposite ends open into a rudimentary duct, the ductus longitudinalis epoophori
(duct of Gдrtner).
Paroophoron.—The paroцphoron consists of a few scattered rudimentary
tubules, best seen in the child, situated in the broad ligament between the
epoцphoron and the uterus.
The ductuli transversi of the epoophoron and the tubules of the paroophoron
are remnants of the tubules of the Wolffian body or mesonephros; the ductus
longitudinalis epoophori is a persistent portion of the Wolffian duct.
The uterine tubes convey the ova from the ovaries to the cavity of the
uterus. They are two in number, one on either side, situated in the upper margin of
the broad ligament, and extending from the superior angle of the uterus to the side
of the pelvis. Each tube is about 10 cm. long, and is described as consisting of
three portions: (1) the isthmus, or medial constricted third; (2) the ampulla, or
intermediate dilated portion, which curves over the ovary; and (3) the
infundibulum with its abdominal ostium, surrounded by fimbriae, one of which,
the ovarian fimbria is attached to the ovary. The uterine tube is directed
lateralward as far as the uterine pole of the ovary, and then ascends along the
mesovarian border of the ovary to the tubal pole, over which it arches; finally it
turns downward and ends in relation to the free border and medial surface of the
ovary. The uterine opening is minute, and will only admit a fine bristle; the
abdominal opening is somewhat larger. In connection with the fimbriae of the
uterine tube, or with the broad ligament close to them, there are frequently one or
more small pedunculated vesicles. These are termed the appendices vesiculosae
(hydatids of Morgagni).
The uterine tube consists of three coats: serous, muscular, and mucous.
The external or serous coat is peritoneal. The middle or muscular coat consists
of an external longitudinal and an internal circular layer of non-striped muscular
fibers continuous with those of the uterus. The internal or mucous coat is
continuous with the mucous lining of the uterus, and, at the abdominal ostium of
the tube, with the peritoneum. It is thrown into longitudinal folds, which in the
ampulla are much more extensive than in the isthmus. The lining epithelium is
columnar and ciliated. This form of epithelium is also found on the inner surface of
the fimbriae. while on the outer or serous surfaces of these processes the
epithelium gradually merges into the endothelium of the peritoneum.
The uterus is a hollow, thick-walled, muscular organ situated deeply in the
pelvic cavity between the bladder and rectum. Into its upper part the uterine tubes
open, one on either side, while below, its cavity communicates with that of the
vagina. When the ova are discharged from the ovaries they are carried to the
uterine cavity through the uterine tubes. If an ovum be fertilized it imbeds itself in
the uterine wall and is normally retained in the uterus until prenatal development is
completed, the uterus undergoing changes in size and structure to accommodate
itself to the needs of the growing embryo. After parturition the uterus returns
almost to its former condition, but certain traces of its enlargement remains. It is
necessary, therefore, to describe as the type-form the adult virgin uterus, and then
to consider the modifications which are effected as a result of pregnancy.
In the virgin state the uterus is flattened antero-posteriorly and is pyriform in
shape, with the apex directed downward and backward. It lies between the bladder
in front and the pelvic or sigmoid colon and rectum behind, and is completely
within the pelvis, so that its base is below the level of the superior pelvic aperture.
Its upper part is suspended by the broad and the round ligaments, while its lower
portion is imbedded in the fibrous tissue of the pelvis.
The long axis of the uterus usually lies approximately in the axis of the
superior pelvic aperture, but as the organ is freely movable its position varies with
the state of distension of the bladder and rectum. Except when much displaced by a
fully distended bladder, it forms a forward angle with the vagina, since the axis of
the vagina corresponds to the axes of the cavity and inferior aperture of the pelvis.
The uterus measures about 7.5 cm. in length, 5 cm. in breadth, at its upper
part, and nearly 2.5 cm. in thickness; it weighs from 30 to 40 gm. It is divisible
into two portions. On the surface, about midway between the apex and base, is a
slight constriction, known as the isthmus, and corresponding to this in the interior
is a narrowing of the uterine cavity, the internal orifice of the uterus. The portion
above the isthmus is termed the body, and that below, the cervix. The part of the
body which lies above a plane passing through the points of entrance of the uterine
tubes is known as the fundus.
Body (corpus uteri).—The body gradually narrows from the fundus to the
isthmus.
The vesical or anterior surface (facies vesicalis) is flattened and covered by
peritoneum, which is reflected on to the bladder to form the vesicouterine
excavation. The surface lies in apposition with the bladder.
The intestinal or posterior surface (facies intestinalis) is convex
transversely and is covered by peritoneum, which is continued down on to the
cervix and vagina. It is in relation with the sigmoid colon, from which it is usually
separated by some coils of small intestine.
The fundus (fundus uteri) is convex in all directions, and covered by
peritoneum continuous with that on the vesical and intestinal surfaces. On it rest
some coils of small intestine, and occasionally the distended sigmoid colon.
The lateral margins (margo lateralis) are slightly convex. At the upper end
of each the uterine tube pierces the uterine wall. Below and in front of this point
the round ligament of the uterus is fixed, while behind it is the attachment of the
ligament of the ovary. These three structures lie within a fold of peritoneum which
is reflected from the margin of the uterus to the wall of the pelvis, and is named the
broad ligament.
Cervix (cervix uteri; neck).—The cervix is the lower constricted segment of
the uterus. It is somewhat conical in shape, with its truncated apex directed
downward and backward, but is slightly wider in the middle than either above or
below. Owing to its relationships, it is less freely movable than the body, so that
the latter may bend on it. The long axis of the cervix is therefore seldom in the
same straight line as the long axis of the body. The long axis of the uterus as a
whole presents the form of a curved line with its concavity forward, or in extreme
cases may present an angular bend at the region of the isthmus.
The supravaginal portion (portio supravaginalis [cervicis]) is separated in front from
the bladder by fibrous tissue (parametrium), which extends also on to its sides and
lateralward between the layers of the broad ligaments. The uterine arteries reach the
margins of the cervix in this fibrous tissue, while on either side the ureter runs
downward and forward in it at a distance of about 2 cm. from the cervix. Posteriorly,
the supravaginal cervix is covered by peritoneum, which is prolonged below on to the
posterior vaginal wall, when it is reflected on to the rectum, forming the rectouterine
excavation. It is in relation with the rectum, from
which it may be separated by coils of small intestine. The vaginal portion (portio
vaginalis [cervicis]) of the cervix projects free into the anterior wall of the vagina
between the anterior and posterior fornices. On its rounded extremity is a small,
depressed, somewhat circular aperture, the external orifice of the uterus, through
which the cavity of the cervix communicates with that of the vagina. The external
orifice is bounded by two lips,an anterior and a posterior, of which the anterior is the
shorter and thicker,although, on account of the slope of the cervix, it projects lower than
the posterior.Normally, both lips are in contact with the posterior vaginal wall.Interior
of the Uterus — The cavity of the uterus is small in comparison with the size of the
organ. The Cavity of the Body (cavum uteri) is a mere slit, flattened anteroposteriorly. It is triangular in shape, the base being formed by the internal surface of the
fundus between the orifices of the uterine tubes, the apex by the internal orifice of the
uterus through which the cavity of the body communicates with the canal of the cervix.
The Canal of the Cervix (canalis cervicis uteri) is somewhat fusiform,
flattened from before backward, and broader at the middle than at either extremity. It
communicates above through the internal orifice with the cavity of the body, and below
through the external orifice with the vaginal cavity. The wall of the canal presents an
anterior and a posterior longitudinal ridge, from each of which proceed a number of
small oblique columns, the palmate folds, giving the appearance of branches from the
stem of a tree; to this arrangement the name arbor vitae uterine is applied. The folds
on the two walls are not exactly opposed, but fit between one
another so as to close the cervical canal. Ligaments.—The ligaments of the uterus are
eight in number: one anterior; one posterior; two lateral or broad; two uterosacral;
and two round ligaments.
The anterior ligament consists of the vesicouterine fold of peritoneum,
which is reflected on to the bladder from the front of the uterus, at the junction of the
cervix and body.
The posterior ligament consists of the rectovaginal fold of peritoneum,
which is reflected from the back of the posterior fornix of the vagina on to the front of
the rectum. It forms the bottom of a deep pouch called the rectouterine excavation,
which is bounded in front by the posterior wall of the uterus, the supravaginal cervix,
and the posterior fornix of the vagina; behind, by the rectum; and laterally by two
crescentic folds of eritoneum which pass backward from the cervix uteri on either side
of the rectum to the posterior wall of the pelvis. These folds are named the
sacrogenital or rectouterine folds. They contain a considerable amount of fibrous
tissue and non-striped muscular fibers which are attached to the front of the sacrum and
constitute the uterosacral ligaments. The two lateral or broad ligaments (ligamentum
latum uteri) pass from the sides of the uterus to the lateral walls of the pelvis. Together
with the uterus they
form a septum across the female pelvis, dividing that cavity into two portions. In the
anterior part is contained the bladder; in the posterior part the rectum, and in certain
conditions some coils of the small intestine and a part of the sigmoid colon. The round
ligaments (ligamentum teres uteri) are two flattened bands between 10 and 12 cm. in
length, situated between the layers of the broad ligament in front of and below the
uterine tubes.
Structure - The uterus is composed of three coats: an external or serous, a middle or
muscular, and an internal or mucous. The serous coat (tunica serosa) is derived
from the peritoneum; it invests the fundus and the whole of the intestinal surface of the
uterus; but covers the vesical surface only as far as the junction of the body and cervix.
In the lower
fourth of the intestinal surface the peritoneum, though covering the uterus, is not closely
connected with it, being separated from it by a layer of loose cellular tissue and some
large veins. The muscular coat (tunica muscularis) forms the chief bulk of the
substance of the uterus. In the virgin it is dense, firm, of a grayish color, and cuts almost
like cartilage. It is thick opposite the middle of the body and fundus, and thin at the
orifices of the uterine tubes. It consists of bundles of unstriped muscular fibers,
disposed in layers, intermixed with areolar tissue, bloodvessels, lymphatic
vessels, and nerves. The layers are three in number: external, middle, and internal. The
external and middle layers constitute the muscular coat proper, while the inner layer is a
greatly hypertrophied muscularis mucosae. During pregnancy the muscular tissue
becomes more prominently developed, the fibers being greatly enlarged. The external
layer, placed beneath the peritoneum, is disposed as a thin plane on the vesical and
intestinal surfaces. It consists of fibers which pass transversely across the fundus, and,
converging at each lateral angle of the uterus,
are continued on to the uterine tube, the round ligament, and the ligament of the ovary:
some passing at each side into the broad ligament, and others running backward from
the cervix into the sacrouterine ligaments. The middle layer of fibers presents no
regularity in its arrangement, being disposed longitudinally,obliquely, and
transversely. It contains more bloodvessels than either of the other two layers. The
internal or deep layer consists of circular fibers arranged in the form of two hollow
cones, the apices of which surround the orifices of the uterine tubes, their bases
intermingling with one another on the middle of the body of the uterus. At the internal
orifice these circular fibers form a distinct sphincter. The mucous membrane (tunica
mucosa) is smooth, and closely adherent to
the subjacent tissue. It is continuous through the fimbriated extremity of the uterine
tubes, with the peritoneum; and, through the external uterine orifice, with the lining of
the vagina. In the body of the uterus the mucous membrane is smooth, soft, of a pale
red color, lined by columnar ciliated epithelium, and presents, when viewed with a
lens, the orifices of numerous tubular follicles, arranged perpendicularly to the surface.
The structure of the corium differs from that of ordinary mucous membranes, and
consists of an embryonic nucleated and highly cellular form of connective tissue in
which run numerous large lymphatics. In it are the tube-like uterine glands, lined by
ciliated columnar epithelium. They are of small size in the unimpregnated uterus, but
shortly after impregnation become enlarged and elongated, presenting a contorted or
waved appearance. The vagina extends from the vestibule to the uterus, and is situated
behind the bladder and in front of the rectum; it is directed upward and backward, its
axis forming with that of the uterus an angle of over 90°, opening forward. Its walls are
ordinarily in contact, and the usual shape of its lower part on transverse section is that
of an H, the transverse limb being slightly curved forward or backward, while the
lateral limbs are somewhat convex toward the median line; its middle part has the
appearance of a transverse slit. Its length is 6 to 7.5 cm. along its anterior wall,and 9
cm. along its posterior wall. It is constricted at its commencement, dilated in the
middle, and narrowed near its uterine extremity; it surrounds the vaginal portion of the
cervix uteri, a short distance from the external orifice of the uterus, its attachment
extending higher up on the posterior than on the anterior wall of the uterus. To the
recess behind the cervix the term posterior fornix is applied, while the smaller recesses
in front and at the sides are called the anterior and lateral fornices.
Relations.—The anterior surface of the vagina is in relation with the
fundus of the bladder, and with the urethra. Its posterior surface is separated from the
rectum by the rectouterine excavation in its upper fourth, and by the rectovesical fascia
in its middle two-fourths; the lower fourth is separated from the anal canal by the
perineal body. Its sides are enclosed between the Levatores ani muscles. As the terminal
portions of the ureters pass forward and medialward to reach the fundus of the bladder,
they run close to the lateral fornices of the vagina, and as they enter the bladder are
slightly in front of the anterior fornix.
Structure.—The vagina consists of an internal mucous lining and a
muscular coat separated by a layer of erectile tissue.
The mucous membrane (tunica mucosa) is continuous above with that
lining the uterus. Its inner surface presents two longitudinal ridges, one on its anterior
and one on its posterior wall. These ridges are called the columns of the
vagina and from them numerous transverse ridges or rugae extend outward on
either side. These rugae are divided by furrows of variable depth, giving to the
mucous membrane the appearance of being studded over with conical projections
or papillae; they are most numerous near the orifice of the vagina, especially
before parturition. The epithelium covering the mucous membrane is of the
stratified squamous variety. The submucous tissue is very loose, and contains
numerous large veins which by their anastomoses form a plexus, together with
smooth muscular fibers derived from the muscular coat; it is regarded by
Gussenbauer as an erectile tissue. It contains a number of mucous crypts, but no
true glands.
The muscular coat (tunica muscularis) consists of two layers: an external
longitudinal, which is by far the stronger, and an internal circular layer. The
longitudinal fibers are continuous with the superficial muscular fibers of the uterus.
The strongest fasciculi are those attached to the rectovesical fascia on either side.
The two layers are not distinctly separable from each other, but are connected by
oblique decussating fasciculi, which pass from the one layer to the other. In
addition to this, the vagina at its lower end is surrounded by a band of striped
muscular fibers, the Bulbocavernosus.
External to the muscular coat is a layer of connective tissue, containing a
large plexus of bloodvessels. The erectile tissue consists of a layer of loose
connective tissue, situated between the mucous membrane and the muscular coat;
imbedded in it is a plexus of large veins, and numerous bundles of unstriped
muscular fibers, derived from the circular muscular layer. The arrangement of the
veins is similar to that found in other erectile tissues.
External female genital organs.
The external genital organs of the female are: the mons pubis, the labia
majora et minora pudendi, the clitoris, the vestibule of the vagina, the bulb of
the vestibule, and the greater vestibular glands. The term pudendum or vulva,
as generally applied, includes all these parts.
The Mons Pubis (commissura labiorum anterior; mons Veneris), the
rounded eminence in front of the pubic symphysis, is formed by a collection of
fatty tissue beneath the integument. It becomes covered with hair at the time of
puberty.
The Labia Majora (labia majora pudendi) are two prominent longitudinal
cutaneous folds which extend downward and backward from the mons pubis and
form the lateral boundaries of a fissure or cleft, the pudendal cleft or rima, into
which the vagina and urethra open. Each labium has two surfaces, an outer,
pigmented and covered with strong, crisp hairs; and an inner, smooth and beset
with large sebaceous follicles. Between the two there is a considerable quantity of
areolar tissue, fat, and a tissue resembling the dartos tunic of the scrotum, besides
vessels, nerves, and glands. The labia are thicker in front, where they form by their
meeting the anterior labial commissure. Posteriorly they are not really joined, but
appear to become lost in the neighboring integument, ending close to, and nearly
parallel with, each other. Together with the connecting skin between them, they
form the posterior labial commissure or posterior boundary of the pudendum.
The interval between the posterior commissure and the anus, from 2.5 to 3 cm. in
length, constitutes the perineum. The labia majora correspond to the scrotum in
the male.
The Labia Minora (labia minora pudendi; nymphae) are two small
cutaneous folds, situated between the labia majora, and extending from the clitoris
obliquely downward, lateralward, and backward for about 4 cm. on either side of
the orifice of the vagina, between which and the labia majora they end; in the
virgin the posterior ends of the labia minora are usually joined across the middle
line by a fold of skin, named the frenulum of the labia or fourchette. Anteriorly,
each labium minus divides into two portions: the upper division passes above the
clitoris to meet its fellow of the opposite side, forming a fold which overhangs the
glans clitoridis, and is named the preputium clitoridis; the lower division passes
beneath the clitoris and becomes united to its under surface, forming, with its
fellow of the opposite side, the frenulum of the clitoris. On the opposed surfaces
of the labia minora are numerous sebaceous follicles.
The Clitoris is an erectile structure, homologous with the penis. It is situated
beneath the anterior labial commissure, partially hidden between the anterior ends
of the labia minora. It consists of two corpora cavernosa, composed of erectile
tissue enclosed in a dense layer of fibrous membrane, united together along their
medial surfaces by an incomplete fibrous pectiniform septum; each corpus is
connected to the rami of the pubis and ischium by a crus; the free extremity (glans
clitoridis) is a small rounded tubercle, consisting of spongy erectile tissue, and
highly sensitive. The clitoris is provided like the penis, with a suspensory ligament,
and with two small muscles, the Ischiocavernosi, which are inserted into the crura
of the clitoris.
The Vestibule (vestibulum vaginae).—The cleft between the labia minora
and behind the glans clitoridis is named the vestibule of the vagina: in it are seen
the urethral and vaginal orifices and the openings of the ducts of the greater
vestibular glands.
The external urethral orifice (orificium urethrae externum; urinary
meatus) is placed about 2.5 cm behind the glans clitoridis and immediately in front
Materials for self-check.
А. Tasks for self-check: To report the development of the female reproductive system
in ontogenesis. In the tables designate the structure of internal, external genitalia and
perineum.
B. Choose the correct answer:
1.A 28-year-old woman has been diagnosed with extrauterine pregnancy complicated by
the fallopian tube rupture. The blood is most likely to penetrate the following peritoneal
space:
A.Rectouterine
B.Vesicouterine
C.Right mesenteric sinus
D.Left mesenteric sinus
E.Intersigmoid sinus
2.Ovarian tumour was diagnosed in the woman. Surgery was indicated. What ligament
should be cut by the surgeon to disconnect the ovary and the uterus?
A.The ovarial ligament
B.Broad ligament of uterus
C.Lateral umbilical ligament
D.Suspensory ligament of ovary
E.Round ligament of uterus
3.A woman underwent an operation because of extrauterine (tubal) pregnancy. In course
of the operation the surgeon should ligate the branches of the following arteries:
A.Uterine and ovarian
B.Superior cystic and ovarian
C.Inferior cystic and ovarian
D.Uterine and superior cystic
E.Uterine and inferior cystic
4.Inflammatory process of modified subserous layer around cervix of the uterus caused
an intensive pain syndrome. In what region of genitals does the pathological process take
place?
A.Parametrium
B.Mesometrium
C.Myometrium
D.Endometrium
E.Perimetrium
5.During the examination of a patient, the presence of suppurative exudation in the
straight rectouterine pouch was suspected. Through what anatomic formation is it better
to puncture the pouch?
A.Posterior vaginal fornix
B.Anterior vaginal fornix
C.Rectal ampulla
D.Anterior vaginal wall
E.Pelvic diaphragm
6.A 28-year-old woman was admitted to a gynecology department with complaints of
pain in the abdominal region. An ovary tumor was clinically detected and prescribed to
be removed. During the operation a ligament connecting the ovary with the uterus is to
be dissected. Which ligament is it?
A.Lig. ovarii proprium
B.Lig. latum uteri
C.Lig. cardinale
D.Lig. umbilicalis lateralis
E.Lig. suspensorium ovarii
7.During a gynecologic examination, a patient has endometritis (inflammation of
endometrium) diagnosed. Which membrane of uterine wall is affected by the
inflammatory process?
A.Mucous tunic
B.Serous tunic.
C.Muscular tunic.
D.Adventitious membrane.
E.Parametrium.
8.Specify surfaces of the uterus.
A.Vesical and intestinal
B.Interlobar
C.Lateral and medial
D.Diaphragmatic and visceral
E.Costal and mediastinal
9.Specify surfaces of the ovary.
A.Lateral and medial
B.Vesical and intestinal
C.Interlobar
D.Diaphragmatic and visceral
E.Costal and mediastinal
10.Peritoneal relations of the uterine tube.
A.Intraperitoneally
B.All answers are correct
C.All answers are incorrect
D.Extraperitoneally
E.Mesoperitoneally
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 17. The general principle of the structure of the endocrine glands. Central
part of the endocrine system. The pineal gland. The pituitary gland.
1. Relevance of the topic:
Regulation of human vital activity carried out by neurohumoral. An important role in
this process is played by the endocrine glands, which inkrety enter directly into the
blood. Knowledge of the topography, structure, functions of the glands of the study
required students many clinical disciplines, such as therapy, endocrinology,
pathophysiology, pharmacology, surgery and others.
A very important place in the structure of diseases with lesions of the pancreas
(diabetes), thyroid (hyperthyroidism), the pituitary and gonads.
2. The specific aims:
To explain the distribution of glands in the endocrine, exocrine.
Classify cancer by functional signs and development.
Have an understanding of neurosecretory.
Have an understanding of the main manifestations of the pathology glands.
Explain and show the main elements of the glands function call them: and -hipofizu
epiphysis.
Analyze diffuse, endocrine system.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Discipline
Know
Be able
Histology
On the difference in the Give examples of endocrine,
structure of the excretory tract exocrine glands and mixed
endocrine and exocrine glands
Pathophysiology Know gland dysfunction
What are the main diseases in
the defeat of the glands
Pharmacology
Find function of glands that act Name the brain hormones of
like autonomic nervous system the adrenal glands, thyroid
gland
4. The tasks for student’s individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class.
Peripheral organs of endocrine system (thyroid gland, parathyroid gland, adrenal gland,
endocrine portion of the pancreas, gonads).
GLANDULAE ENDOCRINAE
Endocrine glands
Hypophysis
Pituitary
Glandula thyroidea
Thyroid gland
Adenohypophysis
Adenohypophysis
Lobus anterior
Front proportion
Pars distalis
The distal part
Neurohypophysis
Neurohypophysis
Lobus posterior
Rear share
Lobus nervosus
Nervous share
Pars nervosa
The nervous portion
4.2. Theoretical questions for the class (to the topic):
1. Share the classification glands on functional signs ?.
2. Share the classification glands on development?
3. Share of neurosecretory formation of the hypothalamic-pituitary-adrenal system,
pituitary - dependent cancer.
4. Name and show the main elements of glands called their function and clinical
manifestations of the excitation functions: pituitary; epiphysis.
5. To have an idea of the diffuse endocrine system.
4.3. Practical tasks pertaining to the topic and to be completed during the class: On
anatomical preparation, tables, models to study the structure of the central department of
the endocrine system (pituitary, pineal gland).
The content of the topic:
Hormones are molecules that function as chemical signals. They are
liberated by specialized cells that are called endocrine cells because they secrete
"inward," as opposed to exocrine cells, which secrete into a body cavity or toward
the body surface. Endocrine cells usually aggregate as endocrine glands, where
they typically arrange themselves as cords of cells. A notable exception is the
thyroid gland, in which the cells are organized as microspheres called follicles. In
addition to the glands, there are many isolated endocrine cells in the body, such as
the endocrine cells of the digestive tract, the cells of the placenta, the cells of the
heart that produce the atrial natriuretic factor, and the juxtaglomerular cells of the
kidney. Most hormones act at a distance from die site of their secretion. Therefore,
die endocrine cells are always very close to blood capillaries, which receive die
secreted hormones and distribute them throughout die organism. Many cells,
however, produce hormones or other molecules (eg, cytokines) that act at a short
distance by diffusing through the extracellular matrix. This is called paracrine
secretion. A good example of paracrine secretion is seen in islets of Langerhans,
where insulin secretion is inhibited by somatostarin produced by cells of the same
islet. Another mechanism is juxtacrine control, by which a molecule present on the
surface of a cell influences adjacent cells that have receptors for this molecule.
However, in autocrine control, cells secrete molecules that act on themselves or on
cells of the same type. Insulin-like growth factors (IGFs) produced by several cell
types may act on the same cells that produced them.
The tissues and organs on which the hormones act are called target tissues or
target organs. They react because their cells have receptors that specifically
recognize and respond to the hormones. Because of this, the hormones may
circulate in the blood and do not indiscriminantly influence all cells of the body.
Another advantage of receptors is that target cells respond to the respective
hormones even when they are present in very small concentrations in the blood,
which typically is the case. Endocrine glands are also target organs providing a
way for the body to control hormone secretion through a mechanism of feedback
and to keep blood hormonal levels within strict limits.
The endocrine system, however, does not act alone in the control of body
functions. It interacts closely with the nervous system (mainly through the
connection between the adenohypophysis and die central nervous system) and the
immune system. Endocrine disfunctions may affect the immune response and vice
versa.
Classification of the endocrine glands.
1) Central part
a) hypothalamus
b) hypophysis
c) epiphysis
2) Peripheral part
a) Specialized glands:
1) thyroid
2) parathyroid
3) adrenal cortex
b) Non-specialized gland (also with exocrine function):
1) genital glands
2) pancreas
3) prostate
4) kidneys
5) placent
b) Diffuse endocrine system
Classification by development.
Entodermal glands
a) thyroid
b) parathyroid
c) pancreatic islets
2) Mesodermal
a) adrenal cortex
b) endocrine part of genital glands
3) Neuro-ectodermal
a) hypophysis
b) epiphysis
c) adrenal medulla
d) paraganglions
HYPOPHYSIS
The hypophysis (Gr. hypo, under, + physis, growth), or pituitary gland, weighs about 0.5 g,
and its normal dimensions in humans are about 1 0 x 1 3 x 6 mm. It lies in a cavity of the
sphenoid bone—the sella turcica—
an important radiological landmark. During
embryogenesis, the hypophysis develops partly from oral ectoderm and partly from nerve
tissue. The neural component arises as an evagination from the floor of the diencephalon
and grows caudally as a stalk without detaching itself from the brain. The oral component
arises as an out- pocketing of ectoderm from the roof of the primitive mouth of the embryo
and grows cranially, forming a structure called Rathke's pouch. Later, a constriction at
the base of this pouch separates it from the oral cavity. At the same time, its anterior wall
thickens, reducing the lumen of Rathke's pouch to a small fissure. Because of its dual
origin, the hypophysis actually consists of two glands— the neurohypophysis and the
adenohypophysis— that are united anatomically but that have different functions. The
neurohypophysis, the part of the hypophysis that develops from nerve tissue, consists of a
large portion, the pars nervosa, and the smaller infundibulum, or neural stalk. The neural
stalk is composed of the stem and median eminence. The part of the hypophysis that arises
from oral ectoderm is known as the adenohypophysis and is subdivided into three portions:
a large pars distalis, or anterior lobe; a cranial part, the pars tuberalis, which surrounds the
neural stalk; and the pars intermedia.
The Hypothalamo-Hypophyseal System
Because of its embryological origin, the hypophysis is connected to the hypothalamus,
with which it has important anatomic and functional relationships. In the hypothalamohypophyseal system there are three known sites of production of hormones that liberate
three groups of hormones:
1. The first group consists of peptides produced by aggregates (nuclei) of
secretory neurons in the hypothalamus: the supraoptic and the paraventricular
nuclei. The hormones are transported along the axons of these neurons and
accumulate in the ends of these axons, which are situated in the neu-rohypophysis.
These hormones are released by exocytosis, enter capillaries of the neurohypophysis, and
are distributed by the blood.
2. The second group of peptide hormones is produced by neurons of the dorsal medial,
ventral medial, and infundibular nuclei of the hypothalamus. These hormones are carried
along axons that end in the median eminence where the hormones are stored. After being
released these hormones enter the blood capillaries of the median eminence and are
transported to the adenohypophysis through the first stretch of the hypophyseal portal
system.
3. The third group of hormones consists of proteins and glycoproteins
produced by cells of the pars distalis and liberated into blood capillaries of the
second stretch of the portal system. These capillaries surround the secretory cells
and distribute the hormones to the general circulation.
ADENOHYPOPHYSIS
Pars Distalis
The activities of the cells of the pars distalis are controlled by several mechanisms. The
main mechanism takes place through peptide hormones produced in the hypothalamic
aggregates of neurosecretory cells and stored in the median eminence. When liberated, they
are transported to the pars distalis through the capillary plexuses and act on specific cells of
the pars distalis. Most of these hormones are hypothalamic-releasing hormones whereas
two hormones (hypothalamic-inhibiting hormones) inhibit the release of hormones.
Because of the strategic position of the hypothalamic neurons and the control they exert on
the hypophysis and therefore on many bodily functions, many exterior stimuli as well as
stimuli arising in the body and transmitted to the brain may affect the function of the
hypophysis and consequently the function of many organs and tissues.
A second control mechanism is the direct effect of hormones secreted by endocrine cells
on the release of peptides from the median eminence and the pars distalis. A third
mechanism depends on the action of nerve impulses or of molecules that are produced
neither in the hypothalamic nuclei nor in target tissues. Some examples of this mechanism
include the following: (1) inhibin and activin, peptides produced in the gonads, and which
are members of the transforming growth factor-p family, control secretion of folliclestimulating hormone; (2) ghrelin, produced mainly in the stomach mucosa, stimulates the
secretion of growth hormone; (3) dopamine, produced in the central nervous system, is the
main inhibitor of prolactin secretion; and (4) oxytocin, liberated at the eurohypophysis in
the course of breast-feeding, stimulates the secretion of prolactin. All these mechanisms
allow the fine-tuning of the secretion of hormones by cells of the pars distalis.
Pars Tuberalis
The pars tuberalis is a funnel-shaped region surrounding the infundibulum of the
neurohypophysis. Most of the cells of the pars tuberalis secrete gonadotropins (folliclestimulating hormone and luteinizing hormone) and are arranged in cords alongside the
blood vessels.
Pars Intermedia
The pars intermedia, which develops from the dorsal portion of Rathke's pouch, is, in
humans, a rudimentary region made up of cords and follicles of weakly basophilic cells
that contain small secretory granules, a-Melanocyte- stimulating hormone (a-MSH) is
probably produced in the intermediate zone, and probably also by basophils of the pars
distalis.
NEUROHYPOPHYSIS
The neurohypophysis consists of the pars nervosa and the neural stalk. The pars nervosa,
unlike the adenohypophysis, does not contain secretory cells. It is composed of some
100,000 unmyelinated axons of secretory neurons situated in the supraoptic and
paraventricular nuclei. The secretory neurons have all the characteristics of typical
neurons, including the ability to conduct an action potential, but have well-developed Nissi
bodies related to the production of the neurosecretory material. The neurosecretions are
transported along the axons and accumulate at their endings in the pars nervosa. The
granules are released and their content enters the fenestrated capillaries that exist in large
numbers in the pars nervosa; the hormones are then distributed to the general circulation.
The neurosecretory material consists of two hormones. They are vasopressin—also
called antidiuretic hormone (ADH)—and oxytocin. Vasopressin and oxytocin are
released into the blood because of impulses in the nerve fibers from the hypothalamus.
PINEAL GLAND
The pineal gland is also known as the epiphysis cerebri, or pineal body. In the adult, it is a
flattened conical organ situated on the roof of the diencephalons, measuring approximately
5-8 mm in length and 3-5 mm at its greatest width and weighing about 120 mg.
The pineal gland is covered by pia mater. Connective tissue septa containing blood vessels
and unmyelinated nerve fibers originate in the pia mater and penetrate the pineal tissue.
Along with the capillaries, they surround the cellular cords and follicles, forming irregular
lobules. Role of the Pineal Gland in Controlling Biological Cycles The pineal gland is
associated with biorhythms, acting as an interlace between the cyclic environment and the
rhythmic vertebrate body. This results from the secretion of melatonin by the pineal gland.
The functional characteristics of the neuroendocrine system that controls the pineal gland
make the circadian production and secretion of melatonin closely related to the dark
phase of the diurnal lighting cycle. The secretion of melatonin thus increases during the
dark period. As a result of this internal synchronizing role, melatonin is able to regulate
several physiological systems.
Epiphysis (Upper appendage of the brain, pineal gland, corrpus pineale)
Odd, oval body portion an intermediate brain tubercles on the upper midbrain, weight ,110,13 g Provides rhythmic fluctuations of activity of the hypothalamus and pituitary gland.
Secretory activity depends on lighting.
Pituitary neonatal pear-shaped, flattened. Longitudinal size of its approximately 7,5-7,7
mm. The transverse size - 8.5 mm. Weight ranges from 0.05 to 0.15 g pituitary is growing
rapidly in the second year of life, 4-5 years and 11-12 years. Pituitary newborn functionally
well developed. In 15 years increasing its size to 10 mm and 16 mm -pozdovzhni transverse weight up to 0.627 g.
Materials for self-check:
А. Tasks for self-check: on the tables to study the structure of the central department of
the endocrine system (pituitary, pineal).
B. Choose the correct answer:
1.Examination of a 32-year-old patient revealed disproportional skeleton size,
enlargement of superciliary arches, nose, lips, tongue, jawbones, feet. What gland's
function was disturbed?
A.Hypophysis
B.Epiphysis
C.Pancreas
D.Thyroid
E.Suprarenal
2.A histological spacemen presents parenchymal organ, which has cortex and medulla.
Cortex consists of epitheliocytes bars with blood capillaries between them; the bars form
three zones. Medulla consists of chromaffinocytes and venous sinusoids. Which organ
has these morphological features?
A.Adrenal gland
B.Kidney
C.Lymph node
D.Thymus
E.Thyroid
3.A man after 1,5 litre blood loss has suddenly reduced diuresis. The increased secretion
of what hormone caused such diuresis alteration?
A.Vasopressin
B.Corticotropin
C.Natriuretic
D.Cortisol
E.Parathormone
4.A 30-year-old patient complains thirst and dry mouth, which appeared after severe
neurasthenia. Laboratory examination has shown blood sugar increase up to 10
millimoles per litre. Which endocrine gland is affected?
A.Pancreas gland
B.Thyroid gland
C.Sexual gland
D.Adrenal gland
E.Epiphysis
5.A patient is very tall, has long thick fingers, big lower jaw and loppy lower lip.
The increased secretion of which hormone and gland can be suspected?
A.Somatotropin of adenohypophyisis
B.Gonadotropin of adenohypophysis
C.Antidiuretic hormone of neurohypophysis
D.Thyroid hormones
E.Glucocorticoids of adrenal glands
6.A patient with external respiration dysfunctions needs tracheotomy. At the level of
which cartilaginous tracheal retractions is the isthmus of thyroid localized the most
often?
A.II - IV
B.III - IV
C.IV- V
D.I - II
E.V - VI
7.A 27-year-old patient has enlarged hands, feet, and lower jaw. Besides, deformation of
articulations spine and hormonal disorders have been observed. Which gland is
damaged?
A.Adenohypophysis
B.Adrenal
C.Pineal body
D.Thyroid
E.Parathyroid
8.A 10-year-old girl has the signs of precocious puberty. Which endocrine gland
function decline might have caused this?
A.Thyroid gland and Epiphysis
B.Adenohypophysis
C.Parathyroid glands
D.Thymus
E.Medullary substance of adrenal glands
9.Patient admitted to hospital with an injury of the base of the skull. On the radiological
investigation in a patient was diagnosed destruction and increase of the hypophyseal
fossa. What anatomical structure is damaged?
A.Sella turcica
B.Foramen rotundum
C.Pterygoid canal
D.Superior orbital fissure
E.Optic canal
10.On the radiological investigation in a patient was diagnosed increase of the Turkish
saddle's cavity, destruction of the different part of the hypophyseal fossa and anterior
clinoid processes. What endocrine gland is damaged?
A.The pituitary gland (hypophysis)
Epiphysis
Suprarenal gland
Thyroid gland
Parathyroid gland
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
Additional:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Theme 18. Peripheral part of endocrine system (the thyroid gland, the parathyroid
gland, adrenal gland, the suprarenal gland, the endocrine part of gonads).
1. Relevance of the topic.
Regulation of human vital activity carried out by neurohumoral. An important role in this
process is played by the endocrine glands, which inkrety enter directly into the blood.
Knowledge of the topography, structure, functions of the glands of the study required
students many clinical disciplines, such as therapy, endocrinology, patfiziolohiya,
pharmacology, surgery and others.
A very important place in the structure of diseases with lesions of the pancreas (diabetes),
thyroid (hyperthyroidism), the pituitary and gonads.
2. The specific aims.
Classify cancer by functional signs and development.
Explain about neyrosecretory.
Explain the main manifestation of pathology glands.
Explain the basic elements of the glands, their function:
- Thyroid
- Parathyroid glands
- Pancreas
- Gonads, prostate.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Discipline
Histology
To know
Able
On the difference in the Give examples of endocrine,
structure of the excretory tract exocrine glands and mixed
endocrine and exocrine glands
Pathophysiology Know gland dysfunction
What are the main diseases in
the defeat of the glands
Pharmacology
Find function of glands that act Name the brain hormones of
like autonomic nervous system the adrenal glands, thyroid
gland
4. The tasks for student’s individual work .
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class.
Glandula pinealis
The pineal gland
Glandula thyroidea
Thyroid gland
Glandula parathyroidea
Parathyroid glands
Adrenal
Glandula suprarenalis
4.2. Theoretical questions for the class:
1. Share the classification glands on functional signs?
2. Share proklasyfikatsiyu glands on development?
3. Share of neyrosecretore formation of the hypothalamic-pituitary-adrenal system,
pituitary - dependent cancer.
4.Name and show the main elements of glands called their function and clinical
manifestations of the excitation functions:
- Thyroid
- Parathyroid glands
- Adrenal
- Pancreas
- Gonads
5. Share of diffuse endocrine system.
4.3. Practical work (tasks) that are performed in class: on anatomical preparation,
tables, models to study the structure of the peripheral endocrine (thyroid gland,
parathyroid gland, adrenal gland, endocrine portion of the pancreas, gonads).
The content of the topic:
Diffuse endocrine system (DES)
Along with the endocrine tissues (digestive organs, bronchi, the skin, in the course of blood
vessels) hormone producing scattered individual cells.
Among them are nervous origin and others. Clusters of endocrine cells chromaffin range
sympathetic nodes and along the vessels were called - paraganglia.
The largest - sleepy ball, coccygeal ball, paraaortalne body.
ADRENAL (SUPRARENAL) GLANDS
The adrenal glands are paired organs that lie near the superior poles of the
kidneys, embedded in adipose tissue. They are flattened structures with a halfmoon shape; in the human, they are about 4-6 cm long, 1-2 cm wide, and 4-6 mm
thick. Together they weigh about 8 g, but their weight and size vary with the age
and physiological condition of the individual. Examination of a fresh section of
adrenal gland shows that it is formed by two concentric layers: a yellow peripheral
layer, the adrenal cortex; and a reddish-brown central layer, the adrenal medulla.
The adrenal cortex and the adrenal medulla can be considered two organs
with distinct origins, functions, and morphological characteristics that became
united during embryonic development. They arise from different germ layers. The
cortex arises from the coelomic epithelium, whereas the cells of the medulla derive
from the neural crest, from which sympathetic ganglion cells also originate.
Adrenal Cortex
Because of the differences in disposition and appearance of its cells, the
adrenal cortex can be subdivided into three concentric layers whose limits are
usually not sharply defined in humans: the zona glomerulosa, the zona fasciculata,
and the zona reticularis. These layers occupy 15%, 65%, and 7%. respectively, of
the total volume of the adrenal glands.
Cortical Hormones & Their Actions
The steroids secreted by the cortex can be divided into three groups,
according to their main physiological action: mineralocorticoids, glucocorticoids,
and androgens. The main product of the zona glomerulosa is a mineralocorticoid
called aldosterone; the zona fasciculata and possibly the zona reticularis secrete
glucocorticoids, especially cortisol; the zona reticularis produces
dehydroepiandrosterone, a weak androgen. The mineralocorticoids act mainly on
the distal renal tubules as well as on the gastric mucosa, colon, and salivary and
sweat glands, stimulating the reabsorption of sodium by epithelial cells.
The glucocorticoids affect the metabolism of carbohydrates by stimulating
both the production of glucose from amino acids or fatty acids (gluconeogenesis)
and the conversion of glucose into glycogen. Cortisol may decrease the uptake of
glucose by cells, which together with the increased production of glucose may lead
to hyperglycemia or to the maintenance of adequate levels of glucose in the blood
during hunger and stress reactions. In the skin, muscle and adipose tissue,
glucocorticoids not only decrease synthetic activity but also promote protein and
lipid degradation. Glucocorticoids also suppress the immune response by
destroying circulating lymphocytes, inhibiting mitotic activityin lymphocyteforming organs, and controlling secretion of cytokines.
Dehydroepiandrosterone (DHEA) is the only sex hormone that is secreted in
significant physiological quantities by the ad renal cortex. DHEA is a weak
androgen that circulates in the blood as a sulfate and exerts its actions after being
converted into testosterone in several tissues.
Control of the Adrenal Cortex
The secretion of glucocorticoids is controlled initially through the release of
corticotropin-releasing hormone in the median eminence, followed by secretion of
adrenocorticotropic hormone (ACTH, corticotropin) by the pars distalis of the
hypophysis. Free glucocorticoids may then inhibit ACTH secretion. The degree of
pituitary inhibition is proportionate to the concentration or circulating
glucocorticoids; inhibition is exerted at both the pituitary and hypothalamic levels.
Adrenal Medulla
Unlike the cortex, which does not store steroids, cells of the medulla
accumulate and store their hormones in granules. The adrenal medullary cells are
innervated by cholinergic endings of preganglionic sympathetic neurons.
Medullary cells are also found in the paraganglia (collections : catecholaminesecreting cells adjacent to the autonomic ganglia) as well as in various viscera.
Cells of adrenal medulla produce two hormones: adrenalin and noradrenalin.
Function of these hormones similar to sympathetic part of autonomic nervous
system.
ISLETS OF LANGERHANS
The islets of Langerhans are multihormonal endocrine microorgans; they
appear as rounded clusters of cells embedded within the exocrine pancreatic tissue.
Routine stains or trichrome stains allow the recognition of acidophils (a) and
basophils (B). Using immunocytochemical methods, four types of cells—A, B, D,
and F—have been recognized in the islets. Show immunocytochemical
demonstrations of A (glucagon-producing) and B (insulin-producing) cells.
THYROID
The thyroid gland, located in the cervical region anterior to the larynx,
consists of two lobes united by an isthmus. It originates in early embryonic life
from the endoderm of the initial portion of the primitive gut. Its function is to
synthesize the hormones thyroxine (T4) and miodorbyromne (T3), wich are
important for growth, for cell difrerentiaiiotu and for the control of oxygen
consumption and the basal metabolic rate in the body. Thyroid hormones affect the
metabolism of proteins, lipids and carbohydrates.
Thyroid tissue is composed of 20—30 million microscopic spheres called thyroid follicles.
The follicles are lined by simple epithelium and their central cavity contains a gelatinous
instance called colloid. The thyroid is the only endocrine gland whose secretory product is
stored in great quantity. This accumulation is also unusual in that it occurs in the
extracellular colloid. In
humans, there is sufficient hormone within the follicles to supply the organism for up to 3
months. Another type of cell present in the thyroid, the parafollicular, or C, cell, is found as
part of the follicular epithelium or as isolated clusters between thyroid follicles. These cells
are responsible for the synthesis and secretion of calcitonin, a hormone whose main effect is
to lower blood calcium levels by inhibiting bone resorption. Secretion of calcitonin is
triggered by an elevation in blood calcium concentration.
Control of the Thyroid
2. The major regulator of the anatomic and functional state of the thyroid is
thyroid-stimulating hormone (TSH; thyrotropin), secreted by the anterior pituitary.
PARATHYROID GLANDS
The parathyroids are four small glands—3 x 6 mm—with a total weight of
about 0.4 g. They are located behind the thyroid gland, one at each end of the upper and
lower poles, usually in the capsule that covers the lobes of the thyroid. Sometimes they are
embedded in the thyroid gland. The parathyroid glands are derived from the pharyngeal
pouches—the superior glands from the fourth pouch and the inferior glands from the third
pouch. They can also be found in the mediastinum, lying beside the thymus, which
originates from the same pharyngeal pouches.
Parathyroid glands newborns have a rounded shape, dimensions variable. The upper
parathyroid glands lie on the back surface of the particles of the thyroid gland, lower - at its
lower pole, sometimes - the progress of laryngeal nerve. Newborn parathyroid glands are in
a state of functional activity. Checked their intensive growth throughout childhood and to
slow after puberty.
The adrenal glands newborns have a triangular shape, weight - 6.8 g front and rear
surfaces of convex, lower - vhnuta. There are more small glands located on the surface of
most adrenal glands or in the kidney capsule. Dimensions adrenal gland: vertical - 3-3.5 cm
horizontal - 3-4.5 cm, lateral - 2.5 cm. Capsule adrenal glands loose. The layer adrenal gland
cortex defined primary (embryonic) and secondary (permanent) cortical substance. The latter
can be active. After 2-3 weeks after birth is involution embryonic cortex and adrenal gland
weight reduction of 50%. It is set to 3-5 years and in 16 years reaches 13-14 g.
The pineal gland (glandula pinealis) develops from the upper wall of the diencephalon
first as empty grow. Known by many names (epiphysis cerebri, corpus pineale, Organum
pineale, coronarium), but the term glandula pinealis most accurate, because the endocrine
function of the pineal gland undoubtedly proven its impact on growth and puberty the body.
The gland is located in deepening between the upper hills chotyryhorbkovoyi plate, the size
of a newborn: ZMM length, width 2.5 mm, thickness 2 mm; 4 years of age respectively
reach these dimensions 9, 6 and 3 mm in adults 9-10 mm, 5-7 mm, 4-5 mm. Weight gland
increases in the first year of life, ages 3 to 6 years becomes final value ranging from 7 years
of age, before puberty, the glands appear involutional signs. Newborn in the center of the
pineal gland schilepodibnyy can be allocated space in the form of epiphyseal ventricle, lined
with cubic or prismatic epithelium. The gland contains small baby is not differentiated cells
disappear on the 8th month of life, and large cells with vesicular nucleus. The presence of
two types of cells within the gland explains the arrangement of light and dark islands.
Connective tissue in the gland newborn little pigment absent. At the age of 6-8 years an
increasing number of connective tissue, which are formed by membrane gland of pigment
gradually increased, reaching its maximum of 14 years.
Materials for self-check:
А. Tasks for self- check: in tables examine the structure of peripheral endocrine (thyroid
gland, parathyroid gland, adrenal gland, endocrine portion of the pancreas, gonads).
B. Choose the correct answer:
1.Examination of a 32-year-old patient revealed disproportional skeleton size,
enlargement of superciliary arches, nose, lips, tongue, jawbones, and feet. What gland's
function was disturbed?
A.Hypophysis
B.Epiphysis
C.Pancreas
D.Thyroid
E.Suprarenal
2.Vegetative abnormalities in the sleep, heat regulation, all kinds of metabolism, diabetes
insipidus are developing in the patient due to grouth of the tumour in the III ventricle of
brain. Irritation of the nucleus of what part of the brain can cause this symptoms?
A.Hypothalamus
B.Cerebral peduncles (cruces cerebri)
C.Mesencephalic tegmentum
D.Pons cerebelli
E.Medulla
3.A histological spacemen presents parenchymal organ, which has cortex and medulla.
Cortex consists of epitheliocytes bars with blood capillaries between them; the bars form
three zones. Medulla consists of chromaffinocytes and venous sinusoids. Which organ
has these morphological features?
A.Adrenal gland
B.Kidney
C.Lymph node
D.Thymus
E.Thyroid
4.A patient was diagnosed cretinism manifested as stunted growth, mental debility and
underdevelopment of gonads. Which endocrine gland is affected?
A.Thyroid gland
B.Pancreas gland
C.Sexual gland
D.Adrenal gland
E.Epiphysis
5.A patient was diagnosed Basedow's disease in which metabolism intensity increases (it
manifests as tachycardia, high body temperature, increased excitability of central nervous
system). Which endocrine gland is affected?
A.Thyroid gland
B.Pancreas gland
C.Sexual gland
D.Adrenal gland
E.Epiphysis
6.Specify functions of glucocorticoids.
A.Inhibit immunity
B.Arrest secretion of biologically active substances in nearly all endocrine glands
performing thus function of adaptive «biological clock»
C.Stimulate growth and development of an organism promote puberty; regulate intensity
of all types of metabolism
D.Regulates metabolism of carbohydrates (namely decreases glucose blood level),
proteins, lipids
E.Responsible for T-lymphocytes maturation
7.Specify functions of mineralocorticoids.
A.Regulate sodium and potassium turnover
B.Responsible for T-lymphocytes maturation
C.Stimulate growth and development of an organism promote puberty; regulate intensity
of all types of metabolism
D.Regulates metabolism of carbohydrates (namely decreases glucose blood level),
proteins, lipids
E.Inhibit immunity
8.Specify functions of the pineal gland.
A.Arrest secretion of biologically active substances in nearly all endocrine glands
performing thus function of adaptive «biological clock»
B.Regulates growth and development of an organism, metabolism process
C.Responsible for T-lymphocytes maturation
D.Regulates metabolism of carbohydrates (namely decreases glucose blood level),
proteins, lipids
E.Inhibit immunity
9.Specify functions of somatotropin.
A.Regulate linear growth and body weight, influence cellular biosyntesis
B.Arrest secretion of biologically active substances in nearly all endocrine glands
performing thus function of adaptive «biological clock»
C.Regulates growth and development of an organism, metabolism process
D.Regulates metabolism of carbohydrates (namely decreases glucose blood level),
proteins, lipids
E.Inhibit immunity
10.Specify functions of lipotropic factors.
A.Mobilize fat from fat deposits and assist in its utilization
B.Arrest secretion of biologically active substances in nearly all endocrine glands
performing thus function of adaptive «biological clock»
C.Regulates growth and development of an organism, metabolism process
D.Regulates metabolism of carbohydrates (namely decreases glucose blood level),
proteins, lipids
E.Inhibit immunity
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 19. Submodule on Splanchnology. Situations problems.
1. Relevance of the topic.
Knowledge of anatomy end of this section is important for students to further studies.
2. The specific aims.
To analyze the development of the digestive, respiratory, urinary, reproductive and
endocrine systems in ontogenesis.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
subjects
Biology
The acquired knowledge
Anatomy
Ontogeny teeth, knowledge of the structure of the upper and
lower jaw;
Phylogeny of the digestive system;
To further explore topics.
The content of the topic.
See. content themes number 1 - 18.
4. The tasks for students' individual work.
4.2. Theoretical questions for the class:
Anatomy of the digestive system
1. Systems of internal organs: definition, name the bodies that forming these systems
give a general description of the functions of system.
2. Classification of internal organs. General plan of tubular organs.
3. Organ structural features of the mucous membrane of tubular organs.
4. General muscle layer of the structure of tubular organs walls.
5. The general laws of the structure of the outer casing of the tubular wall, give a brief
description of; the ratio of options to peritoneym.
6. Describe the general anatomical and functional exocrine glands of the structure.
7. General anatomical and functional exocrine glands of the structure.
8. Development of the mouth and its derivatives. Malformations of the mouth.
9. Mouth, its departments. Vestibule of mouth: walls, their structure, describe and
demonstrate on the preparations.
10. Mouth and its departments. Actually the oral cavity and its walls, connections;
describe and demonstrate on the preparations.
11.Palate, its structure; describe and demonstrate on the preparations.
12.Soft palate, part, structure. Tonsils, their topography. Describe and demonstrate on the
preparations.
13. The muscles of the soft palate. Describe and demonstrate on the preparations.
14. Tongue: parts, structure; features the mucous membrane of the tongue, the tongue
functions. Describe and demonstrate on the preparations.
15. Embryological and anatomic classification tongue muscles, their morpho-functional
characteristics; features language. Describe and demonstrate on the preparations.
16. Teeth: tooth. Periodontal, periodontal, dental organ: definition. Bite.
17. Permanent teeth: formula, description of types of teeth.
18. Milk teeth, their formula. Terms of eruption milk teeth.
19. Mouth glands: classification. Small salivary glands, their topography and morphofunctional characteristics.
20. Mouth glands: classification. Parotid gland: topography, structure; describe and
demonstrate on the preparations.
21. Mouth glands: classification. Sublingual gland: topography, structure; describe and
demonstrate on the preparations.
22. Mouth glands: classification. Submandibular gland: topography, structure; describe
and demonstrate on the preparations.
23. Pharyngs: boundaries, connections, describe and demonstrate the preparation.
24. Pharyngs intestine: development, parts. The original main (pharyngeal) ulcers.
25. Throat: topography, parts, their connections; lymphatic pharyngeal ring. Describe
and demonstrate the preparation.
26. Throat: structure mucosa, muscle and outer shells.
27. Malformations of the gastrointestinal tract.
28. The development of the alimentary canal and sources of formation of mucous,
muscular and outer shells.
29. Esophagus: parts, their topography (holotopy, skeletopy, syntopy); describe and
demonstrate the preparation.
30. Esophagus, structure of wall; anatomical and physiological narrowing of the
esophagus.
X-ray anatomy of the esophagus.
31. Lots of abdominal wall: describe and demonstrate the preparation.
32. Stomach: topography (holotopy, skeletopy, syntopy) parts; describe and demonstrate
the preparation.
33. Stomach: structure of wall; describe and demonstrate the preparation structure
mucosa. X-ray anatomy of the stomach.
34. Stomach: structure of wall; describe the structure of muscle and serous membranes.
35. .Small intestine: parts, their topography, relation to peritoneum.
36. Duodenum: parts, their topography (holotopy, skeletopy, syntopy); describe and
demonstrate the preparation.
37. Small intestine, structure of wall; relation to the peritoneum; describe and
demonstrate on the preparations. X-ray anatomy of the small intestine.
38. Small intestine, structure of the mucosa of the small intestine.
39. Duodenum: structural features mucosa.
40. The colon: parts, their topography (holotopy, syntopy); describe and demonstrate on
the preparations.
41. The colon: structure wall (structural features of mucous, muscular and serous
membranes), relation to peritoneum; describe and demonstrate on the preparations. X-ray
anatomy of the colon.
42. Cecum: topography (holotopy, syntopy) structural features; describe and demonstrate
on the preparations.
43. Parts and bends of the colon, their topography (holotopy, syntopy) related to the
peritoneum; describe and demonstrate on the preparations.
44. Avilable wall of the colon. The relief of the mucous membrane.
45. Rectum: parts, bends, relation to peritoneum, topography men and women; describe
and demonstrate on the preparations.
46. Rectum: structural features of mucous, muscular and outer shells.
47. External signs of colon; describe and demonstrate on the preparations.
48. The development of liver.
49. Liver: external structure; relief diaphragm and internal surfaces; describe and
demonstrate on the preparations.
50. Liver: topography (holotopy, skeletopy, syntopy) connections liver relation to
peritoneum; describe and demonstrate the preparation.
51. Liver: internal structure (parts, pieces, segments, slices).
52. Liver: formation and ways of outflow of bile.
53. Gall bladder: topography, parts, structure of wall, functions; describe and
demonstrate on the preparations.
54. The common bile duct: formation, topography, structure, functions, describe and
demonstrate on the preparations.
55. The development of the pancreas.
56. Pancreas: parts, their topography (skeletopy, syntopy) related to the peritoneum;
describe and demonstrate on the preparations.
57. Exocrine and endocrine parts of pancreas ways of removing the products of their
work.
58. Peritoneum: definition, general characteristics; peritoneal cavity and its contents.
59. Peritoneum: general characteristics. Gaskets, connections, ripples, their structure and
formation; describe and demonstrate on the preparations.
60. Peritoneum: general characteristics. Gaskets, their structure; describe and
demonstrate on the preparations.
61. Peritoneal cavity, departments (floors), their boundaries; describe and demonstrate on
the preparations.
62. Upper floor of peritoneal cavity: hepatic bag, its limits and traffic; describe and
demonstrate on the preparations.
63. Upper floor of peritoneal cavity: peredshlunkova bag, its limits and traffic; describe
and demonstrate on the preparations.
64. Upper floor of peritoneal cavity: salnikovaja bag, its limits and traffic; describe and
demonstrate on the preparations.
65. Peritoneal hole: its limits; describe and demonstrate on the preparations.
66. Middle floor of peritoneal cavity: canals, sinuses, recesses, folds, holes; describe and
demonstrate on the preparations.
67. The ground floor peritoneal cavity, depressions; progress peritoneum in the pelvis in
men and women, to describe and to demonstrate on preparations.
Anatomy of the respiratory system
1. Which organs belong to the respiratory system?
2. What belongs to the upper respiratory tract?
3. Development of the respiratory system in embryogenesis.
4. Avilable tubular wall of the respiratory system.
5. Development of the external nose and nasal cavity in embryogenesis. Anomalies of
development.
6. Nose: parts, structure; describe and demonstrate the preparation.
7. Nasal cavity: parts, their structure and combination; describe and demonstrate the
preparation.
8. The nasal cavity, nasal passages, their structure and combination; describe and
demonstrate the preparation.
9. Paranasal sinuses: topography, communication, function, age features; describe and
demonstrate the preparation. X-ray anatomy with sinus infections.
10. Nasal cavity: functional parts, their structure and function; describe and demonstrate
the preparation.
11. Larynx: topography (holotopy, skeletopy, syntopy); describe and demonstrate the
preparation.
12. Larynx: cartilages, joints, ligaments, muscles, their structure; describe and
demonstrate the preparation.
13. Larynx: fibro-elastic formation of the larynx, their structure, function, vestibular
ligament, voice; describe and demonstrate the preparation.
14. Laryngeal cavity: parts, their structure, limits; describe and demonstrate the
preparation.
15. Glottis: boundaries, formation, unit; describe and demonstrate the preparation.
16. The functions of the larynx, phonation.
17. Trachea: parts, their topography (holotopy, skeletopy, syntopy), structure of wall;
describe and demonstrate on the preparation.
18. Trachea: structure wall; describe and demonstrate the preparation.
19. The main bronchi: topography, structure of wall; describe and demonstrate the
preparation.
20. Lungs: topography, external structure, describe and demonstrate the preparation.
21. The root of the lung: topography, structure.
22. Lungs: particles, broncho-pulmonary segments slices; their structure. X-ray anatomy
of the lungs.
23. Bronchial Tree: branching, structure of wall, functions.
24. Alveolar tree, branching, structure of wall.
25. Acinus: definition, structure, functions.
26. Pleura: general description, function; pleural cavity and its recesses.
27. Limits pleural sacs.
28. Mediastinum: definitions; classification by international anatomical nomenclature.
29. Mediastinum: definition, topographic classification. Bodies, blood vessels and nerves
anterior mediastinum; describe and demonstrate the preparation.
30. Mediastinum: definition, topographic classification. Bodies vessels and nerves
posterior mediastinum; describe and demonstrate the preparation.
Anatomy of urinary system
1. Which organs belong to the urinary system and their functions.
2. Kidneys: external structure; describe and demonstrate the preparation.
3. Kidneys: topography right and left kidneys (holotopy, skeletopy, syntopy); describe
and demonstrate the preparation.
4. Kidneys: kidney membrane. Describe fascia kidney.
5. Kidneys: Kidney locking device.
6. Kidney: kidney structure on the front opening; describe and demonstrate the
preparation.
7. Kidney: structural and functional unit of the kidney, its component parts.
8. Kidneys, circulatory system of the kidneys.
9. Kidneys: Ways urine (components excretory tract kidneys).
10. Renal sinus (sinus), its cities; describe and demonstrate on the preparations.
11. The construction of the wall macroscopic kidney excretory tract. X-ray anatomy of
the kidney.
12. Ureter: parts, topography (holotopy, skeletopy, syntopy); describe and demonstrate
the preparation.
13. The ureter: structure wall; narrowing; X-ray anatomy of the ureter.
14. Bladder: parts, topography (holotopy, skeletopy, syntopy); describe and demonstrate
the preparation.
15. Bladder: structure of wall, relation to peritoneum; describe and demonstrate the
preparation. X-ray anatomy of the bladder.
16. Bladder: bladder triangle, its limits (especially the mucosa at the site); describe and
demonstrate the preparation.
17. Women urethra; topography, structure of wall.
Anatomy of reproductive system
1. The bodies of the female reproductive system, topographic classification.
2. What authorities reproductive system develop from paramesonephral strait?
3. Ovary: topography, communications, construction, function; describe and demonstrate
the preparation.
4. Uterus: topography, the position of the uterus, uterine relationships, relation to
peritoneum; describe and demonstrate the preparation.
5. Uterus: parts, structure of wall, relation to peritoneum functions; parameters, describe
and demonstrate the preparation. X-ray anatomy uterus.
6. Cervix: parts, structural features of the mucous membrane; describe and demonstrate
the preparation.
7. Uterine tube: topography, parts, structure of wall, relation to peritoneum functions;
describe and demonstrate the preparation. X-ray anatomy fallopian tubes.
8. Vagina: topography, arches, structure of wall; describe and demonstrate the
preparation.
9. Rudimentary ovary applications: nad'yayechnyk, pryyayechnyk, their topography and
education.
10. The external female genital organs: topography, structure.
11. Women's pudendal area (vulva), topography and structure components that constitute
it.
12. Vestibule of vagina: boundaries, which it called?
13. Mammary glands: topography, structure, describe and demonstrate on the
preparations.
14. Male genitalia: classification.
15. testicle: topography, external structure; describe and demonstrate on the preparations.
16. Testicle, internal structure, function; describe and demonstrate the preparation.
17. Testicle: topography, parts, structure, functions; describe and demonstrate the
preparation.
18. Ejaculatory ducts, dimensions, parts, topography, structure of wall, functions;
describe and demonstrate the preparation.
19. Seminal vesicle: topography, structure, functions, describe and demonstrate the
preparation.
20. Ejaculatory duct: its formation. Where did it open?
21. Spermatic cord: its composition, topography, beginning, end, shell, describe and
demonstrate the preparation.
22. The prostate gland: topography, external structure; describe and demonstrate the
preparation.
23. Prostate: parts, internal structure, functions. describe and demonstrate the
preparation.
24. The penis: parts, external structure; describe and demonstrate on the preparation.
25. Male urethra: parts, their topography, narrowing and expansion; describe and
demonstrate the preparation.
26. Male urethra: structure of wall; describe and demonstrate the preparation.
27. Male urethra: parts, which opened in every part?
28. Perineum: topography, structure, functions.
29. Perineum: definition of perineum in narrow and broad sense.
30. Perineum: parts, their boundaries, describe and demonstrate on the preparations.
31. Urogenital diaphragm: boundaries, muscles and fascia that her form. Which bodies
penetrate urogenital diaphragm women and men? Describe and demonstrate on the
preparations.
32. Pelvic diaphragm: boundaries, muscles and fascia that her form. Describe and
demonstrate on the preparations.
33. Pelvic diaphragm: its walls, content., Describe and demonstrate on the preparations.
Anatomy of the endocrine system
1. Endocrine glands: Embryological classification.
2. Thyroid gland: topography (holotopy, skeletopy, syntopy), parts, structure, functions;
describe and demonstrate the preparation.
3. Parathyroid glands: topography, structure, functions.
4. Adrenal gland: topography right and left adrenal glands (holotopy, skeletopy,
syntopy), structure, function; describe and demonstrate the preparation.
5. Chromaffin body (paraganglia): topography, structure, function and development.
6. Pituitary: topography, parts, functions.
7. The pineal gland: topography, function; describe and demonstrate the preparation.
8. The endocrine part of the pancreas: structure, function.
9. In which part of the pancreas are mainly islands, endocrine cells which perform
functions?
4.3 Choose the correct answer:
1.A 30-year-old patient with a second upper molar pulp inflammation appealed to a
doctor with complaints of headache and nose rheum. After examination, pulpilis
complicated with sinusitis was diagnosed. Which sinus did the infection enter from this
tooth root canal?
A.Maxillary sinus
B.Frontal sinus
C.Sphenoidal sinus
D.Ethmoid cells
E.Mastoid cells
2.Chronic rhinitis is complicated with the signs of maxillary sinus mucous tunic affection
(maxillary sinusitis). Through what nasal cavity formation has the infection spread?
A.Maxillary hiatus
B.Ethmoidal infundibutum
C.Sphenopalatine foramen
D.Sphenoethmoidal recess
E.Ethmoid cells
3.A patient complains of headache and heavy breathing. X-ray examination confirmed
the diagnosis - frontitis (inflammation of the frontal sinus). In what nasal meatus may
purulent discharge be observed during the examination of the nasal cavity?
A.Middle
B.Superior
C.Inferior
D.Common
E.Above the superior nasal concha
4.During the right-side lobectomy surgeon reached the right lung root in pick out and
process its components. Point the order of lung root component from top to bottom?
A.Bronchus, pulmonary artery, pulmonary veins
B.Pulmonary artery, bronchus, pulmonary veins
C.Pulmonary vein, pulmonary artery, bronchus
D.Bronchus, pulmonary artery, phrenic nerve
E.Phrenic nerve, bronchus, pulmonary artery and vein
5.Acute inflammatory process of the nasolacrimal duct mucosa of a 28-year- old has
been diagnosed. Influenza was followed by 10-days' discharge from the nose. From that
part of the nasal cavity could the infection get into the nasolacrimal duct?
A.Inferior nasal meatus
B.Middle nasal meatus
C.Superior nasal meatus
D.Vestibule of nose
E.Frontal sinus
6.A patient has a right-side pulmonectomy performed because of the carcinoma of lung.
After the dissection of the mediastinal pleura pulmonary veins must be ligated first of all
to decrease the possibility of malignant cells metastasis. To avoid mistakes a surgeon
must know the order of the root anatomic of the right lung from top to bottom?
A.Artery, bronchus, veins.
B.Bronchus, artery, veins.
C.Artery, veins, bronchus.
D.Veins, artery, bronchus.
E.Bronchus, artery, nerves
7.A 45-year-old patient was hospitalized with complaints of high temperature, pain
during respiration, dyspnea and cough. Examination and radiodiagnostics diagnosed
pleurisy. For exudation evacuation pleurocentesis was prescribed. In what place of the
pleura cavity is the largest quantity of exudation?
A.In the costodiaphragmatic recess
B.In the phrenico-mediastinal sinus
C.n the costomediastinal sinus
D.Under the cervical pleura
E.Under the root of lungs 8.A 10-year-old patient was admitted to a clinic. The day
before he had swallowed a nut after what continuous cough and signs of heavy breathing
appeared. Phonation function wasn't affected. Where may the foreign body localize
A.In the right principal bronchus
B.In the left principal bronchus
C.In the trachea
D.In the vestibular fissure
E.In the fissure of glottis
9.During the examination of a 67-year-old patient, a roentgenogram shows a tumor of the
middle lobe of the right lung. What segments are located in this lobe?
A.Medial, lateral
B.Superior lingular, inferior lingular
C.Anterior and posterior primary
D.Apical, anterior
E.Apical-posterior, anterior
10.After a face injury, a patient has hematoma in the cheek area. What salivary glands
secretion outflow is blocked by the hematoma?
A.Parotid
B.Sublingual
C.Submandibular
D.Labial
E.Bucral
11.A woman was hospitalized with abdominal emergencies symptoms. After the
examination fallopian tube rupture accompanying abdominal gestation is suspected.
Which pelvis anatomical formation is to be punctured to confirm the diagnosis?
A.Rectouterine pouch
B.Vesicouterinc pouch
C.Rectovesical pouch
D.Ischiorectal fossa
E.Vaginal process of peritoneum
12.Dimensioning of liver gave an opportunity to establish that its superior border along
the right middle clavicular line is on the forth intercostal space level; its inferior border
projects from the coastal margin by 4 cm. Evaluate the liver size.
A.Enlarged liver - its lower border dislocated down
B.Reduced liver - its lower border dislocated down
C.Reduced liver - its lover border dislocated upwards
D.Enlarged liver - its upper border dislocated upwards
E.Liver dimensions are normal
13.During the X-ray examination of a 30-year-old patient in vertical position a doctor
detected the presence of air in the stomach. What part of the stomach is it in?
A.At the fundus
B.In the body
C.In the cardial
D.In the pyloric
E.In the area of the lesser curvature
14.During a duodenal intubation, the probe docs not pass from the stomach into the
duodenum. What part of the stomach is an obstacle (tumor) in?
A.In the pyloric part
B.In the cardial part
C.In the fundus area
D.In the body area
E.In the area of the lesser curvature
15.A patient has pain in epigastric region. What organs disease can it indicate?
A.Stomach, duodenum
B.Small intestine, liver
C.Spleen, kidney
D.Colon, gallbladder
E.Fundus of stomach, transverse colon
16.During a duodenal intubation, the probe does not pass to the stomach from the gullet.
What part of the stomach is an obstacle (tumor) in?
A.in the cardial
B.in the pyloric
C.in the fundus area
D.in the body area
E.In the greater curvature area
17.During fibrogastroduodenoscopy a doctor has to examine the major duodentnal
papilla. What anatomic formation can serve as a landmark for its revealing?
A.Longitudinal fold of the duodenum
B.Circular folds of the duodenum
C.Duodenal cap
D.Duodenal glands
E.Hepatoduodenal ligament
18.X-ray examination has shown a foreign body in the gullet at TIV level. In what field of
gullet constriction did the foreign body stop?
A.Bronchial
B.Pharyngeal
C.Pyloric
D.Diaphragmatic
E.Cardiac
19.A 45-year-old patient was hospitalized to a surgical department with complaints of
sudden acute pain in epigastric region. After the examination the perforated ulcer of the
posterior wall of the stomach was diagnosed. Where did stomach contents issue at the
moment of perforation?
A.Into the omental bursa.
B.Into the hepatic bursa.
C.Into the pregastric bursa.
D.Into the left mesenteric sinus.
E.Into the right mesenteric sinus.
20.A 60-year-old patient's malignant tumor of the major duodenal papilla caused
obstructive jaundice. The lumen of what anatomic structure squeezes the tumor?
A.Hepaticopancreatic ampulla
B.Cystic duct.
C.Common hepatic duct
D.Right hepatic duct
E.Left hepatic duct
21.After a significant weight loss a 70-year-old man has dull pain in the loin. The
diagnose is a floating kidney. In which part of the kidney fixative apparatus have the
changes taken place?
A.Capsula adiposa
B.Capsula fibrosa
C.M. iliopsoas
D.Lig. hepatorenalis
E.M. quadratus lumborum
22.An elderly man has complicated urination. Which part of urethra becomes narrower
with age the most often?
A.Pars prostatica
B.Glandulae urethrales
C.M. sphincter urethrae externum
D.Pars membranacea
E.Pars spongiosa
23.Urography has shown calculi in the macroscopic parts of the kidney urinary tracts. It
was detected that they are located in:
A.Minor and major renal calices, renal pelvis
B.Gathering tubules, papillary ducts, minor renal calices
C.Straight tubules, minor and major renal calices
D.Papillary ducts, major renal calices, renal pelvis
E.Papillary ducts, minor renal calices, straight tubules
24.A woman of 58 has undergone complete hysterectomy and salpingo-oopriorectomy,
after which urinary excretions stopped. Cystoscopy has shown that the bladder does not
contain urine; urine does not flow from the openings of ureters. Which part of the urinary
excretion system is damaged?
A.Ureter
B.Urethra
C.Vesica urinaria
D.Pelvis renalis
E.Ren
25.A 40-year-old man had a ureteral calculus instrumentally removed, which was
complicated by a rupture of the ureter wall in the abdominal part. Where will urine get
through the rupture in the ureter wall?
A.Retroperitoneal space
B.Hepatic bursa
C.Peritoneal cavity
D.Omental bursa
E.Vertebral canal
26.Examination of a 32-year-old patient revealed disproportional skeleton size,
enlargement of superciliary arches, nose, lips, tongue, jawbones, and feet. What gland's
function was disturbed?
A.Hypophysis
B.Epiphysis
C.Pancreas
D.Thyroid
E.Suprarenal
27.Vegetative abnormalities in the sleep, heat regulation, all kinds of metabolism,
diabetes insipidus are developing in the patient due to grouth of the tumour in the III
ventricle of brain. Irritation of the nucleus of what part of the brain can cause this
symptoms?
A.Hypothalamus
B.Cerebral peduncles (cruces cerebri)
C.Mesencephalic tegmentum
D.Pons cerebelli
E.Medulla
28.A histological spacemen presents parenchymal organ, which has cortex and medulla.
Cortex consists of epitheliocytes bars with blood capillaries between them; the bars form
three zones. Medulla consists of chromaffinocytes and venous sinusoids. Which organ
has these morphological features?
A.Adrenal gland
B.Kidney
C.Lymph node
D.Thymus
E.Thyroid
29.A man after 1,5 litre blood loss has suddenly reduced diuresis. The increased
secretion of what hormone caused such diuresis alteration?
A.Vasopressin
B.Corticotropin
C.Natriuretic
D.Cortisol
E.Parathormone
30.A 30-year-old patient complains thirst and dry mouth, which appeared after severe
neurasthenia. Laboratory examination has shown blood sugar increase up to 10
millimoles per litre. Which endocrine gland is affected?
A.Pancreas gland
B.Thyroid gland
C.Sexual gland
D.Adrenal gland
E.Epiphysis
31.During the first days of a newborn child, a pediatrician detected that milk gets into the
child's nasal cavity. What malformation does this fact indicate?
A.Non-closed palate
B.Diverticulum of esophagus
C.Esophageal atresia
D.Cleft clip
E.Esophagus constriction
32.During a meal, milk gets into the nasal cavity of a newborn child. What is the
probable cause of this pathology?
A.Cleft palate.
B.Nasal septum deviation to the right.
C.Basal skull fracture.
D.Cleft clip.
E.Nasal septum deviation to the left.
33.A sick has an acute inflammation of nasolacrimal duct mucous membrane. It is
known that after influenza nasal discharges had been observed for a long time. From
what part of the nasal cavity could the infection get to the nasolacrimal duct?
A.Inferior nasal meatus
B.Middle nasal meatus
C.Superior nasal meatus
D.Common nasal meatus
E.Sphenoethmoidal recess
34.A patient has a suppurative inflammation of the sphenoid sinus. What part of the
nasal cavity does the pus flow out into?
A.Meatus nasi superior
B.Meatus nasi communis
C.Meatus nasi medius
D.Meatus nasi inferior
E.Infundibulum
35.A patient has an inflammation of sphenoid sinus. Where does the aperture of this
sinus open?
A.Sphenoethmoidal recess
B.Common nasal meatus.
C.Middle nasal meatus.
D.Inferior nasal meatus.
E.Infundibulum.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 20. Introduction in nervous system. Basic principles of the structure of the
reflex arc. Wheit and grey matters of the central nervous system. Development of
the central nervous system. External structure of the spinal cord. Meninges and
blood vessels of the spinal cord.
1. Relevance of the topic:
In spinal cord injury complications arise that result in violations of sensitivity, motor
activity. Knowledge of the structure of the spinal cord allows the patient to put a true
topical diagnosis.
2. The specific aims:
To analyze the general characteristics of the CNS.
Explain:
- Structure of the gray matter of the spinal cord;
- The structure of the white matter of the spinal cord;
- The nucleus of the spinal cord, their function;
- The structure of the reflex arc.
In preparation isolated (cut the spinal cord) to be able to show gray, white matter, rear,
front spine, spinal ganglion.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Biology
Knowing the structure of the To be able to distinguish
spinal cord of mammals
between gray and white matter
Histology
Know the histological structure To
of thebe
spinal
able
cordto distinguish
of gray and white matter
between gray and white matter
4. The tasks for students' individual work. of the spinal cord
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
SYSTEMA NERVOSUM
Nervous System
Neuron
Neuron
Medulla spinalis
Spinal cord
Intumescentia cervicalis
necks thickening
Intumescentia lumbosacralis
Lumbosacral thickening
Conus medullaris
Filum terminale, pars spinalis
Fissura mediana anterior
Sulcus medianus posterior
Septum medianum posterius
Sulcus anterolateralis
Sulcus posterolateralis
Funiculi medullae spinalis
Pars cervicalis; Segmenta cervicalia
Pars thoracica; Segmenta thoracica
Pars lumbalis; Segmenta lumbalia
Pars sacralis; Segmenta sacralia
Pars coccygea; Segmenta coccygea
Brain cone
The final thread
Anterior median fissure
Back median furrow
Back median wall
Forward-lateral furrow
Posterior-lateral furrow
Spinal cord
The neck part; The neck segments
The rib portion; chest segments
Lumbar; lumbar segments
Sacral part; sacral segments
Coccygeal part; coccyx segments
4.2. Theoretical questions for the class:
1. Name the boundaries and show the spinal cord.
2. The name and display the external structure of the spinal cord.
3. What is spinal segment and that their number.
4. How many segments distinguish each of the spinal cord reflex?
5. What are the components of the reflex arc.
6. What is represented mostly gray and white matter of the spinal cord?
7. What distinguished cord in the spinal cord?
8. What form the gray matter of the spinal cord and which parts of it are distinguished?
9. What are the core distinction within the gray matter of the spinal cord, and where are
they?
10. As built spinal nerve?
11. Due to what formed the anterior and posterior roots of spinal nerves?
4.3. Practical tasks pertaining to the topic and to be completed during the class:
the preparations, tables, models to study the general principles of the structure of the
reflex arc, gray and white matter of the CNS. The development of the central nervous
system in onto - and phylogeny. To know the anatomy of the spinal cord, the external
structure, topography.
The content of the topic.
Spinal cord (medulla spinalis, rp. myelos)
The spinal cord is roughly cylindrical in shape. It begins superiorly at the
foramen magnum in the skull, where it is continuous with the medulla
oblongata
of the brain, and it terminates inferiorly in the adult at the level of the lower
border of the first lumbar vertebra. In the young child, it is relatively longer
and
usually ends at the upper border of the third lumbar vertebra. Thus it occupies the
upper two-thirds of the vertebral canal of the vertebral column and is
surrounded
by the three meninges, the dura mater, the arachnoid mater, and the pia mater.
Further protection is provided by the cerebrospinal fluid, which surrounds the
spinal cord in the subarachnoid space.
In the cervical region, where it gives origin to the brachial plexus, and in the
lower thoracic and lumbar regions, where it gives origin to the lumbosacral
plexus, the spinal cord is fusiformly enlarged; the enlargements are referred to as
the cervical and lumbar enlargements. Inferiorly, the spinal cord tapers off
into the conus medullaris, from the apex of which a prolongation of the pia
mater, the filum terminale, descends to be attached to the posterior surface of
the coccyx. The cord possesses, in the midline anteriorly, a deep longitudinal
fissure called the anterior median fissure and, on the posterior surface, a
shallow furrow called the posterior median sulcus. Along the entire length of
the spinal cord are attached 31 pairs of spinal nerves by the anterior or motor
roots and the posterior or sensory roots. Each root is attached to the cord by a
series of rootlets, which extend the whole length of the corresponding segment of
the cord. Each posterior nerve root possesses a posterior root ganglion, the
cells of which give rise to peripheral and central
nerve fibers.
STRUCTURE OF THE SPINAL CORD
The spinal cord is composed of an inner core of gray matter, which is
surrounded by an outer covering of white matter; there is no indication that the
cord is segmented.
Gray Matter
On cross section, the gray matter is seen as an H-shaped pillar with anterior
and posterior gray columns, or horns, united by a thin gray commissure
containing the small central canal. A small lateral gray column or horn is
present in the thoracic and upper lumbar segments of the cord. The amount of gray
matter present at any given level of the spinal cord is related to the amount of
muscle innervated at that level. Thus, its size is greatest within the cervical and
lumbosacral enlargements of the cord, which innervate the muscles of the upper
and lower limbs, respectively.
Structure
As in other regions of the central nervous system, the gray matter of the
spinal cord consists of a mixture of nerve cells and their processes, neuroglia, and
blood vessels. The nerve cells are multipolar, and the neuroglia forms an intricate
network around the nerve cell bodies and their neurites.
Nerve Cell Groups in the Anterior Gray Columns
Most nerve cells are large and multipolar, and their axons pass out in the
anterior roots of the spinal nerves as alpha efferents, which innervate skeletal
muscles. The smaller nerve cells are also multipolar, and the axons of many of
these pass out in the anterior roots of the spinal nerves as gamma efferents, which
innervate the intrafusal muscle fibers of neuromuscular spindles.
For practical purposes, the nerve cells of the anterior gray column may be
divided into three basic groups or columns: medial, central, and lateral.
The medial group is present in most segments of the spinal cord and is
responsible for innervating the skeletal muscles of the neck and trunk, including
the intercostal and abdominal musculature.
The central group is the smallest and is present in some cervical and
lumbosacral segments. In the cervical part of the cord, some of these nerve cells
(segments C3, 4, and 5) specifically innervate the diaphragm and are collectively
referred to as the phrenic nucleus. In the upper five or six cervical segments, some
of the nerve cells innervate the sternocleidomastoid and trapezius muscles and are
referred to as the accessory nucleus. The axons of these cells form the spinal part
of the accessory nerve. The lumbosacral nucleus present in the second lumbar
down to the first sacral segment of the cord is made up of nerve cells whose axons
have an unknown distribution.
The lateral group is present in the cervical and lumbosacral segments of the
cord and is responsible for innervating the skeletal muscles of the limbs.
Nerve Cell Groups in the Posterior Gray Columns
There are four nerve cell groups of the posterior gray column, two that
extend throughout the length of the cord and two that are restricted to the thoracic
and lumbar segments.
The substantia gelatinosa group is situated at the apex of the posterior gray
column throughout the length of the spinal cord. It is largely composed of Golgi
type II neurons and receives afferent fibers concerned with pain, temperature, and
touch from the posterior root. Furthermore, it receives input from descending fibers
from supraspinal levels. It is believed that the inputs of the sensations of pain and
temperature are modified by excitatory or inhibitory information from other
sensory inputs and by information from the cerebral cortex.
The nucleus proprius is a group of large nerve cells situated anterior to the
substantia gelatinosa throughout the spinal cord. This nucleus constitutes the main
bulk of cells present in the posterior gray column and receives fibers from the
posterior white column that are associated with the senses of position and
movement (proprioception), two-point discrimination, and vibration.
The nucleus dorsalis (Clark's column) is a group of nerve cells situated at
the base of the posterior gray column and extending from the eighth cervical
segment caudally to the third or fourth lumbar segment. Most of the cells are
comparatively large and are associated with proprioceptive endings
(neuromuscular spindles and tendon spindles).
The visceral afferent nucleus is a group of nerve cells of medium size
situated lateral to the nucleus dorsalis; it extends from the first thoracic to the third
lumbar segment of the spinal cord. It is believed to be associated with receiving
visceral afferent information.
Nerve Cell Groups in the Lateral Gray Columns
The intermediolateral group of cells form the small lateral gray column,
which extends from the first thoracic to the second or third lumbar segment of the
spinal cord. The cells are relatively small and give rise to preganglionic
sympathetic fibers.
A similar group of cells found in the second, third, and fourth sacral
segments of the spinal cord give rise to preganglionic parasympathetic fibers. The Gray
Commissure and Central Canal
In transverse sections of the spinal cord, the anterior and posterior gray
columns on each side are connected by a transverse gray commissure, so that the
gray matter resembles the letter H. In the center of the gray commissure is situated
the central canal. The part of the gray commissure that is situated posterior to the
central canal is often referred to as the posterior gray commissure; similarly, the
part that lies anterior to the canal is called the anterior gray commissure.
Comparison of Structural Details in Different Regions of the Spinal Cord
Region Shape White
Matter
Gray Matter
Anterior Gray Posterior
Column
Column
Gray Lateral
Gray
Column
Cervical Oval Fasciculus
cuneatus
and
fasciculus
gracilis
present
Medial group of Substantia gelatinosa Absent
cells
present, continuous
for neck muscles; with Sp.N. of cranial
central group of nerve V at level C2;
cells
nucleus proprius
for accessory present; nucleus
nucleus (CI-5) dorsalis (Clark's
and
phrenic column) absent
nucleus (C3, 4,
and 5); lateral
group of cells for
upper
limb
muscles
Thoracic Round Fasciculus Medial group of Substantia
Present;
cuneatus
cells
gelatinosa,
gives rise to
(Tl-6) and for trunk muscles nucleus proprius,
preganglionic
fasciculus
nucleus dorsalis sympathetic
gracilis
(Clark's column), fibers
present
and visceral afferent
nucleus present
Lumbar Round Fasciculus
Medial group of Substantia
Present (LI-2
to
cuneatus
cells
gelatinosa,
[3]); gives
oval absent;
for lower limb
nucleus proprius,
rise to
fasciculus
muscles; central nucleus dorsalis
preganglionic
gracilis
group of cells for (Clark's column) at sympathetic
present
lumbosacral nerve LI—4, and visceral fibers
afferent
nucleus
present
Sacral
Round Small
Medial group of Substantia gelatinosa Absent;
amount;
cells
and nucleus proprius group of cells
fasciculus
for lower limb
present
present at S2cuneatus
and
4, for
absent;
perineal muscles
parasympathe
fasciculus
tic outflow
gracilis
present
The central canal is present throughout the spinal cord. Superiorly, it is
continuous with the central canal of the caudal half of the medulla oblongata, and
above this, it opens into the cavity of the fourth ventricle. Inferiorly in the conus
medullaris, it expands into the fusiform terminal ventricle and terminates below
within the root of the filum terminale. It is filled with cerebrospinal fluid and is
lined with ciliated columnar epithelium, the ependyma. Thus the central canal is
closed inferiorly and opens superiorly into the fourth ventricle.
White Matter
The white matter, for purposes of description, may be divided into anterior,
lateral, and posterior white columns or funiculi. The anterior column on each
side lies between the midline and the point of emergence of the anterior nerve
roots; the lateral column lies between the emergence of the anterior nerve roots and
the entry of the posterior nerve roots; the posterior column lies between the entry
of the posterior nerve roots and the midline.
Structure
As in other regions of the central nervous system, the white matter of the
spinal cord consists of a mixture of nerve fibers, neuroglia, and blood vessels. It
surrounds the gray matter, and its white color is due to the high proportion of
myelinated nerve fibers.
Arrangement of Nerve Fiber Tracts
The arrangement of the nerve fiber tracts within the spinal cord has been deduced
as the result of animal experimentation and study of the human spinal cord for
degenerative nerve fibers resulting from injury or disease. Although some nerve
tracts are concentrated in certain areas of the white matter, it is now generally
accepted that considerable overlap is present. For purposes of description, the
spinal tracts are divided into ascending, descending, and intersegmental tracts, and
their relative positions in the white matter are described below.
A reflex may be defined as an involuntary response to a stimulus. It depends
on the integrity of the reflex arc. In its simplest form, a reflex arc consists of the
following anatomical structures: (1) a receptor organ, (2) an afferent neuron, (3) an
effector neuron, and (4) an effector organ. A reflex arc involving only one synapse
is referred to as a monosynaptic reflex arc. Interruption of the reflex arc at any
point along its course would abolish the response.
In the spinal cord, reflex arcs play an important role in maintaining muscle
tone, which is the basis for body posture. The receptor organ is situated in the skin,
muscle, or tendon. The cell body of the afferent neuron is located in the posterior
root ganglion, and the central axon of this first-order neuron terminates by
synapsing on the effector neuron. Since the afferent fibers are of large diameter
and are rapidly conducting and because of the presence of only one synapse, a very
quick response is possible.
Physiological study of the electrical activity of the effector neuron shows
that following the very quick monosynaptic discharge, there is a prolonged
asynchronous discharge.
The reason for this later discharge is that the afferent fibers entering the
spinal cord frequently branch, and the branches synapse with many internuncial
neurons, which ultimately synapse with the effector neuron. These additional
neuronal circuits prolong the bombardment of the effector neurons after the initial
stimulation by the afferent neuron has ceased. The presence of internuncial
neurons also results in the spread of the afferent stimulus to neurons at different
segmental levels of the spinal cord.
In considering reflex skeletal muscle activity, it is important to understand
the law of reciprocal innervation. Simply stated, it means that the flexor and
extensor reflexes of the same limb cannot be made to contract simultaneously. For
this law to work, the afferent nerve fibers responsible for flexor reflex muscle
action must have branches that synapse with the extensor motor neurons of the
same limb, causing them to be inhibited.
Another interesting property of spinal reflexes should be pointed out. The
evocation of a reflex on one side of the body causes opposite effects on the limb of
the other side of the body. This crossed extensor reflex may be demonstrated as
follows. Afferent stimulation of the reflex arc that causes the ipsilateral limb to
flex results in the contralateral limb being extended.
Materials for self-check.
A. Tasks for self-check: draw a reflex arc segment of the spinal cord.
B. Choose the correct answer:
1.A. 65 years old patient has been diagnosed with bleeding in the anterior horn of the
spinal cord. Which, by the function are anterior horns?
A.Motiona
B.Sensitive
C.Sympathetic
D.Parasympathetic
E.Mixed
2.A. 41 years old patient got into an infectious department of the hospital with a high
body temperature. Meningeal symptoms objectively expressed. A lumbar puncture was
done. What anatomical formation was punctured?
A.spatium subarachnoideum
B.spatium subdurale
C.spatium epidurale
D.cavum trigeminale
E.cisterna cerebellomedullaris posterior
3.The patient with fractures of the thoracic spine (Th1) with spinal cord injury has
arrived to the surgical department. Which segment of the spinal cord is injured?
A.2 thoracic
B.1 thoracic
C.1 lumbar
D.5 lumbar
E.5 sacral
4.For the purpose of differential diagnosis of meningitis a study of cerebrospinal fluid is
conducted. In what place the lumbar puncture is safe?
A.L III -L IV
B.L II -L III
C.L I –L II
D.Th XII - L I
E.L V - S I
5.The patient complaints of pain in the lumbar region. The doctor reveals tenderness in
the paravertebral points and diagnoses "lumbar radicular pain." Where most likely
happened compression of spinal roots?
A.In the intervertebral apertures lumbar spine.
B.In nutritional apertures of the lumbar vertebrae
C.In the spinal canal.
D.In the apertures in the transverse processes of the cervical vertebrae.
E.In the structures of in the brain substance in lumbar segments of the spinal cord.
6.To define the topography of the spinal cord:
A.CI-LII
B.СI-L5
C.CII-L4
D.CI-LII
E.CII-LI
7.In case of injury cervical spine segments of the spinal cord are damaged. Specify this
number:
A. 4
B.8
C.5
D.6
E.7
8.In case of injury spine thoracic segments of the spinal cord are damaged. Specify this
number:
A.12
B.8
C.5
D.10
E.11
9.In case of injury spine lumbar segments of the spinal cord are damaged. Specify this
number:
A.5
B.4
C.6
D.7
E.8
10.In case of injury spine sacral segments of the spinal cord are damaged. Specify this
number:
A.5
B.4
C.6
D.7
E.8
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. - Lugansk:
LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. - Lugansk:
LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams
& Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009.
– 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell,
1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. –
2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 21. Internal structure of spinal cord. White and grey matters of the spinal
cord.
1. Relevance of the topic:
In spinal cord injury complications arise that result in violations of sensitivity, motor
activity. Knowledge of the structure of the spinal cord allows the patient to put a true
topical diagnosis.
2. The specific aims:
Explain the internal structure of the spinal cord.
To explain:
- Structure of the gray matter of the spinal cord;
- The structure of the white matter of the spinal cord;
- The nucleus of the spinal cord, their function.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Biology
Knowing the structure of the To be able to distinguish between
spinal cord of mammals
gray and white matter of the spinal
cordbe able to distinguish between
Histology
Know the histological structure To
of gray and white matter
gray and white matter of the spinal
cord
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
Canalis centralis
The central channel
Substantia grisea
Grey matter
Cornu anterius
The front horn
Cornu laterale
Side horns
Cornu posterius
Rear horns
Substantia alba
White matter
Substantia gelatinosa centralis
Central gelatinous substance
Columnae griseae
Gray column
Columna anterior
The front pillar
Columna posterior
The rear pillar
4.2. Theoretical questions for the class:
1. Name the boundaries and show the spinal cord.
2. The name and display the external structure of the spinal cord.
3. What is spinal segment and that their number.
4. How many segments distinguish each of the spinal cord reflex What?
5. What are the components of the reflex arc.
6. What is represented mostly gray and white matter of the spinal cord?
7. What distinguished cord in the spinal cord?
8. What form the gray matter of the spinal cord and which parts of it are distinguished
(in operechnomu cut)?
9. What are the core distinction within the gray matter of the spinal cord, and where are
they?
10. As built spinal nerve?
11. Due to what formed the anterior and posterior roots of spinal nerves?
4.3. Practical tasks pertaining to the topic and to be completed during the
class:The isolated preparation (cut the spinal cord) to be able to show gray, white
matter, rear, front spine, spinal ganglion.
The content of the topic:
INTERNAL ORGANIZATION
In transverse section, the spinal cord is incompletely divided into symmetrical halves by
a dorsal (posterior) median septum and a ventral (anterior) median sulcus . It consists of
an outer layer of white matter and an inner core of grey matter; their relative sizes and
configuration vary according to level. The amount of grey matter reflects the number of
neurones present; it is proportionately largest in the cervical and lumbar enlargements,
which contain the neurones that innervate the limbs. The absolute amount of white
matter is greatest at cervical levels, and decreases progressively at lower levels, because
descending tracts shed fibres as they descend and ascending tracts accumulate fibres as
they ascend.
A diminutive central canal, lined by columnar, ciliated epithelium (ependyma) and
containing cerebrospinal fluid (CSF), extends the whole length of the spinal cord lying in
the centre of the spinal grey matter. Rostrally, the central canal extends into the caudal
half of the medulla oblongata and then opens into the fourth ventricle.
SPINAL GREY MATTER
In three dimensions, the spinal grey matter is shaped like a fluted column .In transverse
section the column is often described as being ‘butterfly-shaped’ or resembling the letter
‘H’ .It consists of four linked cellular masses, the right and left dorsal and ventral horns,
that project dorsolaterally and ventrolaterally towards the surface respectively. The grey
matter that immediately surrounds the central canal and unites the two sides constitutes
the dorsal and ventral grey commissures. The dorsal horn is the site of termination of the
primary afferent fibres that enter the cord via the dorsal roots of spinal nerves. The tip of
the dorsal horn is separated from the dorsolateral surface of the cord by a thin fasciculus
or tract (of Lissauer) in which primary afferent fibres ascend and descend for a short
distance before terminating in the subjacent grey matter. The ventral horn contains
efferent neurones whose axons leave the spinal cord in ventral nerve roots. A small
intermediate, or lateral, horn is present at thoracic and upper lumbar levels; it contains
the cell bodies of preganglionic sympathetic neurones.
Spinal grey matter is a complex mixture of neuronal cell bodies, their processes and
synaptic connections, neuroglia and blood vessels. Neurones in the grey matter are
multipolar. They vary in size and features such as the length and the arrangement of their
axons and dendrites. Neurones may be intrasegmental, i.e. contained within a single
segment, or intersegmental, i.e. their ramifications spread through several segments.
Neuronal cell groups of the spinal cord
Viewed from the perspective of its longitudinal columnar organization, the grey matter of
the spinal cord consists of a series of discontinuous cell groupings associated with their
corresponding segmentally arranged spinal nerves. At any particular cross-sectional level
these cell groupings are often considered to correspond approximately with one or more of
ten cell layers, known as Rexed's laminae. These laminae are defined on the basis of
neuronal size, shape, cytological features and density and are numbered in a dorsoventral
sequence.
Laminae I–IV correspond to the dorsal part of the dorsal horn, and are the main site of
termination of cutaneous primary afferent terminals and their collaterals. Many
complex polysynaptic reflex paths (ipsilateral, contralateral, intrasegmental and
intersegmental) start from this region, as also do many long ascending tract fibres which
pass to higher levels. Lamina I (lamina marginalis) is a very thin layer with an illdefined boundary at the dorsolateral tip of the dorsal horn. It has a reticular appearance,
reflecting its content of intermingling bundles of coarse and fine nerve fibres. It
contains small, intermediate and large neuronal somata, many of which are fusiform in
shape. The much larger lamina II consists of densely packed small neurones,
responsible for its dark appearance in Nissl-stained sections. With myelin stains, lamina
II is characteristically distinguished from adjacent laminae by the almost total lack of
myelinated fibres. Lamina II corresponds to the substantia gelatinosa. Lamina III
consists of somata which are mostly larger, more variable and less closely packed than
those in lamina II. It also contains many myelinated fibres. Some workers consider that
the substantia gelatinosa contains part or all of lamina III as well as lamina II. The illdefined nucleus proprius of the dorsal horn corresponds to some of the cell constituents
of laminae III and IV. Lamina IV is a thick, loosely packed, heterogeneous zone
permeated by fibres. Its neuronal somata vary considerably in size and shape, from
small and round, through intermediate and triangular, to very large and stellate.
Laminae V and VI lie at the base of the dorsal horn. They receive most of the terminals
of proprioceptive primary afferents, profuse corticospinal projections from the motor
and sensory cortex and input from subcortical levels, suggesting their involvement in
the regulation of movement. Lamina V is a thick layer, divisible into a lateral third and
medial two-thirds. Both have a mixed cell population but the former contains many
prominent well-staining somata interlaced by numerous bundles of transverse,
dorsoventral and longitudinal fibres. Lamina VI is most prominent in the limb
enlargements. It has a densely staining medial third of small, densely packed neurones
and a lateral two-thirds containing larger, more loosely packed, triangular or stellate
somata.
Laminae VII–IX show a variety of forms in the limb enlargements. Lamina VII
includes much of the intermediate (lateral) horn. It contains prominent neurones of
Clarke's column (nucleus dorsalis, nucleus thoracis, thoracic nucleus) and
intermediomedial and intermediolateral cell groupings .The lateral part of lamina VII
has extensive ascending and descending connections with the midbrain and cerebellum
(via the spinocerebellar, spinotectal, spinoreticular, tectospinal, reticulospinal and
rubrospinal tracts) and is thus involved in the regulation of posture and movement. Its
medial part has numerous propriospinal reflex connections with the adjacent grey
matter and segments concerned both with movement and autonomic functions. Lamina
VIII spans the base of the thoracic ventral horn but is restricted to its medial aspect in
limb enlargements. Its neurones display a heterogeneous mixture of sizes and shapes
from small to moderately large. Lamina VIII is a mass of propriospinal interneurones. It
receives terminals from the adjacent laminae, many commissural fibres from the
contralateral lamina VIII, and descending connections from the interstitiospinal,
reticulospinal and vestibulospinal tracts and the medial longitudinal fasciculus. The
axons from these interneurones influence α motor neurone activity bilaterally, perhaps
directly but more probably by excitation of small γ motor neurones supplying efferent
fibres to muscle spindles. Lamina IX is a complex array of cells consisting of α and γ
motor neurones and many interneurones. The large α motor neurones supply motor endplates of extrafusal muscle fibres in striated muscle. Recording techniques have
demonstrated tonic and phasic α motor neurones. The former have a lower rate of firing
and lower conduction velocity and tend to innervate type S muscle units. The latter
have higher conduction velocity and tend to supply fast twitch (type FR, FF) muscle
units. The smaller γ motor neurones give rise to small-diameter efferent axons
(fusimotor fibres), which innervate the intrafusal muscle fibres in muscle spindles.
There are several functionally distinct types of γ motor neurone. The ‘static’ and
‘dynamic’ responses of muscle spindles have separate controls mediated by static and
dynamic fusimotor fibres, which are distributed variously to nuclear chain and nuclear
bag fibres.
Lamina X surrounds the central canal and consists of the dorsal and ventral grey
commissures.
Dorsal horn
The dorsal horn is a major zone of termination of primary afferent fibres, which enter the
spinal cord through the dorsal roots of spinal nerves. Dorsal root fibres contain numerous
molecules, which are either known, or suspected, to fulfil a neurotransmitter or
neuromodulator role. These include glutamic acid, substance P, calcitonin gene-related
peptide (CGRP), bombesin, vasoactive intestinal polypeptide (VIP), cholecystokinin
(CCK), somatostatin, dynorphin and angiotensin II. Dorsal root afferents carry
exteroceptive, proprioceptive and interoceptive information. Laminae I–IV are the main
cutaneous receptive areas; lamina V receives fine afferents from the skin, muscle and
viscera; lamina VI receives proprioceptive and some cutaneous afferents. Most, if not all,
primary afferent fibres divide into ascending and descending branches on entering the
cord. These then travel for variable distances in the tract of Lissauer, near the surface of
the cord, and send collaterals into the subjacent grey matter. The formation, topography
and division of dorsal spinal roots have all been confirmed in man.
The lamina marginalis is a thin lamina of neurones at the dorsolateral tip of the dorsal
horn, deep to the tract of Lissauer. Beneath it lies the substantia gelatinosa (laminae II and
III), which is present at all levels, and consists mostly of small neurones, together with
some larger neurones. The substantia gelatinosa receives afferents via the dorsal roots, and
its neurones give rise to fibres that form the contralateral spinothalamic tract. The large
propriospinal neurones of the nucleus proprius lie ventral to the substantia gelatinosa; they
link segments for the mediation of intraspinal coordination . Clarke's column lies at the
base of the dorsal horn. At most levels, it is near the dorsal white funiculus and may
project into it. In the human spinal cord, it can usually be identified from the eighth
cervical to the third or fourth lumbar segments. Neurones of Clarke's column vary in size,
but most are large, especially in the lower thoracic and lumbar segments. Some send
axons into the dorsal spinocerebellar tracts and others are interneurones.
Lateral horn
The lateral horn is a small lateral projection of grey matter located between the dorsal
and ventral horns. It is present from the eighth cervical or first thoracic segment to the
second or third lumbar segment. It contains the cell bodies of preganglionic sympathetic
neurones. These develop in the embryonic cord dorsolateral to the central canal and
migrate laterally, forming intermediomedial and intermediolateral cell columns. Their
axons travel via ventral spinal roots and white rami communicantes to the sympathetic
trunk. A similar cell group is found in the second to fourth sacral segments, but unlike
the thoracolumbar lateral cell column, it does not form a visible lateral projection. It is
the source of the sacral outflow of parasympathetic preganglionic nerve fibres.
Ventral horn
Neurones in the ventral horn vary in size. The largest cell bodies, which may exceed 25
μm in diameter, are those of α motor neurones, the axons of which emerge in ventral
roots to innervate extrafusal fibres in striated skeletal muscles. Large numbers of
smaller neurones, 15–25 μm in diameter, are also present. Some of these are γ motor
neurones, which innervate intrafusal fibres of muscle spindles, and the rest are
interneurones. Motor neurones utilize acetylcholine as their neurotransmitter.
Considered longitudinally, ventral horn neurones are arranged in elongated groups, and
form a number of separate columns, which extend through several segments. These are
seen most easily in transverse sections. The ventral horn may be divided into medial,
central and lateral cell columns, which all exhibit subdivision at certain levels, usually
into dorsal and ventral parts . The medial group extends throughout the cord, but may
be absent in the fifth lumbar and first sacral segments. In the thoracic and the upper four
lumbar segments, it is subdivided into ventromedial and dorsomedial groups. In
segments cranial and caudal to this region, the medial group has only a ventromedial
moiety, except in the first cervical segment, where only the dorsomedial group exists.
The central group of cells is the least extensive, and is found only in some cervical and
lumbosacral segments. The centrally situated phrenic nucleus, containing the motor
neurones that innervate the diaphragm, lies in the third to seventh cervical segments. An
irregular accessory group of neurones in the upper five or six cervical segments at the
ventral border of the ventral horn give rise to axons that are thought to enter the spinal
accessory nerve .
The lateral group of cells in the ventral horn is subdivided into ventral, dorsal and
retrodorsal groups, largely confined to the spinal segments which innervate the limbs.
The nucleus of Onuf, which is thought to innervate the perineal striated muscles, is a
ventrolateral group of cells in the first and second sacral segments.
The motor neurones of the ventral horn are somatotopically organized. The basic
arrangement is that medial cell groups innervate the axial musculature, and lateral cell
groups innervate the limbs. The basic building block of the somatic motor neuronal
populations is represented by a longitudinally disposed group of neurones, which
innervate a given muscle, and in which the α and γ motor neurones are intermixed. The
various groups innervating different muscles are aggregated into two major longitudinal
columns, medial and lateral. In transverse section these form the medial and lateral cell
groups in the ventral horn.
The medial longitudinal motor column extends throughout the length of the spinal
cord. Its neurones innervate epaxial and hypaxial muscle groups. Basically, epaxial
muscles include the erector spinae group (which extend the head and vertebral
column), while hypaxial muscles include prevertebral muscles of the neck, intercostal
and anterior abdominal wall muscles (which flex the neck and the trunk). The epaxial
muscles are innervated by branches of the dorsal primary rami of the spinal nerves,
and the hypaxial muscles by branches of the ventral primary rami. In the medial
column, motor neurones supplying epaxial muscles are sited ventral to those supplying
hypaxial muscles.
The lateral longitudinal motor column is found only in the enlargements of the spinal
cord. The motor neurones in this column in the cervical and lumbar enlargements
innervate muscles of the upper and lower limbs, respectively. In the cervical
enlargement, motor neurones which supply muscles intrinsic to the upper limb are
situated dorsally in the ventral grey column, and those innervating the most distal
(hand) muscles are sited further dorsally. Motor neurones of the girdle muscles lie in
the ventrolateral part of the ventral horn. There is a further somatotopic organization in
that the proximal muscles of the limb are supplied from motor cell groups located
more rostrally in the enlargement than those supplying the distal muscles. For
example, motor neurones innervating intrinsic muscles of the hand are sited in
segments C8 and T1, while motor neurones of shoulder muscles are in segments C5
and 6. A similar overall arrangement of motor neurones innervating lower limb
muscles applies in the lumbosacral cord
Vascularization of the spinal cord
Arteries
There are two systems of blood supply to the spinal cord:
vertical (due to the left and right front and rear spinal cord arteries);
Horizontal (many branches spinal vertebral, deep cervical, posterior intercostal,
lumbar, lateral sacral arteries).
Veins of the spinal cord arteries are companions, but not the same name with them.
They form osnovnohrebtsevymy veins with front and rear internal vertebral venous
plexus.
Materials for self-check.
A.Tasks for self- check:
Draw a nucleus of the spinal cord and write pathways.
B. Choose the correct answer:
1.A 30 years old patient has been arrived in the neurosurgical department with stab
wounds in the area of lowthoracic spine. During the examination was found that the
knife blade passed between the procesus spinosus of 10th and 11th thoracic vertebrae
and damaged posterior spinal cord. The fibers of which pathways have been damaged
in this case?
A.fasciculus gracilis and fasciculus cuneatus
B.fasciculus cuneatus
C.fasciculus gracilis
D.spinocerebellaris dorsalis
E.spinocerebellaris ventralis
2.A. skier dosen’t have knee-jerk after after spinal cord injury. Which segments of the
spinal cord were injured?
A.2-4 lumbar segments of the spinal cord
B.1-2 cervical segments of the spinal cord
C.8-9 thoracic spinal cord segments
D.10-11 thoracic spinal cord segments
E.5-6 cervical segments of the spinal cord
3.A patient has lost tactile sensitivity, body position sense and vibrations sense. Which
pathways were damaged?
A.fasciculus cuneatus et gracilis
B.tractus reticulospinalis
C.tractus spinocerebellares lateralis et ventralis
D.tractus rubrospinalis
E.tractus tectospinalis
4.A 65 years old patient has been diagnosed with bleeding in the anterior horn of the
spinal cord. Which, by the function are anterior horns?
A.Motional
B.Sensitive
C.Sympathetic
D.Parasympathetic
E.Mixed
5.A patient has meningitis. The puncture of the arachnoid area was proposed.
Determine shells between which it is located:
A.Arachnoid and pia maters.
B.The periosteum and arachnoid membrane.
C.The solid and the arachnoid membranes.
D.The periosteum and dura mater.
E.The dura mater pia mater.
6.A patient has severe headache, stiffness in the neck muscles, repeated vomiting, pain
on skull percussion, increased sensitivity to light stimuli. Diagnosis is meningitis.
Lumbar puncture was shown. Point the location of the puncture:
A.Between 3 and 4 lumbar vertebrae
B.Between 1 and 2 lumbar vertebrae
C.Between 12 thoracic and 1 lumbar vertebrae
D.Between 5 lumbar and sacrum foundation
E.Between 11 and 12 thoracic vertebrae
7.In order to different diagnosis of meningitis a research of cerebrospinal fluid is
conducting. Where lumbar puncture is safe?
A.L III -L IV
B.LV - S I
C.L II -L III
D.L I –L II
E.Th XII - L I
8.A 41 years old patient got into an infectious department of the hospital with a high
body temperature. Meningeal symptoms objectively expressed. A lumbar puncture
was done. What anatomical formation was punctured?
A.spatium subaraсhnoideum
B.spatium subdurale
C.spatium epidurale
D.cavum trigeminale
E.cisterna cerebellomedullaris posterior
9.A car accident victim was got with injury of the rear pillars of the spinal cord. Which
infringement of the functions should appear due to this injury?
A.Loss of vibration sensitivity
B.The loss of pain sensitivity
C.Loss of the ability to voluntary movements of limbs
D.The loss of temperature sensitivity
E.Raising tone of skeletal muscles
10.A patient had been taken to hospital with spinal injuries. Discovered injury of rear
ropes of the spinal cord at the 1st thoracic vertebra. Which pathways were affected in
this case?
A.Tactile and proprioceptive sensitivity
B.Spina cerebellar
C.Cortical-spinal
D.Pain and temperature sensitivity
E.Extrapyramidal
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 22. Medulla oblongata, pons.
1. Relevance of the topic:
Knowledge of anatomy section and necessary for students of all specialties for further
study.
2. The specific aims:
Explain to students general characteristics of the brain and its components, the
development of the brain. Examine the outer structure of the medulla oblongata and
the bridge location of gray and white matter.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The preceding
The acquired knowledge
subjects
Biology
The phylogeny of the nervous system;
Topics for further study.
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class.
MYELENCEPHALON;
MEDULLA OBLONGATA;
BULBUS
Medulla oblongata
Fissura mediana anterior
Anterior median fissure
Foramen caecum medullae oblongataeBlind hole medulla
Pyramis medullae oblongatae
The pyramids of the medulla oblongata
Funiculus lateralis
lateral cord
Oliva
Olive
Substantia alba
White matter
Tractus pyramidalis
pyramidal way
Fibrae corticospinales
Cortical-spinal fibers
Fibrae corticonucleares bulbi
Cortex-core fibers of the medulla oblongata
Fasciculus gracilis
Gentle bunch
Fasciculus cuneatus
wedge-shaped beam
Fibrae arcuatae internae
The internal arcuate fibers
Decussatio lemnisci medialis
Tractus spinalis nervi trigemini
Crossroads medial loop
Tractus spinoolivaris
Tractus olivocerebellaris
Pedunculus cerebellaris inferior
Tractus solitaries
Spinal trigeminal nerve path
Spina oiled path
Oils-cerebellar path
Lower cerebellar legs
Single way
4.2. Theoretical questions for the class:
1. The development of the brain.
2. The parts of the brain. Brainstem.
3. The external structure of the medulla oblongata?
4. The internal structure of the medulla oblongata? The nuclei of the cranial nerves?
5. Bridge: external and internal structure? The nuclei of the cranial nerves?
6. Pathways medulla oblongata? The medial loop.
7. Pathways bridge
4.3. Practical tasks pertaining to the topic and to be completed during the class:
the preparations, tables, models to study the structure of the medulla oblongata and the
bridge, the gray and white matter. To know the anatomy of the medulla oblongata and
the bridge, the external structure, topography.
The content of the topic:
The brain - Encephalon
Brainstem, including the medulla oblongata, the bridge and the average brain weighs a
newborn less than 10 g (2.7% by weight of the brain). Most formed until the birth roof
brainstem its phylogenetically older formations, poorly developed phylogenetic youth
front of the barrel. Differentiation of nerve nuclei and the ways in roof continues in the
first months and years of life, and in the front of the brain stem ends in older children.
The medulla oblongata connects the pons superiorly with the spinal cord
inferiorly. The junction of the medulla and spinal cord is at the origin of the
anterior and posterior roots of the first cervical spinal nerve, which corresponds
approximately to the level of the foramen magnum. The medulla oblongata is
conical in shape, its broad extremity being directed superiorly. The central canal
of the spinal cord continues upward into the lower half of the medulla; in the upper
half of the medulla, it expands as the cavity of the fourth ventricle.
On the anterior surface of the medulla is the anterior median fissure, which
is continuous inferiorly with the anterior median fissure of the spinal cord. On
each side of the median fissure, there is a swelling called the pyramid. The
pyramids are composed of bundles of nerve fibers, corticospinal fibers, which
originate in large nerve cells in the precentral gyrus of the cerebral cortex. The pyramids taper inferiorly, and it is here that the majority of the descending fibers cross
over to the opposite side, forming the decussation of the pyramids. The anterior
external arcuate fibers are a few nerve fibers that emerge from the anterior
median fissure above the decussation and pass laterally over the surface of the
medulla oblongata to enter the cerebellum. Posterolateral to the pyramids are the
olives, which are oval elevations produced by the underlying inferior olivary
nuclei. In the groove between the pyramid and the olive emerge the rootlets of the
hypoglossal nerve. Posterior to the olives are the inferior cerebellar peduncles,
which connect the medulla to the cerebellum. In the groove between the olive and
the inferior cerebellar peduncle emerge the roots of the glossopharyngeal and
vagus nerves and the cranial roots of the accessory nerve.
The posterior surface of the superior half of the medulla oblongata forms the
lower part of the floor of the fourth ventricle. The posterior surface of the inferior
half of the medulla is continuous with the posterior aspect of the spinal cord and
possesses a posterior median sulcus. On each side of the median sulcus, there is
an elongated swelling, the gracile tubercle, produced by the underlying gracile
nucleus. Lateral to the gracile tubercle is a similar swelling, the cuneate tubercle,
produced by the underlying cuneate nucleus.
INTERNAL STRUCTURE
As in the spinal cord, the medulla oblongata consists of white matter and
gray matter, but a study of transverse sections of this region shows that they have
been extensively rearranged. This rearrangement can be explained embryologically
by the expansion of the neural tube to form the hindbrain vesicle, which
becomes the fourth ventricle. The extensive lateral spread of the fourth ventricle
results in an alteration in the position of the derivatives of the alar and basal
plates of the embryo. To assist in understanding this concept, remember that in the
spinal cord the derivatives of the alar and basal plates are situated posterior and
anterior to the sulcus limitans, respectively, and in the case of the medulla
oblongata, they are situated lateral and medial to the sulcus limitans, respectively.
The internal structure of the medulla oblongata is considered at four levels:
(1) level of decussation of pyramids, (2) level of decussation of lemnisci, (3) level
of the olives, and (4) level just inferior to the pons.
Level of Decussation of Pyramids
A transverse section through the inferior half of the medulla oblongata
passes through the decussation of the pyramids, the great motor decussation. In
the superior part of the medulla, the corticospinal fibers occupy and form the
pyramid, but inferiorly, about three-fourths of the fibers cross the median plane
and continue down the spinal cord in the lateral white column as the lateral
corticospinal tract. As these fibers cross the midline, they sever the continuity
between the anterior column of the gray matter of the spinal cord and the gray
matter that surrounds the central canal. The fasciculus gracilis and the fasciculus
cuneatus continue to ascend superiorly posterior to the central gray matter. The
nucleus gracilis and the nucleus cuneatus appear as posterior extensions of the central
gray matter. The substantia gelatinosa in the posterior gray column of the spinal cord
becomes continuous with the inferior end of the nucleus of the spinal tract of the
trigeminal nerve. The fibers of the tract of the nucleus are situated between the
nucleus and the surface of the medulla oblongata. The lateral and anterior white
columns of the spinal cord are easily identified in these sections, and their fiber
arrangement is unchanged.
Level of Decussation of Lemnisci
A transverse section through the inferior half of the medulla oblongata, a
short distance above the level of the decussation of the pyramids, passes through
the decussation of lemnisci, the great sensory decussation. The decussation of the
lemnisci takes place anterior to the central gray matter and posterior to the
pyramids. It should be understood that the lemnisci have been formed from the
internal arcuate fibers, which have emerged from the anterior aspects of the
nucleus gracilis and nucleus cuneatus. The internal arcuate fibers first travel
anteriorly and laterally around the central gray matter. They then curve medially
toward the midline, where they decussate with the corresponding fibers of the
opposite side.
The nucleus of the spinal tract of the trigeminal nerve lies lateral to the
internal arcuate fibers. The spinal tract of the trigeminal nerve lies lateral to the
nucleus.
The lateral and anterior spinothalamic tracts and the spinotectal tracts
occupy an area lateral to the decussation of the lemnisci. They are very close to
one another and collectively are known as the spinal lemniscus. The
spinocerebellar, vestibulospinal, and the rubrospinal tracts are situated in the
anterolateral region of the medulla oblongata.
Level of the Olives
A transverse section through the olives passes across the inferior part of the
fourth ventricle. The amount of gray matter has increased at this level owing to the
presence of the olivary nuclear complex; the nuclei of the vestibulocochlear,
glossopharyngeal, vagus, accessory, and hypoglossal nerves; and the arcuate
nuclei.
Olivary Nuclear Complex
The largest nucleus of this complex is the inferior olivary nucleus. The
gray matter is shaped like a crumpled bag with its mouth directed medially; it is
responsible for the elevation on the surface of the medulla called the olive. Smaller
dorsal and medial accessory olivary nuclei also are present. The cells of the
inferior olivary nucleus send fibers medially across the midline to enter the
cerebellum through the inferior cerebellar peduncle. Afferent fibers reach the
inferior olivary nuclei from the spinal cord (the spino-olivary tracts) and from the
cerebellum and cerebral cortex. The function of the olivary nuclei is associated
with voluntary muscle movement.
Vestibulocochlear Nuclei
The vestibular nuclear complex is made up of the following nuclei. (1)
medial vestibular nucleus, (2) inferior vestibular nucleus, (3) lateral vestibular
nucleus, and (4) superior vestibular nucleus. The details of these nuclei and their
connections are discussed later. The medial and inferior vestibular nuclei can be
seen on section at this level.
There are two cochlear nuclei. The anterior cochlear nucleus is situated
on the anterolateral aspect of the inferior cerebellar peduncle, and the posterior
cochlear nucleus is situated on the posterior aspect of the peduncle lateral to the
floor of the fourth ventricle. The connections of these nuclei are described later.
The Nucleus Ambiguus
The nucleus ambiguus consists of large motor neurons and is situated deep
within the reticular formation. The emerging nerve fibers join the
glossopharyngeal, vagus, and cranial part of the accessory nerve and are distributed
to voluntary skeletal muscle.
Central Gray Matter
The central gray matter lies beneath the floor of the fourth ventricle at this
level. Passing from medial to lateral, the following important structures may be
recognized: (1) the hypoglossal nucleus, (2) the dorsal nucleus of the vagus, (3)
the nucleus of the tractus solitarius, and (4) the medial and inferior vestibular
nuclei. The nucleus ambiguus, referred to above, has become deeply placed within
the reticular formation.
The arcuate nuclei are thought to be inferiorly displaced pontine nuclei and
are situated on the anterior surface of the pyramids. They receive nerve fibers from
the cerebral cortex and send efferent fibers to the cerebellum through the anterior
external arcuate fibers.
The pyramids containing the corticospinal and some corticonuclear fibers
are situated in the anterior part of the medulla separated by the anterior median
fissure; the corticospinal fibers descend to the spinal cord, and the corticonuclear
fibers are distributed to the motor nuclei of the cranial nerves situated within the
medulla.
The medial lemniscus forms a flattened tract on each side of the midline
posterior to the pyramid. These fibers emerge from the decussation of the lemnisci
and convey sensory information to the thalamus.
The medial longitudinal fasciculus forms a small tract of nerve fibers
situated on each side of the midline posterior to the medial lemniscus and anterior
to the hypoglossal nucleus. It consists of ascending and descending fibers.
The inferior cerebellar peduncle is situated in the posterolateral corner of
the section on the lateral side of the fourth ventricle.
The spinal tract of the trigeminal nerve and its nucleus are situated on the
anteromedial aspect of the inferior cerebellar peduncle.
The anterior spinocerebellar tract is situated near the surface in the
interval between the inferior olivary nucleus and the nucleus of the spinal tract of
the trigeminal nerve. The spinal lemniscus, consisting of the anterior
spinothalamic, the lateral spinothalamic, and spinotectal tracts, is deeply
placed.
The reticular formation, consisting of a diffuse mixture of nerve fibers and
small groups of nerve cells, is deeply placed posterior to the olivary nucleus. The
reticular formation represents, at this level, only a small part of this system, which
is also present in the pons and midbrain.
The glossopharyngeal, vagus, and cranial part of the accessory nerves
can be seen running forward and laterally through the reticular formation. The
nerve fibers emerge between the olives and the inferior cerebellar peduncles. The
hypoglossal nerves also run anteriorly and laterally through the reticular formation
and emerge between the pyramids and the olives.
Level Just Inferior to the Pons
There are no major changes, in comparison to the previous level, in the distribution
of the gray and white matter. The lateral vestibular nucleus has replaced the inferior
vestibular nucleus, and the cochlear nuclei now are visible on the anterior
and posterior surfaces of the inferior cerebellar peduncle.
The pons is anterior to the cerebellum and connects the medulla oblongata to
the midbrain. It is about 1 inch (2.5 cm) long and owes its name to the appearance
presented on the anterior surface, which is that of a bridge connecting the right and
left cerebellar hemispheres.
The anterior surface is convex from side to side and shows many transverse
fibers that converge on each side to form the middle cerebellar peduncle. There is
a shallow groove in the midline, the basilar groove, which lodges the basilar
artery. On the anterolateral surface of the pons, the trigeminal nerve emerges on
each side. Each nerve consists of a smaller, medial part, known as the motor root,
and a larger, lateral part, known as the sensory root. In the groove between the
pons and the medulla oblongata, there emerge, from medial to lateral, the
abducent, facial, and vestibulocochlear nerves.
The posterior surface of the pons is hidden from view by the cerebellum. It
forms the upper half of the floor of the fourth ventricle and is triangular in shape.
The posterior surface is limited laterally by the superior cerebellar peduncles and
is divided into symmetrical halves by a median sulcus. Lateral to this sulcus is an
elongated elevation, the medial eminence, which is bounded laterally by a sulcus,
the sulcus limitans. The inferior end of the medial eminence is slightly expanded
to form the facial colliculus, which is produced by the root of the facial nerve
winding around the nucleus of the abducent nerve. The floor of the superior part of
the sulcus limitans is bluish-gray in color and is called the substantia ferruginea; it owes its color to a group of deeply pigmented nerve cells. Lateral to the
sulcus limitans is the area vestibuli produced by the underlying vestibular nuclei.
INTERNAL STRUCTURE OF THE PONS
For purposes of description, the pons is commonly divided into a posterior
part, the tegmentum, and an anterior basal part by the transversely running fibers
of the trapezoid body.
The structure of the pons may be studied at two levels: (1) transverse section
through the caudal part, passing through the facial colliculus, and (2) transverse
section through the cranial part, passing through the trigeminal nuclei. See Table 52 for a comparison of the two levels of the pons and the major structures present at
each level.
Transverse Section Through the Caudal Part
The medial lemniscus rotates as it passes from the medulla into the pons. It
is situated in the most anterior part of the tegmentum with its long axis running
transversely. The medial lemniscus is accompanied by the spinal and lateral
lemnisci.
The facial nucleus lies posterior to the lateral part of the medial lemniscus.
The fibers of the facial nerve wind around the nucleus of the abducent nerve,
producing the facial colliculus. The fibers of the facial nerve then pass anteriorly
between the facial nucleus and the superior end of the nucleus of the spinal tract of
the trigeminal nerve.
The medial longitudinal fasciculus is situated beneath the floor of the
fourth ventricle on either side of the midline. The medial longitudinal fasciculus is
the main pathway that connects the vestibular and cochlear nuclei with the nuclei
controlling the extraocular muscles (oculomotor, trochlear, and abducent nuclei).
The medial vestibular nucleus is situated lateral to the abducent nucleus
and is in close relationship to the inferior cerebellar peduncle. The superior part of
the lateral and the inferior part of the superior vestibular nucleus are found at this
level. The posterior and anterior cochlear nuclei are also found at this level.
The spinal nucleus of the trigeminal nerve and its tract lie on the
anteromedial aspect of the inferior cerebellar peduncle.
The trapezoid body is made up of fibers derived from the cochlear nuclei
and the nuclei of the trapezoid body. They run transversely in the anterior part of
the tegmentum.
The basilar part of the pons, at this level, contains small masses of nerve
cells called pontine nuclei. The corticopontine fibers of the crus cerebri of the
midbrain terminate in the pontine nuclei. The axons of these cells give origin to the
transverse fibers of the pons, which cross the midline and intersect the
corticospinal and corticonuclear tracts, breaking them up into small bundles. The
transverse fibers of the pons enter the middle cerebellar peduncle and are
distributed to the cerebellar hemisphere. This connection forms the main pathway
linking the cerebral cortex to the cerebellum.
Transverse Section Through the Cranial Part
The internal structure of the cranial part of the pons is similar to that seen at
the caudal level, but it now contains the motor and principal sensory nuclei of the
trigeminal nerve.
The motor nucleus of the trigeminal nerve is situated beneath the lateral
part of the fourth ventricle within the reticular formation. The emerging motor
fibers travel anteriorly through the substance of the pons and exit on its anterior
surface.
The principal sensory nucleus of the trigeminal nerve is situated on the
lateral side of the motor nucleus; it is continuous inferiorly with the nucleus of the
spinal tract. The entering sensory fibers travel through the substance of the pons
and lie lateral to the motor fibers.
The superior cerebellar peduncle is situated posterolateral to the motor
nucleus of the trigeminal nerve. It is joined by the anterior spinocerebellar tract.
The trapezoid body and the medial lemniscus are situated in the same position as
they were in the previous section. The lateral and spinal lemnisci lie at the lateral
extremity of the medial lemniscus.
Materials for self-check:
A. Tasks for self-c check: Draw a nucleus of the medulla oblongata and the bridge
and prescribe pathways.
B. Choose the correct answer:
1.From the medulla oblongata, namely the nucleus cuneatus et nucleus gracilis starts:
A.tractus bulbo-thalamicus
B.tractus spinothalamicus anterior
C.tractus spinothalamicus posterior
D.tractus corticospinalis
E.tractus corticonuclearis
2.Patient has a damage of the pathways that starts from the pontis, namely from the
auditory nuclei vestibulocochlear nerve. Name it:
A.lateral loop
B.medial loop
C.tractus corticopontocerebellaris
D.tractus spinothalamicus anterior
E.tractus bulbo-thalamicus
3.The pontis connects to the cerebellum through:
A.medialis peduncule of cerebellum.
B.superior peduncule of cerebellum.
C.inferior peduncule of cerebellum.
D.Through all peduncles
E.There is no right answer
4.A 58 years-old woman addressed to the doctor with complaints on violations of the
tongue taste sensitivity. An examination using MRI has found a small hemorrhage in
the area of the medulla oblongata. The damage of which the nuclei of the medulla
oblongata could result in a violation of taste?
A.nucleus tracti solitarii
B.nucleus ambiguus
C.nucleus nervi hypoglossi
D.nucleus salivatorius inferior
E.dorsalis nuclei cochleares
5.60-years-old woman addressed to the doctor with complaints on the difficulties of
movements of the tongue that interferes the abilities to speak and eat. Examination of
brain using IRAs showed that the patient has a small hemorrhage in the lower part of
medulla oblongata. Which the nuclei of the medulla oblongata are damaged?
A.nuclei nervi hypoglossi.
B.nuclei salivatorius inferior
C.nuclei nervi accessorii
D.nuclei ambiguus
E.nuclei tracti solitarii
6.After stroke (bleeding) in the brain stem the patient has disorders in respiratory and
cardiovascular activity. In which brain structure is localized pathological process?
A.In nuclei dorsalis nervi vagi
B.in the ventral part of the pons
C.In nuclei of formatio reticularis of medulla oblongata
D.In nuclei of formatio reticularis of the pons.
E.In nucleus ambiguus of medulla oblongata
7.The patient has a bleeding in the back of the medulla oblongata. The patient
complains on respiratory disorders. Which nuclei are damaged?
A.Nuclei – respiration centers
B.nuclei nervus glossopharyngeus
C.nuclei nervi accessorii
D.nuclei nervi hypoglossi
E.Nuclei - centers of the cardiovascular system.
8.During the examination of the patient using IRAs in the brain in the area of the pons
doctor saw the tumor, which held its ventral part. What anatomical structure divides
the pons into dorsal and ventral parts?
A.fibrosi corpus trapezoideum
B.nuclei nervus trigeminus
C.nuclei nervus abducens
D.nuclei nervus facialis
E.nuclei corpus trapezoideum.
9.The patient arrived to the clinic with damaged skull base in the slope area. Intensive
therapy was appointed to prevent extensive swelling and compression of the brain,
where are situated respiratory and vasomotor centers. Point their location:
A.in myelencephalon
B.in mesencephalon
C.in pons
D.in cerebellum.
E.in the whole brain stem
10.When examining patients with disorders of auditory function was found that the
pathological process is localized at the lemniscus lateralis formation. At the level of
which brain it is normally formed?
A.metencephalon (pons).
B.cervical.
C.thoracic.
D.medulla oblongata.
E.Mesencephalon
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier
GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart.
– 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 23. Cerebellum. The isthmus of the fhombencephalon.
1. Relevance of the topic:
If the damage cerebellum occur dystaxia regulation of muscle tone, balance the
body. Perfect knowledge of the structure of the cerebellum help determine the
correct diagnosis of the patient.
2. The specific aims:
Explain the general characteristics of hindbrain.
To explain: - the location of the cerebellum;
- Diamond-shaped isthmus brain;
- External structure of the cerebellum;
- The internal structure of the cerebellum;
- Cerebellar pathways;
CEREBELLUM
Cerebellum
Vestibulocerebellum
Vestibular-cerebellar
Pontocerebellum
Bridge cerebellar
Neocerebellum
Lobus cerebelli anterior
Neo cerebellum
Lobulus centralis
Nuclei cerebelli
Nucleus dentatus;
Nucleus emboliformis
Front proportion cerebellum
Central share
cerebellar nuclei
Tooth core
core cortex
Nucleus globosus
globular core
- Isthmus diamond-shaped structure of the brain.
3. Basic knowledge and skills necessary to study the topic (interdisciplinary integration).
Disciplines
Biology
Histology
Know
The development of the
nervous system in mammals.
Features of the cerebellum in
mammals.
The structure of gray and white
matter of the cerebellum.
Be able
Show the location of the
main parts of the central
nervous
system
To be able
to distinguish
between gray and white
matter, the nucleus of the
cerebellum.
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student should
master while preparing for the class.
4.2. Theoretical questions for the class:
1. What are the department is diamond-shaped brain?
2. The boundaries of the location of the cerebellum.
3. Derivatives bubble which brain structures are related to the back of the brain?
4. What are the parts of the cerebellum is?
5. Location of diamond-shaped isthmus brain.
6. The external structure of the cerebellum.
7. The internal structure of the cerebellum.
8. Characteristics of the cerebellar nuclei.
9. 3 structures which combined stem cerebellum?
10. Name the components of the diamond-shaped isthmus brain
11. Pathways of the cerebellum
4.3. Practical tasks pertaining to the topic and to be completed during the class:
1. Show on isolated preparations brain stem.
2. Show location, boundaries cerebellum, isthmus, diamond-shaped brain
3. Be able to show hemisphere of the cerebellum worm surface cracks, slices,
piece, legs cerebellum
4.Cerebellum section showing the gray and white matter, the nucleus of the
cerebellum.
5.Display components isthmus diamond-shaped brain (redunculi cerebellares
superiors, vellum medullare superius, trigonum lemnisci).
The content of the topic:
Cerebellum - cerebellum
The cerebellum is situated in the posterior cranial fossa and covered
superiorly by the tentorium cerebelli. It is the largest part of the hindbrain and
lies
posterior to the fourth ventricle, the pons, and the medulla oblongata. The
cerebellum is somewhat ovoid in shape and constricted in its median part. It
consists of two cerebellar hemispheres joined by a narrow median vermis. The
cerebellum is connected to the posterior aspect of the brainstem by three
symmetrical bundles of nerve fibers called the superior, middle, and inferior
cerebellar peduncles.
The cerebellum is divided into three main lobes: the anterior lobe, the
middle lobe, and the flocculonodular lobe. The anterior lobe may be seen on
the superior surface of the cerebellum and is separated from the middle lobe by a
wide V-shaped fissure called the primary fissure. The middle lobe (sometimes
called the posterior lobe), which is the largest part of the cerebellum, is situated
between the primary and uvulo-nodular fissures. The flocculonodular lobe
is situated posterior to the uvulonodular fissure. A deep horizontal fissure that is
found along the margin of the cerebellum separates the superior from the inferior
surfaces; it is of no morphological or functional significance.
STRUCTURE OF THE CEREBELLUM
The cerebellum is composed of an outer covering of gray matter called the
cortex and inner white matter. Embedded in the white matter of each hemisphere
are three masses of gray matter forming the intracerebellar nuclei.
Structure of the Cerebellar Cortex
The cerebellar cortex can be regarded as a large sheet with folds lying in the
coronal or transverse plane. Each fold or folium contains a core of white matter
covered superficially by gray matter.
A section made through the cerebellum parallel with the median plane
divides the folia at right angles, and the cut surface has a branched appearance,
called the arbor vitae.
The gray matter of the cortex throughout its extent has a uniform structure. It
may be divided into three layers: (1) an external layer, the molecular layer, (2) a
middle layer, the Purkinje cell layer; and (3) an internal layer, the granular
layer.
Molecular Layer
The molecular layer contains two types of neurons: the outer stellate cell
and the inner basket cell. These neurons are scattered among dendritic
arborizations and numerous thin axons that run parallel to the long axis of the
folia. Neuroglial cells are found between these structures.
Purkinje Cell Layer
The Purkinje cells are large Golgi type I neurons. They are flask-shaped and
are arranged in a single layer. In a plane transverse to the folium, the dendrites of
these cells are seen to pass into the molecular layer, where they undergo profuse
branching. The primary and secondary branches are smooth, and subsequent
branches are covered by short, thick dendritic spines. It has been shown that the
spines form synaptic contacts with the parallel fibers derived from the granule
cell axons. At the base of the Purkinje cell, the axon arises and passes through the
granular layer to enter the white matter. On entering the white matter, the axon
acquires a myelin sheath, and it terminates by synapsing with cells of one of the
intracerebellar nuclei. Collateral branches of the Purkinje axon make synaptic
contacts with the dendrites of basket and stellate cells of the granular layer in the
same area or in distant folia. A few of the Purkinje cell axons pass directly to end
in the vestibular nuclei of the brainstem.
Granular Layer
The granular layer is packed with small cells with densely staining nuclei
and scanty cytoplasm. Each cell gives rise to four or five dendrites, which make
clawlike endings and have synaptic contact with mossy fiber input. The axon of
each granule cell passes into the molecular layer, where it bifurcates at a T
junction, the branches running parallel to the long axis of the cerebellar folium.
These fibers, known as parallel fibers, run at right angles to the dendritic
processes of the Purkinje cells. Most of the parallel fibers make synaptic contacts
with the spinous processes of the dendrites of the Purkinje cells. Neuroglial cells
are found throughout this layer. Scattered throughout the granular layer are Golgi
cells. Their dendrites ramify in the molecular layer, and their axons terminate by
splitting up into branches that synapse with the dendrites of the granular cells.
Functional Areas of the Cerebellar Cortex
Clinical observations by neurologists and neurosurgeons and the
experimental use of the PET scan have shown that it is possible to divide up the
cerebellar cortex into three functional areas.
The cortex of the vermis influences the movements of the long axis of the
body, namely, the neck, the shoulders, the thorax, the abdomen, and the hips.
Immediately lateral to the vermis is a so-called intermediate zone of the cerebellar
hemisphere. This area has been shown to control the muscles of the distal parts of
the limbs, especially the hands and feet. The lateral zone of each cerebellar
hemisphere appears to be concerned with the planning of sequential movements of
the entire body and is involved with the conscious assessment of movement errors.
Intracerebellar Nuclei
Four masses of gray matter are embedded in the white matter of the
cerebellum on each side of the midline. From lateral to medial, these nuclei are the
dentate, the emboliform, the globose, and the fastigial.
The dentate nucleus is the largest of the cerebellar nuclei. It has the shape
of a crumpled bag with the opening facing medially. The interior of the bag is
filled with white matter made up of efferent fibers that leave the nucleus through
the opening to form a large part of the superior cerebellar peduncle.
The emboliform nucleus is ovoid and is situated medial to the dentate
nucleus, partially covering its hilus.
The globose nucleus consists of one or more rounded cell groups that lie
medial to the emboliform nucleus.
The fastigial nucleus lies near the midline in the vermis and close to the
roof of the fourth ventricle; it is larger than the globose nucleus.
The intracerebellar nuclei are composed of large, multipolar neurons with
simple branching dendrites. The axons form the cerebellar outflow in the superior
and inferior cerebellar peduncles.
White Matter
There is a small amount of white matter in the vermis; it closely resembles
the trunk and branches of a tree and thus is termed the arbor vitae. There is a large
amount of white matter in each cerebellar hemisphere. The white matter is made up
of three groups of fibers: (1) intrinsic, (2)
afferent, and (3) efferent. The intrinsic fibers do not leave the cerebellum but
connect different regions of the organ. Some interconnect folia of the cerebellar
cortex and vermis on the same side; others connect the two cerebellar hemispheres
together. The afferent fibers form the greater part of the white matter and proceed to
the cerebellar cortex. They enter the cerebellum mainly through the inferior and
middle cerebellar peduncles.
The efferent fibers constitute the output of the cerebellum and commence
as the axons of the Purkinje cells of the cerebellar cortex. The great majority of the
Purkinje cell axons pass to and synapse with the neurons of the cerebellar nuclei
(fastigial, globose, emboliform, and dentate). The axons of the neurons then leave
the cerebellum. A few Purkinje cell axons in the flocculonodular lobe and in parts of
the vermis bypass the cerebellar nuclei and leave the cerebellum without synapsing.
Fibers from the dentate, emboliform, and globose nuclei leave the
cerebellum through the superior cerebellar peduncle. Fibers from the fastigial
nucleus leave through the inferior cerebellar peduncle.
CEREBELLAR CORTICAL MECHANISMS
As a result of extensive cytological and physiological research, certain basic
mechanisms have been attributed to the cerebellar cortex. The climbing and the
mossy fibers constitute the two main lines of input to the cortex and are excitatory
to the Purkinje cells.
The climbing fibers are the terminal fibers of the olivocerebellar tracts.
They are so named because they ascend through the layers of the cortex like a vine
on a tree. They pass through the granular layer of the cortex and terminate in the
molecular layer by dividing repeatedly. Each climbing fiber wraps around and
makes a large number of synaptic contacts with the dendrites of a Purkinje cell. A
single Purkinje neuron makes synaptic contact with only one climbing fiber.
However, one climbing fiber makes contact with one to ten Purkinje neurons. A
few side branches leave each climbing fiber and synapse with the stellate cells and
basket cells.
The mossy fibers are the terminal fibers of all other cerebellar afferent
tracts. They have multiple branches and exert a much more diffuse excitatory
effect. A single mossy fiber may stimulate thousands of Purkinje cells through the
granule cells. What then is the function of the remaining cells of the cerebellar
cortex, namely, the stellate, basket, and Golgi cells? Neurophysiological research,
using microelectrodes, would indicate that they serve as inhibitory interneurons. It
is believed that they not only limit the area of cortex excited but influence the
degree of Purkinje cell excitation produced by the climbing and mossy fiber input.
By this means, fluctuating inhibitory impulses are transmitted by the Purkinje cells
to the intracerebellar nuclei, which, in turn, modify muscular activity through the
motor control areas of the brainstem and cerebral cortex. It is thus seen that the
Purkinje cells form the center of a functional unit of the cerebellar cortex.
Intracerebellar Nuclear Mechanisms
The deep cerebellar nuclei receive afferent nervous information from two sources:
(1) the inhibitory axons from the Purkinje cells of the overlying cortex, and (2) the
excitatory axons that are branches of the afferent climbing and rnos; fibers that are
passing to the overlying cortex. In this mai ner, a given sensory input to the
cerebellum sends excit tory information to the nuclei, which a short time later, r
ceive cortical processed inhibitory information from tr: Purkinje cells. Efferent
information from the deep cerebell; nuclei leaves the cerebellum to be distributed
to the r mainder of the brain and spinal cord.
Cerebellar Peduncles
The cerebellum is linked to other parts of the central nervous system by numerous
efferent and afferent fibers that a grouped together on each side into three large
bundles, or peduncles. The superior cerebellar peduncli connect the cerebellum
to the midbrain, the middle cer bellar peduncles connect the cerebellum to the
pons, and the inferior cerebellar peduncles connect the cerebellum the medulla
oblongata.
Cerebellum Newborn weighs in at 20 grams, which is 5.4% of the weight of the entire
brain. In the early years of the cerebellum grows rapidly, and 6 years of its weight
reaches the lower limit weight gain in adults (142-150 g 125-135 g of boys and girls).
The relative weight of the cerebellum is increased to 10% by weight of the brain.
Especially strong developing cerebellar hemisphere.
Materials for self-check:
A. Tasks for self- check: Draw and write cerebellar nuclei pathways that take place
in the upper, middle and lower legs.
B. Choose the correct answer:
1.The patient has a tumor in site of connection with the cerebellum and medulla
oblongata. It is:
A.pedunculi cerebellares inferiores
B.pedunculi cerebellares superiores
C.pedunculi cerebellares medii
D.Leaflets of the cerebellum.
E.cerebellar vermis
2.A patient has a tumor in site of connection with the cerebellum and pontis. It is:
A.pedunculi cerebellares medii
B.pedunculi cerebellares superiores
C.pedunculi cerebellares inferiores
D.Leaflets of the cerebellum.
E.cerebellar vermis
3.A patient has a tumor in site of connection with the cerebellum and average brain. It
is:
A.pedunculi cerebellares superiores
B.pedunculi cerebellares inferiores.
C.pedunculi cerebellares medii
D.Leaflets of the cerebellum.
E.cerebellar vermis
4.The cerebellum is connected with other parts of the central nervous system by:
A.3 pairs of peduncles
B.5 peduncles
C.2 peduncles
D.3 peduncles
E.4 peduncles
5.A patient was diagnosed with a damage of superior cerebellar peduncles, superior
medullary velum and trigone of lateral lemniscus. These formations belong to:
A.isthmus rhombencephali
B.medulla oblongata
C.pons
D.The spinal cord
E.the midbrain
6.Cerebellar tumor has spread to all layers of the cerebellar cortex. It consists of:
A.3 stratum of nerve cells
B.2 stratum of nerve cells
C.1 stratum of nerve cells
D.only of nerve processes
7.During the work man gets tired quickly. In a standing position with closed eyes he
staggers, loses balance. Tonus of skeletal muscle is low. Which of the following brain
structures is affected?
A.cerebellum
B.the pons
C.nucleus of accessory nerve
D.nucleus of the vagus nerve
E.medulla oblongata
8.During the examination of woman’s brain bleeding was found, that is localized in
the superior cerebellar peduncle. Which ways cross it?
A.anterior spinocerebellar tract, tractus tectospinalis
B.posterior and anterior spinocerebellar tract, olivocerebellar tract
C.posterior spinocerebellar tract, olivocerebellar tract, vestibulocerebellar tract, lateral
vestibulospinal tract
D.anterior spinocerebellar tract, olivocerebellar tract, vestibulocerebellar tract, lateral
vestibulospinal tract.
E.pontocerebellaris tract.
9.During the examination of woman’s brain bleeding was found, that is localized in
the medial cerebellar peduncle. Which ways cross it?
A.pontocerebellaris tract.
B.posterior and anterior spinocerebellar tract, olivocerebellar tract
C.posterior spinocerebellar tract, olivocerebellar tract, vestibulocerebellar tract, lateral
vestibulospinal tract .
D.anterior spinocerebellar tract, olivocerebellar tract, vestibulocerebellar tract, lateral
vestibulospinal tract.
E.anterior spinocerebellar tract, tractus tectospinalis.
10.During the examination of woman’s brain bleeding was found, that is localized in
the inferior cerebellar peduncle. Which ways cross it?
A.posterior spinocerebellar tract, olivocerebellar tract, vestibulocerebellar tract, lateral
vestibulospinal tract .
B.posterior and anterior spinocerebellar tract, olivocerebellar tract
C.anterior spinocerebellar tract, olivocerebellar tract, vestibulocerebellar tract, lateral
vestibulospinal tract.
D.pontocerebellaris tract.
E.anterior spinocerebellar tract, tractus tectospinalis.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 24. The fourth ventricle. Rhomboid fossa.
1. Relevance of the topic:
Defeat cores bridge and the medulla oblongata cause serious damage to the health
of the patient, can cause death. Knowledge of localization, functionality cores will
help in the resolution of the correct diagnosis of the patient.
2. The specific aims:
To analyze the functionality of the nuclei of the bridge and the medulla oblongata.
Explain:
- Structure of the foreign rhomboid fossa;
- The projection of sensory nuclei in diamond-shaped hole;
- Projection motor nuclei in diamond-shaped hole;
- Projection parasympathetic nuclei in diamond-shaped hole;
- IV ventricle structure and location of the IV ventricle.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Disciplines
Know
Be able
Biology
The development of the Show the location of the
nervous system in mammals. main parts of the central
Features
diamond-shaped nervous system
lesions of the brain of
vertebrates.
Histology
The
structure of the nucleus To be able to distinguish
rhomboid fossa
between gray and white matter
rhomboid fossa
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
Ventriculus quartus
The fourth ventricle
Fossa rhomboidea
Trigonum nervi hypoglossi
Diamond shaped hole
Triangle hypoglossal nerve
Trigonum nervi vagi
Triangle vagus nerve
Plexus choroideus
Vascular plexus
4.2. Theoretical questions for the class:
1. What are the department is diamond-shaped hole?
2. The external structure of the dorsal surface of the medulla oblongata.
3. The external structure of the dorsal surface of the bridge.
4. Name the legs of the cerebellum, which they interfaced structures.
5. Placement and connection IV ventricle.
6. Projection sensitive cranial nerve nuclei in diamond-shaped hole.
7. Projection motor cranial nerve nuclei in diamond-shaped hole.
8. The projection parasympathetic cranial nerve nuclei in diamond-shaped hole.
9. Structure IV ventricle as built covering IV ventricle.
10. Cavity bubbles whose brain is a 4th ventricle?
11. What are vital centers within the medulla oblongata?
4.3. Practical tasks pertaining to the topic and to be completed during the
class:
Show location on the skull of the medulla oblongata, the bridge.
Demonstrate isolated on wet preparation of the foreign structure of the medulla
oblongata, the bridge.
Show space projection cranial nuclei of the bridge.
Show location projection cranial nuclei of the medulla oblongata.
In wet isolated anatomical lesions show drug IV
ventricle, plumbing midbrain.
The content of the topic:
Fourth Ventricle
The fourth ventricle is a tent-shaped cavity filled with cerebrospinal fluid. It
is situated anterior to the cerebellum and posterior to the pons and the superior half
of the medulla oblongata. It is lined with ependyma and is continuous above with
the cerebral aqueduct of the midbrain and below with the central canal of the
medulla oblongata and the spinal cord. The fourth ventricle possesses lateral
boundaries, a roof, and a rhomboid-shaped floor.
Lateral Boundaries
The caudal part of each lateral boundary is formed by the inferior cerebellar
peduncle. The cranial part of each lateral boundary is formed by the superior
cerebellar peduncle.
Roof or Posterior Wall
The tent-shaped roof projects into the cerebellum. The superior part is
formed by the medial borders of the two superior cerebellar peduncles and a connecting sheet of white matter called the superior medullary velum. The inferior
part of the roof is formed by the inferior medullary velum, which consists of a
thin sheet devoid of nervous tissue and formed by the ventricular ependyma and its
posterior covering of pia mater. This part of the roof is pierced in the midline by a
large aperture, the median aperture or foramen of Magendie. Lateral recesses
extend laterally around the sides of the medulla and open anteriorly as the lateral
openings of the fourth ventricle, or the foramina of Luschka. Thus, the cavity of
the fourth ventricle communicates with the subarachnoid space through a single
median opening and two lateral apertures. These important openings permit the
cerebrospinal fluid to flow from the ventricular system into the subarachnoid
space.
Floor or Rhomboid Fossa
The diamond-shaped floor is formed by the posterior surface of the pons and
the cranial half of the medulla oblongata. The floor is divided into symmetrical
halves by the median sulcus. On each side of this sulcus, there is an elevation, the
medial eminence, which is bounded laterally by another sulcus, the sulcus
limitans. Lateral to the sulcus limitans, there is an area known as the vestibular
area. The vestibular nuclei lie beneath the vestibular area.
The facial colliculus is a slight swelling at the inferior end of the medial
eminence that is produced by the fibers from the motor nucleus of the facial nerve
looping over the abducens nucleus. At the superior end of the sulcus limitans, there
is a bluish-gray area, produced by a cluster of nerve cells containing melanin
pigment; the cluster of cells is called the substantia ferruginea. Strands of nerve
fibers, the stria medullaris, derived from the arcuate nuclei, emerge from the
median sulcus and pass laterally over the medial eminence and the vestibular area
and enter the inferior cerebellar peduncle to reach the cerebellum.
Inferior to the stria medullaris, the following features should be recognized
in the floor of the ventricle. The most medial is the hypoglossal triangle, which
indicates the position of the underlying hypoglossal nucleus. Lateral to this is the
vagal triangle, beneath which lies the dorsal motor nucleus of the vagus. The area
postrema is a narrow area between the vagal triangle and the lateral margin of the
ventricle, just rostral to the opening into the central canal. The inferior part of the
vestibular area also lies lateral to the vagal triangle.
Choroid Plexus of the Fourth Ventricle
The choroid plexus has a T shape; the vertical part of the T is double. It is suspended
from the inferior half of the roof of the ventricle and is formed from the
highly vascular tela choroidea. The tela choroidea is a two-layered fold of pia
mater that projects through the roof of the ventricle and is covered by ependyma.
The blood supply to the plexus is from the posterior inferior cerebellar arteries.
The function of the choroid plexus is to produce cerebrospinal fluid.
Materials for self-check.
A. Tasks for self- check: Draw a projection cranial nerve nuclei in diamond-shaped
hole.
B. Tasks for self- check:
1.On the examination of a woman who had a brain injury the bleeding in the area of the
triangle vagus nerve rhomboid fossa was found. Nuclei of which pairs of cranial nerves
are projected in this part of the rhomboid fossa?
A.The nuclei of the X pair of cranial nerves
B.The nuclei of I, II pairs of cranial nerves
C.The nuclei of the III, IV, V pair of cranial nerves
D.The nuclei of IV, V, VI pairs of cranial nerves
E.The nuclei of the VII pair of cranial nerves
2.On the examination of a man who had a brain injury the violation of the integrity of
brain structures that limit the diamond-shaped hole that shape it from both sides above
was found. Which structures of the brain are damaged?
A.Superior medullary velum
B.The lower legs of the cerebellum
C.The upper legs of the cerebellum
D.Inferior medullary velum
3.On the examination of a man who had a brain injury the foreign body in the area of
the triangle hypoglossal nerve was detected. In this triangle such nuclei projected:
A.The nuclei of the IV, V, VI pairs of cranial nerves
B.The nuclei of I, II pairs of cranial nerves
C.The nuclei of the III, IV, V pairs of cranial nerves
D.The nuclei of the VII pair of cranial nerves
E.The nuclei of the X pair of cranial nerves
4.In the formation of the walls of the fourth ventricle the Superior medullary velum
takes part. It is stretched between:
A.crurasuperioris cerebelli
B.cruribus cerebellum
C.Mediocris posterior pedes.
D.Folia cerebellum.
E.Cerebelli vermis etexiguo.
5.At postmortem brain research is necessary to determine the measure between Medulla
oblongata and pons on the dorsal side
A.Ingeniumnudaveris
B.The roots of language-pharyngeal nerves.
C.Roots additional nerves.
D.Hypoglossal nerve roots.
E.I par nervorumspinalium radices.
6.In the lower triangle of rhomboid fossa is projected:
A.The nuclei IX, X, XI, XII pairs of cranial nerves
B.The nuclei I, II, III pairs of cranial nerves
C.The nuclei III, IV, V pairs of cranial nerves
D.The nuclei IV, V, VI pairs of cranial nerves
E.The nuclei VI, VII, VIII pairs of cranial nerves
7.In the lower triangle of rhomboid fossa is projected:
A.The nuclei V, VI, VII, VIII pairs of cranial nerves
B.The nuclei I, II, III pairs of cranial nerves
C.The nuclei III, IV, V pairs of cranial nerves
D.The nuclei IV, V, VI pairs of cranial nerves
E.The nuclei IX, X, XI, XII pairs of cranial nerves
8.Rhomboid fossa is divided into the left and right triangles:
A.Median furrow
B.Front of the median slit
C.Retro-olivary groove
D.Preolivary groove
E.Cerebral stripes
9.Rhomboid fossa is divided into the upper and lower triangle:
A.Cerebral stripes
B.Posterior median sulcus
C.Front of the median slit
D.Retro-olivary groove
E.Preolivary groove
10.IV ventricle is the residue of the cavity of:
A.Diamond-shaped vesicles
B.Anterior cerebral vesicles
C.Posterior cerebral vesicles
D.Middle cerebral vesicles
E.All of the above listed brain vesicles
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh
edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 25. Midbrain.
1. Relevance of the topic:
If the damage midbrain there are complications that lead to disruption of
motor reactions of the patient, visual, auditory.
2. The specific aims:
To explain the structure of the brain stem and midbrain location.
Analyze: elements of the external structure of the midbrain;
- The internal structure of the midbrain;
- Pathways midbrain.
3. Basic knowledge and skills necessary to study the topic (interdisciplinary integration).
Disciplines
Know
Be able
1) interim
discipline
Biology
Distribution of the nervous Show the location of the main
system to the central and elements of the central
peripheral.
Features nervous system
mammalian CNS
Histology
The structure of gray and Distinguish between white and
white matter of the gray matter in the midbrain
midbrain
histological preparations
2) Courses are provided: Normal and Pathological Physiology, topographical
and pathological anatomy, surgery, nerve disease.
3)
Intersubject Knowing the structure of Show middle cranial fossa.
integration -rozdil the middle cranial fossa.
Show on the preparation of the
"Osteology"
Know the blood supply to internal carotid and vertebral
Section
the brain and spinal cord. artery.
"Angiology"
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
MESENCEPHALON
Midbrain
Sulcus nervi oculomotorii
Furrow oculomotor nerve
Pedunculus cerebri
brain stem
Sulcus lateralis mesencephali
Lateral sulcus midbrain
Tegmentum mesencephali
The roof of the midbrain
Pedunculus cerebellaris superior
The upper cerebellar legs
Lamina tecti
plate roof
Brachium colliculi inferioris
Handle lower mound
Brachium colliculi superioris
Handle upper mound
Colliculus inferior
Lower hill
Colliculus superior
Pedunculus cerebri
Upper hill
Basis pedunculi
Crus cerebri
Tractus pyramidalis
Fibrae corticospinales
Fibrae corticonucleares
Tractus corticopontinus
Fibrae frontopontinae
Fibrae occipitopontinae
Fibrae parietopontinae
Fibrae temporopontinae
Actually brain stem
Base legs
brain stem
pyramidal way
Cortical-spinal fibers
Cortex-core fiber
Bridge cortical fiber
Fronto-bridge fiber
Neck-bridge fiber
Thyme-bridge fiber
Roofing-bridge fiber
Fibrae corticoreticulares
Cortex-fiber mesh
Substantia nigra
Black stuff
Tegmentum mesencephali
The roof of the midbrain
Substantia alba
White matter
4.2. Theoretical questions for the class:
1. Derivative which is a think bubble structure, belonging to the midbrain?
2. What are the patterns seen in the context middle frontal brain?
3. Nuclei of cranial nerves which are located within the mid-brain, and what is their
topography?
4. Where to go from the brain III, IV pairs of cranial nerves?
5. The oral derivative which is a think bubble water pipe and that the brain
it connects brain cavity?
4.3. Practical tasks pertaining to the topic and to be completed during the class:
1.Show the skull projection location of the midbrain.
2.Demonstrate the wet preparation of the foreign structure
midbrain.
3.On cross-section to show the red nucleus, white matter, water cord.
4.Demonstrate communication plumbing brain III, IV ventricles
brain.
5.In isolated brain preparation to be able to display the anatomical
midbrain lesions (tire, brain stem, plumbing brain).
The content of the topic:
The midbrain measures about 0.8 inch (2 cm) in length and connects the
pons and cerebellum with the forebrain. Its long axis inclines anteriorly as it
ascends through the opening in the tentorium cerebelli. The midbrain is traversed
by a narrow channel, the cerebral aqueduct, which is filled with cerebrospinal
fluid.
On the posterior surface are four colliculi (corpora quadrigemina). These are
rounded eminences that are divided into superior and inferior pairs by a vertical
and a transverse groove. The superior colliculi are centers for visual reflexes, and
the inferior colliculi are lower auditory centers. In the midline below the inferior
colliculi, the trochlear nerves emerge. These are small-diameter nerves that wind
around the lateral aspect of the midbrain to enter the lateral wall of the cavernous
sinus.
On the lateral aspect of the midbrain, the superior and inferior brachia
ascend in an anterolateral direction. The superior brachium passes from the
superior colliculus to the lateral geniculate body and the optic tract. The inferior
brachium connects the inferior colliculus to the medial geniculate body.
On the anterior aspect of the midbrain, there is a deep depression in the
midline, the interpeduncular fossa, which is bounded on either side by the crus
cerebri. Many small blood vessels perforate the floor of the interpeduncular fossa,
and this region is termed the posterior perforated substance. The oculomotor
nerve emerges from a groove on the medial side of the cms cerebri and passes
forward in the lateral wall of the cavernous sinus.
INTERNAL STRUCTURE OF THE MIDBRAIN
The midbrain comprises two lateral halves, called the cerebral peduncles;
each of these is divided into an anterior part, the crus cerebri, and a posterior part,
the tegmentum, by a pigmented band of gray matter, the substantia nigra. The
narrow cavity of the midbrain is the cerebral aqueduct, which connects the third
and fourth ventricles. The tectum is the part of the midbrain posterior to the
cerebral aqueduct; it has four small surface swellings referred to previously; these
are the two superior and two inferior colliculi. The cerebral aqueduct is lined by
ependyma and is surrounded by the central gray matter. On transverse sections of
the midbrain, the interpeduncular fossa can be seen to separate the crura cerebri,
whereas the tegmentum is continuous across the median plane.
Transverse Section of the Midbrain at the Level of the Inferior Colliculi
The inferior colliculus, consisting of a large nucleus of gray matter, lies
beneath the corresponding surface elevation and forms part of the auditory
pathway. It receives many of the terminal fibers of the lateral lemniscus. The
pathway then continues through the inferior brachium to the medial geniculate
body.
The trochlear nucleus is situated in the central gray matter close to the
median plane just posterior to the medial longitudinal fasciculus. The emerging
fibers of the trochlear nucleus pass laterally and posteriorly around the central gray
matter and leave the midbrain just below the inferior colliculi. The fibers of the
trochlear nerve now decussate completely in the superior medullary velum. The
mesencephalic nuclei of the trigeminal nerve are lateral to the cerebral aqueduct.
The decussation of the superior cerebellar peduncles occupies the central part of
the tegmentum anterior to the cerebral aqueduct. The reticular formation is
smaller than that of the pons and is situated lateral to the decussation.
The medial lemniscus ascends posterior to the substantia nigra; the spinal
and trigeminal lemnisci are situated lateral to the medial lemniscus. The lateral
lemniscus is located posterior to the trigeminal lemniscus.
The substantia nigra is a large motor nucleus situated between the
tegmentum and the crus cerebri and is found throughout the midbrain. The nucleus
is composed of medium-size multipolar neurons that possess inclusion granules of
melanin pigment within their cytoplasm. The substantia nigra is concerned with
muscle tone and is connected to the cerebral cortex, spinal cord, hypothalamus, and
basal nuclei.
The crus cerebri contains important descending tracts and is separated from
the tegmentum by the substantia nigra. The corticospinal and corticonuclear fibers
occupy the middle two-thirds of the crus. The frontopontine fibers occupy the
medial part of the crus, and the temporopontine fibers occupy the lateral part of
the crus. These descending tracts connect the cerebral cortex to the anterior gray
column cells of the spinal cord, the cranial nerve nuclei, the pons, and the cerebellum.
Transverse Section of the Midbrain at the Level of the Superior Colliculi
The superior colliculus, a large nucleus of gray matter that lies beneath the
corresponding surface elevation, forms part of the visual reflexes. It is connected
to the lateral geniculate body by the superior brachium. It receives afferent fibers
from the optic nerve, the visual cortex, and the spinotectal tract. The efferent
fibers form the tectospinal and tectobulbar tracts, which are probably responsible
for the reflex movements of the eyes, head, and neck in response to visual stimuli.
The afferent pathway for the light reflex ends in the pretectal nucleus. This is a
small group of neurons situated close to the lateral part of the superior colliculus.
After relaying in the pretectal nucleus, the fibers pass to the parasympathetic
nucleus of the oculomotor nerve (Edinger-Westphal nucleus). The emerging fibers
then pass to the oculomotor nerve. The oculomotor nucleus is situated in the
central gray matter close to the median plane, just posterior to the medial
longitudinal fasciculus. The fibers of the oculomotor nucleus pass anteriorly
through the red nucleus to emerge on the medial side of the crus cerebri in the
interpeduncular fossa. The nucleus of the oculomotor nerve is divisible into a
number of cell groups.
The medial, spinal, and trigeminal lemnisci form a curved band posterior
to the substantia nigra, but the lateral lemniscus does not extend superiorly to this
level.
The red nucleus is a rounded mass of gray matter situated between the
cerebral aqueduct and the substantia nigra. Its reddish hue, seen in fresh specimens,
is due to its vascularity and the presence of an iron-containing pigment in the
cytoplasm of many of its neurons. Afferent fibers reach the red nucleus from (1)
the cerebral cortex through the corticospinal fibers, (2) the cerebellum through the
superior cerebellar peduncle, and (3) the Ientiform nucleus, subthalamic and
hypothalamic nuclei, substantia nigra, and spinal cord. Efferent fibers leave the red
nucleus and pass to (1) the spinal cord through the rubrospinal tract (as this tract
descends, it decussates), (2) the reticular formation through the rubroreticular tract,
(3) the thalamus, and (4) the substantia nigra.
The reticular formation is situated in the tegmentum lateral and posterior
to the red nucleus.
The crus cerebri contains the identical important descending tracts, the
corticospinal, corticonuclear, and corticopontine fibers, that are present at the
level of the inferior colliculus.
Cerebral Aqueduct (Aqueduct of Sylvius)
The cerebral aqueduct, a narrow channel about 3/4 of an inch (1.8 cm) long,
connects the third ventricle with the fourth ventricle. It is lined with ependyma and
is surrounded by a layer of gray matter called the central gray. The direction of
flow of cerebrospinal fluid is from the third to the fourth ventricle. There is no
choroid plexus in the cerebral aqueduct.
Materials for self-check.
A. Tasks for self- check: Draw midbrain nuclei, gray and white matter.
B. Choose the correct answer:
1.During the appendectomy anesthesiologist noticed the patient has no pupillary
reflex as a result of an overdose of anaesthetic. Which structure of the brainstem
involved in the process?
A.Midbrain.
B.cerebrum.
C.Interim brain.
D.Medulla oblongata.
E.Rear brain.
2.To the neurosurgical department was admitted a patient in a coma (disturbance of
consciousness and lack of purposeful reactions to any stimuli). When examining
doctor found that dysfunction of the cerebral cortex was caused by the brainstem
neuronal network, which supported the activity of the cerebral cortex. What
impressed brain structure?
A.Reticular formation.
B.Basal nucleus.
C.The nuclei of the cerebellum.
D.Caudate nucleus.
E.The nuclei of the hypothalamus.
3.As a result of a damage of a.cerebri posteriores often a so-called red nucleus
syndrome occurs - paralysis of the oculomotor nerve on the side of the pathological
source, trembling limbs on the opposite side. What part of the brain is affected?
A.Mesencephalon.
B.Thalamus.
C.Metathalamus.
D.Epithalamus.
E.Hypothalamus.
4. The patient with an ophthalmoplegic form of botulism occurs a midbrain lesions,
clinical manifestations of which are diplopia, paralysis of accommodation, ptosis,
expansion and deformation of the pupils, the absence of reaction of pupils to light.
Damage of which midbrain nuclei leads to such clinical symptoms?
A.Nuclei oculomotor nerve, vagus
B.Superior colliculi
C.Inferior colliculi
D.Red nucleus.
E.Substantia nigra
5.The patient has a midbrain tumor associated with violation of embryonic
development. Out of what vesicle does a midbrain develop?
A.3rd.
B.1st.
C.2nd.
D.4th.
E.5th
6.As a result of hemorrhage damage to brain structures is observed that relate to the
midbrain. Which of these structures in NOT located in the midbrain?
A.subcortical center of smell.
B.subcortical center of hearing.
C.subcortical center of vision.
D.pathways linking the cortex of the forebrain to the spinal cord.
E.nuclei of the oculomotor nerves.
7.Patient has a disorder in a liquor flow at the midbrain. What are the cavities of the
midbrain?
A.Aqueduct.
B.IV ventricle.
C.III ventricle.
D.lateral ventricle.
E.Central Canal.
8.After an infection a patient is left with a damaged midbrain nuclei. Which of the
structures in located outside of the midbrain?
A.Nucl. tracti mesencephalici n. trigemini.
B.Nucl. n. oculomotorii.
C.Nucl. accessorius.
D.Nucl. n. trochlearis.
9.The patient has a violationof the reflex reaction to sudden visual stimuli.
Subcortical centers of vision of the midbrain laid down in:
A.Colliculi superiores.
B.Corpus geniculatum laterale.
C.Brachium colliculi inferiores.
D.Brachium colliculi superiores.
E.Colliculi inferiores.
10.Reflex center for various movements that have arisen under the influence of visual
and auditory stimuli are:
A.inferior colliculi and superior colliculi of the tectum
B.Red nucleus.
C.Substantia nigra.
D.The nuclei of the cranial nerves.
E.Reticular formation.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 26. Diencephalon, the third ventricle.
1. Relevance of the topic:
Knowledge of the topography, the structure of all departments of an intermediate brain
will help in determining the correct diagnosis of the patient, because the brain lesions
of intermediate appear serious disorders of various kinds of sensitivity and autonomic
function disorder.
2. The specific aims:
Analyze the structure of the brain stem and limits the location of the intermediate
brain.
Explain: - included in the intermediate brain;
- Part of which is the visual area of the hill;
- What external and internal structure of the thalamus;
- Which represents a functionally thalamus;
- III ventricle structure and because it connects with other
ventricles of the brain.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Disciplines
Know
Be able
1) interim discipline The development of the Show the location of the main
Biology
nervous system in mammals. parts of the central nervous
Features
affection system and diencephalon.
diencephalon.
Histology
The structure of the nucleus of To be able to distinguish
the diencephalon
between white and gray matter
the diencephalon.
2) Courses are provided: Normal and Pathological of
Physiology,
topographical and
pathological anatomy, surgery, nerve disease.
3)
Intersubject Know the boundaries of the To be able to show the skull
integration -rozdil middle cranial fossa, pituitary projection
location
"Osteology"
fossa.
diencephalon.
section:
Know the features of blood To be able to show on wet
"Angiology"
supply to the brain.
preparation of the internal
carotid and vertebral artery.
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
DIENCEPHALON
Interim brain
Triangle leash
Trigonum habenulare
Thalamus
Thalamus
Tuberculum anterius thalami
Front mound thalamus
Pulvinar thalami
Pillow thalamus
Subthalamus
subthalamic
Metathalamus
Metatalamus
Соrpus geniculatum laterale
Lateral body kolinchaste
Hypothalamus
The hypothalamus
papillary body
Соrpus mamillare
The nervous part
Pars nervosa
chiasm
Chiasma opticum
Tractus opticus
Visual way
Radix lateralis
lateral roots
Radix medialis
The medial root
Ventriculus tertius
The third ventricle
Foramen interventriculare
interventricular hole
Tela choroidea
vascular layer
4.2. Theoretical questions for the class:
1. Name the show and the three main parts of the diencephalon in different series
anatomical preparations brain.
2. Name the show and the thalamus, the relief of its external structure, the kernel
tell its function.
3. Calling and show parts of the hypothalamus, tell them to function.
4. Name and show neurosecretory nuclei of the hypothalamus, talk about their
relationship with the pituitary gland.
5. Name the show and intermediate parts of the brain that consists of six walls of the
third ventricle.
6. Name the show and relations with third ventricle and fourth ventricle side.
4.3. Practical tasks pertaining to the topic and to be completed during the class:
1.Show the location of the main parts of NS.
2.Show location diencephalon.
3.Show white and gray matter of the diencephalon.
4.Show the skull projection location diencephalon.
5. Show on wet preparation of the internal carotid and vertebral artery.
The content of the topic:
Interim brain
SUBDIVISIONS OF THE CEREBRUM
The cerebrum is the largest part of the brain and is situated in the anterior
and middle cranial fossae of the skull occupying the whole concavity of the vault
of the skull. It may be divided into two parts: the diencephalon, which forms the
central core, and the telencephalon, which forms the cerebral hemispheres.
DIENCEPHALON
The diencephalon consists of the third ventricle and the structures that form
its boundaries. It extends posteriorly to the point where the third ventricle becomes
continuous with the cerebral aqueduct and anteriorly as far as the interventricular
foramina. Thus the diencephalon is a midline structure with symmetrical right and
left halves. Obviously, these subdivisions of the brain are made for convenience,
and from a functional point of view, nerve fibers freely cross the boundaries.
Gross Features
The inferior surface of the diencephalon is the only area exposed to the
surface in the intact brain. It is formed by hypothalamic and other structures, which
include, from anterior to posterior, the optic chiasma, with the optic tract on
either side; the infundibulum, with the tuber cinereum; and the mammillary
bodies.
The superior surface of the diencephalon is concealed by the fornix, which
is a thick bundle of fibers that originates in the hippocampus of the temporal lobe
and arches posteriorly over the thalamus to join the mammillary body. The actual
superior wall of the diencephalon is formed by the roof of the third ventricle.
This consists of a layer of ependyma, which is continuous with the rest of the
ependymal lining of the third ventricle. It is covered superiorly by a vascular
fold of pia mater, called the tela choroidea of the third ventricle. From the roof
of the third ventricle, a pair of vascular processes, the choroid plexuses of the
third ventricle, project downward from the midline into the cavity of the third
ventricle.
The lateral surface of the diencephalon is bounded by the internal capsule
of white matter and consists of nerve fibers that connect the cerebral cortex with
other parts of the brainstem and spinal cord. Since the diencephalon is divided into
symmetrical halves by the slitlike
third ventricle, it also has a medial surface. The medial surface of the
diencephalon (i.e., the lateral wall of the third ventricle) is formed in its superior
part by the medial surface of the thalamus and in its inferior part by the
hypothalamus. These two areas are separated from one another by a shallow
sulcus, the hypothalamic sulcus. A bundle of nerve fibers, which are afferent
fibers to the habenular nucleus, forms a ridge along the superior margin of the
medial surface of the diencephalon and is called the stria medullaris thalami.
The diencephalon can be divided into four major parts: (1) the thalamus, (2)
the subthalamus, (3) the epithalamus, and (4) the hypothalamus.
Thalamus
The thalamus is a large ovoid mass of gray matter that forms the major part
of the diencephalon. It is a region of great functional importance and serves as a
cell station to all the main sensory systems (except the olfactory pathway). The
thalamus is situated on each side of the third ventricle. The anterior end of the
thalamus is narrow and rounded and forms the posterior boundary of the interventricular foramen. The posterior end is expanded to form the pulvinar, which
overhangs the superior colliculus and the superior brachium. The lateral
geniculate body forms a small elevation on the under aspect of the lateral portion
of the pulvinar.
The superior surface of the thalamus is covered medially by the tela
choroidea and the fornix, and laterally, it is covered by ependyma and forms part
of the floor of the lateral ventricle; the lateral part is partially hidden by the choroid
plexus of the lateral ventricle. The inferior surface is continuous with the
tegmentum of the midbrain.
The medial surface of the thalamus forms the superior part of the lateral wall
of the third ventricle and is usually connected to the opposite thalamus by a band
of gray matter, the interthalamic connection (interthalamic adhesion).
The lateral surface of the thalamus is separated from the lentiform nucleus
by the very important band of white matter called the internal capsule.
The thalamus is a very important cell station and receives the main sensory
tracts (except the olfactory pathway). It should be regarded as a station where
much of the information is integrated and relayed to the cerebral cortex and many
other subcortical regions. It also plays a key role in the integration of visceral and
somatic functions.
Subthalamus
The subthalamus lies inferior to the thalamus and, therefore, is situated
between the thalamus and the tegmentum of the midbrain; craniomedially, it is
related to the hypothalamus. The structure of the subthalamus is extremely complex,
and only a brief description is given here. Among the collections of nerve cells found
in the subthalamus are the cranial ends of the red nuclei and the substantia nigra. The
subthalamic nucleus has the shape of a biconvex lens. The nucleus has important
connections with the corpus striatum; as a result, it is involved in the control of
muscle activity. The subthalamus also contains many important tracts that pass up
from the tegmentum to the thalamic nuclei; the cranial ends of the medial, spinal, and
trigeminal lemnisci are examples.
Epithalamus
The epithalamus consists of the habenular nuclei and their connections and
the pineal gland.
Habenular Nucleus
The habenular nucleus is a small group of neurons situated just medial to the
posterior surface of the thalamus. Afferent fibers are received from the amygdaloid
nucleus in the temporal lobe through the stria medullaris thalami; other fibers pass
from the hippocampal formation through the fornix. Some of the fibers of the stria
medullaris thalami cross the midline and reach the habenular nucleus of the
opposite side; these latter fibers form the habenular commissure. Axons from the
habenular nucleus pass to the interpeduncular nucleus in the roof of the interpeduncular fossa, the tectum of the midbrain, the thalamus, and the reticular
formation of the midbrain. The habenular nucleus is believed to be a center for
integration of olfactory, visceral, and somatic afferent pathways.
Pineal Gland (Body)
The pineal gland is a small, conical structure that is attached by the pineal
stalk to the diencephalon. It projects backward so that it lies posterior to the
midbrain. The base of the pineal stalk possesses a recess that is continuous with the
cavity of the third ventricle. The superior part of the base of the stalk contains the
habenular commissure; the inferior part of the base of the stalk contains the
posterior commissure.
On microscopic section, the pineal gland is seen to be incompletely divided
into lobules by connective tissue septa that extend into the substance of the gland
from the capsule. Two types of cells are found in the gland, the pinealocytes and
the glial cells. Concretions of calcified material called brain sand progressively
accumulate within the pineal gland with age.
The pineal gland possesses no nerve cells, but adrenergic sympathetic fibers
derived from the superior cervical sympathetic ganglia enter the gland and run in
association with the blood vessels and the pinealocytes.
Functions of the Pineal Gland
The pineal gland, once thought to be of little importance, is now recognized
as an endocrine gland capable of influencing the activities of the pituitary gland,
the islets of Langerhans of the pancreas, the parathyroids, the adrenals, and the
gonads. The pineal secretions, produced by the pinealocytes, reach their target
organs via the bloodstream or through the cerebrospinal fluid. Their actions are
mainly inhibitory and either directly inhibit the production of hormones or
indirectly inhibit the secretion of releasing factors by the hypothalamus. It is
interesting to note that the pineal gland does not possess a blood-brain barrier.
Animal experiments showed that pineal activity exhibits a circadian rhythm
that is influenced by light. The gland has been found to be most active during
darkness. The probable nervous pathway from the retina runs to the suprachiasmatic nucleus of the hypothalamus, then to the tegmentum of the midbrain, and
then to the pineal gland to stimulate its secretions. The latter part of this pathway
may include the reticulospinal tract, the sympathetic outflow of the thoracic part of
the spinal cord, and the superior cervical sympathetic ganglion and postganglionic
nerve fibers that travel to the pineal gland on blood vessels.
Melatonin and the enzymes needed for its production are present in high
concentrations within the pineal gland. Melatonin and other substances are released
into the blood or into the cerebrospinal fluid of the third ventricle where they pass
to the anterior lobe of the pituitary gland and inhibit the release of the
gonadotrophic hormone. In humans, as in animals, the plasma melatonin level rises
in darkness and falls during the day. It would appear that the pineal gland plays an
important role in the regulation of reproductive function.
Hypothalamus
The hypothalamus is that part of the diencephalon that extends from the
region of the optic chiasma to the caudal border of the mammillary bodies. It lies
below the hypothalamic sulcus on the lateral wall of the third ventricle. It is thus
seen that anatomically the hypothalamus is a relatively small area of the brain that
is strategically well placed close to the limbic system, the thalamus, the ascending
and descending tracts, and the hypophysis. Microscopically, the hypothalamus is
composed of small nerve cells that are arranged in groups or nuclei.
Physiologically, there is hardly any activity in the body that is not influenced
by the hypothalamus. The hypothalamus controls and integrates the functions of
the autonomic nervous system and the endocrine systems and plays a vital role in
maintaining body homeostasis. It is involved in such activities as regulation of
body temperature, body fluids, drives to eat and drink, sexual behavior, and
emotion.
Relations of the Hypothalamus
Anterior to the hypothalamus is an area that extends forward from the optic
chiasma to the lamina terminalis and the anterior commissure; it is referred to as
the preoptic area. Caudally, the hypothalamus merges into the tegmentum of the
midbrain. The thalamus lies superior to the hypothalamus, and the subthalamic
region lies inferolaterally to the hypothalamus.
When observed from below, the hypothalamus is seen to be related to the
following structures, from anterior to posterior: (1) the optic chiasma, (2) the tuber
cinereum and the infundibulum, and (3) the mammillary bodies.
Optic Chiasma
The optic chiasma is a flattened bundle of nerve fibers situated at the
junction of the anterior wall and floor of the third ventricle. The superior surface is
attached to the lamina terminalis, and interiorly, it is related to the hypophysis
cerebri, from which it is separated by the diaphragma sellae. The anterolateral
corners of the chiasma are continuous with the optic nerves, and the posterolateral
corners are continuous with the optic tracts. A small recess, the optic recess of
the third ventricle, lies on its superior surface.
It is important to remember that the fibers originating from the nasal half of
each retina cross the median plane at the chiasma to enter the optic tract of the
opposite side.
Tuber Cinereum
The tuber cinereum is a convex mass of gray matter, as seen from the
inferior surface. It is continuous inferiorly with the infundibulum. The
infundibulum is hollow and becomes continuous with the posterior lobe of the
hypophysis cerebri. The median eminence is a raised part of the tuber cinereum
to which is attached the infundibulum. The median eminence, the infundibulum,
and the posterior lobe (pars nervosa) of the hypophysis cerebri together form the
neurohypophysis.
Mammillary Bodies
The mammillary bodies are two small hemispherical bodies situated side by
side posterior to the tuber cinereum. They possess a central core of gray matter invested by a capsule of myelinated nerve fibers. Posterior to the mammillary bodies
lies an area of the brain that is pierced by a number of small apertures and is called
the posterior perforated substance. These apertures transmit the central branches of
the posterior cerebral arteries.
Third Ventricle
The third ventricle, which is derived from the forebrain vesicle, is a slitlike
cleft between the two thalami. It communicates anteriorly with the lateral
ventricles through the interventricular foramina (foramina of Monro), and it
communicates posteriorly with the fourth ventricle through the cerebral
aqueduct. The third ventricle has anterior, posterior, lateral, superior, and inferior
walls and is lined with ependyma.
The anterior wall is formed by a thin sheet of gray matter, the lamina
terminalis, across which runs the anterior commissure. The anterior commissure
is a round bundle of nerve fibers that are situated anterior to the anterior columns
of the fornix; they connect the right and left temporal lobes.
The posterior wall is formed by the opening into the cerebral aqueduct.
Superior to this opening is the small posterior commissure. Superior to the
commissure is the pineal recess, which projects into the stalk of the pineal body.
Superior to the pineal recess is the small habenular commissure.
The lateral wall is formed by the medial surface of the thalamus superiorly
and the hypothalamus inferiorly. These two structures are separated by the
hypothalamic sulcus. The lateral wall is limited superiorly by the stria
medullaris thalami. The lateral walls are joined by the interthalamic connection.
The superior wall or roof is formed by a layer of ependyma that is
continuous with the lining of the ventricle. Superior to this layer is a two-layered
fold of pia mater called the tela choroidea of the third ventricle. The vascular
tela choroidea projects downward on each side of the midline, invaginating the
ependymal roof to form the choroid plexuses of the third ventricle. Within the
tela choroidea lie the internal cerebral veins. Superiorly, the roof of the ventricle
is related to the fornix and the corpus callosum.
The inferior wall or floor is formed by the optic chiasma the tuber
cinereum, the infundibulum, with its funnel-shaped recess, and the mammillary
bodies. The hypophysis is attached to the infundibulum. Posterior to these
structures lies the tegmentum of the cerebral peduncles.
Materials for self-check.
A. Tasks for self-check: the tables to designate intermediate parts of the brain.
B. Choose the correct answer:
1.Patient notes the loss of all kinds of sensitivity (surface and deep) on one side of
the body, forced laughter and crying, upset autonomic functions. Which part of
brain is injured?
A.Diencephalon
B.Mesencephalon.
C.Pons.
D.Medulla oblongata.
E.Telencephalon.
2.A 3 years old boy has a premature puberty. Which part of brain is injured?
A.Diencephalon
B.Mesencephalon.
C.Pons.
D.Medulla oblongata.
E.Telencephalon.
3.The patient during the examination of the brain using MRI revealed markedly
dilated lateral and third ventricles. The doctor diagnosed blockade of cerebrospinal
fluid pathways. Point the level of occlusion:
A.Cerebral aqueduct
B.interventricular hole
C.median aperture of the fourth ventricle
D.lateral aperture of the fourth ventricle
E.granulationes arachnoidae
4.A patient with a damaged cord intermediate breach hearing. What are the core
while damaged?
A.medial geniculate body
B.lateral geniculate body
C.nucleus ruber
D.Anterior nucleus of the hypothalamus
E.Posterior ventral nucleus
5.A 50 years old patient was diagnosed with a brain tumor in the visual area of the
hypothalamus. There is an elevated levels of vasopressin in the blood of patient.
Which nucleus of the hypothalamus produces this hormone?
A.Nucl. supraopticus
B.Nucl. preopticus
C.Nucl.paraventricularis
D.Nucl.corporis mamillaris
E.Nucl.in undibularis
6.The patient hypothalamic-pituitary syndrome (Babinsky-Fröhlich), fat deposits in
the shoulder belt, breasts, loss of secondary sexual characteristics, susceptibility to
hypothermia. Which department applies to the hypothalamus of the brain?
A.Diencephalon
B.Mesencephalon.
C.Pons.
D.Medulla oblongata.
E.Telencephalon.
7.A patient was diagnosed with malignant exophthalmos caused by excessive
secretion of pituitary thyroid stimulating hormone. Which department diencephalon
does pituitary belong to?
A.Hypothalamus
B.Mesencephalon
C.Thalamus
D.Metathalamus
E.Epithalamus
8.The patient was diagnosed with bulimia -- increased hunger. Has been detected
the injure of the hypothalamic receptor site that signals to the brain about
accumulation of carbohydrates in the blood. What brain is affected?
A.Diencephalon
B.Medulla oblongata
C.Mesencephalon
D.Pons.
E.Medulla oblongata
9.Because of injury a.cerebri posteriores observed symptoms of nuclei oculomotor
nerve (Parinaud's Syndrome). What wall of the III ventricle forms comissura
cerebri posterior?
A.Posterior
B.Inferior
C.Superior
D.Anterior
E.Lateralis
10.The patient in '50 revealed thalamic syndrome, symptoms of which are an
intense pain of the half of the body, "thalamic hand", hyperkinetic disorder.
Sometimes these manifestations are joined with smell disorder, violent laughter, and
crying. What part of the brain is functionally damaged?
A.Thalamus
B.Metathalamus
C.Epithalamus
D.Hypothalamus
E.Mesencephalon
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Theme 27. External structure of cerebral hemispheres.
1. Relevance of the topic:
Knowledge of the topography, the structure of the brain will help in determining the
correct diagnosis of the patient, since the defeat of the brain there are serious
disturbances to the loss of sensitivity of different types of motor responses. Will help
be prevented inflammation and traumatic brain damage.
2. The specific aims:
Analyze the structure of the forebrain, the particles, the poles and the surface of the
forebrain.
Explain:
- The limits of the cerebral hemispheres;
the boundaries between the particles of the forebrain;
sulcus and frontal lobe gyrus;
sulcus and parietal lobe gyrus;
temporal gyrus and sulcus share; and
gyrus and sulcus of the occipital lobe.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Disciplines
Know
Be able
1) interim discipline Distribution of the nervous system Show the location of the
Biology
to the central and peripheral. main elements of the CNS.
Features of the central nervous
system of mammals.
2) Courses are provided: Normal and Pathological Physiology topographical and
pathological anatomy, surgery, nerve disease.
3)
Interdiscipline Knowing the structure of the Show limits cranial fossa.
integration cranial fossa. The blood supply of Show the internal carotid
the "Osteology" to the brain.
artery.
"Angiology"
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
TELENCEPHALON; CEREBRUM
cerebrum
Hemispherium cerebri
The cerebral hemispheres
Gyri cerebri
Gyrus of the brain
Lobi cerebri
shares brain
Sulci cerebri
Furrows brain
Lobus frontalis
frontal lobe
Lobus parietalis
Lobus temporalis
parietal lobe
temporal lobe
Lobus occipitalis
occipital lobe
Lobus insularis
Islet
4.2. Theoretical questions for the class:
1. Derivative which is a think bubble hemisphere of the brain?
2. Why of the cerebral hemisphere separated from one another?
3. What are the surface and edges are distinguished in each hemisphere of the brain?
4. Part of each hemisphere of the brain?
5. How many fractions divided each hemisphere?
6. What is called the fifth section of the hemisphere (hidden) and the fate of the
brain where it
posted?
7. What is the fate of borders between the brain?
8. What distinguished within gyrus frontal sulci fate and that they
are separate?
9. What are the branches away from the lateral sulcus (fissure) in the brain and
which parts they divide the lower frontal gyrus?
10. What are the limits and show the parietal lobe.
11. What gyrus distinguished within the parietal lobe sulci and what they
are separate?
12. What gyrus is completed by the end of the lateral and posterior superior
temporal end
furrow?
13. Which lobe gyrus these two related?
14. What distinguished gyrus in the temporal lobe sulci and that they are separate?
15. What groups are divided gyrus and sulcus occipital lobe?
16. What fate gyrus and sulcus differ on the medial surface of the hemispheres?
4.3. Practical tasks pertaining to the topic and to be completed during the
class:
In preparations demonstrate cerebral hemisphere, their surfaces, edges and
boundaries between particles last.
On the surface verhnobichniy demonstrate the central and lateral grooves brain.
Showcasing the furrows and convolutions of the frontal lobe.
Showcasing the grooves and wedges parietal lobe.
Showcasing temporal gyrus and sulcus share.
Showcasing gyrus and sulcus of the occipital lobe.
Showcasing the island, its grooves and convolutions.
The content of the topic:
GENERAL APPEARANCE OF THE CEREBRAL HEMISPHERES
The cerebral hemispheres are the largest part of the brain and are separated
by a deep midline sagittal fissure, the longitudinal cerebral fissure. The fissure
contains the sickle-shaped fold of dura mater, the falx cerebri, and the anterior
cerebral arteries. In the depths of the fissure, the great commissure, the corpus
callosum, connects the hemispheres across the midline. A second horizontal fold
of dura mater separates the cerebral hemispheres from the cerebellum and is called
the tentorium cerebelli.
To increase the surface area of the cerebral cortex maximally, the surface of
each cerebral hemisphere is thrown into folds or gyri, which are separated from
each other by sulci or fissures. For ease of description, it is customary to divide
each hemisphere into lobes, which are named according to the cranial bones under
which they lie. The central and parieto-occipital sulci and the lateral and
calcarine sulci are boundaries used for the division of the cerebral hemisphere into
frontal, parietal, temporal, and occipital lobes.
MAIN SULCI
The central sulcus is of great importance because the gyrus that lies anterior
to it contains the motor cells that initiate the movements of the opposite side of the
body; posterior to it lies the general sensory cortex that receives sensory
information from the opposite side of the body. The central sulcus indents the
superior medial border of the hemisphere about 0.4 inch (1 cm) behind the
midpoint. It runs downward and forward across the lateral aspect of the
hemisphere, and its lower end is separated from the posterior ramus of the lateral
sulcus by a narrow bridge of cortex.
The lateral sulcus is a deep cleft found mainly on the inferior and lateral
surfaces of the cerebral hemisphere. It consists of a short stem that divides into
three rami. The stem arises on the inferior surface, and on reaching the lateral
surface, it divides into the anterior horizontal ramus and the anterior ascending
ramus and continues as the posterior ramus. An area of cortex called the insula
lies at the bottom of the deep lateral sulcus and cannot be seen from the surface
unless the lips of the sulcus are separated.
The parieto-occipital sulcus begins on the superior medial margin of the
hemisphere about 2 inches (5 cm) anterior to the occipital pole. It passes downward and anteriorly on the medial surface to meet the calcarine sulcus.
The calcarine sulcus is found on the medial surface of the hemisphere. It
commences under the posterior end of the corpus callosum and arches upward and
backward to reach the occipital pole, where it stops. In some brains, however, it
continues for a short distance onto the lateral surface of the hemisphere. The
calcarine sulcus is joined at an acute angle by the parieto-occipital sulcus about
halfway along its length.
LOBES OF THE CEREBRAL HEMISPHERE
Superolateral Surface of the Hemisphere
The frontal lobe occupies the area anterior to the central sulcus and superior
to the lateral sulcus. The superolateral surface of the frontal lobe is divided by
three sulci into four gyri. The precentral sulcus runs parallel to the central sulcus,
and the precentral gyrus lies between them. Extending anteriorly from the
precentral sulcus are the superior and inferior frontal sulci. The superior frontal
gyrus lies superior to the superior frontal sulcus, the middle frontal gyrus lies
between the superior and inferior frontal sulci, and the inferior frontal gyrus lies
inferior to the inferior frontal sulcus. The inferior frontal gyrus is invaded by the
anterior and ascending rami of the lateral sulcus.
The parietal lobe occupies the area posterior to the central sulcus and
superior to the lateral sulcus; it extends posteriorly as far as the parieto-occipital
sulcus. The lateral surface of the parietal lobe is divided by two sulci into three
gyri. The postcentral sulcus runs parallel to the central sulcus, and the postcentral
gyrus lies between them. Running posteriorly from the middle of the postcentral
sulcus is the intraparietal sulcus. Superior to the intraparietal sulcus is the
superior parietal lobule (gyrus), and inferior to the intraparietal sulcus is the
inferior parietal lobule (gyrus).
The temporal lobe occupies the area inferior to the lateral sulcus. The
lateral surface of the temporal lobe is divided into three gyri by two sulci. The
superior and middle temporal sulci run parallel to the posterior ramus of the
lateral sulcus and divide the temporal lobe into the superior, middle, and inferior
temporal gyri; the inferior temporal gyrus is continued onto the inferior surface of
the hemisphere.
The occipital lobe occupies the small area behind the parieto-occipital
sulcus.
Medial and Inferior Surfaces of the Hemisphere
The lobes of the cerebral hemisphere are not clearly defined on the medial
and inferior surfaces. However, there are many important areas that should be
recognized. The corpus callosum which is the largest commissure of the brain,
forms a striking feature on this surface. The cingulate gyrus begins beneath the
anterior end of the corpus callosum and continues above the corpus callosum until
it reaches its posterior end. The gyrus is separated from the corpus callosum by the
callosal sulcus. The cingulate gyrus is separated from the superior frontal gyrus by
the cingulate sulcus.
The paracentral lobule is the area of the cerebral cortex that surrounds the
indentation produced by the central sulcus on the superior border. The anterior part
of this lobule is a continuation of the precentral gyrus on the superior lateral
surface, and the posterior part of the lobule is a continuation of the postcentral
gyrus.
The precuneus is an area of cortex bounded anteriorly by the upturned
posterior end of the cingulate sulcus and posteriorly by the parieto-occipital sulcus.
The cuneus is a triangular area of cortex bounded above by the parietooccipital sulcus, inferiorly by the calcarine sulcus, and posteriorly by the superior
medial margin.
The collateral sulcus is situated on the inferior surface of the hemisphere.
This runs anteriorly below the calcarine sulcus. Between the collateral sulcus and
the calcarine sulcus is the lingual gyrus. Anterior to the lingual gyrus is the
parahippocampal gyrus; the latter terminates in front as the hooklike uncus.
The medial occipitotemporal gyrus extends from the occipital pole to the
temporal pole. It is bounded medially by the collateral and rhinal sulci and
laterally by the occipitotemporal sulcus. The occipitotemporal gyrus lies lateral
to the sulcus and is continuous with the inferior temporal gyrus.
On the inferior surface of the frontal lobe, the olfactory bulb and tract
overlie a sulcus called the olfactory sulcus. Medial to the olfactory sulcus is the
gyrus rectus, and lateral to the sulcus are a number of orbital gyri.
INTERNAL STRUCTURE OF THE CEREBRAL HEMISPHERES
The cerebral hemispheres are covered with a layer of gray matter, the
cerebral cortex. Located in the interior of the cerebral hemispheres are the lateral
ventricles, masses of gray matter, the basal nuclei, and nerve fibers. The nerve
fibers are embedded in neuroglia and constitute the white matter.
Basal Nuclei (Basal Ganglia)
The term basal nuclei is applied to a collection of masses of gray matter
situated within each cerebral hemisphere. They are the corpus striatum, the
amygdaloid nucleus, and the claustrum.
White Matter of the Cerebral Hemispheres
The white matter is composed of myelinated nerve fibers of different
diameters supported by neuroglia. The nerve fibers may be classified into three
groups according to their connections: (1) commissural fibers, (2) association
fibers, and (3) projection fibers.
Commissure Fibers
These fibers essentially connect corresponding regions of the two
hemispheres. They are as follows: the corpus callo-sum, the anterior commissure,
the posterior commissure, the fornix, and the habenular commissure.
The corpus callosum, the largest commissure of the brain, connects the two
cerebral hemispheres. It lies at the bottom of the longitudinal fissure. For purposes
of description, it is divided into the rostrum, the genu, the body, and the splenium.
The rostrum is the thin part of the anterior end of the corpus callosum,
which is prolonged posteriorly to be continuous with the upper end of the lamina
terminalis.
The genu is the curved anterior end of the corpus callosum that bends
inferiorly in front of the septum pellucidum.
The body of the corpus callosum arches posteriorly and ends as the
thickened posterior portion called the splenium.
Traced laterally, the fibers of the genu curve forward into the frontal lobes
and form the forceps minor.
The fibers of the body extend laterally as the radiation of the corpus
callosum. They intersect with bundles of association and projection fibers as they
pass to the cerebral cortex. Some of the fibers form the roof and lateral wall of the
posterior horn of the lateral ventricle and the lateral wall of the inferior horn of the
lateral ventricle; these fibers are referred to as the tapetum. Traced laterally, the
fibers in the splenium arch backward into the occipital lobe and form the forceps
major.
The anterior commissure is a small bundle of nerve fibers that crosses the
midline in the lamina terminalis. When traced laterally, a smaller or anterior
bundle curves forward on each side toward the anterior perforated substance and
the olfactory tract. A larger bundle curves posteriorly on each side and grooves the
inferior surface of the lentiform nucleus to reach the temporal lobes.
The posterior commissure is a bundle of nerve fibers that crosses the
midline immediately above the opening of the cerebral aqueduct into the third
ventricle; it is related to the inferior part of the stalk of the pineal gland. Various
collections of nerve cells are situated along its length. The destinations and
functional significance of many of the nerve fibers are not known. However, the
fibers from the pretectal nuclei involved in the pupillary light reflex are believed to
cross in this commissure on their way to the parasympathetic part of the
oculomotor nuclei.
The fornix is composed of myelinated nerve fibers and constitutes the
efferent system of the hippocampus that passes to the mammillary bodies of the
hypothalamus. The nerve fibers first form the alveus, which is a thin layer of white
matter covering the ventricular surface of the hippocampus, and then converge to
form the fimbria. The fimbriae of the two sides increase in thickness and, on
reaching the posterior end of the hippocampus, arch forward above the thalamus
and below the corpus callosum to form the posterior columns of the fornix. The
two columns then come together in the midline to form the body of the fornix.
The commissure of the fornix consists of transverse fibers that cross the midline
from one column to another just before the formation of the body of the fornix.
The function of the commissure of the fornix is to connect the hippocampal
formations of the two sides.
The habenular commissure is a small bundle of nerve fibers that crosses
the midline in the superior part of the root of the pineal stalk. The commissure is
associated with the habenular nuclei, which are situated on either side of the
midline in this region. The habenular nuclei receive many afferents from the
amygdaloid nuclei and the hippocampus. These afferent fibers pass to the
habenular nuclei in the stria medullaris thalami. Some of the fibers cross the
midline to reach the contralateral nucleus through the habenular commissure. The
function of the habenular nuclei and its connections in humans is unknown.
Association Fibers
These nerve fibers essentially connect various cortical regions within the
same hemisphere and may be divided into short and long groups. The short
association fibers lie immediately beneath the cortex and connect adjacent gyri;
these fibers run transversely to the long axis of the sulci. The long association
fibers are collected into named bundles that can be dissected in a formalinhardened brain. The uncinate fasciculus connects the first motor speech area and
the gyri on the inferior surface of the frontal lobe with the cortex of the pole of the
temporal lobe. The cingulum is a long, curved fasciculus lying within the white
matter of the cingulate gyrus. It connects the frontal and parietal lobes with
parahippocam-pal and adjacent temporal cortical regions. The superior
longitudinal fasciculus is the largest bundle of nerve fibers. It connects the
anterior part of the frontal lobe to the occipital and temporal lobes. The inferior
longitudinal fasciculus runs anteriorly from the occipital lobe, passing lateral to
the optic radiation, and is distributed to the temporal lobe. The fronto-occipital
fasciculus connects the frontal lobe to the occipital and temporal lobes. It is
situated deep within the cerebral hemisphere and is related to the lateral border of
the caudate nucleus.
Projection Fibers
Afferent and efferent nerve fibers passing to and from the brainstem to the
entire cerebral cortex must travel between large nuclear masses of gray matter
within the cerebral hemisphere. At the upper part of the brainstem, these fibers
form a compact band known as the internal capsule, which is flanked medially by
the caudate nucleus and the thalamus and laterally by the lentiform nucleus.
Because of the wedge shape of the lentiform nucleus, as seen on horizontal section,
the internal capsule is bent to form an anterior limb and a posterior limb, which
are continuous with each other at the genu. Once the nerve fibers have emerged
superiorly from between the nuclear masses, they radiate in all directions to the
cerebral cortex. These radiating projection fibers are known as the corona radiata.
Most of the projection fibers lie medial to the association fibers, but they intersect
the commissural fibers of the corpus callosum and the anterior commissure. The
nerve fibers lying within the most posterior part of the posterior limb of the
internal capsule radiate toward the calcarine sulcus and are known as the optic
radiation.
Septum Pellucidum
The septum pellucidum is a thin vertical sheet of nervous tissue consisting of
white and gray matter covered on either side by ependyma. It stretches between the
fornix and the corpus callosum. Anteriorly, it occupies the interval between the
body of the corpus callosum and the rostrum. It is essentially a double membrane
with a closed, slitlike cavity between the membranes. The septum pellucidum
forms a partition between the anterior horns of the lateral ventricles.
Lateral Ventricles
There are two large lateral ventricles, and one is present in each cerebral
hemisphere. The ventricle is a roughly C-shaped cavity and may be divided into a
body, which occupies the parietal lobe and from which anterior, posterior, and
inferior horns extend into the frontal, occipital, and temporal lobes, respectively.
The lateral ventricle communicates with the cavity of the third ventricle through
the interventricular foramen. This opening, which lies in the anterior part of the
medial wall of the ventricle, is bounded anteriorly by the anterior column of the
fornix and posteriorly by the anterior end of the thalamus.
The body of the lateral ventricle extends from the interventricular foramen
posteriorly as far as the posterior end of the thalamus. Here it becomes continuous
with the posterior and the inferior horns. The body of the lateral ventricle has a
roof, a floor, and a medial wall.
The roof is formed by the undersurface of the corpus callosum. The floor is
formed by the body of the caudate nucleus and the lateral margin of the thalamus.
The superior surface of the thalamus is obscured in its medial part by the body of
the fornix. The choroid plexus of the ventricle projects into the body of the
ventricle through the slitlike gap between the body of the fornix and the superior
surface of the thalamus. This slitlike gap is known as the choroidal fissure;
through it the blood vessels of the plexus invaginate the pia mater of the tela
choroidea and the ependyma of the lateral ventricle. The medial wall is formed by
the septum pellucidum anteriorly; posteriorly the roof and the floor come together
on the medial wall.
The anterior horn of the lateral ventricle extends forward into the frontal
lobe. It is continuous posteriorly with the body of the ventricle at the interventricular foramen. The anterior horn has a roof, a floor, and a medial wall. The roof
is formed by the undersurface of the anterior part of the corpus callosum; the
genu of the corpus callosum limits the anterior horn anteriorly.
The floor is formed by the rounded head of the caudate nucleus, and
medially a small portion is formed by the superior surface of the rostrum of the
corpus callosum. The medial wall is formed by the septum pellucidum and the
anterior column of the fornix.
The posterior horn of the lateral ventricle extends posteriorly into the
occipital lobe. The roof and lateral wall are formed by the fibers of the tapetum
of the corpus callosum. Lateral to the tapetum are the fibers of the optic
radiation. The medial wall of the posterior horn has two elevations. The superior
swelling is caused by the splenial fibers of the corpus callosum, called the forceps
major, passing posteriorly into the occipital lobe; this superior swelling is referred
to as the bulb of the posterior horn. The inferior swelling is produced by the
calcarine sulcus and is called the calcar avis.
The inferior horn of the lateral ventricle extends anteriorly into the
temporal lobe. The inferior horn has a roof and a floor.
The roof is formed by the inferior surface of the tapetum of the corpus
callosum and by the tail of the caudate nucleus. The latter passes anteriorly to
end in the amygdaloid nucleus. Medial to the tail of the caudate nucleus is the
stria terminalis, which also ends anteriorly in the amygdaloid nucleus.
The floor is formed laterally by the collateral eminence, produced by the
collateral fissure, and medially by the hippocampus. The anterior end of the
hippocampus is expanded and slightly furrowed to form the pes hippocampus.
The hippocampus is composed of gray matter; however, the ventricular surface of
the hippocampus is covered by a thin layer of white matter called the alveus,
which is formed from the axons of the cells of the hippocampus. These axons
converge on the medial border of the hippocampus to form a bundle known as the
fimbria. The fimbria of the hippocampus becomes continuous posteriorly with the
posterior column of the fornix. In the interval between the stria terminalis and the
fimbria is the temporal part of the choroidal fissure. It is here that the lower part of
the choroid plexus of the lateral ventricle invaginates the ependyma from the
medial side and closes the fissure.
Materials for self-check.
A. Tasks for self-check: the tables show anatomical lesions surface of the forebrain.
B. Choose the correct answer:
1.The physician-pathologist conducted the autopsy of 85-year-old man who died
after prolonged cerebrovascular accident. In studying of the man’s brain a physician
determined the presence of hemorrhage in the area of the cortex, located between the
calcarine fissure and parietal-occipital sulcus (BNA). What is the name of this part of
cortex?
A.the cuneus
B.The uncus
C.The precuneus
D.Limbic system
E.paracentral lobule
2.A Lecturer of anatomy during the lesson was showing students the cerebral
hemisphere and explained the relief structure of the cortex. One of the students asked
the name of part of the cortex, located between the marginal share of the cingulate
sulcus and parietal-occipital sulcus. ). What is the name of this part of cortex?
A.The precuneus
B.The insula
C.the cuneus
D.Limbic system
E.The uncus
3.During the brains studying physician determined the presence a hemorrhage in the
area of the cortex, located between the upper and lower frontal sulci (sulcus). What is
the name of this part of cortex?
A.Middle frontal gyrus
B.The uncus
C.The precuneus
D.Superior frontal gyrus
E.Inferior frontal gyrus
4.During the studying of brains physician determined the presence a hemorrhage in the
area of the cortex, located below the lower frontal sulcus (sulci). What is the name of
this part of cortex?
A.Inferior frontal gyrus
B.The uncus
C.The precuneus
D.Superior frontal gyrus
E.Middle frontal gyrus
5.During the studying of brains physician determined the presence a hemorrhage in the
area of the cortex, located fetched and occipital-temporal sulci. What is the name of
this part of cortex?
A.Medial occipitotemporal gyrus
B.The uncus
C.The precuneus
D.Superior frontal gyrus
E.Inferior frontal gyrus
6.A Lecturer of anatomy during the lesson was showing students the cerebral
hemisphere and explained the relief structure of the cortex. One of the students asked
him to name the part of the cortex, located between the marginal share of the cingulate
sulcus and parietal-occipital sulcus. What is the name of this part of cortex?
A.The precuneus
B.The insula
C.the cuneus
D.Limbic system
E.The uncus
7.A Lecturer of anatomy during the lesson was showing students the cerebral
hemisphere and explained the relief structure of the cortex. One of the students asked
him to name the part of the cortex, located between the zonality sulcus and sulcus of
the corpus callosum. What is the name of this part of cortex?
A.The cingulate gyrus
B.The insula
C.the cuneus
D.The precuneus
E.The uncus
8.A Lecturer of anatomy during the lesson was showing students the cerebral
hemisphere and explained the relief structure of the cortex. One of the students asked
him to name the part of the cortex, located between the calcarine sulcus and parietaloccipital sulcus. What is the name of this part of cortex?
A.the cuneus
B.The insula
C.The precuneus
D.Limbic system
E.The uncus
9.A Lecturer of anatomy during the lesson was showing students the cerebral
hemisphere and explained the relief structure of the cortex. One of the students asked
him to name the part of the cortex, which covers the back end of the superior temporal
gyrus. What is the name of this part of cortex?
A.The angular gyrus
B.The insula
C.the cuneus
D.The cingulate gyrus
E.The uncus
10.In explaining the relief structure of the cerebral cortex of one of the students asked
to name the part of the cortex, which is located between the central postcentral gyrus.
What is the name of this part of cortex?
A.the postcentral gyrus
B.the cuneus
C.The precuneus
D.The cingulate gyrus
E.The uncus
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 28. The rhinencephalon. Limbic brain. The basal nuclei.
1. Relevance of the topic:
Knowledge of anatomy section end necessary for students of all specialties for further
study.
2. The specific aims:
To have general knowledge of the topic studied;
To understand, to remember and to use the knowledge received;
To form the professional experience by reviewing, training and authorizing it;
To be able to find studying structure on visual aids.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Disciplines
З
Know
Be able
1) interim discipline Knowing the structure of Demonstrate
horizontal
Biology
the basal nuclei of higher autopsy cerebral hemispheres
mammals
location basal nuclei.
Histology
Know the histological
To be able to distinguish the
structure of the basal
gray, white matter, differentiated
nuclei
core basics
2) Courses are provided: Normal and Pathological Physiology, topographical and
pathological anatomy, surgery, nerve disease.
3)
Interdiscipline "The structure
integration skull"
the "Osteology"
main supply
the "Angiology"
brain.
of
the To be able to show the skull
projection lobes.
To be able to show the
preparation:
- Plexus chorioideus
- A. carotis interna
- V. jugularis interna
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
Nuclei basales et structurae pertinentes
Basal nuclei and the structure formations
Nucleus caudatus
Caudate nucleus
Caput
Head
Corpus
Body
Cauda
Tail
Putamen
putamen
Lamina medullaris lateralis
Brain lateral plate
Lamina medullaris externa
External brain plate
Globus pallidus lateralis
Lateral pale bullet
Lamina medullaris medialis
The medial cerebral plate
Lamina medullaris interna
Internal brain plate
Globus pallidus medialis
The medial pale bullet
Pars lateralis
Pars medialis
The lateral part
Corpus striatum
The medial part
striatum
Striatum dorsale
Dorsal stripe
4.2. Theoretical questions for the class:
1. Distribution of the cerebral hemispheres at the gray and white matter.
2. General characteristics of the foundations of brain nuclei.
3. Functional basal nuclei.
4. Characteristics of layers of white matter between basal nuclei.
5. Which of the basal nuclei form striatum.
6. What are the parts of the caudate nucleus is located and where each of its parts?
7. What is the fence?
4.3. Practical tasks pertaining to the topic and to be completed during the
class:In isolated wet preparation to be able to show the structure and components of
the olfactory brain and basal core striopalidarnu system.
1. Show the wet preparation brain thalamus, caudate
nucleus, internal capsule.
2. To be able to show the fence and almond body.
3. To be able to show the red nucleus and substantia nigr of the midbrain.
The content of the topic.
LIMBIC SYSTEM
The word limbic means border or margin, and the term limbic system was
loosely used to include a group of structures that lie in the border zone between the
cerebral cortex and the hypothalamus. Now it is recognized, as the result of research, that the limbic system is involved with many other structures beyond the
border zone in the control of emotion, behavior, and drive; it also appears to be
important to memory.
Anatomically, the limbic structures include the subcallosal, the cingulate,
and the parahippocampal gyri, the hippocampal formation, the amygdaloid
nucleus, the mam-millary bodies, and the anterior thalamic nucleus. The alveus,
the fimbria, the fornix, the mammillothalamic tract, and the stria terminalis
constitute the connecting pathways of this system.
Hippocampal Formation
The hippocampal formation consists of the hippocampus, the dentate gyrus,
and the parahippocampal gyrus.
The hippocampus is a curved elevation of gray matter that extends
throughout the entire length of the floor of the inferior horn of the lateral ventricle.
Its anterior end is expanded to form the pes hippocampus. It is named hippocampus because it resembles a sea horse in coronal section. The convex
ventricular surface is covered with ependyma, beneath which lies a thin layer of
white matter called the alveus. The alveus consists of nerve fibers that have
originated in the hippocampus, and these converge medially to form a bundle
called the fimbria. The fimbria, in turn, becomes continuous with the crus of the
fornix. The hippocampus terminates posteriorly beneath the splenium of the corpus
callosum.
The dentate gyrus is a narrow, notched band of gray matter that lies
between the fimbria of the hippocampus and the parahippocampal gyrus.
Posteriorly, the gyrus accompanies the fimbria almost to the splenium of the
corpus callosum and becomes continuous with the indusium griseum. The
indusium griseum is a thin, vestigial layer of gray matter that covers the superior
surface of the corpus callosum. Embedded in the superior surface of the indusium
griseum are two slender bundles of white fibers on each side called the medial and
lateral longitudinal striae. The striae are the remains of the white matter of the
vestigial indusium griseum. Anteriorly, the dentate gyrus is continued into the
uncus.
The parahippocampal gyrus lies between the hip-pocampal fissure and the
collateral sulcus and is continuous with the hippocampus along the medial edge of
the temporal lobe.
Amygdaloid Nucleus
The amygdaloid nucleus is so named because it resembles an almond. It is
situated partly anterior and partly superior to the tip of the inferior horn of the
lateral ventricle. It is fused with the tip of the tail of the caudate nucleus, which has
passed anteriorly in the roof of the inferior horn of the lateral ventricle. The stria
terminalis emerges from its posterior aspect. The amygdaloid nucleus consists of a
complex of nuclei which can be grouped into a larger basolateral group and
smaller corticomedial group.
The mammillary bodies and the anterior nucleus of the thalamus are
considered elsewhere in this text.
Connecting Pathways of the Limbic System
These pathways are the alveus, the fimbria, the fornix, the
mammillothalamic tract, and the stria terminalis.
The alveus consists of a thin layer of white matter that lies on the superior or
ventricular surface of the hippocampus. It is composed of nerve fibers that
originate in the hippocampal cortex. The fibers converge on the medial border of
the hippocampus to form a bundle called the fimbria.
The fimbria now leaves the posterior end of the hippocampus as the eras of
the fornix. The cms from each side curves posteriorly and superiorly beneath the
splenium of the corpus callosum and around the posterior surface of the thalamus.
The two crura now converge to form the body of the fornix, which is applied
closely to the undersurface of the corpus callosum. As the two crura come together,
they are connected by transverse fibers called the commissure of the fornix.
These fibers decussate and join the hippocampi of the two sides.
Anteriorly, the body of the fornix is connected to the undersurface of the
corpus callosum by the septum pellucidum. Inferiorly, the body of the fornix is
related to the tela choroidea and the ependymal roof of the third ventricle.
The body of the fornix splits anteriorly into two anterior columns of the
fornix, each of which curves anteriorly and inferiorly over the interventricular
foramen (foramen of Monro). Then each column disappears into the lateral wall of
the third ventricle to reach the mammillary body.
The mammillothalamic tract provides important connections between the
mammillary body and the anterior nuclear group of the thalamus.
The stria terminalis emerges from the posterior aspect of the amygdaloid
nucleus and runs as a bundle of nerve fibers posteriorly in the roof of the inferior
horn of the lateral ventricle on the medial side of the tail of the caudate nucleus. It
follows the curve of the caudate nucleus and comes to lie in the floor of the body
of the lateral ventricle.
Structure of the Hippocampus and the Dentate Gyrus
The cortical structure of the parahippocampal gyrus is six-layered. As the
cortex is traced into the hippocampus, there is a gradual transition from a six- to a
three-layered arrangement. These three layers are the superficial molecular layer,
consisting of nerve fibers and scattered small neurons; the pyramidal layer,
consisting of many large pyramid-shaped neurons; and the inner polymorphic
layer, which is similar in structure to the polymorphic layer of the cortex seen
elsewhere.
The dentate gyrus also has three layers, but the pyramidal layer is replaced
by the granular layer. The granular layer is composed of densely arranged rounded
or oval neurons that give rise to axons that terminate upon the dendrites of the
pyramidal cells in the hippocampus. A few of the axons join the fimbria and enter
the fornix.
Afferent Connections of the Hippocampus
Afferent connections of the hippocampus may be divided into six groups:
1. Fibers arising in the cingulate gyrus pass to the hippocampus.
2. Fibers arising from the septal nuclei (nuclei lying within the midline
close to the anterior commissure) pass posterior in the fornix to the hippocampus.
3. Fibers arising from one hippocampus pass across the midline to the
opposite hippocampus in the commissure of the fornix.
4. Fibers from the indusium griseum pass posteriorly in the longitudinal
striae to the hippocampus.
5. Fibers from the entorhinal area or olfactory-associated cortex pass to the
hippocampus.
6. Fibers arising from the dentate and parahippocampal gyri travel to the
hippocampus.
Efferent Connections of the Hippocampus
Axons of the large pyramidal cells of the hippocampus emerge to form the
alveus and the fimbria. The fimbria continues as the cms of the fornix. The two
crura converge to form the body of the fornix. The body of the fornix splits into the
two columns of the fornix, which curve downward and forward in front of the
interventricular foramina. The fibers within the fornix are distributed to the
following regions:
1. Fibers pass posterior to the anterior commissure to enter the mammillary
body, where they end in the medial nucleus.
2. Fibers pass posterior to the anterior commissure to end in the anterior
nuclei of the thalamus.
3. Fibers pass posterior to the anterior commissure to enter the tegmentum
of the midbrain.
4. Fibers pass anterior to the anterior commissure to end in the septal nuclei,
the lateral preoptic area, and the anterior part of the hypothalamus.
5. Fibers join the stria medullaris thalami to reach the habe-nular nuclei.
Consideration of the above complex anatomical pathways indicates that the
structures comprising the limbic system not only are interconnected, but also send
projection fibers to many different parts of the nervous system. Physiologists now
recognize the importance of the hypothalamus as being the major output pathway
of the limbic system.
Functions of the Limbic System
The limbic system, via the hypothalamus and its connections with the
outflow of the autonomic nervous system and its control of the endocrine system,
is able to influence many aspects of emotional behavior. These include particularly
the reactions of fear and anger and the emotions associated with sexual behavior.
There is also evidence that the hippocampus is concerned with converting
recent memory to long-term memory. A lesion of the hippocampus results in the
individual being unable to store long-term memory. Memory of remote past events
before the lesion developed is unaffected. This condition is called anterograde
amnesia. It is interesting to note that injury to the amygdaloid nucleus and the
hippocampus produces a greater memory loss than injury to either one of these
structures alone.
There is no evidence that the limbic system has an olfactory function. The
various afferent and efferent connections of the limbic system provide pathways
for the integration and effective homeostatic responses to a wide variety of environmental stimuli.
BASAL NUCLEI
The term basal nuclei is applied to a collection of masses of gray matter
situated within each cerebral hemisphere. They are the corpus striatum, the
amygdaloid nucleus, and the claustrum.
Clinicians and neuroscientists use a variety of different terminologies to
describe the basal nuclei. The subthalamic nuclei, the substantia nigra, and the red
nucleus are functionally closely related to the basal nuclei, but they should not be
included with them.
The interconnections of the basal nuclei are complex, but in this account,
only the more important pathways are considered. The basal nuclei play an
important role in the control of posture and voluntary movement.
CORPUS STRIATUM
The corpus striatum is situated lateral to the thalamus and is almost
completely divided by a band of nerve fibers, the internal capsule, into the
caudate nucleus and the lentiform nucleus. The term striatum is used here because
of the striated appearance produced by the strands of gray matter passing through
the internal capsule and connecting the caudate nucleus to the putamen of the
lentiform nucleus.
Caudate Nucleus
The caudate nucleus is a large C-shaped mass of gray matter that is closely
related to the lateral ventricle and lies lateral to the thalamus. The lateral surface of
the nucleus is related to the internal capsule, which separates it from the lentiform
nucleus. For purposes of description, it can be divided into a head, a body, and a
tail.
The head of the caudate nucleus is large and rounded and forms the lateral
wall of the anterior horn of the lateral ventricle. The head is continuous inferiorly
with the putamen of the lentiform nucleus (the caudate nucleus and the putamen
are sometimes referred to as the neostriatum or striatum). Just superior to this
point of union, strands of gray matter pass through the internal capsule, giving the
region a striated appearance, hence the term corpus striatum.
The body of the caudate nucleus is long and narrow and is continuous with
the head in the region of the interventricular foramen. The body of the caudate
nucleus forms part of the floor of the body of the lateral ventricle.
The tail of the caudate nucleus is long and slender and is continuous with
the body in the region of the posterior end of the thalamus. It follows the contour
of the lateral ventricle and continues forward in the roof of the inferior horn of the
lateral ventricle. It terminates anteriorly in the amygdaloid nucleus.
Lentiform Nucleus
The lentiform nucleus is a wedge-shaped mass of gray matter whose broad
convex base is directed laterally and whose blade is directed medially. It is buried
deep in the white matter of the cerebral hemisphere and is related medially to the
internal capsule, which separates it from the caudate nucleus and the thalamus. The
lentiform nucleus is related laterally to a thin sheet of white matter, the external
capsule, which separates it from a thin sheet of gray matter, called the claustrum.
The claustrum, in turn, separates the external capsule from the subcortical white
matter of the insula. A vertical plate of white matter divides the nucleus into a
larger, darker lateral portion, the putamen, and an inner lighter portion, the globus
pallidus. The paleness of the globus pallidus is due to the presence of a high
concentration of myelinated nerve fibers. In-feriorly at its anterior end, the
putamen is continuous with the head of the caudate nucleus.
AMYGDALOID NUCLEUS
The amygdaloid nucleus is situated in the temporal lobe close to the uncus.
Through its connections, it can influence the body's response to environmental
changes. In the sense of fear, for example, it can change the heart rate, blood pressure, skin color, and rate of respiration.
SUBSTANTIA NIGRA AND SUBTHALAMIC NUCLEI
The substantia nigra of the midbrain and the subthalamic nuclei of the
diencephalon are functionally closely related to the activities of the basal nuclei.
The neurons of the substantia nigra are dopaminergic and inhibitory and have
many connections to the corpus striatum. The neurons of the subthalamic nuclei
are glutaminergic and excitatory and have many connections to the globus pallidus
and substantia nigra.
CLAUSTRUM
The claustrum is a thin sheet of gray matter that is separated from the lateral
surface of the lentiform nucleus by the external capsule. Lateral to the claustrum is
the subcortical white matter of the insula. The function of the claustrum is
unknown.
FUNCTIONS OF THE BASAL NUCLEI
The basal nuclei are joined together and connected with many different
regions of the nervous system by a very complex number of neurons.
Basically, the corpus striatum receives afferent information from most of the
cerebral cortex, the thalamus, the subthalamus, and the brainstem, including the
substantia nigra. The information is integrated within the corpus striatum, and the
outflow passes back to the areas listed above. This circular pathway is believed to
function as follows.
The activity of the basal nuclei is initiated by information received from the
premotor and supplemental areas of the motor cortex, the primary sensory cortex,
the thalamus, and the brainstem. The outflow from the basal nuclei is channeled
through the globus pallidus, which then influences the activities of the motor areas
of the cerebral cortex or other motor centers in the brainstem. Thus the basal nuclei
control muscular movements by influencing the cerebral cortex and have no direct
control through descending pathways to the brainstem and spinal cord. In this way
the basal nuclei assist in the regulation of voluntary movement and the learning of
motor skills.
The basal nuclei not only influence the execution of a particular movement
of, say, the limbs, but also help prepare for the movements. This may be achieved
by controlling the axial and girdle movements of the body and the positioning of
the proximal parts of the limbs. The activity in certain neurons of the globus
pallidus increases before active movements take place in the distal limb muscles.
This important preparatory function enables the trunk and limbs to be placed in
appropriate positions before the primary motor part of the cerebral cortex activates
discrete movements in the hands and feet.
Materials for self-check.
A. Tasks for self- check: the tables to designate parts of the olfactory brain and basal
core striopalidarnu system.
B. Choose the correct answer:
1.Patient dysfunction of the basal nuclei. To all basal nuclei include all mentioned
structures except:
A.Red core.
B.amygdala.
C.claustrum.
D.caudate nucleus.
E.putamen.
2.Patient violations of the striatopallidal system. The striatopallidal system is formed
by:
A.caudate nucleus and the lentils like core.
B.caudate nucleus and claustrum.
C.putamen and claustrum.
D.medial and lateral pale ball.
E.almond body and caudate nucleus.
3.The patient abuse striatopallidal system, in particular - in the region of the caudate
nucleus. Caudate nucleus has:
A.head, body, tail.
B.Head, leg.
C. legs, tail.
D.Head, neck.
E.Head, handles, legs.
4.The patient abuse striatopallidal system. system, in particular - lentils like core,
which is divided:
A.The putamen, lateral and medial pale sphere.
B.At the putamen, caudate nucleus.
C.On the putamen, claustrum
D.At the almond kernel and palidum.
E.On the medial and lateral pale ball.
5.When hemorrhage in areas of the forebrain the patient has got violated automatic
movements. Irritation basal nuclei leads:
A.To the appearance is not conscious movements.
B.To the emergence of conscious movements.
C.To enhance motor function of the gastrointestinal tract.
D.To rejection of cold and hot.
E.To reduce motor function of the gastrointestinal tract.
6.When done a CT scan of the brain of the patient revealed that damaged the left
striatum. What structures belong to it from below mentioned?
A.Sochevytsepodibne and caudate nucleus.
B.caudate nucleus and putamen.
C.Sochevytsepodibne nucleus and putamen.
D.Palidum and putamen.
E.medial pale ball and claustrum.
7.The patient in '30 suffered frombleeding in the brain, which damaged the putamen.
The patient complains on difficulty in performing complex coordinated movements.
Whose core component is the putamen?
A.Lentils like core
B.amygdala.
C.claustrum.
D.caudate nucleus.
E.internal capsule
8.Damage of Striatopallidal system led to the development athetosis (rhythmic limb
movements). Which cores are damaged?
A.striatum.
B.Front nucleus of the hypothalamus.
C.medial geniculate body.
D.Lateral geniculate body.
E.Rear nuclei of the hypothalamus.
9.A patient was diagnosed with dancing malady. In this disease appear supplementary
and forced movements. Which structures of the brain are involved in this?
A.Substantia nigra et corpus striatum.
B.Pulvinarthalamicus.
C.Fasciculus longitudinalis medialis.
D.Fasciculus longitudinalis posterior.
E.Nucleus ruber.
10.When conducting a CT scan of the brain in a patient with Parkinson's disorders in
the brain stem were found. In the study of forebrain detected pathologies:
A.Lentils like core
B.angular gyrus.
C.Lateral gyrus.
D.Hooks gyrus sea horse.
E.almond kernel.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 29. Structure of grey matter and cortex of cerebral hemispheres.
Functional arrangement of the cerebral cortex.
1. Relevance of the topic:
Knowledge of the topography and the structure of the brain can help in determining
the correct diagnosis of the patient, since the defeat of the brain disorder arising
from the loss of sensitivity of different departments, motor responses.
2. The specific aims:
Analyze the structure of the forebrain, hemispheres of the brain.
Explain:
- Structure of the cerebral cortex;
- Localization of functions in the frontal lobe of the brain;
- Localization of functions in the parietal and occipital lobe of the brain;
- Localization of function in the temporal lobe of the brain.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Disciplines
Know
Be able
1) Interim discipline
Biology
The structure of the
mammalian brain.
Histology
Show the share of brain
Tsytoarhitektonika
Identify the gray and white
brain.
matter of the brain.
2) Courses are provided: Normal and Pathological Physiology, topographical and
pathological anatomy, surgery, nerve disease.
1)
Interdiscipline The structure of the skull. To be able to show well.
integration main supply
Carotis
1) The "Osteology"
brain.
interna.
2) "Angiology"
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
Cortex cerebri
The cerebral cortex
Paleocortex
Old bark
Neocortex
New bark
4.2. Theoretical questions for the class:
1. Share of the structure of the forebrain.
2. Share with the structure of the cerebral hemispheres.
3. Share the structure of the cerebral cortex.
4. Share the localization of functions in the frontal lobe of the brain.
5. Share the localization of functions in the parietal and occipital lobe of the brain.
6. Share the localization of functions in the temporal lobe of the brain.
4.3. Practical tasks pertaining to the topic and to be completed during the
class:
The content of the topic:
THE CEREBRAL HEMISPHERES
The cerebral hemispheres are the largest part of the brain and are separated
by a deep midline sagittal fissure, the longitudinal cerebral fissure. The fissure
contains the sickle-shaped fold of dura mater, the falx cerebri, and the anterior
cerebral arteries. In the depths of the fissure, the great commissure, the corpus
callosum, connects the hemispheres across the midline. A second horizontal fold
of dura mater separates the cerebral hemispheres from the cerebellum and is called
the tentorium cerebelli.
To increase the surface area of the cerebral cortex maximally, the surface of
each cerebral hemisphere is thrown into folds or gyri, which are separated from
each other by sulci or fissures. For ease of description, it is customary to divide
each hemisphere into lobes, which are named according to the cranial bones under
which they lie. The central and parieto-occipital sulci and the lateral and
calcarine sulci are boundaries used for the division of the cerebral hemisphere into
frontal, parietal, temporal, and occipital lobes.
MAIN SULCI
The central sulcus is of great importance because the gyrus that lies anterior
to it contains the motor cells that initiate the movements of the opposite side of the
body; posterior to it lies the general sensory cortex that receives sensory
information from the opposite side of the body. The central sulcus indents the
superior medial border of the hemisphere about 0.4 inch (1 cm) behind the
midpoint. It runs downward and forward across the lateral aspect of the
hemisphere, and its lower end is separated from the posterior ramus of the lateral
sulcus by a narrow bridge of cortex.
The lateral sulcus is a deep cleft found mainly on the inferior and lateral
surfaces of the cerebral hemisphere. It consists of a short stem that divides into
three rami. The stem arises on the inferior surface, and on reaching the lateral
surface, it divides into the anterior horizontal ramus and the anterior ascending
ramus and continues as the posterior ramus. An area of cortex called the insula
lies at the bottom of the deep lateral sulcus and cannot be seen from the surface
unless the lips of the sulcus are separated.
The parieto-occipital sulcus begins on the superior medial margin of the
hemisphere about 2 inches (5 cm) anterior to the occipital pole. It passes downward and anteriorly on the medial surface to meet the calcarine sulcus.
The calcarine sulcus is found on the medial surface of the hemisphere. It
commences under the posterior end of the corpus callosum and arches upward and
backward to reach the occipital pole, where it stops. In some brains, however, it
continues for a short distance onto the lateral surface of the hemisphere. The
calcarine sulcus is joined at an acute angle by the parieto-occipital sulcus about
halfway along its length.
LOBES OF THE CEREBRAL HEMISPHERE
Superolateral Surface of the Hemisphere
The frontal lobe occupies the area anterior to the central sulcus and superior
to the lateral sulcus. The superolateral surface of the frontal lobe is divided by
three sulci into four gyri. The precentral sulcus runs parallel to the central sulcus,
and the precentral gyrus lies between them. Extending anteriorly from the
precentral sulcus are the superior and inferior frontal sulci. The superior frontal
gyrus lies superior to the superior frontal sulcus, the middle frontal gyrus lies
between the superior and inferior frontal sulci, and the inferior frontal gyrus lies
inferior to the inferior frontal sulcus. The inferior frontal gyrus is invaded by the
anterior and ascending rami of the lateral sulcus.
The parietal lobe occupies the area posterior to the central sulcus and
superior to the lateral sulcus; it extends posteriorly as far as the parieto-occipital
sulcus. The lateral surface of the parietal lobe is divided by two sulci into three
gyri. The postcentral sulcus runs parallel to the central sulcus, and the postcentral
gyrus lies between them. Running posteriorly from the middle of the postcentral
sulcus is the intraparietal sulcus. Superior to the intraparietal sulcus is the
superior parietal lobule (gyrus), and inferior to the intraparietal sulcus is the
inferior parietal lobule (gyrus).
The temporal lobe occupies the area inferior to the lateral sulcus. The
lateral surface of the temporal lobe is divided into three gyri by two sulci. The
superior and middle temporal sulci run parallel to the posterior ramus of the
lateral sulcus and divide the temporal lobe into the superior, middle, and inferior
temporal gyri; the inferior temporal gyrus is continued onto the inferior surface of
the hemisphere.
The occipital lobe occupies the small area behind the parieto-occipital
sulcus.
Medial and Inferior Surfaces of the Hemisphere
The lobes of the cerebral hemisphere are not clearly defined on the medial
and inferior surfaces. However, there are many important areas that should be
recognized. The corpus callosum which is the largest commissure of the brain,
forms a striking feature on this surface. The cingulate gyrus begins beneath the
anterior end of the corpus callosum and continues above the corpus callosum until
it reaches its posterior end. The gyrus is separated from the corpus callosum by the
callosal sulcus. The cingulate gyrus is separated from the superior frontal gyrus by
the cingulate sulcus.
The paracentral lobule is the area of the cerebral cortex that surrounds the
indentation produced by the central sulcus on the superior border. The anterior part
of this lobule is a continuation of the precentral gyrus on the superior lateral
surface, and the posterior part of the lobule is a continuation of the postcentral
gyrus.
The precuneus is an area of cortex bounded anteriorly by the upturned
posterior end of the cingulate sulcus and posteriorly by the parieto-occipital sulcus.
The cuneus is a triangular area of cortex bounded above by the parietooccipital sulcus, inferiorly by the calcarine sulcus, and posteriorly by the superior
medial margin.
The collateral sulcus is situated on the inferior surface of the hemisphere.
This runs anteriorly below the calcarine sulcus. Between the collateral sulcus and
the calcarine sulcus is the lingual gyrus. Anterior to the lingual gyrus is the
parahippocampal gyrus; the latter terminates in front as the hooklike uncus.
The medial occipitotemporal gyrus extends from the occipital pole to the
temporal pole. It is bounded medially by the collateral and rhinal sulci and
laterally by the occipitotemporal sulcus. The occipitotemporal gyrus lies lateral
to the sulcus and is continuous with the inferior temporal gyrus.
On the inferior surface of the frontal lobe, the olfactory bulb and tract
overlie a sulcus called the olfactory sulcus. Medial to the olfactory sulcus is the
gyrus rectus, and lateral to the sulcus are a number of orbital gyri.
INTERNAL STRUCTURE OF THE CEREBRAL HEMISPHERES
The cerebral hemispheres are covered with a layer of gray matter, the
cerebral cortex. Located in the interior of the cerebral hemispheres are the lateral
ventricles, masses of gray matter, the basal nuclei, and nerve fibers. The nerve
fibers are embedded in neuroglia and constitute the white matter.
Basal Nuclei (Basal Ganglia)
The term basal nuclei is applied to a collection of masses of gray matter
situated within each cerebral hemisphere. They are the corpus striatum, the
amygdaloid nucleus, and the claustrum.
White Matter of the Cerebral Hemispheres
The white matter is composed of myelinated nerve fibers of different
diameters supported by neuroglia. The nerve fibers may be classified into three
groups according to their connections: (1) commissural fibers, (2) association
fibers, and (3) projection fibers.
Commissure Fibers
These fibers essentially connect corresponding regions of the two
hemispheres. They are as follows: the corpus callo-sum, the anterior commissure,
the posterior commissure, the fornix, and the habenular commissure.
The corpus callosum, the largest commissure of the brain, connects the two
cerebral hemispheres. It lies at the bottom of the longitudinal fissure. For purposes
of description, it is divided into the rostrum, the genu, the body, and the splenium.
The rostrum is the thin part of the anterior end of the corpus callosum,
which is prolonged posteriorly to be continuous with the upper end of the lamina
terminalis.
The genu is the curved anterior end of the corpus callosum that bends
inferiorly in front of the septum pellucidum.
The body of the corpus callosum arches posteriorly and ends as the
thickened posterior portion called the splenium.
Traced laterally, the fibers of the genu curve forward into the frontal lobes
and form the forceps minor.
The fibers of the body extend laterally as the radiation of the corpus
callosum. They intersect with bundles of association and projection fibers as they
pass to the cerebral cortex. Some of the fibers form the roof and lateral wall of the
posterior horn of the lateral ventricle and the lateral wall of the inferior horn of the
lateral ventricle; these fibers are referred to as the tapetum. Traced laterally, the
fibers in the splenium arch backward into the occipital lobe and form the forceps
major.
The anterior commissure is a small bundle of nerve fibers that crosses the
midline in the lamina terminalis. When traced laterally, a smaller or anterior
bundle curves forward on each side toward the anterior perforated substance and
the olfactory tract. A larger bundle curves posteriorly on each side and grooves the
inferior surface of the lentiform nucleus to reach the temporal lobes.
The posterior commissure is a bundle of nerve fibers that crosses the
midline immediately above the opening of the cerebral aqueduct into the third
ventricle; it is related to the inferior part of the stalk of the pineal gland. Various
collections of nerve cells are situated along its length. The destinations and
functional significance of many of the nerve fibers are not known. However, the
fibers from the pretectal nuclei involved in the pupillary light reflex are believed to
cross in this commissure on their way to the parasympathetic part of the
oculomotor nuclei.
The fornix is composed of myelinated nerve fibers and constitutes the
efferent system of the hippocampus that passes to the mammillary bodies of the
hypothalamus. The nerve fibers first form the alveus, which is a thin layer of white
matter covering the ventricular surface of the hippocampus, and then converge to
form the fimbria. The fimbriae of the two sides increase in thickness and, on
reaching the posterior end of the hippocampus, arch forward above the thalamus
and below the corpus callosum to form the posterior columns of the fornix. The
two columns then come together in the midline to form the body of the fornix.
The commissure of the fornix consists of transverse fibers that cross the midline
from one column to another just before the formation of the body of the fornix.
The function of the commissure of the fornix is to connect the hippocampal
formations of the two sides.
The habenular commissure is a small bundle of nerve fibers that crosses
the midline in the superior part of the root of the pineal stalk. The commissure is
associated with the habenular nuclei, which are situated on either side of the
midline in this region. The habenular nuclei receive many afferents from the
amygdaloid nuclei and the hippocampus. These afferent fibers pass to the
habenular nuclei in the stria medullaris thalami. Some of the fibers cross the
midline to reach the contralateral nucleus through the habenular commissure. The
function of the habenular nuclei and its connections in humans is unknown.
Association Fibers
These nerve fibers essentially connect various cortical regions within the
same hemisphere and may be divided into short and long groups. The short
association fibers lie immediately beneath the cortex and connect adjacent gyri;
these fibers run transversely to the long axis of the sulci. The long association
fibers are collected into named bundles that can be dissected in a formalinhardened brain. The uncinate fasciculus connects the first motor speech area and
the gyri on the inferior surface of the frontal lobe with the cortex of the pole of the
temporal lobe. The cingulum is a long, curved fasciculus lying within the white
matter of the cingulate gyrus. It connects the frontal and parietal lobes with
parahippocam-pal and adjacent temporal cortical regions. The superior
longitudinal fasciculus is the largest bundle of nerve fibers. It connects the
anterior part of the frontal lobe to the occipital and temporal lobes. The inferior
longitudinal fasciculus runs anteriorly from the occipital lobe, passing lateral to
the optic radiation, and is distributed to the temporal lobe. The fronto-occipital
fasciculus connects the frontal lobe to the occipital and temporal lobes. It is
situated deep within the cerebral hemisphere and is related to the lateral border of
the caudate nucleus.
Projection Fibers
Afferent and efferent nerve fibers passing to and from the brainstem to the
entire cerebral cortex must travel between large nuclear masses of gray matter
within the cerebral hemisphere. At the upper part of the brainstem, these fibers
form a compact band known as the internal capsule, which is flanked medially by
the caudate nucleus and the thalamus and laterally by the lentiform nucleus.
Because of the wedge shape of the lentiform nucleus, as seen on horizontal section,
the internal capsule is bent to form an anterior limb and a posterior limb, which
are continuous with each other at the genu. Once the nerve fibers have emerged
superiorly from between the nuclear masses, they radiate in all directions to the
cerebral cortex. These radiating projection fibers are known as the corona radiata.
Most of the projection fibers lie medial to the association fibers, but they intersect
the commissural fibers of the corpus callosum and the anterior commissure. The
nerve fibers lying within the most posterior part of the posterior limb of the
internal capsule radiate toward the calcarine sulcus and are known as the optic
radiation.
Septum Pellucidum
The septum pellucidum is a thin vertical sheet of nervous tissue consisting of
white and gray matter covered on either side by ependyma. It stretches between the
fornix and the corpus callosum. Anteriorly, it occupies the interval between the
body of the corpus callosum and the rostrum. It is essentially a double membrane
with a closed, slitlike cavity between the membranes. The septum pellucidum
forms a partition between the anterior horns of the lateral ventricles.
Materials for self-control:
A. Tasks for self-control: explain about brain function.
B. Choose the correct answer:
1.After a head injury in the neck there was a loss of vision. What appeared in the
survey?
A.Revealed pathological process in the cortical end of the visual analyzer (part
calcarine grooves).
B.The pathological process is localized in the parietal lobe of the brain.
C.The pathological process is localized in the medial geniculate body.
D.The pathological process is localized in the cerebellum.
E.The pathological process is localized in the medulla oblongata.
2.The patient (right-handed) lost the ability to fine movements needed to images of
letters, words and other symbols (ahrafiya). What is the area of the cerebral cortex
is affected?
A.Posterior middle frontal gyrus in the left hemisphere.
B.The average share peredtsentralnoyi gyrus in the left hemisphere.
C.Posterior middle frontal gyrus in the right hemisphere.
D.The average share peredtsentralnoyi gyrus in the right hemisphere.
E.The rear section of the upper frontal gyrus in the right hemisphere.
3.After a head injury patient hears the language, understands it, but can not
correctly identify the subject. In which area of the cerebral cortex damage occurred?
A.The lower frontal gyrus.
B.The upper frontal gyrus.
C.In front of the central gyrus.
D.In the middle frontal gyrus.
E.In the middle temporal gyrus.
4.The patient, who had previously worked as a mechanic, suddenly lost the ability
to use tools in the process. In which area of the cerebral cortex appeared cell
destruction?
A.In supramarginal gyrus.
B.In the angular gyrus.
C.In the superior temporal gyrus.
D.In the upper parietal lobules.
E.In the occipital lobe.
5.The patient suddenly lost the ability to read text, see the letter, but unable to make
one word. In which area of cerebral cortex lesion has occurred?
A.In the angular gyrus.
B.In the middle temporal gyrus.
C.In supramarginal gyrus.
D.In the upper parietal lobules.
E.In the occipital lobe.
6.When examining a patient with traumatic injuries of the cerebral cortex revealed
that he has lost tactile sensitivity. What cortex was damaged?
A.Bark posterior central gyrus.
B.Frontal lobe cortex.
C.Occipital lobe cortex.
D.Parietal lobe cortex.
E.Bark anterior central gyrus.
7.Patients after cerebral blood flow lost the ability to write letters and numbers.
What proportion of brain pathology there.
A.In the frontal lobe.
B.In the insular.
C.In the parietal lobe.
D.In the occipital lobe.
E.In the temporal lobe.
8.The patient came unilateral paralysis of the left lower limb. In which area of the
cerebral cortex localized pathological focus?
A.In the right precentral gyrus
B.In a back central gyrus.
C.In an average temporal gyrus.
D.In the top parietal lobe.
E.In the left precentral gyrus.
9.The patient hemorrhage postcentral gyrus. To breach kind of sensitivity with the
other side it will lead?
A.Skin.
B.Olfactory and gustatory.
C.Auditory and visual.
D.Auditory
E.Visual
10.After a brain injury patient has lost the ability to pronounce words clearly. In
some areas of the cerebral cortex lesion appeared?
A.In the frontal lobe.
B.In the occipital lobe.
C.In the parietal lobe.
D.In the temporal lobe.
E.In the insular.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Theme 30. The lateral ventricles. The white matter of thecerebral hemispheres.
Meninges of the brain. Circulation of cerebrospinal liquid.
1. Relevance of the topic:
Knowledge of the topography, the structure of the brain will help in determining the
correct diagnosis of the patient, since the defeat of the brain there are serious
disturbances of different kinds of loss of sensitivity, motor responses. Will help be
prevented inflammation and traumatic brain damage.
2. The specific aims:
Analyze residue which is a think bubble lateral ventricles.
To explain: - part of the lateral ventricles;
- Structures that form the walls of each of the lateral ventricles;
- Part of the corpus callosum;
- Anterior commissure of the brain where it is located, connecting;
- Vaults of the brain;
- Structure of the hard shell of the brain;
- Shoots hard shell of the brain;
- The creation and circulation of cerebrospinal fluid paths.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
Disciplines
Know
Be able
1)
interim Know the structural features Distinguish between membranes
discipline
of the membranes of the of the brain and spinal cord
Biology
brain of higher mammals
subshell spaces
Histology
Know the histological To be able to distinguish
structure of hard, soft and histological
preparations
arachnoid membranes of membrane of the brain.
мозку
2) Courses are provided with normal and abnormal physiology, topographical and
pathological anatomy, surgery, nerve disease.
3)
Interdiscipline Location furrows
To be able to show the skull
integration sinus dura
sulcus sinus dura
the "Osteology"
brain.
brain.
the "Angiology"
main supply
To be able to show the
brain outflow of venous preparation:
blood.
- Plexus chorioideus
- A. carotis interna
- V. jugularis interna
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
Commissure
Commissure
Cavum
Cavity
Lamina
Plate
Nucleus precommissuralis
Before the adhesive core
Ventriculus lateralis
Lateral ventricles
Taenia choroidea
vascular plexus
Fissura choroidea
Vascular gap
Corpus callosum
Corpus callosum
Fornix
Vault
4.2. Theoretical questions for the class:
1. Remains of which are cerebral lateral ventricles bubble?
2.Which parts consists of each of the lateral ventricles and where each of them
placed?
3. What structures form the walls of each of the lateral ventricles?
4. With what and with which combined lateral ventricles?
5. What distinguished spikes brain?
6. What are the parts of the body or corpus is a large spike the brain?
7. What is the anterior commissure of the brain where it is located, connecting?
8. Where transparent partition is located and what it is?
9. What are the parts of the arch is the brain?
10. Name the show and associative fibers.
11. Name and show commissural fibers.
12. Name and show the internal capsule, its limits, parts.
13. Name and pathways show the front leg of the internal capsule.
14. Name and show pathways knee internal capsule.
15. Name and show pathways rear legs inside the capsule.
16. How is the brain membranes, as they are called and how
placing order?
4.3. Practical tasks pertaining to the topic and to be completed during the
class:
1. demonstrates membrane on preparations brain: solid, soft. Indicates the features
of their structure.
2. preparations and processes dummies demonstrated the dura of the brain: cerebral
sickle, cerebellar sickle, cerebellar tent
diaphragm saddle.
The content of the topic.
MENINGES OF THE BRAIN
The brain and spinal cord are surrounded by three membranes, or meninges:
the dura mater, the arachnoid mater, and the pia mater.
Dura Mater
The dura mater of the brain is conventionally described as two layers, the
endosteal layer and the meningeal layer. These are closely united except along
certain lines, where they separate to form venous sinuses.
The endosteal layer is nothing more than the periosteum covering the inner
surface of the skull bones. At the foramen magnum, it does not become continuous
with the dura mater of the spinal cord. Around the margins of all the foramina in
the skull, it becomes continuous with the periosteum on the outside of the skull
bones. At the sutures, it is continuous with the sutural ligaments. It is most
strongly adherent to the bones over the base of the skull.
The meningeal layer is the dura mater proper. It is a dense, strong fibrous
membrane covering the brain and is continuous through the foramen magnum with
the dura mater of the spinal cord. It provides tubular sheaths for the cranial nerves
as the latter pass through the foramina in the skull. Outside the skull, the sheaths
fuse with the epineurium of the nerves.
The meningeal layer sends inward four septa, which divide the cranial cavity
into freely communicating spaces that lodge the subdivisions of the brain. The
function of these septa is to restrict the displacement of the brain associated with
acceleration and deceleration, when the head is moved.
The falx cerebri is a sickle-shaped fold of dura mater that lies in the midline
between the two cerebral hemispheres. Its narrow anterior end is attached to the
internal frontal crest and the crista galli. Its broad posterior part blends in the
midline with the upper surface of the tentorium cerebelli. The superior sagittal
sinus runs in its upper fixed margin; the inferior sagittal sinus runs in its lower
concave free margin; and the straight sinus runs along its attachment to the
tentorium cerebelli.
The tentorium cerebelli is a crescent-shaped fold of dura mater that roofs
over the posterior cranial fossa. It covers the upper surface of the cerebellum and
supports the occipital lobes of the cerebral hemispheres. In the anterior edge there
is a gap, the tentorial notch, for the passage of the midbrain, which produces an
inner free border and an outer attached or fixed border. The fixed border is
attached to the posterior clinoid processes, the superior borders of the petrous
bones, and the margins of the grooves for the transverse sinuses on the occipital
bone. The free border runs forward at its two ends, crosses the attached border, and
is affixed to the anterior clinoid process on each side. At the point where the two
borders cross, the third and fourth cranial nerves pass forward to enter the lateral
wall of the cavernous sinus.
Close to the apex of the petrous part of the temporal bone, the lower layer of
the tentorium is pouched forward beneath the superior petrosal sinus to form a
recess for the trigeminal nerve and the trigeminal ganglion.
The falx cerebri and the falx cerebelli are attached to the upper and lower
surfaces of the tentorium, respectively. The straight sinus runs along its attachment
to the falx cerebri; the superior petrosal sinus runs along its attachment to the
petrous bone; and the transverse sinus runs along its attachment to the occipital
bone.
The falx cerebelli, a small, sickle-shaped fold of dura mater attached to the
internal occipital crest, projects forward between the two cerebellar hemispheres.
Its posterior fixed margin contains the occipital sinus.
The diaphragma sellae is a small, circular fold of dura mater that forms the
roof for the sella turcica. A small opening in its center allows passage of the stalk
of the hypophysis cerebri.
Dural Venous Sinuses
The venous sinuses of the cranial cavity are situated between the layers of
the dura mater. Their main function is to receive blood from the brain through the
cerebral veins and the cerebrospinal fluid from the subarachnoid space through the
arachnoid villi. The blood in the dural sinuses ultimately drains into the internal
jugular veins in the neck. The dural sinuses are lined by endothelium, and their
walls are thick but devoid of muscular tissue. They have no valves. Emissary
veins, which are also valveless, connect the dural venous sinuses with the diploic
veins of the skull and with the veins of the scalp.
The superior sagittal sinus occupies the upper fixed border of the falx
cerebri. It begins anteriorly at the foramen cecum,.where it occasionally receives a
vein from the nasal cavity. It runs posteriorly, grooving the vault of the skull, and
at the internal occipital protuberance it deviates to one or the other side (usually the
right) and becomes continuous with the corresponding transverse sinus. The sinus
communicates through small openings with two or three irregularly shaped venous
lacunae on each side. Numerous arachnoid villi and granulations project into the
lacunae, which also receive the diploic and meningeal veins.
The superior sagittal sinus in its course receives the superior cerebral
veins. At the internal occipital protuberance, it is dilated to form the confluence of
the sinuses. Here, the superior sagittal sinus usually becomes continuous with the
right transverse sinus; it is connected to the opposite transverse sinus and receives
the occipital sinus. The inferior sagittal sinus occupies the free lower margin of
the falx cerebri. It runs backward and joins the great cerebral vein at the free
margin of the tentorium cerebelli, to form the straight sinus. It receives a few cerebral veins from the medial surface of the cerebral hemispheres.
The straight sinus occupies the line of junction of the falx cerebri with the
tentorium cerebelli. It is formed by the union of the inferior sagittal sinus with the
great cerebral vein. It ends by turning to the left (sometimes to the right) to form
the transverse sinus.
The transverse sinuses are paired structures and begin at the internal
occipital protuberance. The right sinus is usually continuous with the superior
sagittal sinus, and the left is continuous with the straight sinus. Each sinus occupies
the attached margin of the tentorium cerebelli, grooving the occipital bone and the
pos-teroinferior angle of the parietal bone. The transverse sinuses receive the
superior petrosal sinuses, the inferior cerebral and cerebellar veins, and the
diploic veins. They end by turning downward as the sigmoid sinuses.
The sigmoid sinuses are a direct continuation of the transverse sinuses. Each
sinus turns downward and medially and grooves the mastoid part of the temporal
bone. It is here that the sinus lies posterior to the mastoid antrum. The sinus then
turns forward and then inferiorly through the posterior part of the jugular foramen
to become continuous with the superior bulb of the internal jugular vein.
The occipital sinus is a small sinus occupying the attached margin of the
falx cerebelli. It commences near the foramen magnum, where it communicates
with the vertebral veins and drains into the confluence of sinuses.
The cavernous sinuses are situated in the middle cranial fossa on each side
of the body of the sphenoid bone. Numerous trabeculae cross their interior, giving
them a spongy appearance, hence the name. Each sinus extends from the superior
orbital fissure in front to the apex of the petrous part of the temporal bone behind.
The tributaries are the superior and inferior ophthalmic veins, the inferior
cerebral veins, the sphenoparietal sinus, and the central vein of the retina.
The sinus drains posteriorly into the superior and inferior petrosal sinuses
and inferiorly into the pterygoid venous plexus.
The two sinuses communicate with each other by means of the anterior and
posterior intercavernous sinuses, which run in the diaphragma sellae anterior and
posterior to the stalk of the hypophysis cerebri. Each sinus has an important
communication with the facial vein through the superior ophthalmic vein. (This is
a route by which infection can travel from the facial skin to the cavernous sinus.)
The superior and inferior petrosal sinuses are small sinuses situated on the
superior and inferior borders of the petrous part of the temporal bone on each side
of the skull. Each superior sinus drains the cavernous sinus into the transverse
sinus, and each inferior sinus drains the cavernous sinus into the internal jugular
vein.
ARACHNOID MATER
The arachnoid mater is a delicate, impermeable membrane covering the
brain and lying between the pia mater internally and the dura mater externally. It is
separated from the dura by a potential space, the subdural space, filled by a film
of fluid; it is separated from the pia by the subarachnoid space, which is filled
with cerebrospinal fluid. The outer and inner surfaces of the arachnoid are
covered with flattened mesothelial cells.
The arachnoid bridges over the sulci on the surface of the brain, and in
certain situations the arachnoid and pia are widely separated to form the
subarachnoid cisternae. The cisterna cerebellomedullaris lies between the
inferior surface of the cerebellum and the roof of the fourth ventricle. The cisterna
interpeduncularis lies between the two cerebral peduncles. All the cisternae are in
free communication with one another and with the remainder of the subarachnoid
space.
In certain areas, the arachnoid projects into the venous sinuses to form
arachnoid villi. The arachnoid villi are most numerous along the superior sagittal
sinus. Aggregations of arachnoid villi are referred to as arachnoid granulations.
Arachnoid villi serve as sites where the cerebrospinal fluid diffuses into the
bloodstream.
The arachnoid is connected to the pia mater across the fluid-filled
subarachnoid space by delicate strands of fibrous tissue.
Structures passing to and from the brain to the skull or its foramina must
pass through the subarachnoid space. All the cerebral arteries and veins lie in the
space, as do the cranial nerves. The arachnoid fuses with the epineurium of the
nerves at their point of exit from the skull.
The cerebrospinal fluid is produced by the choroid plexuses within the
lateral, third, and fourth ventricles of the brain. It escapes from the ventricular
system of the brain through the three foramina in the roof of the fourth ventricle
and so enters the subarachnoid space. It now circulates both upward over the
surfaces of the cerebral hemispheres and downward around the spinal cord. The
spinal subarachnoid space extends down as far as the second sacral vertebra (see
next column). Eventually, the fluid enters the bloodstream by passing into the
arachnoid villi and diffusing through their walls.
In addition to removing waste products associated with neuronal activity, the
cerebrospinal fluid provides a fluid medium in which the brain floats. This
mechanism effectively protects the brain from trauma. In addition, the fluid is now
believed to play a role in hormonal transport.
PIA MATER
The pia mater is a vascular membrane covered by flattened mesothelial cells.
It closely invests the brain, covering the gyri and descending into the deepest sulci.
It extends out over the cranial nerves and fuses with their epineurium. The cerebral
arteries entering the substance of the brain carry a sheath of pia with them.
The pia mater forms the tela choroidea of the roof of the third and fourth
ventricles of the brain, and it fuses with the ependyma to form the choroid plexuses
in the lateral, third, and fourth ventricles of the brain.
MENINGES OF THE SPINAL CORD
Dura Mater. The dura mater is a dense, strong, fibrous membrane that encloses the spinal cord and the cauda equina. It is continuous above through the
foramen magnum with the meningeal layer of dura covering the brain. Inferiorly, it
ends on the filum terminale at the level of the lower border of the second sacral
vertebra. The dural sheath lies loosely in the vertebral canal and is separated from
the wall of the canal by the extradural space. This contains loose areolar tissue
and the internal vertebral venous plexus. The dura mater extends along each
nerve root and becomes continuous with the connective tissue surrounding each
spinal nerve (epineurium). The inner surface of the dura mater is in contact with
the arachnoid mater.
Arachnoid Mater. The arachnoid mater is a delicate impermeable
membrane that covers the spinal cord and lies between the pia mater internally and
dura mater externally. It is separated from the pia mater by a wide space, the
subarachnoid space, which is filled with cerebrospinal fluid. The subarachnoid
space is crossed by a number of fine strands of connective tissue. The arachnoid
mater is continuous above through the foramen magnum with the arachnoid
covering the brain. Inferiorly, it ends on the filum terminale at the level of the
lower border of the second sacral vertebra. The arachnoid mater continues along
the spinal nerve roots, forming small lateral extensions of the subarachnoid space.
Pia Mater. The pia mater, a vascular membrane that closely covers the
spinal cord, is thickened on either side between the nerve roots to form the
ligamentum denticulatum, which passes laterally to adhere to the arachnoid and
dura. It is by this means that the spinal cord is suspended in the middle of the dural
sheath. The pia mater extends along each nerve root and becomes continuous with
the connective tissue surrounding each spinal nerve.
VENTRICULAR SYSTEM
The ventricles are four fluid-filled cavities located within the brain; these are
the two lateral ventricles, the third ventricle, and the fourth ventricle. The two
lateral ventricles communicate through the interventricular foramina (of
Monro) with the third ventricle. The third ventricle is connected to the fourth
ventricle by the narrow cerebral aqueduct (aqueduct of Sylvius). The fourth
ventricle, in turn, is continuous with the narrow central canal of the spinal cord
and, through the three foramina in its roof, with the subarachnoid space. The
central canal in the spinal cord has a small dilatation at its inferior end, referred to
as the terminal ventricle.
The ventricles are lined throughout with ependyma and are filled with
cerebrospinal fluid. The ventricles are developmentally derived from the cavity of
the neural tube.
SUBARACHNOID SPACE
The subarachnoid space is the interval between the arachnid mater and pia
mater and, therefore, is present where these meninges envelop the brain and spinal
cord. The space is filled with cerebrospinal fluid and contains the large blood
vessels of the brain. This space is traversed by a network of fine trabeculae, formed
of delicate connective tissue. The subarachnoid space completely surrounds the
brain and extends along the olfactory nerves to the mucoperiosteum of the nose.
The subarachnoid space also extends along the cerebral blood vessels as they enter
and leave the substance of the brain and stops where the vessels become an
arteriole or a venule.
In certain situations around the base of the brain, the arachnoid does not
closely follow the surface of the brain so that the subarachnoid space expands to
form subarachnoid cisterns. The descriptions of the cerebellomedullary cistern,
the pontine cistern, and the interpeduncular cistern, which are the largest
cisterns.
Inferiorly, the subarachnoid space extends beyond the lower end of the
spinal cord and invests the cauda equina. The subarachnoid space ends below at
the level of the interval between the second and third sacral vertebrae.
The subarachnoid space surrounds the cranial and spinal nerves and follows
them to the point where they leave the skull and vertebral canal. Here the
arachnoid mater and pia mater fuse with the perineurium of each nerve.
CEREBROSPINAL FLUID
The cerebrospinal fluid is found in the ventricles of the brain and in the
subarachnoid space around the brain and spinal cord. It is a clear, colorless fluid. It
possesses, in solution, inorganic salts similar to those in the blood plasma. The
glucose content is about half that of blood, and there is only a trace of protein.
Only a few cells are present, and these are lymphocytes. The normal lymphocyte
count is 0 to 3 cells per cubic millimeter. The pressure of the cerebrospinal fluid is
kept remarkably constant. In the lateral recumbent position, the pressure, as
measured by spinal tap, is about 60 to 150 mm of water. This pressure may be
raised by straining, coughing, or compressing the internal jugular veins in the neck.
The total volume of cerebrospinal fluid in the subarachnoid space and within the
ventricles is about 130 ml.
Functions. The cerebrospinal fluid, which bathes the external and internal
surfaces of the brain and spinal cord, serves as a cushion between the central
nervous system and the surrounding bones, thus protecting it against mechanical
trauma. Because the density of the brain is only slightly greater than that of the
cerebrospinal fluid, it provides mechanical buoyancy and support for the brain. The
close relationship of the fluid to the nervous tissue and the blood enables it to serve
as a reservoir and assist in the regulation of the contents of the skull. For example,
if the brain volume or the blood volume increases, the cerebrospinal fluid volume
decreases. Since the cerebrospinal fluid is an ideal physiological substrate, it
probably plays an active part in the nourishment of the nervous tissue; it almost
certainly assists in the removal of products of neuronal metabolism. It is possible
that the secretions of the pineal gland influence the activities of the pituitary gland
by circulating through the cerebrospinal fluid in the third ventricle.
Formation. The cerebrospinal fluid is formed mainly in the choroid
plexuses of the lateral, third, and fourth ventricles; some originates from the
ependymal cells lining the ventricles and from the brain substance through the
perivascular spaces.
The choroid plexuses have a much folded surface, and each fold consists of a
core of vascular connective tissue covered with cuboidal epithelium of the
ependyma. Electron-microscopic examination of the epithelial cells shows that
their free surfaces are covered with microvilli. The blood of the capillaries is
separated from the ventricular lumen by endothelium, a basement membrane, and
the surface epithelium. The epithelial cells are fenestrated and permeable to large
molecules.
The choroid plexuses actively secrete cerebrospinal fluid, and this creates a
small pressure gradient. At the same time, they actively transport nervous system
metabolites from the cerebrospinal fluid into the blood. Active transport also
explains the fact that the concentrations of potassium, calcium, magnesium,
bicarbonate, and glucose are lower in the cerebrospinal fluid than in the blood
plasma.
The cerebrospinal fluid is produced continuously at a rate of about 0.5 ml
per minute and with a total volume of about 130 ml; this corresponds to a turnover
time of about 5 hours.
It is important to realize that the production of cerebrospinal fluid is not
pressure regulated (as in the case of blood pressure) and it continues to be
produced even if the reabsorption mechanisms are obstructed.
Circulation. The circulation begins with its secretion from the choroid
plexuses in the ventricles and its production from the brain surface. The fluid
passes from the lateral ventricles into the third ventricle through the
interventricular foramina. It then passes into the fourth ventricle through the
narrow cerebral aqueduct. The circulation is aided by the arterial pulsations of the
choroid plexuses and by the cilia on the ependymal cells lining the ventricles.
From the fourth ventricle, the fluid passes slowly through the median
aperture and the lateral foramina of the lateral recesses of the fourth ventricle and
enters the subarachnoid space. The fluid then moves through the cerebellomedullary
cistern and pontine cisterns and flows superiorly through the
tentorial notch of the tentorium cerebelli to reach the inferior surface of the
cerebrum. It then moves superiorly over the lateral aspect of each cerebral hemisphere, assisted by the pulsations of the cerebral arteries. Some of the
cerebrospinal fluid moves inferiorly in the subarachnoid space around the spinal
cord and cauda equina. Here the fluid is at a dead end, and its further circulation
relies on the pulsations of the spinal arteries and the movements of the vertebral
column, respiration, coughing, and the changing of the positions of the body.
The cerebrospinal fluid not only bathes the ependymal and pial surfaces of
the brain and spinal cord but also penetrates the nervous tissue along the blood
vessels.
Absorption. The main sites for the absorption of the cerebrospinal fluid are
the arachnoid villi that project into the dural venous sinuses, especially the
superior sagittal sinus. The arachnoid villi tend to be grouped together to form
elevations known as arachnoid granulations. Structurally, each arachnoid villus
is a diverticulum of the subarachnoid space that pierces the dura mater. The
arachnoid diverticulum is capped by a thin cellular layer, which, in turn, is covered
by the endothelium of the venous sinus. The arachnoid granulations increase in
number and size with age and tend to become calcified with advanced age.
The absorption of cerebrospinal fluid into the venous sinuses occurs when
the cerebrospinal fluid pressure exceeds the venous pressure in the sinus. Electronmicroscopic studies of the arachnoid villi indicate that fine tubules lined with
endothelium permit a direct flow of fluid from the subarachnoid space into the
lumen of the venous sinuses. Should the venous pressure rise and exceed the
cerebrospinal fluid pressure, compression of the tips of the villi closes the tubules
and prevents the reflux of blood into the subarachnoid space. The arachnoid villi
thus serve as valves. Lateral Ventricles
There are two large lateral ventricles, and one is present in each cerebral
hemisphere. The ventricle is a roughly C-shaped cavity and may be divided into a
body, which occupies the parietal lobe and from which anterior, posterior, and
inferior horns extend into the frontal, occipital, and temporal lobes, respectively.
The lateral ventricle communicates with the cavity of the third ventricle through
the interventricular foramen. This opening, which lies in the anterior part of the
medial wall of the ventricle, is bounded anteriorly by the anterior column of the
fornix and posteriorly by the anterior end of the thalamus.
The body of the lateral ventricle extends from the interventricular foramen
posteriorly as far as the posterior end of the thalamus. Here it becomes continuous
with the posterior and the inferior horns. The body of the lateral ventricle has a
roof, a floor, and a medial wall.
The roof is formed by the undersurface of the corpus callosum. The floor is
formed by the body of the caudate nucleus and the lateral margin of the thalamus.
The superior surface of the thalamus is obscured in its medial part by the body of
the fornix. The choroid plexus of the ventricle projects into the body of the
ventricle through the slitlike gap between the body of the fornix and the superior
surface of the thalamus. This slitlike gap is known as the choroidal fissure;
through it the blood vessels of the plexus invaginate the pia mater of the tela
choroidea and the ependyma of the lateral ventricle. The medial wall is formed by
the septum pellucidum anteriorly; posteriorly the roof and the floor come together
on the medial wall.
The anterior horn of the lateral ventricle extends forward into the frontal
lobe. It is continuous posteriorly with the body of the ventricle at the interventricular foramen. The anterior horn has a roof, a floor, and a medial wall. The roof
is formed by the undersurface of the anterior part of the corpus callosum; the
genu of the corpus callosum limits the anterior horn anteriorly.
The floor is formed by the rounded head of the caudate nucleus, and
medially a small portion is formed by the superior surface of the rostrum of the
corpus callosum. The medial wall is formed by the septum pellucidum and the
anterior column of the fornix.
The posterior horn of the lateral ventricle extends posteriorly into the
occipital lobe. The roof and lateral wall are formed by the fibers of the tapetum
of the corpus callosum. Lateral to the tapetum are the fibers of the optic
radiation. The medial wall of the posterior horn has two elevations. The superior
swelling is caused by the splenial fibers of the corpus callosum, called the forceps
major, passing posteriorly into the occipital lobe; this superior swelling is referred
to as the bulb of the posterior horn. The inferior swelling is produced by the
calcarine sulcus and is called the calcar avis.
The inferior horn of the lateral ventricle extends anteriorly into the
temporal lobe. The inferior horn has a roof and a floor.
The roof is formed by the inferior surface of the tapetum of the corpus
callosum and by the tail of the caudate nucleus. The latter passes anteriorly to
end in the amygdaloid nucleus. Medial to the tail of the caudate nucleus is the
stria terminalis, which also ends anteriorly in the amygdaloid nucleus.
The floor is formed laterally by the collateral eminence, produced by the
collateral fissure, and medially by the hippocampus. The anterior end of the
hippocampus is expanded and slightly furrowed to form the pes hippocampus.
The hippocampus is composed of gray matter; however, the ventricular surface of
the hippocampus is covered by a thin layer of white matter called the alveus,
which is formed from the axons of the cells of the hippocampus. These axons
converge on the medial border of the hippocampus to form a bundle known as the
fimbria. The fimbria of the hippocampus becomes continuous posteriorly with the
posterior column of the fornix. In the interval between the stria terminalis and the
fimbria is the temporal part of the choroidal fissure. It is here that the lower part of
the choroid plexus of the lateral ventricle invaginates the ependyma from the
medial side and closes the fissure.
Materials for self-check:
A. Tasks for self-check: to mark tables lateral ventricles and membranes of the
brain and ways cerebral circulation and CSF.
B. Choose the correct answer:
1.Because of stroke (bleeding in the brain), the patient has no volitional movements
of muscles of the head and neck. Examination of the brain using MRI showed
hematoma is the knee of the internal capsule. Which pathways is damaged?
A.Тг. соrtісо-nuclearis
B.Тг. соrtісо-frоntо-pontius.
C.Тг. соrtiсо-spinalis.
D.Тг. согtiсо-thalamicus.
E.Тг. thalamo-соrtiсаlis.
2.Prophylactic examination showed a reduction in all kinds of sensitivity on the
right half of the body. Additional survey NMR showed a small brain tumor
localized in the rear leg of the internal left capsule. Damage of which pathway was
the cause of the mentioned symptoms?
A.Tr. spino-thalamicus.
B.The central visual way.
C.Tr. cortico-spinalis.
D.Tr. cortuico-nuclearis.
E.Central auditory way.
3.Patient hydrocephalus - dropsy on the brain. On MRI enlargement of the lateral
ventricles. The third ventricle is not expanded. At the level of the holes which held
occlusion circulation of cerebrospinal fluid?
A.interventricular holes.
B.Odd middle roof vents IV ventricle (Mazhendi`s).
C.Right side roof vents IV ventricle (Lyushko`s).
D.The left side of the roof vents IV ventricle (Lyushko`s).
E.aqueducts brain.
4.The patient has white matter lesions, which extends from the pillars to the arch of
the corpus callosum and consists of two plates. Point the lesions:
A.transparent partition
B.head of the caudate nucleus
C.corpus callosum
D.thalamus
E.body arch.
5.During the examination of the brain using MRI were revealed markedly dilated
lateral and third ventricles. The doctor diagnosed blockade of cerebrospinal fluid
pathways. Determine the level of occlusion.
A.Cerebral aqueduc
B.between ventricular holes.
C.median aperture of the fourth ventricle.
D.The side openings of the fourth ventricle.
E.Pacchioni's granulations
6.After inflammation of the brain (encephalitis) was found elevated cerebrospinal
fluid pressure in the right lateral ventricle of the brain. What could be related to this
phenomenon?
A.Closure of the interventricular hole on the right.
B.Closure of the interventricular hole left.
C.imperforate of central canal of the spinal cord.
D.imperforate of plumbing brain.
E.imperforate of holes of Mazhendi and Lyushko of IV ventricle.
7.In the neurosurgical department enrolled patient with damage of the upper wall of
the lateral ventricle center. It is formed by:
A.Corpus callosum
B.septum pelucidum
C.Caput caudati
D.Thalamus
E.fornix
8.In the neurosurgical department enrolled patient with damage of the lower wall of
the anterior horn of the lateral ventricle. It is formed by:
A.Caput n. caudati
B.septum pelucidum
C.Corpus callosum
D.Thalamus
E.fornix
9.Patient has been diagnosed the injury of substantia alba that connects the papillary
bodies with seahorse and is situated under the mesolobus. Point lesions:
A.fornix
B.septum pelucidum
C.Caput caudati
D.Corpus callosum
E.Thalamus
10.Patient has been diagnosed the injury of substantia alba that is situated from the
temporal and parietal lobes of the cortex to the inferior frontal gyrus. Point lesions:
A.radius reflectitur
B.Caput caudati
C.Corpus callosum
D.thalamus
E.fornix
Literature.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 31-32. General esthesiology. Visual analyzer. Eyeball: layers, chambers,
refracting medias. Accessory structures of visual analyzer. Nervous pathway of
visual analyzer.
1. Relevance of the topic:
Information about sense organs, the eye and related structures, the accessory visual
structures, the pathway of the visual analyzer are important for students of all
specialties for further study.
2. The specific aims:
Explain to students the structure of the eye, explore the utility of the
device body, leading the way visual analyzer.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration).
The
The acquired knowledge
preceding
subjects
Biology
phylogeny visual analyzer;
Topics for further study.
4. The tasks for students' individual work.
4.1. The list of basic terms, parameters, characteristics which the student
should master while preparing for the class.
Organa sensorium
Sense organs
Bulbus oculi
Eyeball
Tunica fibrosa bulbi
Fibrous membrane of the
eye
Tunica vasculosa bulbi
Choroid
Cornea
Musculus ciliaris
Iris
Lens
Camerae bulbi
Apparatus lacrimalis
Cornea
Ciliary muscle
Iris
The lens
Cameras eyeball
Lacrimal apparatus
4.2. Theoretical questions for the class:
1. Components of the visual analyzer?
2. The represented capsule eyeball?
3. Structure and function of membranes eyeball?
4. Components of the uvea and their functions?
5. avilable inner lining of the eyeball?
6. What structures form the inner core of the eyeball?
7. Structure cameras eyeball creation and circulation of fluid inside the eye?
8. What applies to support staff eye?
9. Where are the cortical and subcortical centers of authority?
10.Providnyy way of eye.
11. Define the term "blyzorukist" "dalnozorkist" that these methods may correct
blurred vision?
4.3. Practical tasks pertaining to the topic and to be completed during the
class:
working with wet preparations, models, decision of test tasks and situational
problems with the database "Step 1"
The content of the topic.
The Organ of Sight; the visual organ (Organum Visus; The Eye). Related
terminology: oculus (Lat.) and ophthalmos (Greek) stand for «eye».
The bulb of the eye (bulbus oculi; eyeball), or organ of sight, is contained in the
cavity of the orbit, where it is protected from injury and moved by the ocular
muscles. Associated with it are certain accessory structures, viz., the muscles,
fasciæ, eyebrows, eyelids, conjunctiva, and lacrimal apparatus.
The bulb of the eye is imbedded in the fat of the orbit, but is separated from it by a
thin membranous sac, the fascia bulbi. It is composed of segments of two spheres
of different sizes. The anterior segment is one of a small sphere; it is transparent,
and forms about one-sixth of the bulb. It is more prominent than the posterior
segment, which is one of a larger sphere, and is opaque, and forms about five-sixths
of the bulb. The term anterior pole is applied to the central point of the anterior
curvature of the bulb, and that of posterior pole to the central point of its posterior
curvature; a line joining the two poles forms the optic axis. The axes of the two
bulbs are nearly parallel, and therefore do not correspond to the axes of the orbits,
which are directed forward and lateralward. The optic nerves follow the direction of
the axes of the orbits, and are therefore not parallel; each enters its eyeball 3 mm. to
the nasal side and a little below the level of the posterior pole. The bulb measures
rather more in its transverse and antero-posterior diameters than in its vertical
diameter, the former amounting to about 24 mm., the latter to about 23.5 mm.; in
the female all three diameters are rather less than in the male; its antero-posterior
diameter at birth is about 17.5 mm., and at puberty from 20 to 21 mm.
From without inward the three tunics are: (1) A fibrous tunic, consisting of the
sclera behind and the cornea in front; (2) a vascular pigmented tunic, comprising,
from behind forward, the choroid, ciliary body, and iris; and (3) a nervous tunic,
the retina.
The Fibrous Tunic (tunica fibrosa oculi).—The sclera and cornea form the fibrous
tunic of the bulb of the eye; the sclera is opaque, and constitutes the posterior fivesixths of the tunic; the cornea is transparent, and forms the anterior sixth.
The sclera has received its name from its extreme density and hardness; it is a firm,
unyielding membrane, serving to maintain the form of the bulb. It is much thicker
behind than in front; the thickness of its posterior part is 1 mm. Its external surface
is of white color, and is in contact with the inner surface of the fascia of the bulb; it
is quite smooth, except at the points where the Recti and Obliqui are inserted into it;
its anterior part is covered by the conjunctival membrane.
The cornea is the projecting transparent part of the external tunic, and forms the
anterior sixth of the surface of the bulb. It is almost circular in outline, occasionally
a little broader in the transverse than in the vertical direction. It is convex anteriorly
and projects like a dome in front of the sclera. Its degree of curvature varies in
different individuals, and in the same individual at different periods of life, being
more pronounced in youth than in advanced life.
The Vascular Tunic (tunica vasculosa oculi) — The vascular tunic of the eye is
formed from behind forward by the choroid, the ciliary body, and the iris.
The choroid invests the posterior five-sixths of the bulb, and extends as far forward
as the ora serrata of the retina. The ciliary body connects the choroid to the
circumference of the iris. The iris is a circular diaphragm behind the cornea, and
presents near its center a rounded aperture, the pupil.
The choroid is a thin, highly vascular membrane, of a dark brown or chocolate
color, investing the posterior five-sixths of the globe; it is pierced behind by the
optic nerve, and in this situation is firmly adherent to the sclera. It is thicker behind
than in front. Its outer surface is loosely connected by the lamina suprachorioidea
with the sclera; its inner surface is attached to the pigmented layer of the retina.
The ciliary body comprises the orbiculus ciliaris, the ciliary processes, and the
Ciliaris muscle.
The iris has received its name from its various colors in different individuals. It is a
thin, circular, contractile disk, suspended in the aqueous humor between the cornea
and lens, and perforated a little to the nasal side of its center by a circular aperture,
the pupil. By its periphery it is continuous with the ciliary body, and is also
connected with the posterior elastic lamina of the cornea by means of the pectinate
ligament; its surfaces are flattened, and look forward and backward, the anterior
toward the cornea, the posterior toward the ciliary processes and lens. The iris
divides the space between the lens and the cornea into an anterior and a posterior
chamber. The anterior chamber of the eye is bounded in front by the posterior
surface of the cornea; behind by the front of the iris and the central part of the lens.
The posterior chamber is a narrow chink behind the peripheral part of the iris, and
in front of the suspensory ligament of the lens and the ciliary processes. In the adult
the two chambers communicate through the pupil, but in the fetus up to the seventh
month they are separated by the membrana pupillaris.
The Retina (tunica interna).—The retina is a delicate nervous membrane, upon
which the images of external objects are received. Its outer surface is in contact with
the choroid; its inner with the hyaloid membrane of the vitreous body. Behind, it is
continuous with the optic nerve; it gradually diminishes in thickness from behind
forward, and extends nearly as far as the ciliary body, where it appears to end in a
jagged margin, the ora serrata. Here the nervous tissues of the retina end, but a thin
prolongation of the membrane extends forward over the back of the ciliary
processes and iris, forming the pars ciliaris retinæ and pars iridica retinæ already
referred to. This forward prolongation consists of the pigmentary layer of the retina
together with a stratum of columnar epithelium. The retina is soft, semitransparent,
and of a purple tint in the fresh state, owing to the presence of a coloring material
named rhodopsin or visual purple; but it soon becomes clouded, opaque, and
bleached when exposed to sunlight. Exactly in the center of the posterior part of the
retina, corresponding to the axis of the eye, and at a point in which the sense of
vision is most perfect, is an oval yellowish area, the macula lutea; in the macula is
a central depression, the fovea centralis. At the fovea centralis the retina is
exceedingly thin, and the dark color of the choroid is distinctly seen through it.
About 3 mm. to the nasal side of the macula lutæ is the entrance of the optic nerve
(optic disk), the circumference of which is slightly raised to form an eminence
(colliculus nervi optici); the arteria centralis retinæ pierces the center of the disk.
This is the only part of the surface of the retina which is insensitive to light, and it is
termed the blind spot.
Macula Lutea and Fovea Centralis.—In the macula lutea the nerve fibers are
wanting as a continuous layer, the ganglionic layer consists of several strata of cells,
there are no rods, but only cones, which are longer and narrower than in other parts,
and in the outer nuclear layer there are only cone-granules, the processes of which
are very long and arranged in curved lines. In the fovea centralis the only parts
present are (1) the cones; (2) the outer nuclear layer, the cone-fibers of which are
almost horizontal in direction; (3) an exceedingly thin inner plexiform layer. The
pigmented layer is thicker and its pigment more pronounced than elsewhere. The
color of the macula seems to imbue all the layers except that of the rods and cones;
it is of a rich yellow, deepest toward the center of the macula, and does not appear
to be due to pigment cells, but simply to a staining of the constituent parts.
At the ora serrata the nervous layers of the retina end abruptly, and the retina is
continued onward as a single layer of columnar cells covered by the pigmented
layer. This double layer is known as the pars ciliaris retinæ, and can be traced
forward from the ciliary processes on to the back of the iris, where it is termed the
pars iridica retinæ or uvea.
The Refracting Media. The refracting media are three, viz.:
Aqueous humor.
Vitreous body.
Crystalline lens.
The Aqueous Humor (humor aqueus). — The aqueous humor fills the anterior and
posterior chambers of the eyeball. It is small in quantity, has an alkaline reaction,
and consists mainly of water, less than one-fiftieth of its weight being solid matter,
chiefly chloride of sodium.
The Vitreous Body (corpus vitreum). — The vitreous body forms about four-fifths
of the bulb of the eye. It fills the concavity of the retina, and is hollowed in front,
forming a deep concavity, the hyaloid fossa, for the reception of the lens. It is
transparent, of the consistence of thin jelly, and is composed of an albuminous fluid
enclosed in a delicate transparent membrane, the hyaloid membrane. It has been
supposed, by Hannover, that from its surface numerous thin lamellæ are prolonged
inward in a radiating manner, forming spaces in which the fluid is contained. In the
adult, these lamellæ cannot be detected even after careful microscopic examination
in the fresh state, but in preparations hardened in weak chromic acid it is possible to
make out a distinct lamellation at the periphery of the body. In the center of the
vitreous body, running from the entrance of the optic nerve to the posterior surface
of the lens, is a canal, the hyaloid canal, filled with lymph and lined by a
prolongation of the hyaloid membrane. This canal, in the embryonic vitreous body,
conveyed the arteria hyaloidea from the central artery of the retina to the back of the
lens. The fluid from the vitreous body is nearly pure water; it contains, however,
some salts, and a little albumin.
The Crystalline Lens (lens crystallina).—The crystalline lens, enclosed in its
capsule, is situated immediately behind the iris, in front of the vitreous body, and
encircled by the ciliary processes, which slightly overlap its margin.
The Accessory Organs of the Eye (Organa Oculi Accessoria)
The accessory organs of the eye include the ocular muscles, the conjunctiva, and
the lacrimal apparatus.
The Ocular Muscles (musculi oculi).—The ocular muscles are the:
Rectus inferior.
Rectus medialis.
Rectus superior.
Rectus lateralis.
Obliquus inferior.
Obliquus superior.
The four Recti arise from a fibrous ring (annulus tendineus communis) which
surrounds the upper, medial, and lower margins of the optic foramen and encircles
the optic nerve. The ring is completed by a tendinous bridge prolonged over the
lower and medial part of the superior orbital fissure and attached to a tubercle on the
margin of the great wing of the sphenoid, bounding the fissure. Two specialized
parts of this fibrous ring may be made out: a lower, the ligament, which gives
origin to the Rectus inferior, part of the Rectus internus, and the lower head of
origin of the Rectus lateralis; and an upper, which gives origin to the Rectus
superior, the rest of the Rectus medialis, and the upper head of the Rectus lateralis.
This upper band is sometimes termed the superior tendon of Lockwood. Each
muscle passes forward in the position implied by its name, to be inserted by a
tendinous expansion into the sclera, about 6 mm. from the margin of the cornea.
Between the two heads of the Rectus lateralis is a narrow interval, through which
pass the two divisions of the oculomotor nerve, the nasociliary nerve, the abducent
nerve, and the ophthalmic vein. Although these muscles present a common origin
and are inserted in a similar manner into the sclera, there are certain differences to
be observed in them as regards their length and breadth. The Rectus medialis is the
broadest, the Rectus lateralis the longest, and the Rectus superior the thinnest and
narrowest.
The Obliquus oculi superior (superior oblique) is a fusiform muscle, placed at the
upper and medial side of the orbit. It arises immediately above the margin of the
optic foramen, above and medial to the origin of the Rectus superior, and, passing
forward, ends in a rounded tendon, which plays in a fibrocartilaginous ring or pulley
attached to the trochlear fovea of the frontal bone. The contiguous surfaces of the
tendon and ring are lined by a delicate mucous sheath, and enclosed in a thin fibrous
investment. The tendon is reflected backward, lateralward, and downward beneath
the Rectus superior to the lateral part of the bulb of the eye, and is inserted into the
sclera, behind the equator of the eyeball, the insertion of the muscle lying between
the Rectus superior and Rectus lateralis.
The Obliquus oculi inferior (inferior oblique) is a thin, narrow muscle, placed near
the anterior margin of the floor of the orbit. It arises from the orbital surface of the
maxilla, lateral to the lacrimal groove. Passing lateralward, backward, and upward,
at first between the Rectus inferior and the floor of the orbit, and then between the
bulb of the eye and the Rectus lateralis, it is inserted into the lateral part of the
sclera between the Rectus superior and Rectus lateralis, near to, but somewhat
behind the insertion of the Obliquus superior.
The Lacrimal Apparatus (apparatus lacrimalis) consists of (a) the lacrimal
gland, which secretes the tears, and its excretory ducts, which convey the fluid to
the surface of the eye; (b) the lacrimal ducts, the lacrimal sac, and the
nasolacrimal duct, by which the fluid is conveyed into the cavity of the nose.
The Lacrimal Gland (glandula lacrimalis). — The lacrimal gland is lodged in the
lacrimal fossa, on the medial side of the zygomatic process of the frontal bone. It is
of an oval form, about the size and shape of an almond, and consists of two
portions, described as the superior and inferior lacrimal glands. The superior
lacrimal gland is connected to the periosteum of the orbit by a few fibrous bands,
and rests upon the tendons of the Recti superioris and lateralis, which separate it
from the bulb of the eye. The inferior lacrimal gland is separated from the superior
by a fibrous septum, and projects into the back part of the upper eyelid, where its
deep surface is related to the conjunctiva. The ducts of the glands, from six to
twelve in number, run obliquely beneath the conjunctiva for a short distance, and
open along the upper and lateral half of the superior conjunctival fornix.
Structures of the Lacrimal Gland — In structure and general appearance the
lacrimal resembles the serous salivary glands. In the recent state the cells are so
crowded with granules that their limits can hardly be defined. They contain oval
nuclei, and the cell protoplasm is finely fibrillated.
The Lacrimal Ducts (ductus lacrimalis; lacrimal canals).—The lacrimal ducts,
one in each eyelid, commence at minute orifices, termed puncta lacrimalia, on the
summits of the papillæ lacrimales, seen on the margins of the lids at the lateral
extremity of the lacus lacrimalis. The superior duct, the smaller and shorter of the
two, at first ascends, and then bends at an acute angle, and passes medialward and
downward to the lacrimal sac. The inferior duct at first descends, and then runs
almost horizontally to the lacrimal sac. At the angles they are dilated into ampullæ;
their walls are dense in structure and their mucous lining is covered by stratified
squamous epithelium, placed on a basement membrane. Outside the latter is a layer
of striped muscle, continuous with the lacrimal part of the Orbicularis oculi; at the
base of each lacrimal papilla the muscular fibers are circularly arranged and form a
kind of sphincter.
The Lacrimal Sac (saccus lacrimalis).—The lacrimal sac is the upper dilated end
of the nasolacrimal duct, and is lodged in a deep groove formed by the lacrimal
bone and frontal process of the maxilla. It is oval in form and measures from 12 to
15 mm. in length; its upper end is closed and rounded; its lower is continued into
the nasolacrimal duct. Its superficial surface is covered by a fibrous expansion
derived from the medial palpebral ligament, and its deep surface is crossed by the
lacrimal part of the Orbicularis oculi, which is attached to the crest on the lacrimal
bone.
The Nasolacrimal Duct (ductus nasolacrimalis; nasal duct).—The nasolacrimal
duct is a membranous canal, about 18 mm. in length, which extends from the lower
part of the lacrimal sac to the inferior meatus of the nose, where it ends by a
somewhat expanded orifice, provided with an imperfect valve, the plica lacrimalis
(Hasneri), formed by a fold of the mucous membrane. It is contained in an osseous
canal, formed by the maxilla, the lacrimal bone, and the inferior nasal concha; it is
narrower in the middle than at either end, and is directed downward, backward, and
a little lateralward. The mucous lining of the lacrimal sac and nasolacrimal duct is
covered with columnar epithelium, which in places is ciliated.
Materials for self-check.
A. Tasks for self-check: show and name on tables structure the eyeball(layers,
chambers, refracting medias).
1. Name three compartments of analyzer.
2. Name types of receptors featured by sense organs.
3. Name parts of the visual analyzer.
4. Describe development, developmental anomalies and external features of eyeball.
5. Name and recognize the layers of eyeball.
6. Describe the retractive media of eyeball.
7. The structure of chambers of eyeball, the production and circulation of the
aqueous humor.
8. Describe the accessory visual structures.
9. Describe the visual pathway.
B. Choose the correct answer:
1. To the ophthalmologist the woman with complaints to sight deterioration has
addressed. At inspection the diagnosis has been established: a coloboma (a slitlike
foramen at one of the eyeball structures). What of structures is involved?
A.Iris
B.Corpus vitreum
C.Lens
D.Cornea
E.Corpus ciliare
2. To the oculist the patient of pension age has addressed. After the carried
investigation the glaucoma (ophthalmotonus rising) is diagnosed. The cause of it is
deterioration of outflow of fluid from an eye anterior chamber. What structure does
not carry out function inherent in it?
A. Subchoroidal space
B. Slit spaces iridokorneal angle
C. Vitreous body.
D. Pupil
E. Perichoroidal space
3. The patient of 45 years old, has addressed to the doctor with complaints to
possibility loss to distinguish colours that has appeared after the tolerated electrical
trauma. After survey of a retina of an eye lesions of receptors which are responsible
for this kind of sensitivity are found. What it for receptors?
A. Bipolar cells
B. The rod
C. The cones
D. Amacrine cells
E Horizontal cells
4. The patient of 52 years old, complains of a pain of eyeballs. At survey
ophthalmotonus rising is found. Disturbance of outflow of what fluid has provoked
the given state?
A. Lymph
B. Endolimph
C. Perilymph
D. Aqueous humor
E. Tears
5. The patient had a steady expansion of the pupil after application of drops which
contain atropine. Name muscle which does not work?
A. The dilator pupillae
B. The superior rectus
C. The ciliary muscle
D. The medial rectus
E. The sphincter pupillae
6. In the patient with rupture of a. carotis interna in the cavernous sinus is observed
pulsating exophthalmos (sync pulse), blowing noise is listened (in the eyeball),
expansion orbit fissure. Which pair of cranial nerves that pass in sinus cavernosus
with damaged vessel, hematoma compressed?
A III, IV, VI, I branch of the V.
B II, IV, I branch of the V.
C IV, VI, a branch of the V.
D VI.
E VII.
7. A patient with epidemic encephalitis has uni- or bilateral ptosis (blepharoptosis),
divergent strabismus (squint), accomodation disorder, dilation pupil (mydriatic
pupils). The nuclei of what pair of cranial nerves have been affected?
A IV
B III
C I branch of the V.
D VI.
E VII.
8. In patients with epidemic encephalitis observed one-or two-sided ptosis
(drooping eyelids), strabismus divergent, disturbance of accommodation. The pupils
were dilated. Nuclei which pair of cranial nerves affected?
A V
B IV.
C III.
D VI.
E VII.
9. The patient turned to the eye doctor with complaints of ptosis. The examination
was diagnosed with brain tumors. The core of a pair of cranial nerves affected
pathological process?
A VII
B II
C IV
D III
E VI
10. A patient has appealed with complaints of visual impairment accompanied by
blepharoptosis, impossibility to lift the eyeball upwards and to the middle.
Examination has shown that the eyeball is diverted outside, the pupil is dilated, does
not react to light, the patient can′t see at a short distance. Which nerve has been
injured?
A n. abducens dexter
B n. trochlearis
C n. opticus
D n. abducens sinister
E n. oculomotorius
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M.
Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by
Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education,
2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS,
Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 33 -34. General characteristic of organ for hearing. External and
middle ears. Bones of middle ear, tympanic cavity, its walls.
Internal ear. Periotic and otic labyrinths. The eights pair of cranial nervous.
1. Relevance of the topic.
Information about sense organs, the ear and the pathways of the
auditory analyzer, the neural pathways of the vestibular analyzer are
important for students of all specialties for further study.
2. The specific aims.
Explain to students general characteristics of the organ of hearing and
balance, learn the components of the hearing, the structure of the
external, middle and inner ear, auditory pathways analyzer.
3. Basic knowledge and skills necessary to study the topic (interdisciplinary integration):
The
The acquired knowledge
preceding
subjects
Physical
Of sound waves;
Biology
Phylogeny hearing and balance;
Topics for further study.
4. The tasks for stydents’ individual work.
4.1. The list of basic terms, parameters characteristic which the
student master while preparing for the class:
Auris externa
External ear
Auricula
Auricle
Helix
Helix
Antihelix
Antihelix
Meatus acusticus externus
The external ear canal
Auris media
middle ear
Malleus
Malleus
Incus
Incus
Stapes
stirrup
4.2. Theoretical questions for the class:
1. Name and recognize the principal parts of ear.
2. Discuss embryonic development of the ear and its developmental
anomalies.
3. Describe the external ear.
4. Describe the auricle.
5. Describe the external acoustic meatus.
6. Describe the tympanic membrane.
7. Describe the middle ear.
8. Describe the tympanic cavity with related canals.
9. Describe the auditoryossicles with related joints and muscles.
10. Describe the auditory tube.
4.3. Practical questions for the class: working anatomical preparations,
models, decision of test tasks and situational problems.
The content of the topics.
The Organ of Hearing (Organon Auditus; The Ear).
The ear, or organ of hearing, is divisible into three parts: the external ear, the middle
ear or tympanic cavity, and the internal ear or labyrinth.
The external ear consists of the expanded portion named the auricula or pinna, and
the external acoustic meatus. The former projects from the side of the head and
serves to collect the vibrations of the air by which sound is produced; the latter
leads inward from the bottom of the auricula and conducts the vibrations to the
tympanic cavity.
The External Acoustic Meatus (meatus acusticus externus; external auditory canal
or meatus) extends from the bottom of the concha to the tympanic membrane. It is
about 4 cm. in length if measured from the tragus; from the bottom of the concha its
length is about 2.5 cm. It forms an S-shaped curve, and is directed at first inward,
forward, and slightly upward (pars externa); it then passes inward and backward
(pars media), and lastly is carried inward, forward, and slightly downward (pars
interna). It is an oval cylindrical canal, the greatest diameter being directed
downward and backward at the external orifice, but nearly horizontally at the inner
end. It presents two constrictions, one near the inner end of the cartilaginous
portion, and another, the isthmus, in the osseous portion, about 2 cm. from the
bottom of the concha. The tympanic membrane, which closes the inner end of the
meatus, is obliquely directed; in consequence of this the floor and anterior wall of
the meatus are longer than the roof and posterior wall.
The external acoustic meatus is formed partly by cartilage and membrane, and
partly by bone, and is lined by skin.
The cartilaginous portion (meatus acusticus externus cartilagineus) is about 8 mm.
in length; it is continuous with the cartilage of the auricula, and firmly attached to
the circumference of the auditory process of the temporal bone. The cartilage is
deficient at the upper and back part of the meatus, its place being supplied by
fibrous membrane; two or three deep fissures are present in the anterior part of the
cartilage.
The osseous portion (meatus acusticus externus osseus) is about 16 mm. in length,
and is narrower than the cartilaginous portion. It is directed inward and a little
forward, forming in its course a slight curve the convexity of which is upward and
backward. Its inner end is smaller than the outer, and sloped, the anterior wall
projecting beyond the posterior for about 4 mm.; it is marked, except at its upper
part, by a narrow groove, the tympanic sulcus, in which the circumference of the
tympanic membrane is attached. Its outer end is dilated and rough in the greater part
of its circumference, for the attachment of the cartilage of the auricula. The front
and lower parts of the osseous portion are formed by a curved plate of bone, the
tympanic part of the temporal, which, in the fetus, exists as a separate ring (annulus
tympanicus,) incomplete at its upper part.
Relations of the Meatus.—In front of the osseous part is the condyle of the
mandible, which however, is frequently separated from the cartilaginous part by a
portion of the parotid gland. The movements of the jaw influence to some extent the
lumen of this latter portion. Behind the osseous part are the mastoid air cells,
separated from the meatus by a thin layer of bone.
The middle ear or tympanic cavity is an irregular, laterally compressed space within
the temporal bone. It is filled with air, which is conveyed to it from the nasal part of
the pharynx through the auditory tube. It contains a chain of movable bones, which
connect its lateral to its medial wall, and serve to convey the vibrations
communicated to the tympanic membrane across the cavity to the internal ear.
The tympanic cavity consists of two parts: the tympanic cavity proper, opposite the
tympanic membrane, and the attic or epitympanic recess, above the level of the
membrane; the latter contains the upper half of the malleus and the greater part of
the incus. Including the attic, the vertical and antero-posterior diameters of the
cavity are each about 15 mm. The transverse diameter measures about 6 mm. above
and 4 mm. below; opposite the center of the tympanic membrane it is only about 2
mm. The tympanic cavity is bounded laterally by the tympanic membrane;
medially, by the lateral wall of the internal ear; it communicates, behind, with the
tympanic antrum and through it with the mastoid air cells, and in front with the
auditory tube.
The Tympanic Membrane (membrana tympani) separates the tympanic cavity
from the bottom of the external acoustic meatus. It is a thin, semitransparent
membrane, nearly oval in form, somewhat broader above than below, and directed
very obliquely downward and inward so as to form an angle of about fifty-five
degrees with the floor of the meatus.
The auditory tube (tuba auditiva; Eustachian tube) is the channel through which the
tympanic cavity communicates with the nasal part of the pharynx. Its length is about
36 mm., and its direction is downward, forward, and medialward, forming an angle
of about 45 degrees with the sagittal plane and one of from 30 to 40 degrees with
the horizontal plane. It is formed partly of bone, partly of cartilage and fibrous
tissue.
The tympanic cavity contains a chain of three movable ossicles, the malleus, incus,
and stapes. The first is attached to the tympanic membrane, the last to the
circumference of the fenestra vestibuli, the incus being placed between and
connected to both by delicate articulations.
The internal ear is the essential part of the organ of hearing, receiving the ultimate
distribution of the auditory nerve. It is called the labyrinth, from the complexity of
its shape, and consists of two parts: the osseous labyrinth, a series of cavities within
the petrous part of the temporal bone, and the membranous labyrinth, a series of
communicating membranous sacs and ducts, contained within the bony cavities.
The Osseous Labyrinth (labyrinthus osseus) — The osseous labyrinth consists of
three parts: the vestibule, semicircular canals, and cochlea. These are cavities
hollowed out of the substance of the bone, and lined by periosteum; they contain a
clear fluid, the perilymph, in which the membranous labyrinth is situated.
The Vestibule (vestibulum).—The vestibule is the central part of the osseous
labyrinth, and is situated medial to the tympanic cavity, behind the cochlea, and in
front of the semicircular canals. It is somewhat ovoid in shape, but flattened
transversely; it measures about 5 mm. from before backward, the same from above
downward, and about 3 mm. across. In its lateral or tympanic wall is the fenestra
vestibuli, closed, in the fresh state, by the base of the stapes and annular ligament.
On its medial wall, at the forepart, is a small circular depression, the recessus
sphæricus, which is perforated, at its anterior and inferior part, by several minute
holes (macula cribrosa media) for the passage of filaments of the acoustic nerve to
the saccule; and behind this depression is an oblique ridge, the crista vestibuli, the
anterior end of which is named the pyramid of the vestibule. This ridge bifurcates
below to enclose a small depression, the fossa cochlearis, which is perforated by a
number of holes for the passage of filaments of the acoustic nerve which supply the
vestibular end of the ductus cochlearis. As the hinder part of the medial wall is the
orifice of the aquæductus vestibuli, which extends to the posterior surface of the
petrous portion of the temporal bone. It transmits a small vein, and contains a
tubular prolongation of the membranous labyrinth, the ductus endolymphaticus,
which ends in a cul-de-sac between the layers of the dura mater within the cranial
cavity. On the upper wall or roof is a transversely oval depression, the recessus
ellipticus, separated from the recessus sphæricus by the crista vestibuli already
mentioned. The pyramid and adjoining part of the recessus ellipticus are perforated
by a number of holes (macula cribrosa superior). The apertures in the pyramid
transmit the nerves to the utricle; those in the recessus ellipticus the nerves to the
ampullæ of the superior and lateral semicircular ducts. Behind are the five orifices
of the semicircular canals. In front is an elliptical opening, which communicates
with the scala vestibuli of the cochlea.
The Bony Semicircular Canals (canales semicirculares ossei).—The bony
semicircular canals are three in number, superior, posterior, and lateral, and are
situated above and behind the vestibule. They are unequal in length, compressed
from side to side, and each describes the greater part of a circle. Each measures
about 0.8 mm. in diameter, and presents a dilatation at one end, called the ampulla,
which measures more than twice the diameter of the tube. They open into the
vestibule by five orifices, one of the apertures being common to two of the canals.
The Cochlea. — The cochlea bears some resemblance to a common snail-shell; it
forms the anterior part of the labyrinth, is conical in form, and placed almost
horizontally in front of the vestibule; its apex (cupula) is directed forward and
lateralward, with a slight inclination downward, toward the upper and front part of
the labyrinthic wall of the tympanic cavity; its base corresponds with the bottom of
the internal acoustic meatus, and is perforated by numerous apertures for the
passage of the cochlear division of the acoustic nerve. It measures about 5 mm.
from base to apex, and its breadth across the base is about 9 mm. It consists of a
conical shaped central axis, the modiolus; of a canal, the inner wall of which is
formed by the central axis, wound spirally around it for two turns and threequarters, from the base to the apex; and of a delicate lamina, the osseous spiral
lamina, which projects from the modiolus, and, following the windings of the canal,
partially subdivides it into two. In the recent state a membrane, the basilar
membrane, stretches from the free border of this lamina to the outer wall of the
bony cochlea and completely separates the canal into two passages, which,
however, communicate with each other at the apex of the modiolus by a small
opening named the helicotrema.
The modiolus is the conical central axis or pillar of the cochlea. Its base is broad,
and appears at the bottom of the internal acoustic meatus, where it corresponds with
the area cochleæ; it is perforated by numerous orifices, which transmit filaments of
the cochlear division of the acoustic nerve; the nerves for the first turn and a half
pass through the foramina of the tractus spiralis foraminosus; those for the apical
turn, through the foramen centrale. The canals of the tractus spiralis foraminosus
pass up through the modiolus and successively bend outward to reach the attached
margin of the lamina spiralis ossea. Here they become enlarged, and by their
apposition form the spiral canal of the modiolus, which follows the course of the
attached margin of the osseous spiral lamina and lodges the spiral ganglion
(ganglion of Corti). The foramen centrale is continued into a canal which runs up
the middle of the modiolus to its apex. The modiolus diminishes rapidly in size in
the second and succeeding coil.
The Membranous Labyrinth (labyrinthus membranaceus) — The membranous
labyrinth is lodged within the bony cavities just described, and has the same general
form as these; it is, however, considerably smaller, and is partly separated from the
bony walls by a quantity of fluid, the perilymph. In certain places it is fixed to the
walls of the cavity. The membranous labyrinth contains fluid, the endolymph, and
on its walls the ramifications of the acoustic nerve are distributed.
Within the osseous vestibule the membranous labyrinth does not quite preserve the
form of the bony cavity, but consists of two membranous sacs, the utricle, and the
saccule.
Materials for self.
A. Tasks for self-check. Show on tables, structure of organ for hearing.
B. Choose the correct answer.
1. In the рatient was diagnosed mesootitis (inflammation of the mucousa of the
middle ear). This morbid condition was complicated
with mastoiditis
(inflammation of the mucousa of the mastoid process). On which wall of the
tympanic cavity are holes that connect the tympanic cavity and cells of the mastoid
process?
A. Posterior wall
B. Medial wall
C. Lateral wall
D. Upper wall
E. Anterior wall
2. In the the child was found signs of meningitis (inflammation of the dura mater)
which appeared after suffering of the boy from a purulent otitis (inflammation of the
inner ear). Through which way infection could spread in the dura mater?
A. Utriculosaccular duct
B. Endolymphatic duct
C. Aqueductus cochleae
D. Oval window
E. Round window
3. In the patient is observed the smoke from the ear while he is smoking out. What
is the structure of the organ of hearing was damaged?
A. The cochlea
B. The vestibule
C. The tympanic membrane
D. The auditory ossicles
E. The Eustachian tube
4.
Boy 4 years old often suffer from pneumonias. As a result - he has enlarging
tonsils, which close pharyngeal opening of auditory tube. The auditory tube
connects the cavity of the pharynx with:
A. With the larynx
B. With an inner ear
C. With the nasal cavity
D. With the middle ear
E. With the oral cavity
5. At the patient the deсrease of the acuteness of the hearing is observed. What
anatomical structure does not participate in carrying out of mechanical vibrations of
the organ of Corti (spiral organ)?
A. The cochlea
B. The vestibule
C. The tympanic membrane
D. The auditory ossicles
E. The Eustachian tube
6. To the doctor the woman, 54 years old, with complaints to giddiness, a nausea,
disturbance of balance after falling and a head injury has addressed. Disturbance of
function of what structure of the internal ear is more probable?
A. Bony labyrinth
B. The auditory tube
C. The tympanic cavity
D. Tympanic membrane
E. The malleus
7. The child, 7 years, often is ill acute respiratory diseases. At survey substantial
growth of a pharyngeal tonsil that occludes a pharyngeal foramen of the tuba
auditiva is taped. It has led to the decrease of acoustical sensitivity at the child. On
what wall of the tympanic cavity does the auditory tube open?
A. Paries jugularis
B. Paries caroticus
C. Paries labyrinthicus.
D. Paries mastoideus.
E. Paries tegmentalis.
8. The patient, 18 years old, has addressed to hospital with complaints of noise
painful sensations in the ear. At objective inspection at the patient acute respiratory
disease, a rhinitis has been found. Through what foramen in the pharynx the
infection contamination has got to the tempanic cavity and has entailed its
inflammation?
A. Choanae
B. Tympanic opening of auditory tube
C. Pharyngeal opening of auditory tube
D. The mouth
E. Entrance to the larynx
9. The diagnosis the mastoiditis is put to the patient. Specify a probable source of
the diffusion of the pyoinflammatory process in mastoid alveoles.
A. The tensor tympani muscle
B. The auditory tube
C. Tympanic membrane
D. The tympanic cavity
E. The stapedius muscle
10. At the child, 2 years old, after the tolerated flu have appeared complaints to a
pain in an ear. The doctor has found the deсrease of hearing and the inflammation
of the mucous of the middle ear. How the infection contamination has got to a
middle ear?
A. Due to the auditory tube
B. A foramen jugularis.
C. A canalis caroticus.
D. After atrium mastoideum.
E. A canalis nasolacrimalis.
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Topic 35. Olphactory and taste analyzers. Nervous pathways of taste
and smell.
1.Relevents of the topic.
Knowledge of anatomy section and necessary for students of all
specialties for further study.
2. The specific aims.
Explain organ of taste, its parts and body smell, its components.
Collate pathways these analyzers.
3. Basic knowledge and skills necessary to study the topic (interdisciplinary integration):
The
The acquired knowledge
preceding
subjects
Biology
Phylogeny organ of taste, smell;
Topics for further study.
4. The tasks for stydents’ individual work.
4.1. The list of basic terms, parameters characteristic which the
student master while preparing for the class:
Organum olfactorium
olfactory organ
Regio olfactorium
Olfactory region
Lamina cribrosa
Сribrosa plate
Nervi olfactorii
Olfactory nerves
Organum gustatorium
The body taste
4.2. Theoretical questions for the class:
1. Describe the olfactory organ.
2. Where are the subcortical and cortical centers of smell?
3. Where are the receptors of the organ of taste?
4. What cranial nerves carry taste sensations to the brainstem?
5. Where is the second and third neurons analyzer of taste?
6. Where is the cortical center of the organ of taste?
4.3. Practical questions for the class: working with wet preparations,
models, decision of test tasks and situational problems with the database "Step 1"
The content of the topic.
The olfactory organ.
The receptors of the olfactory organ occupy the olfactory part of nasal mucosa – the
area related to the superior nasal concha and adherent portion of the nasal septum
(its area is about 2-3 cubic cm). The olfactory part comprises three types of cells –
the receptor cells, the supporting cells and the basal cells. The receptors are the first
neurons of the olfactory pathway. Their peripheral processes pass through the
cribriform plate of the ethmoid as the olfactory nerves. These fibers constitute the I
pair of cranial nerves. They reach the olfactory bulb to synapse with the pertaining
cells. The dendrite of each receptor cell ends with the dilation (the olfactory club)
with 10 to 12 olfactory hair on it. The second neurons of the chain reside within the
olfactory bulb, their axons extend posteriorly as the olfactory tract, which
terminates within the olfactory trigone, the anterior perforated substance and the
septum pellucidum. These areas contain the third neurons of the pathway. Some
fibers given by the neurons of the olfactory bulb run directly to the amygdaloid
body and the olfactory cortex of the parahippocampal gyrus (the lateral olfactory
stria).
The gustatory organ. The receptors of the gustatory analyzer are represented with
the taste buds, situated within all papillae of tongue except for the filiform papillae.
Single taste buds occur in the buccal mucosa, the palatine mucosa, the epiglottic
mucosa and the posterior wall of the pharynx. The taste buds comprise the epithelial
cells, some of them are the receptor hair cells. The taste buds are in contact with the
gustatory fibers of the facial, the lingual and the glossopharyngeal nerves.
The first neurons of the pathway are the pseudounipolar neurons of the sensory
ganglia of facial and glossopharyngeal nerves:
1)
the geniculate ganglion sends the peripheral processes to the facial nerve, to
the chorda tympani and to the lingual nerve that supply the anterior two thirds of
tongue. The central processes join the intermediate nerve and terminate within the
nucleus of solitary tract (of the medulla oblongata);
2)
the inferior ganglion of the glossopharyngeal nerve (the IX pair) gives the
fibers to the glossopharyngeal nerve; they supply the posterior third of the tongue.
The central processes also reach the nucleus of solitary tract.
The second neurons of the pathway are the neurons of the nucleus of solitary tract;
their axons decussate and join the medial lemniscus that ascends to the thalamus.
The axons of the thalamic neurons traverse the posterior limb of the internal capsule
and reach the superior analyzing units of the uncus of the parahippocampal gyrus.
Materials for self-check
.
B. Choose the correct answer.
1. How many are nasal meatusis in the nasal cavity?
A. 1
B. 2
C. 3
D. 4
Е. 5
2. In the patient the tumour in the field of the superior nasal concha is found. What
disturbances of functions can be expected?
A. Disturbances of taste
B. Breath disturbances
S. Disturbances of swallowing
D. Salivation disturbances
E. Disturbances of smell
3. After a trauma of temporal area of a head at the patient sense of smell has
worsened. What disturbance of anatomical formation is observed?
А The olfactory tract
B. Uncus
C. The olfactory stria
D. The olfactory trigone
E. The olfactory bulb
4. In otorhinolaryngological department to the patient is set the diagnosis: a chronic
rhinitis. Disorder of smell is observed. What nervous structures are damaged?
A. The olfactory bulb
B. The olfactory tract
C. A cingular gyrus
D. The olfactory nerve receptors
E. Uncus
5. Owing to a trauma the breakage of olfactory fibers which leave a nasal cavity has
taken place. Through what bone do these fibers pass?
A. The parietal
B. The frontal
C. The ethmoid bone
D. The inferior nasal concha
E. The nasal bone
6. At the patient the sensation of taste is broken. Thus tactile, painful and the tongue
thermoesthesia is stored. What papillas of tongue are not gustatory?
A. The filiform papillae
B. The fungiform papillae
C. The vallate papillae
D. The foliate papillae
E. Lingual tonsil
7. The patient, 82 years, complains of loss of gustatory sensitivity. Inspection has
established cortical localisation of pathological process. Where exactly?
A. The postcentral gyrus
B. The calcarine sulcus of the occipital lobe
C. The inferior frontal gyrus
D. An angle gyrus
E. The uncus of the parahippocampal gyrus
8. How many pairs cranial nerves carry out a sensitive innervation of tongue?
A. 7
B. 5
C. 3
D. 4
Е. 6
9. How many pairs cranial nerves carry out a gustatory innervation of tongue?
A. 2
B. 7
C. 6
D. 5
Е. 4
10. In the middle nasal meatus open:
А. The nasolacrimal canal
B. The sphenoidal sinus
С. The frontal and maxillary sinuses, the anterior and middle ethmoidal cells
D. The posterior and middle ethmoidal cells
Е. The frontal and maxillary sinuses
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Theme 36. The integumentary system. Derivates of the skin. Mammary gland.
1.Relevents of the topic.
Information about sense organs, the skin, the breast are
important for students of all specialties for further study.
2. The specific aims.
To explain the structure and function of the skin, skin derivatives.
Collate pathways.
3. Basic knowledge and skills necessary to study the topic (interdisciplinary integration):
- Topics for further study.
4. The tasks for stydents’ individual work.
4.1. The list of basic terms, parameters characteristic which the
student master while preparing for the class:
Cutis
Skin
Epidermis
Epidermis
Dermis
Derma
Tela subcutanea
Subcutaneous tissue
Glandulae sebaceae
The sebaceous glands
Pili
Hair
Unguis
Unguis
Mamma
Mammary gland
Papilla mammaria
Chest papilla
4.2. Theoretical questions for the class:
1. The structure and development of the skin.
2. The functions of the skin, especially its structure in different parts of the human
body.
3. Sebaceous glands and sweat glands, structure, functions.
4. Nails and hair structure, especially the location of the human body.
5. Mammary gland, structure, topography, blood supply, innervation, the outflow of
lymph.
4.3. Practical questions for the class:
Working with wet preparations, models.
Content topics.
The Common Integument (Integumentum Commune; Skin, cutis).
The integument covers the body and protects the deeper tissues from injury, from
drying and from invasion by foreign organisms; it contains the peripheral endings of
many of the sensory nerves; it plays an important part in the regulation of the body
temperature, and has also limited excretory and absorbing powers. It consists
principally of a layer of vascular connective tissue, named the corium or cutis vera,
and an external covering of epithelium, termed the epidermis or cuticle. On the
surface of the former layer are sensitive and vascular papillæ within, or beneath it,
are certain organs with special functions: namely, the sudoriferous and sebaceous
glands, and the hair follicles.
The epidermis, cuticle, or scarf skin is non-vascular, and consists of stratified
epithelium, and is accurately moulded on the papillary layer of the corium. It varies
in thickness in different parts. In some situations, as in the palms of the hands and
soles of the feet, it is thick, hard, and horny in texture. This may be in a measure
due to the fact that these parts are exposed to intermittent pressure, but that this is
not the only cause is proved by the fact that the condition exists to a very
considerable extent at birth. The more superficial layers of cells, called the horny
layer (stratum corneum), may be separated by maceration from a deeper stratum,
which is called the stratum mucosum, and which consists of several layers of
differently shaped cells. The free surface of the epidermis is marked by a net-work
of linear furrows of variable size, dividing the surface into a number of polygonal or
lozenge-shaped areas. Some of these furrows are large, as opposite the flexures of
the joints, and correspond to the folds in the corium produced by movements. In
other situations, as upon the back of the hand, they are exceedingly fine, and
intersect one another at various angles. Upon the palmar surfaces of the hands and
fingers, and upon the soles of the feet, the epidermal ridges are very distinct, and are
disposed in curves; they depend upon the large size and peculiar arrangements of
the papillæ upon which the epidermis is placed. The function of these ridges is
primarily to increase resistance between contact surfaces for the purpose of
preventing slipping whether in walking or prehension. The direction of the ridges is
at right angles with the force that tends to produce slipping or to the resultant of
such forces when these forces vary in direction. In each individual the lines on the
tips of the fingers and thumbs form distinct patterns unlike those of any other
person. A method of determining the identity of a criminal is based on this fact,
impressions (“finger-prints”) of these lines being made on paper covered with soot,
or on white paper after first covering the fingers with ink. The deep surface of the
epidermis is accurately moulded upon the papillary layer of the corium, the papillæ
being covered by a basement membrane; so that when the epidermis is removed by
maceration, it presents on its under surface a number of pits or depressions
corresponding to the papillæ, and ridges corresponding to the intervals between
them. Fine tubular prolongations are continued from this layer into the ducts of the
sudoriferous and sebaceous glands.
The black color of the skin in the negro, and the tawny color among some of the
white races, is due to the presence of pigment in the cells of the epidermis. This
pigment is more especially distinct in the cells of the stratum mucosum, and is
similar to that found in the cells of the pigmentary layer of the retina. As the cells
approach the surface and desiccate, the color becomes partially lost; the
disappearance of the pigment from the superficial layers of the epidermis is,
however, difficult to explain.
The pigment (melanin) consists of dark brown or black granules of very small
size, closely packed together within the cells, but not involving the nucleus.
The main purpose served by the epidermis is that of protection, as the surface is
worn away new cells are supplied and thus the true skin, the vessels and nerves
which it contains are defended from damage.
The Corium, Cutis Vera, Dermis, or True Skin is tough, flexible, and highly
elastic. It varies in thickness in different parts of the body. Thus it is very thick in
the palms of the hands and soles of the feet; thicker on the posterior aspect of the
body than on the front, and on the lateral than on the medial sides of the limbs. In
the eyelids, scrotum, and penis it is exceedingly thin and delicate.
It consists of felted connective tissue, with a varying amount of elastic fibers and
numerous bloodvessels, lymphatics, and nerves. The connective tissue is arranged
in two layers: a deeper or reticular, and a superficial or papillary. Unstriped
muscular fibers are found in the superficial layers of the corium, wherever hairs are
present, and in the subcutaneous areolar tissue of the scrotum, penis, labia majora,
and nipples. In the nipples the fibers are disposed in bands, closely reticulated and
arranged in superimposed laminæ.
The reticular layer (stratum reticulare; deep layer) consists of strong interlacing
bands, composed chiefly of white fibrous tissue, but containing some fibers of
yellow elastic tissue, which vary in number in different parts; and connective-tissue
corpuscles, which are often to be found flattened against the white fibrous tissue
bundles. Toward the attached surface the fasciculi are large and coarse, and the
areolæ left by their interlacement are large, and occupied by adipose tissue and
sweat glands. Below the reticular layer is the subcutaneous areolar tissue, which,
except in a few situations, contains fat.
The papillary layer (stratum papillare; superficial layer; corpus papillare of
the corium) consists of numerous small, highly sensitive, and vascular eminences,
the papillæ, which rise perpendicularly from its surface. The papillæ are minute
conical eminences, having rounded or blunted extremities, occasionally divided into
two or more parts, and are received into corresponding pits on the under surface of
the cuticle. On the general surface of the body, more especially in parts endowed
with slight sensibility, they are few in number, and exceedingly minute; but in some
situations, as upon the palmar surfaces of the hands and fingers, and upon the
plantar surfaces of the feet and toes, they are long, of large size, closely aggregated
together, and arranged in parallel curved lines, forming the elevated ridges seen on
the free surface of the epidermis. Each ridge contains two rows of papillæ, between
which the ducts of the sudoriferous glands pass outward to open on the summit of
the ridge. Each papilla consists of very small and closely interlacing bundles of
finely fibrillated tissue, with a few elastic fibers; within this tissue is a capillary
loop, and in some papillæ, especially in the palms of the hands and the fingers, there
are tactile corpuscles.
The derivatives of the skin—The derivatives of the skin are the nails, the hairs, and
the sudoriferous and sebaceous glands with their ducts.
The Nails (ungues) are flattened, elastic structures of a horny texture, placed upon
the dorsal surfaces of the terminal phalanges of the fingers and toes. Each nail is
convex on its outer surface, concave within, and is implanted by a portion, called
the root, into a groove in the skin; the exposed portion is called the body, and the
distal extremity the free edge. The nail is firmly adherent to the corium, being
accurately moulded upon its surface; the part beneath the body and root of the nail
is called the nail matrix, because from it the nail is produced. Under the greater part
of the body of the nail, the matrix is thick, and raised into a series of longitudinal
ridges which are very vascular, and the color is seen through the transparent tissue.
Near the root of the nail, the papillæ are smaller, less vascular, and have no regular
arrangement, and here the tissue of the nail is not firmly adherent to the connectivetissue stratum but only in contact with it; hence this portion is of a whiter color, and
is called the lunula on account of its shape.
The cuticle as it passes forward on the dorsal surface of the finger or toe is attached
to the surface of the nail a little in advance of its root; at the extremity of the finger
it is connected with the under surface of the nail a little behind its free edge. The
cuticle and the horny substance of the nail (both epidermic structures) are thus
directly continuous with each other. The superficial, horny part of the nail consists
of a greatly thickened stratum lucidum, the stratum corneum forming merely the
thin cuticular fold (eponychium) which overlaps the lunula; the deeper part consists
of the stratum mucosum. The cells in contact with the papillæ of the matrix are
columnar in form and arranged perpendicularly to the surface; those which succeed
them are of a rounded or polygonal form, the more superficial ones becoming
broad, thin, and flattened, and so closely packed as to make the limits of the cells
very indistinct. The nails grow in length by the proliferation of the cells of the
stratum mucosum at the root of the nail, and in thickness from that part of the
stratum mucosum which underlies the lunula.
Hairs (pili) are found on nearly every part of the surface of the body, but are absent
from the palms of the hands, the soles of the feet, the dorsal surfaces of the terminal
phalanges, the glans penis, the inner surface of the prepuce, and the inner surfaces
of the labia. They vary much in length, thickness, and color in different parts of the
body and in different races of mankind. In some parts, as in the skin of the eyelids,
they are so short as not to project beyond the follicles containing them; in others, as
upon the scalp, they are of considerable length; again, in other parts, as the
eyelashes, the hairs of the pubic region, and the whiskers and beard, they are
remarkable for their thickness. Straight hairs are stronger than curly hairs, and
present on transverse section a cylindrical or oval outline; curly hairs, on the other
hand, are flattened. A hair consists of a root, the part implanted in the skin; and a
shaft or scapus, the portion projecting from the surface.
The breast (mammary gland, mamma). Synonym «mastos» gives rise to
«mastitis» - inflammation of breast. The mammæ secrete the milk, and are
accessory glands of the generative system. They exist in the male as well as in the
female; but in the former only in the rudimentary state, unless their growth is
excited by peculiar circumstances. In the female they are two large hemispherical
eminences lying within the superficial fascia and situated on the front and sides of
the chest; each extends from the second rib above to the sixth rib below, and from
the side of the sternum to near the midaxillary line. Their weight and dimensions
differ at different periods of life, and in different individuals. Before puberty they
are of small size, but enlarge as the generative organs become more completely
developed. They increase during pregnancy and especially after delivery, and
become atrophied in old age. The left mamma is generally a little larger than the
right. The deep surface of each is nearly circular, flattened, or slightly concave, and
has its long diameter directed upward and lateralward toward the axilla; it is
separated from the fascia covering the Pectoralis major, Serratus anterior, and
Obliquus externus abdominis by loose connective tissue. The subcutaneous surface
of the mamma is convex, and presents, just below the center, a small conical
prominence, the papilla.
The Mammary Papilla or Nipple (papilla mammæ) is a cylindrical or conical
eminence situated about the level of the fourth intercostal space. It is capable of
undergoing a sort of erection from mechanical excitement, a change mainly due to
the contraction of its muscular fibers. It is of a pink or brownish hue, its surface
wrinkled and provided with secondary papillæ; and it is perforated by from fifteen
to twenty orifices, the apertures of the lactiferous ducts. The base of the mammary
papilla is surrounded by an areola. In the virgin the areola is of a delicate rosy hue;
about the second month after impregnation it enlarges and acquires a darker tinge,
and as pregnancy advances it may assume a dark brown or even black color. This
color diminishes as soon as lactation is over, but is never entirely lost throughout
life. These changes in the color of the areola are of importance in forming a
conclusion in a case of suspected first pregnancy. Near the base of the papilla, and
upon the surface of the areola, are numerous large sebaceous glands, the areolar
glands, which become much enlarged during lactation, and present the appearance
of small tubercles beneath the skin. These glands secrete a peculiar fatty substance,
which serves as a protection to the integument of the papilla during the act of
sucking. The mammary papilla consists of numerous vessels, intermixed with plain
muscular fibers, which are principally arranged in a circular manner around the
base: some few fibers radiating from base to apex.
Materials for self.
A.Tasks for self-check. Show on tables structure of the skin.
B. Choose the correct answer.
1. The cosmetician has offered the girl an epilation (excision of hair together with
hair bulbuses). In what layer of a skin hair bulbuses settle down?
A.In the papillary layer of the skin
B.In the subcutaneous tissue
C.In the epidermis of the skin
D.In the reticular layer
E.Between the epidermis and the dermis
2.In hospital has addressed the patient, 26 years old, with complaints to pains,
erubescences and tumescence formation in the right axillary field. These
phenomena have arisen after application of poor-quality deodorants. The doctor has
diagnosed - a hydroadenitis (an inflammation of sudoriferous glands). In what layer
of a skin sweat glands settle down?
A.In the reticular layer
B.In the subcutaneous tissue
C.In the epidermis of the skin
D.In the papillary layer of the skin
E.Between the epidermis and the dermis
3.The patient, 38 years old, has got serious burns during a fire. Doctors have
defined that the area of the damaged surface of integuments represented 60%. What
average area of integuments are in the person?
A.1,5-2,0 м2
B.2,5-3,0 м2
C.2,3-2,5 м2
D.1,0-1,2 м2
E.1,2-1,4 м2
4.At pathoanatomical research in one of samples of a skin the greatest quantity of
sudoriferous glands has been found. What field of a skin of the died posessed the
given stuff?
A.The skin of the palms
B.The skin of the abdomen
C.The skin of the elbow
D.The skin of the back
E.The skin of the breast
5.At pathoanatomical research in samples of the skin of the cadaveric stuff it has not
been found sebaceous glands. What fields of a body of the person possessed a skin?
A.The skin of the lips
B.The skin of the foot
C.The skin of the glans penis
D.The skin of mammary glands
E.The skin of the scrotum
6.During the medical examination in the military the young man was diagnosed,
gynecomastia. What kind of abnormalities of the skin derivatives are those?
A.The development of breast on the female type
B.Absence of hair
C.The development of additional breast
D.Reducing the number of sweat glands
E.The formation of false labia
7.Operating on the breast, surgeons prefer radial slits. From the structural features
which anatomical structures related equipment such operations?
A.Apical segments converge to the nipple
B.Gland lobes are transversely
C.Fundamentals of particles directed to the nipple
D.Gland slices vertically
E.The formation of false labia
8.At the patient at preventive inspection on a medial side of the left axillary fossa
the enlarged lymph node of a metastatic parentage is found. Specify localisation of
a primary tumour.
A.A mammary gland
B.A submandibular gland
C.Lungs
D.A stomach
E.A pancreas
9.At the woman, who have addressed to the surgeon, consolidatoin in a mammary
gland is defined. In what direction should perform a cut the surgeon during
operation for reduction of a traumatising of tissues of a mammary gland?
A.Radially
B.Upright
C.Cross-section
D.Arcually
E.Any
10.As a result of a purulent inflammation of a distal phalanx of a thumb, it was
necessary for patient to remove a nail plate. What factors of an anatomical
constitution of a nail the surgeon should consider during operation?
A.The nail is the skin derivative
B.The nail is the excrescence of the osseous tissue
C.The nail is a cartilaginous plate
D.The nail is the excrescence of the tendon
E.The nail is the excrescence of the muscular tissue
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Theme 37. Afferent nervous pathways of cortical direction. Medial
lemniscus. Afferent nervous pathways of cerebellar direction.
1. Relevance of the topic.
Knowledge of anatomy section and necessary for students of all
specialties for further study.
2. The specific aims.
Explain to students the ascending pathways of the brain and spinal
cord.
3. Basic knowledge and skills necessary to study the topic (interdisciplinary integration):
The
The acquired knowledge
preceding
subjects
Biology
The phylogeny of the nervous system;
Topics for further study.
4. Tasks for independent work during preparation for the classes.
4.1. The list of key terms that student is to assimilate while
preparing for the class:
Tractus spinothalamicus
Anterior spinal-thalamic path
anterior
Tractus spinothalamicus
Lateral
spinal-thalamic
lateralis
path
Tractus spinocerebellaris anterior
Front-spinal cerebellar path
Tractus spinocerebellaris
Rear-spinal cerebellar path
posterior
4.2. Theoretical questions for the class:
1. Discuss classification and functional significance of the association fibers.
2. Discuss commissural fibers and their functional significance.
3. Discuss projection fibers and their functional significance.
4. Describe topography, parts and related pathways of the internal capsule.
5. Give definition of the neural pathways and discuss their classification.
6. Discuss proprioceptive pathways.
7. Discuss exteroceptive pathways.
8. Describe topography, structure, associations and functuonal significance of the
reticular formation.
4.3. Practical work (tasks) that are executed on employment: working with wet
preparations, models.
Content topics.
PATHWAYS OF THE BRAIN AND SPINAL CORD
Pathways of the brain and spinal cord subdivide into: associative,
commissural and projection fibers.
Associative pathways are the tracts communicating functional areas of one
hemisphere. They can be divided into long associative fibres and short associative
fibres. The long associative pathways include:
1. Superior longitudinal fascicle communicates frontal, parietal and
occipital lobes;
2. Inferior longitudinal fascicle communicates parietal, occipital,
temporal lobes;
3. Uncinate fascicle - communicates frontal, parietal and temporal
lobes;
4. Fornicate fascicle -communicates central areas of rhinencephalon;
To short associative tracts are arcuate fibres of the cerebrum, which
communicate neighbouring convolutions within hemisphere.
The Commissural pathways communicate symmetric areas of both
hemispheres of cerebrum and both halves of spinal cord for coordination of their
activity. There are:
1. corpus callosum;
2. anterior cerebral commissura;
3. posterior cerebral commissura;
4. habenular commissura;
5. fornicate commissura;
6. interthalamic adhesion;
7. posterior white commissura of spinal cord.
The Projecting pathways are the tracts, which communicate the cerebrum
and spinal cord with working organs. They subdivided into ascending (sensible) and
descending (motor). The sensible projecting tracts into its turn subdivide into
exteroreceptive, interoceptive and proprio-receptive. The motor projecting fibers
tracts are pyramidali and extrapyramidal.
To exteroreceptive (E) tracts belong the tracts temperatural, palpable, pain
sensivity, also vision, hearing, olfaction. The proprioreceptive (P) tracts subdivided
into tracts of cortical direction (Goll tracts and Burdach) and cerebellar directions
(Flechsig and Cowers tracts). Anterior and lateral corticospinal tracts and also
corticonuclear tract belong to pyramidal pathways. The extrapyramidal tracts
include rubrospinal, vestibulospinal, reticulospinal, olivospinal pathways.
(E) Pain and temperature sensation pathway (Lateral spinothalamic tract).
1. Body of first neuron is found in spinal ganglion. The peripheral process of
this neuron terminates by exteroreceptor in skin, and central - on the strength of
posterior rootlets into posterior horns of spinal cord, where contacts with second
neuron.
2. The second neuron localised in proper nucleus of posterior horns of spinal
cord. Its axons make a crossing in grey commissura of spinal cord and pass in
lateral funiculus (lateral spinothalamic tract). Axons within the medial of lemniscus
reach the thalamus, where terminate by synapse with body of third neuron.
3. The third neuron is in lateral nucleus of thalamus, and its axons
'thalamocortical tract' pass to postcentral gyrus (cortical analyser of skin sensation)
through the back third of internal capsule.
(E) Pressure and touch sensation pathway (Anterior spinothalamic tract).
1. Body of first neuron is found in spinal ganglion. The peripheral process of
this neuron terminates by exteroreceptor in skin, and central - in the gelatinose
substance of spinal cord, where contacts with second neuron.
2. The second neuron axons make a crossing in grey commissura of spinal
cord and pass in lateral funiculus (anterior spinothalamic tract). Axons reach the
thalamus, where terminate by synapse with body of third neuron.
3. The third neuron is in thalamus, it passes to postcentral gyrus (cortical
analyser of skin sensation) through the back third of internal capsule.
Proprioreceptive pathway (cortical direction) - Bulbothalamic tract.
1. The first neuron of this tract lies in spinal ganglion. Its peripheral process
terminates by proprioreceptor in muscles, tendoms, jonts capsules and ligaments.
The central process passeswith posterior rootlets into spinal cord and form in white
matter Goll tract - fascicle (upper 11 segments). The process passes to medulla
oblongata, where terminate by synapse with second neuron.
2. The second neurons are in gracilis and cuneate nuclei of medulla
oblongata. Axons this neuron form bulbothalamic tract, which composes a base of
medial lemniscus. Axons of second neuron cross (deccusation of lemniscus) and
reach the thalamus, where terminate by synapse with third neuron.
3. The third neurons pass through the internal capsule and form the
thalamocortical tract.
(P) Proprioreceptive pathways with cerebellar direction (Spinocerebellar
tracts).
Posterior spinocerebellar tract (Flechsig tract)
1. The first neuron is in spinal ganglion. Its peripheral process terminates by
proprioreceptor and central with the posterior rootlets of spinal cord passes to the
grey matter.
2. The second neuron lies in thoracic nucleus of posterior horns (ClarcSteiling). Its axons pass in lateral funiculus. Then it reaches the cortex of the
cerebellar vermis through the inferior cerebellar pedunculi and dentate nucleus.
Nervous impulse passes to the ruber nucleus.
Anterior spinocerebellar tract (Cowers tract). Two-neurons way. This tract
differs from previous by its second neuron, a body of which is found in medial
intermediate nucleus of spinal cord. Axons of the second neuron get across and pass
into lateral funiculus, reaching the superior cerebral velum. They cross here and
pass to the vermis and dentate nucleus. Nervous impulse also passes to the ruber
nucleus.
Materials for self-check.
A. Tasks for self-check. Show and explain on tables spinocerebral tract.
B. Choose the correct answer.
1. At the patient the full demyelination of conductors of ascending tracts takes
place. What kind of sensitivity will remain under these conditions?
A. A thermoesthesia.
B. Vibratory sensitivity.
C. Sensation of pressure.
D. A proprioception.
E. Sight.
2. At the man as a result of a spinal trauma it is damaged painful and a
thermoesthesia that is caused by disturbance of such ascending pathways:
A. Anterior spinothalamic tract
B. The posterior spinocereballar tract
C. The anterior spinocereballar tract
D. The reticulospinal tract
E. Lateral spinothalamic tract
3. As a result of the tolerated trauma of a vertabral column at the patient is absent
painful and a thermoesthesia of the left half of trunk. What damage of a conductive
pathway can cause this condition?
A. Anterior spinothalamic tract at the left
B. Lateral spinothalamic tract on the right
C. The anterior spinocereballar tract on the right
D. The reticulospinal tract
E. Lateral spinothalamic tract at the left
4. At inspection of the patient with disturbance of is muscular-articulate sensitivity
it has been established that pathological process is localised at level of white matter
of a spinal cord. Where in norm do conduction pathways of proprioceptive
sensitivity of a cortical direction pass?
A. The grey matter of the spinal cord
B. Central canal
C. The anterior funiculus of the spinal cord
D. The posterior funiculus of the spinal cord
E. The lateral funiculus of the spinal cord
5. As a result of knife wounds in the victim were damaged the posterior funiculus of
the white matter of the spinal cord. What neurological disorders can occur in this
case?
A. Violations of pain and temperature sensitivity
B. Violations of sense of touch and pressure
C. Violations proprioceptive sensitivity, tactile sensitivity
D. Violation of conscious movements
E. Violation of unconscious movements
6. At the patient disturbance of superficial and deep sensitivity on the circumscribed
fields of a body is revealed. The lesion of what gyrus was diagnosed by the doctor?
A. The postcentral gyrus
B. The precentral gyrus
C. The superior frontal gyrus
D. The superior temporal gyrus
Е. The supramarginal gyrus
7. In the neurosurgical department a man, 30 years old, with stab wounds in the
field of the thoracic part of the spinal cord has addressed. On examination it was
found that the blade is held between the spinous processes of the tenth and eleventh
thoracic vertebraes and was damaged the spinal cord. Fibres which pathways were
damaged in this case?
A. Anterior spinothalamic tract at the left
B. Lateral spinothalamic tract on the right
C. Anterior spinothalamic tract on the right
D. Lateral spinothalamic tract at the left
E. The cuneate and the gracile fasciculi
8. Spinal cord injury in a traffic accident led to the loss of tactile sensitivity,
sensation of body position, sensation of vibration. What are the pathways damaged?
A. Anterior spinothalamic tract
B. The anterior spinnocerebellar tract (Gowers′ tract) and the posterior
spinnocereballar tract (Flechsigs′ tract)
C. The reticulospinal tract
D. Lateral spinothalamic tract at the left
E. The cuneate and the gracile fasciculi
9. At the patient a hemorrhage in the postcentral gyrus. In what disturbance of a
kind of sensitivity from the opposite side it will result?
A. Olfactory and taste sensitivities
B. Auditory sensitivity
C. Visual sensitivities
D. Skin and propreoceptiv sensitivities
E. Olfactory sensitivity
10. At the patient a rough gait is observed, the body is unsteady at standing as a
result of damage of a nucleus of the analyzer of position and head locomotion (the
static analyzer). In what field of a cerebral cortex damage is localised?
A. Gyrus parietal is superior
B. Gyrus frontalis superior
C. Gyrus temporalis medialis et inferior
D. Gyrus temporalis superior
E. Gyrus supramarginalis
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/
Theme 38. Efferent pyramidal nervous pathways. Efferent extrapyramidal
nervous pathways.
1. Actuality of theme.
Knowledge of anatomy section end necessary for students of all specialties for
further study.
2. Specific objectives.
Explain to students descending pathways of the brain and spinal
cord.
3. Materials for classroom work and interdisciplinary integration:
- Of course biology - the phylogeny of the nervous system;
- Topics for further study.
4. Tasks for independent work during preparation for the classes.
4.1. The list of key terms that student is to assimilate while
preparing for the class:
Tractus
cortico-pontoCortical-cerebellar-way
cerebellaris
bridge
Tractus
corticospinales
The lateral and anterior
lateralis et anterior
cortical-spinal routes
Tractus corticonuclearis
Cortical-nuclear path
Tractus rubrospinalis
Red core-spinal path
Tractus tectospinalis
Roofing-spinal path
Tractus reticulospinalis
Net cerebral way
Tractus olivospinalis
Oils-spinal path
Tractus
Medial longitudinal bundle
4.2. Theoretical questions for the class:
1. Classification of descending pathways.
2. The corticospinal tract, topography, structure, functions.
3. The corticonuclear tract, topography, structure, functions.
4. What belongs to the extrapyramidal system and its role in the human body?
5. General characteristics of the extrapyramidal nervous system.
6. The tectospinal tract, topography, structure.
7. The rubrospinal tract, topography, structure.
8. The vestibulospinal tract, topography, structure.
9. The olivospinal tract, topography, structure.
4.3. Practical work (tasks) that are executed on employment: working with wet
preparations, models.
Content topics.
Lateral corticospinal (pyramidal) tract
1. A body of first neuron is found in gigantic pyramidal cells (Bets) of top
and middle third of precentral gyrus of the cortex. Axons pass through anterior third
part of internal capsule, pons, medulla oblongata; part of fibres gets across forming
the pyramids. The crossed fibres of first neuron pass in lateral funiculus of the
spinal cord 'lateral corticospinal (pyramidal) tract' and terminate in anterior horns of
spinal cord.
2. The second neuron lies in motor nucleus of anterior horns, and its axons
pass with the anterior rootlets and spinal nerves as far as skeletal muscles of the
trunk and extremities.
Anterior corticospinal (pyramidal) tract
1. Major part of fibres of first neurons of anterior corticospinal tract does not
cross in pyramids of medulla oblongata, and passes in anterior funiculus of the
spinal cord. Axons cross in grey commissura terminate by synapse with bodies of
second neurons.first
2. The second neuron lies in motor nucleus of anterior horns, and its axons
pass within the anterior rootlets and spinal nerves as far as skeletal muscles of the
trunk and extremities.
Corticonuclear tract
1. The first neuron of this tract is found in gigantic pyramidal cells of cortex
in lower third of precentral gyrus. Axons pass through the genu of internal capsule,
base of cerebral peduncles and terminate in motor nucleus of rhomboid fossa and
midbrain, previously passing across partially on opposite side.
2. The second neuron lies in motor nucleus of rhomboid fossa and midbrain
of opposite side, and its axons with cranial nerves pass as far as stripped muscles of
the head and superficial neck muscles.
Extrapyramidal pathways transmit impulses providing muscles tone and
reflexes of equilibrium and execution of automated motions. They include
rubrospinal, tectospinal, vestibulospinal, reticulospinal and olivospinal tracts.
Rubrospinal tract
1. The first neuron is found in red nucleus (n. rubber). Its axons make tegmental
decussation and pass through the base of cerebral peduncles, pons and medulla
oblongata. They form tract in lateral funiculus and reach motor nuclei in anterior
horns of spinal cord.
2. The second neuron lies in motor nucleus of anterior horns of spinal cord, and its
axons on the strength of anterior rootlets and spinal nerves reach trunk and
extremities muscles.
This 2-neuron tract is descending link for reflex link of unconscious motion
coordination. Spinocerebellar tracts (Flechsig and Gowers tracts) are the ascending
links for this regulation. Spinocerebellar tracts send impulses for rubrospinal tracts
through the intermediate link (from cerebellar vermis and dentate nuclei to the
rubber nuclei).
Corticopontocerebellar tract (way of cortical correction of the cerebellum).
This 2-neuron tract starts from all lobes of cerebral hemispheres. Axons run
through the internal capsula to the proper pontini nuclei. Second neurons cross and
pass to the cerebellar vermis through the middle cerebellar pedunculi. Some links
directed also to dentate and rubber nuclei. This pathway materializes cortical
correction of unconscious motion coordination.
Materials for self-check.
A.Tasks for self-check. Explein the schematic tables.
B. Choose the correct answer.
1. As a result of a stroke (a hemorrhage in a brain) the patient does not have
locomotions of muscles of a head and a neck. Inspection of a brain by means of a
magnitno-resonant tomography has shown that the hematoma is in a knee of the
internal capsule. What conductive pathway is damaged at the patient?
A. The corticonuclear tract
B. Тhe anterior corticospinal tract
C. Тhe lateral corticospinal tract
D. Тhe tectospinal tract
Е. The rubrospinal tract
2. At the patient after a stroke (the hemorrhage in the brain) is observed absence of
conscious movements of muscles of a trunk on the right. Additional inspection by
means of magnitno-resonant therapy has shown that the hematoma is at the left in
the posterior limb of the internal capsule, near to the knee. What conductive
pathway is damaged at the patient?
A. The corticonuclear tract
B. The rubrospinal tract
C. Тhe lateral spinothalamic tract
D. Тhe tectospinal tract
Е. Тhe corticospinal tract
3. At inspection of the patient the neoplasm in white matter of hemicerebrums with
localisation in the knee and anterior part of the posterior limb of the internal capsule
is taped. What fibers of a conductive pathway of the brain will be damaged?
A. Tr. parietooccipitopontinus
B. Tr. frontothalamicus
C. Tr. thalamocorticalis
D. Tr. frontopontinus
E. Tr. pyramidalis, tr. corticonuclearis
4. A patient has appealed with complaints of visual impairment accompanied by
blepharoptosis (drooping eyelids), impossibility to lift the eyeball upwards and to
the middle. Examination has shown that the eyeball is diverted outside, the pupil is
dilated, does not react to light, the patient can′t see at a short distance. Which nerve
has been injured?
A. N. abducens dexter
B. N. trochlearis
C. N. opticus
D. N. abducens sinister
E. N. oculomotorius
5. At the patient at a local lesion of a brainstem (it is observed at neurosyphilis)
conduction pathways in the cerebral peduncle are damaged. What conductive
pathway forms decussatio tegmenti dorsalis?
A. The corticonuclear tract
B. The lateral spinothalamic tract
C. Тhe rubrospinal tract
D. Тhe tectospinal tract
Е. Тhe corticospinal tract
References.
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/8. http://anatom.ua/nomina-anatomica/
Topic 39. Final control of module 2. "Splanchnology. Central nervous system
and sense organs. "
1. Relevance of the topic.
Knowledge of anatomy section and necessary for students of all specialties for
further study.
2. The specific aims.
To analyze students' knowledge of the module 2 "Splanchnology. Central nervous
system and sense organs.
3. Basic knowledge and skills necessary to study the topic (inter-disciplinary
integration):
The preceding
The acquired knowledge
subjects
Biology
Phylogeny peripheral nervous system, autonomic nervous
system and sensory organs;
To further explore topics.
4. The tasks for student’s individual work. See materials topics of practical
lessons № 1-38.
Materials for self- cheeck.
A. Questions.
Theoretical questions.
1. The development of the gastrointestinal tract. Anomalies and variants of the
digestive system.
2. The general scheme of the structure of the digestive tube (characteristics of each
layer).
3. Mouth: parts, walls, their structure, connections. The development of the oral
cavity abnormalities.
4. Palate: parts, their structure. The development of the palate; abnormalities.
5. Tongue: development, structure, functions.
6. Teeth: types of teeth, tooth, tooth substance, the formula for permanent and
primary teeth.
7. Mouth cancer. Classification. Parotid gland, development, topography, structure.
8. Mouth cancer. Classification. Sublingual and submandibular salivary glands,
development, topography, structure.
9. Throat: development, parts, topography, structure of wall, lymphatic throat ring.
10. Esophagus: development, topography, parts, structure, narrowing of the
esophagus.
11. Stomach: development, topography, parts, structure walls.
12. Small intestine: development, parts, topography, structure of wall, relation to
peritoneum.
13. Duodenum: parts, topography, structure of wall.
14. The colon: development, parts, topography, structure of wall, relation to
peritoneum.
15. cecum and appendix, topography, structural features of the wall, relation to
peritoneum.
16. Rectum: topography, parts, structural features of the wall.
17. Pancreas: development, topography, parts, structure, functions.
18. Liver: development, topography, structure, functions.
19. Gall bladder: topography, structure. Common bile duct: formation, topography,
structure.
20. Peritoneum: general characteristics. Gaskets, ligaments, mesentery.
21. peritoneal cavity, departments, bags, channels, depressions.
22. Bags peritoneal cavity. Salnikovaja bag, its walls and connections.
23. Nose: parts, structure. Nasal cavity: development, parts, their structure and
communication.
24. Nasal cavity: functional parts, their structure and function.
25. Larynx: cartilages, a compound muscle.
26. The cavity of the larynx, its part of the wall.
27. The trachea and bronchi, development, topography, structure.
28. Lungs: development, topography, structure, functions.
29. Shares, broncho-pulmonary segments slices lungs: their structure. Structural and
functional unit of the lung.
30. The lungs, the bronchial tree alveolar tree of branching, structure, functions.
31. pleura: development, structure, topography, pleural cavity, pleural corners,
borders pleural sacs.
32. mediastinum, determining divisions. Bodies anterior mediastinum.
33. mediastinum, determining divisions. Bodies posterior mediastinum.
34. The bodies of the urinary system, the kidneys, Her development, structure,
topography. Anomalies of the kidneys.
35. The bodies of the urinary system, ureters, bladder, their development, structure,
topography. Anomalies of development.
36. The male and female urethra: development, structure, topography.
37. The external female genitals: the development, construction, abnormalities.
38. The internal female sex organs. Ovaries: topography, structure, functions,
rudimentary applications.
39. The internal female sex organs. Uterus: development, structure, topography,
communications.
40. The ratio of the uterus to the peritoneum. Anomalies of development.
41. The internal female sex organs. Uterine tube: development, structure,
topography.
42. The ratio of the fallopian tubes to the peritoneum. Anomalies of development.
43.Man's genitals. Testicle, nad'yayechko: topography, structure, functions.
44. Man's genitals. Testicle, the development process of lowering the testicle in the
scrotum. Anomalies of development. Shell testicles. Spermatic cord: topography,
parts, structure.
45. Man's genitals. The prostate gland, seminal vesicle, bulbous-sechivnykova
gland: its topography, structure.
46. The external male genitalia: development, structure.
47. Perineum: definition of muscles, fascia, sexual characteristics. Sciaticvidhidnykova fossa: walls, content.
48. Endocrine glands. General characteristics. The thyroid gland, parathyroid
glands, their development, topography, structure, functions.
49. Endocrine gland. General characteristics. The adrenal glands, development,
topography, structure, functions.
50. Endocrine gland. General characteristics. The pituitary and pineal gland,
development, topography, structure, functions.
51. The development of the central system. The main stages of the nervous system.
52. The concept of the neuron. The gray and white matter of the central nervous
system. The nerve fiber bundles, roots, nodes, nerves. The structure of simple
and complex reflex arcs.
53. Spinal cord: topography, external structure. Segments of the spinal cord. The
development of the spinal cord in embryogenesis abnormalities of the spinal
cord.
54. Spinal cord: development, topography, internal structure. Morpho-functional
characteristics of the gray matter.
55. Spinal cord: development, topography, internal structure. Morpho-functional
characteristic white matter.
56. Meninges of spinal cord spaces between them, and their contents.
57. The development of the brain (brain blisters and their derivatives). Anomalies of
development.
58. brainstem. Characteristics of the cranial nerve nuclei
59. Medulla oblongata: development, external and internal structure ..
60. Bridge: development, external and internal structure.
61. Rhomboid fossa: its borders, relief. Projection nuclei of cranial nerves. IV
ventricle: topography, walls, connections.
62.Cerebellum: development, external and internal structure.
63. Midbrain: development, external and internal structure.
64. Interim brain: structure, functional significance. III ventricle walls, connections.
65. The basal nuclei of the cerebral hemispheres: topography, structure, functions.
66. Lateral ventricles: parts, their walls, connections.
67. White matter of cerebral hemispheres, associative, commissural, projection
fibers. Inside the capsule: parts, topography of pathways.
68. Olfactory brain, central and peripheral divisions.
69. extrapyramidal motor system: kernel pathways function.
70. Relief verhnobichnoyi surface of the cerebral hemispheres. Localization of
cortical ends of analyzers in the cortex of the parietal lobe. The structure of the
crust.
71. Relief verhnobichnoyi surface of the cerebral hemispheres. Localization of
cortical ends of analyzers in the cortex of the frontal and temporal lobes.
72. Relief medial and lower surfaces of the cerebral hemispheres.
73. Meninges brain space between them and their contents. Formation and outflow
of cerebrospinal fluid. Anomalies of brain membranes.
74. What is represented by peripheral olfactory analyzer?
75. Where are the subcortical and cortical centers of smell?
76. The structure of the conductor path olfactory analyzer.
77. Where are the receptors of the organ of taste? What cranial nerves carry taste
sensations to the brain stem?
78. Where is the second and third neurons analyzer taste?
79. Where is the center of cortical organ of taste?
80. The structure and development of the skin.
81. Functions of the skin, especially its structure in different parts of the body.
82.Salni and sweat glands, structure, functions.
83.The nails and hair structure, especially the location on the body.
84. The mammary gland, structure, topography, blood supply, innervation,
vidtiklimfy.
85. Components of the visual analyzer?
86. What is represented capsule eyeball?
87. The structure and function of membranes eyeball?
88. Components of the uvea and their functions?
89. avilable inner lining of the eyeball?
90. What structures form the inner core of the eyeball?
91. The structure of the chambers of the eyeball, the creation and circulation of fluid
inside the eye?
92. What applies to support staff eye?
93. Where are the cortical and subcortical centers of authority?
94. Providnyy way of eye.
95. Define the term "blyzorukist" "dalnozorkist" that these methods may correct
blurred vision?
96. Which of the produce in the organ of hearing?
97. What are the parts of the outer ear is built?
98. What education relating to zvukoulovlyuyuchoyi and the conductive system?
99. As the external auditory canal built?
100. What is the drum cavity?
101. What is the drum wall cavity?
102. The structure and function of the auditory tube.
103. The structure of the inner ear.
104. Where are the cortical and subcortical centers of hearing and balance?
105. Budova pathways hearing and balance?
106. Parasympatychna of 9 pairs of cranial nerves?
107. Parasympathetic part 7 pairs of cranial nerves?
108. parasympathetic part 3 pairs of cranial nerves?
109. parasympathetic part of the 10 pairs of cranial nerves?
110. visceral reflex arc SNS?
111. Leading the way organ of taste?
112. Leading the way hearing?
113. Pathways of eye?
114. Leading the way organ of smell?
115. Leading the way organ of balance?
116. Pyramid ways?
117. Extrapyramidal ways?
118. Ways cerebellum: afferent, asotsyatyvni, efferent?
119. Reticular formation? How nuclei of the reticular formation?
120. Tsentry ways and spinal afferent innervation of the pelvis?
121. centers and how spinal afferent innervation of the chest cavity?
122. Ways innervation of the heart, afferent innervation, efferent innervation,
parasympathetic innervation?
B. Choose the correct answer.
1.A 65 years old patient has been diagnosed with bleeding in the anterior horn of
the spinal cord. Which, by the function are anterior horns?
A.Motional
B.Sensitive
C.Sympathetic
D.Parasympathetic
E.Mixed
2.A 41 years old patient got into an infectious department of the hospital with a high
body temperature. Meningeal symptoms objectively expressed. A lumbar puncture
was done. What anatomical formation was punctured?
A.spatium subarachnoideum
B.spatium subdurale
C.spatium epidurale
D.cavum trigeminale
E.cisterna cerebellomedullaris posterior
3.The patient with fractures of the thoracic spine (Th1) with spinal cord injury has
arrived to the surgical department. Which segment of the spinal cord is injured?
A.2 thoracic
B.1 thoracic
C.1 lumbar
D.5 lumbar
E.5 sacral
4.A 65 years old patient has been diagnosed with bleeding in the anterior horn of
the spinal cord. Which, by the function are anterior horns?
A.Motional
B.Sensitive
C.Sympathetic
D.Parasympathetic
E.Mixed
5.A patient has meningitis. The puncture of the arachnoid area was proposed.
Determine shells between which it is located:
A.Arachnoid and soft shells.
B.The periosteum and arachnoid membrane.
C.The solid and the arachnoid membranes.
D.The periosteum and dura mater.
E.The dura mater soft shell.
6.The patient experiences a severe headache, stiffness in the neck muscles, repeated
vomiting, pain on percussion of the skull, increased sensitivity to light stimuli. The
documented diagnosis - meningitis. A lumbar puncture was prescribed. Indicate an
area where to perform it.
A.Between 3 and 4 lumbar vertebrae
B.Between 1 and 2 lumbar vertebrae
C.between 12 thoracic and 1 lumbar vertebrae
D.Between 5 lumbar and sacrum
E.between 11 and 12 thoracic vertebrae
7.A man gets tired quickly while working. In a standing position with eyes closed is
not stable, loses balance. A tension of skeletal musclesis decreased. Which of the
following is most likely brain structures to be affected?
A.Cerebellum.
B.Pons.
C.The nucleus of accessory nerves.
D.The nucleus of the vagus nerve.
E.Medulla oblongata.
8.When examining a women's brain it was found that haemorrhage is localised in
the anterior pedunculus of the cerebellum. What neural tracts go through it?
A.Spinal cerebellar anterior, Foliocerebellar.
B.Spinocerebellar anterior and posterior, Olivocerebellar.
C.Spinocerebellar posterior, Olivocerebellar, Vestibulaocerebellar, Vestibulospinal.
D.Spinocerebellar anterior, Olivocerebellar, Vestibulocerebellar, Vestibulospinal.
E.Pontocerebellar.
9.When examining a women's brain it was found that haemorrhage is localised in
the middle pedunculus of the cerebellum. What neural tracts go through it?
A.Pontocerebellar.
B.Spinocerebellar anterior and posterior, Olivocerebellar.
C.Spinocerebellar posterior, Olivocerebellar, Vestibulocerebellar, Vestibulospinal.
D.Spinocerebellar anterior, Olivocerebellar, Vestibulocerebellar, Vestibulospinal.
E.Spinal cerebellar anterior, Foliocerebellar.
10.When examining a women's brain it was found that haemorrhage is localised in
the inderior pedunculus of the cerebellum. What neural tracts go through it?
A.Spinocerebellar posterior, Olivocerebellar, Vestibulocerebellar, Vestibulospinal.
B.Spinocerebellar anterior and posterior, Olivocerebellar.
C.Spinocerebellar anterior, Olivocerebellar, Vestibulocerebellar, Vestibulospinal.
D.Pontocerebellar.
E.Spinal cerebellar anterior, Foliocerebellar.
11.The patient was admitted the clinic with a damage of the skull base in the are od
clivus. Intensive therapy was prescribed to prevent extensive swelling and
compression of the brain part, where a respiratory and vasomotor centres are
located. Where are they located?
A.In the medulla oblongata.
B.In the midbrain.
C.In Pons.
D.In the Cerebellum.
E.Around the brain stem.
12.When examining patients with impaired auditory function was found that the
pathological process is localised at the lateral lemniscus formation. At the level of
the brain which is normally formed?
A.Hindbrain (cities).
B.Сervical spinal cord.
C.Thoracic spinal cord.
D.Medulla oblongata.
E.Midbrain.
13.To the neurosurgical department, the patient in a coma was admitted
(unconsciousness and with a lack of purposeful reactions to any stimuli). When
examining doctor has found that dysfunction of the cerebral cortex was caused by
the damage to the patient's brainstem neuronal network, which supported the
activity of the cerebral cortex. What brain structures are damaged?
A.Reticular formation.
B.Basal nuclei.
C.The nuclei of the cerebellum.
D.Caudalie nuclei.
E.The nuclei of the hypothalamus.
14.The patient has a damaged pyramid of the medulla oblongata by tumor. Which
of the pathways of nerve impulses will be broken?
A.Tr. corticospinalis.
B.Tr. corticopontinus.
C.Tr. corticonuclearis.
D.Tr. dentatorubralis.
E.Tr. spinocerebellaris.
15.At postmortem study, it is necessary to determine the boundary between the
medulla and the spinal cord. What is the benchmark that separates these parts of the
central nervous system?
A.Roots of the 1 pair of spinal nerves.
B.Glossopharyngeal nerve roots.
C.Additional nerves roots.
D.Hypoglossal nerve roots.
E.Nuclei - centres of the cardiovascular system.
16.The patient is difficult to form a food ball and swallow food. Objectively: tongue
motionless, the defects in a speech were observed. The cause of these disorders may
be damage to the nuclei, which is projects on the bottom of the rhomboid fossa.
Which nuclei of the nerve is damaged?
A.The nuclei of the XII pairs of cranial nerves
B.The nuclei of the III pairs of cranial nerves
C.The nuclei of the V pair of cranial nerves
D.The nuclei of the VI pairs of cranial nerves
E.The nuclei of the VIII pairs of cranial nerves
17.The patient was diagnosed with a damage of the efferent fibres after a long
illness injury that depart, those fibres begin from the accessory nerve nuclei in the
brain stem. What are these nuclei?
A.Dualnucleus, additional nucleus.
B.Solitary nucleus, additional nucleus.
C.The nucleus of the hypoglossal nerve, dual nucleus.
D.Inferior salivatory nucleus, dual core.
E.Dorsal nucleus of the vagus nerve, additional nucleus.
18.As a result of the pathological process the autonomic dysfunction of the nucleus
of the vagus nerve occurred. The patient complains of bradycardia, reduced
intestinal motility. What is the core affected?
A.Dorsal nucleus of the vagus nerve.
B.Solitary nucleus.
C.Dual nucleus.
D.Hypoglossal nerve nucleus.
E.Inferior salivatory nucleus.
19.The patient after an arachnoiditis developed an elevated cerebrospinal fluid
pressure in the 4th ventricle of the brain. Fusion of which openings led to this?
A.Middle and lateral apertures.
B.Interventricular left opening
C.Interventricular right opening
D.An aqueduct
E.Centre channel.
20.After imaging in the brain of the patient was revealed tuberkuloma on the level
of the facial tubercules of fossa rhomboid. Nuclei of which pairs of cranial nerves
are projected on the facial tubercules?
A.Nucleus n. abducentis
B.Nucleus motorius n. trigemini
C.Nucleus ambiguus
D.Nucleus impar
E.Nucleus n. facialis
21.A patient has an affected muscle tension and impaired automatic movements.
What nuclei of the midbrain are damaged?
A.Red nucleus.
B.The black substance.
C.The nuclei of cranial nerves.
D.Superior colliculi and Inferior colliculi
E.Reticular formation.
22.Because of the patient neuroinfection the patient developed a disorder of the
extrapyramidal system. What midbrain nuclei can be damaged?
A.Red nucleus.
B.The core Darkshevycha.
C.The nuclei of cranial nerves.
D.Superior colliculi and Inferior colliculi
E.Reticular formation.
23.In the care of the haemorrhage in the midbrain the patient complained of ptosis,
impaired movement of the eyeball. What are the nuclei which suffered a damage?
A.Nuclei of the 3rd pair of cranial nerves.
B.Red nucleus.
C.The black substance.
D.Nuclei of the 4th pair of cranial nerves.
E.Reticular formation.
24.Pathological processes damaged the nucleus of the diencephalon. Which of the
nuclei from the list are located in the diencephalon?
A.Nucl. n. oculomotorii.
B.Nucl.ruber.
C.Nucl. pulvinares.
D.Nucl. subthalamicus.
E.Nucl. reticulares thalami.
25.The patient during the brain imaging using MRT the inflammation in the brain in
the colliculi area was determined. What applies to this area?
A.Medial and lateral geniculate body.
B.Superior colliculi and Inferior colliculi
C.Mastoid bodies.
D.Pituitary gland.
E.Pineal gland.
26.Patient has a damaged hypothalamic area.What does not apply to the
hypothalamus?
A.Pineal gland.
B.Visual intersection.
C.Gray hump.
D.A papillary body.
E.Funnel.
27.The patient has an impaired outflow of the liquid from the III ventricle. What
wall of the third ventricle restricts the medial thalamus?
A.Lateral
B.Middle
C.Superior
D.Inferior
E.Posterior
28.After the head injury in a patient, 39 years, the dysfunction of the motoric
centres is observed, this centres manage an activity of the face muscles. In which
areas of the cerebral cortex this centres (nuclei) are normally localised?
A.The lower part of the precentral gyrus
B.The upper part of the precentral gyrus
C.Supramarginal gyrus
D.The upper parietal lobe.
E.Angular gyrus.
29.The patient has a motor aphasia. Where is the damage of the nervous system
located?
A.The lower frontal gyrus.
B.Superior temporal gyrus.
C.Hypoglossal nerve.
D.The middle frontal gyrus.
E.Angular gyrus.
30.The patient has ataxia, a staggering body when standing due to damage to
nucleus of the analyser and head statute and movements (static analyser). In which
area of the cerebral cortex is the damage localised?
A.Gyrus temporalis medialis et inferior.
B.Gyrus parietalis superior.
C.Gyrus frontalis superior.
D.Gyrus temporalis superior.
E.Gyrus supramarginalis.
31.Patient after a car accident got a fractured ethmoid bone and its ethmoid plate
and a break of the fibres of 1st pairs of cranial nerves. Which part of the peripheral
olfactory brain gives a start to the fibres of the olfactory nerves?
A.Olfactory bulb.
B.Olfactory band.
C.Olfactory triangle.
D.Dentate gyrus.
E.Front permeated substance.
32.The patient has a bleeding in the area of external capsule. It is a layer of white
matter, which is limited by:
A.Nucleus lentiform and claustrum
B.claustrum and island сщкеуч
C.The head of the caudate nucleus, thalamus and nucleus lentiform nucleus
D.Corpus callosum and thalamus
E.Thalamus and corpus amygdaloideum
33.The spinal cord injury in a traffic accident caused a damage to the sensory fibres
of the trigeminal nerve. This will lead to the lost of:
A.Pain and temperature sensitivity of facial skin sensitivity
B.Sensation of body position, vibration sensation
C.Skin sensitivity of the body
D.Vision
E.Hearing
34.The patient has a damaged overall sensitivity of the mucous layer of the tongue
(feels no pain, temperature). What fibres are damaged?
A.Lateral spinal-thalamic bundle.
B.bunch of Gaulle and Burdach.
C.Bunch of Fleksih and Gowers.
D.Rubrospinal track
E.Reticulospinal track
35.The patient has a damaged pyramidal tract, that manifests in an impaired
movements of facial muscles. Specify this way:
A.Corticonuclear
B.Corticospinal
C.Tegmentospinal
D.Olivospinal
E.Reticulospinal
Recommended Books
Basic:
1.Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2008. – 248p.
2.Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. Lugansk: LTD «Virtualnaya realnost», 2009. – 384p.
3.Gray′s anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W.
M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson;
photographs by Ansell Horn. – 2nd ed. 2012 – 1103p.
4.Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. –
Elsevier GmbH, Munich, 2008 . – 895p.
5.Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and
Treatment. 2003.
6.Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore:
Wiliams & Wolters, 2009. – 864 p.
7.Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson
Education, 2009. – 250p.
8.Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. //
ILS, Medimedia USA Company, 1997. – 548p.
The additional literature:
1.Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. –
384p.
2.Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin.
Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11.
3.Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford:
Blackwell, 1985. – V. 11. – 372p.
4.Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. 917p.
5.Clinical Anatomy. Applied anatomy for clinical students and junior doctors:
eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p.
6.Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme,
Stuttgart. – 2000. – 510p.
7. https://human.biodigital.com/
8. http://anatom.ua/nomina-anatomica/