Holotopy, syntopy and skeletopy of organs. Show sections, syntopy of the stomach. Projection of the vagus nerves and vessels of the stomach. Choose a set of instruments for suturing the gastric wound Syntopy of the stomach

The digestive system, systema digestorium, is a long canal (8-10 m), starting with the oral fissure, rima oris, and ending with the anus, anus. Throughout the digestive canal has an uneven diameter; narrowing and expanding, it forms numerous bends. The digestive system consists of organs that provide mechanical and chemical enzymatic processing of food, the subsequent absorption of split nutrients into the blood and lymphatic vessels and the removal of undigested parts of food to the outside.

The wall of the alimentary canal consists of four membranes: the mucous membrane, the submucosa, the muscular membrane, and the outer serous or connective tissue membrane (adventitia). Depending on the functional purpose, the wall of each section of the digestive canal (pharynx, esophagus, stomach, small intestine, large intestine) has its own anatomical features - these are mainly the number and structure of the glands of the mucous membrane, the thickness of the submucosa, the direction and concentration of muscle bundles , the development of a connective tissue or serous membrane.

The first section of the digestive system is the oral cavity, cavitas oris, which opens on the face with a mouth opening - oral fissure, rima oris. The oral cavity is followed by: isthmus of the pharynx, isthmus faucium, pharynx, pharynx, esophagus, esophagus, stomach, ventriculus (gaster), small intestine, intestinum tenue, and large intestine, intestinum crassum, ending in the anus, anus. The digestive system also includes the salivary glands, glandulae salivariae, the liver, hepar, and the pancreas, pancreas.

Stomach structure

The stomach, gaster (ventriculus), is located in the upper left (5/6) and right (76) parts of the abdominal cavity; its long axis goes from above to the left and from behind to the right down and forward and is almost in the frontal plane. The shape and size of the stomach are variable and depend on the degree of its filling, the functional state of the muscles of its walls (contraction, relaxation).

The shape of the stomach also changes with age. It is customary to distinguish 3 forms of the stomach: the shape of a horn, the shape of a stocking and the shape of a hook.

The left side of the stomach is located on the left side under the diaphragm, and the narrow right side is located under the liver. The length of the stomach along its long axis is on average 21-25 cm. The capacity of the stomach is 3 liters.

The stomach consists of several parts: cardiac, fundus (arch), body and pyloric (pyloric).

The input, or cardial part, pars cardiaca, begins with an opening through which the stomach communicates with the esophagus - the cardiac opening, ostium cardiacum.

Directly to the left of the cardial part is the convex upward bottom (arch) of the stomach, fundus (fornix) gastricus.

The largest part of the stomach is the body of the stomach, corpus gastricum, which continues upward without sharp boundaries into the bottom, and to the right, gradually narrowing, passes into the pyloric part.

The pyloric (pyloric) part, parspylorica, is directly adjacent to the pyloric opening, ostium pyloricum, through which the lumen of the stomach communicates with the lumen of the duodenum.

The pyloric part is subdivided into the pylorus cave, antrum pyloricum, the pylorus canal, canalis pyloricus, equal in diameter to the adjacent duodenum, and the pylorus itself, pylorus, - the section of the stomach that passes into the duodenum, and at this level the layer of circular muscle bundles thickens, forming a sphincter gatekeeper, t. sphincter pyloricus.

The cardial part, the bottom and the body of the stomach are directed from top to bottom and to the right. The pyloric part is located at an angle to the body from the bottom up and to the right. The body on the border with the gatekeeper's cave forms the narrowest part of the cavity.

The described form of the stomach, observed during x-ray examination, resembles a hook in shape, it occurs most often. The stomach can have the shape of a horn, while the position of the body of the stomach approaches the transverse, and the pyloric part is a continuation of the body, without forming an angle with it.

The third form of the stomach is the form of a stocking. The stomach of this form is characterized by a vertical position and a long body, the lower edge of which is at the level of the IV lumbar vertebra, and the pyloric part is at the level of the II lumbar vertebra in the midline.

The anteriorly facing surface of the stomach is its anterior wall, paries anterior, and the posteriorly facing surface is the posterior wall, paries posterior. The upper edge of the stomach, which forms the border between the anterior and posterior walls, is arcuately concave, it is shorter and forms the lesser curvature of the stomach, curvatura gastrica (ventruculi) minor. The lower edge, which makes up the lower border between the walls of the stomach, is convex, it is longer - this is the greater curvature of the stomach, curvatura gastrica (ventriculi) major.

Lesser curvature on the border of the body of the stomach and the pyloric part forms an angular notch, incisura angularis; along the greater curvature, there is no sharp border between the body of the stomach and the pyloric part. Only during the period of digestion of food, the body is separated from the pyloric part (cave) by a deep fold, which can be seen with an X-ray examination.

Such a constriction is usually visible on the corpse. Along the greater curvature there is a notch that separates the cardial part from the bottom - the cardiac notch, incisura cardiaca.

The wall of the stomach consists of three membranes: the outer one - the peritoneum (serous membrane), the middle one - muscular and the inner one - the mucosa.

The serous membrane, tunica serosa, is an visceral sheet of the peritoneum and covers the stomach from all sides; thus, the stomach is located intraperitoneally (intraperitoneally). Under the peritoneum lies a thin subserous base, tela subserosa, due to which the serous membrane fuses with the muscular membrane, tunica muscularis.

Only narrow strips along the lesser and greater curvature remain uncovered by the serous membrane, where the peritoneal sheets covering the anterior and posterior walls converge to form the abdominal ligaments of the stomach. Here, along one and the other curvature, between the sheets of the peritoneum lie blood and lymphatic vessels, nerves of the stomach and regional lymph nodes. Not covered by the peritoneum is also a small area of the posterior wall of the stomach to the left of the cardial part, where the wall of the stomach is in contact with the diaphragm.

The muscular membrane of the stomach, tunica muscularis, consists of two layers: longitudinal and circular, as well as oblique fibers. The outer, longitudinal layer, stratum longitudinale, which is a continuation of the esophageal layer of the same name, has the greatest thickness in the region of the lesser curvature. At the point of transition of the body to the pyloric part (incisura angularis), its fibers fan-shaped diverge along the anterior and posterior walls of the stomach and are woven into bundles of the next - circular - layer. In the region of greater curvature and fundus of the stomach, longitudinal muscle bundles form a thinner layer, but occupy a wider area.

The circular layer, stratum circulare, is a continuation of the circular layer of the esophagus. This is a continuous layer covering the stomach throughout its entire length.

A somewhat weaker circular layer is expressed in the bottom area; at the level of the pylorus, it forms a significant thickening - the pyloric sphincter, i.e. sphincter pyloricus.

Inward from the circular layer are oblique fibers, fibrae obliquae. These bundles do not represent a continuous layer, but form separate groups; in the region of the entrance to the stomach, bundles of oblique fibers loop around it, passing to the anterior and posterior surfaces of the body.

The contraction of this muscle loop causes the presence of a cardiac notch, incisura cardiaca. Near the lesser curvature, oblique beams take a longitudinal direction.

The mucous membrane, tunica mucosa, like the muscle layers, is a continuation of the mucous membrane of the esophagus. A well-defined serrated strip represents the boundary between the epithelium of the mucous membrane of the esophagus and stomach. At the level of the pylorus, according to the position of the sphincter, the mucous membrane forms a permanent fold. The mucous membrane of the stomach has a thickness of 1.5-2 mm; it forms numerous folds of the stomach, plicae gastricae, mainly on the back wall of the stomach.

The folds have different lengths and different directions. Near the lesser curvature, there are long longitudinal folds that delimit a smooth section of the mucous membrane of the curvature area - the gastric canal, canalis ventricularis, which mechanically directs the food bolus into the pyloric cave. In other parts of the stomach wall, they have a varied direction, and they distinguish between longer folds, interconnected by shorter ones. The direction and number of longitudinal folds are more or less constant, and in a living person the folds are well defined by X-ray examination using contrasting masses. When the stomach is stretched, the folds of the mucous membrane are smoothed out.

The mucous membrane of the stomach has its own muscular layer of the mucous membrane, lamina musculis mucosae, separated from the muscular membrane by a well-developed loose submucosa, tela submucosa; the presence of these two layers causes the formation of folds.

The mucous membrane of the stomach is divided into small, 1-6 mm in diameter, sections - gastric fields, ageae gastricae. On the margins there are depressions - gastric dimples, foveolae gastricae, having a diameter of 0.2 mm; dimples are surrounded by villous folds, plicae villosae, which are more pronounced in the pylorus area. Openings of 1-2 ducts of the gastric glands open into each dimple. There are gastric glands (own), glandulae gastricae (propriae), located in the area of the bottom and body, cardiac glands, glandulae cardiacae, as well as pyloric glands, glandulae pyloricae. If the cardiac glands of the stomach are branched tubular in structure, then the pyloric glands are simple mixed alveolar tubular. Lymphatic follicles lie in the mucous membrane (mainly in the pyloric part).

Syntopy and skeletopy of the stomach. Topography of the stomach

Most of the stomach is located to the left of the median plane of the body. The projection of the stomach onto the anterior wall of the abdomen occupies the left hypochondrium and epigastric regions.

Skeletotopically, the entrance to the stomach lies to the left of the spinal column, at the level of the X or XI thoracic vertebra, the exit is to the right of the spine, at the level of the XII thoracic or I lumbar vertebra.

The upper (vertical with a hook-shaped) section of the lesser curvature is located along the left edge of the spinal column, its lower section crosses the spinal column from left to right.

The back wall of the stomach in the bottom area is adjacent to the spleen; for the rest of its length, it adjoins the organs located on the back wall of the abdomen: the left adrenal gland, the upper end of the left kidney, the pancreas, the aorta and the vessels departing from it.

The stomach is displaced during breathing and depending on the filling of neighboring hollow organs (transverse colon). The least mobile points of the stomach are the cardial and pyloric parts, the remaining parts are characterized by significant displacement. The lowest point (lower pole) of the greater curvature with a hook-shaped stomach and its more vertical position sometimes reaches the level of the line between the iliac crests and is located below it.

The bottom of the stomach is located under the dome of the left half of the diaphragm. The lesser curvature and the upper part of the anterior wall are adjacent to the visceral surface of the left lobe of the liver.

The lower anterior surface of the body and the pyloric part of the stomach is adjacent to the costal part of the diaphragm and to the anterior abdominal wall in the region of the epigastrium. The left area of the greater curvature adjoins the visceral surface of the spleen; in the rest of the length (to the right) it is adjacent to the transverse colon. If the stomach is horn-shaped and occupies a more transverse position, the greater curvature is located at the level of the line connecting the ends of the X ribs, or at the level of the umbilical ring.

Liver structure

The liver, hepar, is the largest of the digestive glands, occupies the upper part of the abdominal cavity, located under the diaphragm, mainly on the right side. The shape of the liver somewhat resembles the cap of a large mushroom, has an upper convex and a slightly concave lower surface. However, the convexity is devoid of symmetry, since the most protruding and voluminous part is not the central, but the right rear, which narrows anteriorly and to the left in a wedge-shaped manner. Liver sizes: from right to left - an average of 26-30 cm, from front to back - right lobe 20-22 cm, left lobe 15-16 cm, maximum thickness (right lobe) - 6-9 cm.

The mass of the liver is on average 1500 g. Its color is red-brown, the texture is soft.

In the liver, a convex upper diaphragmatic surface, fades diaphragmatica, is distinguished; lower, sometimes concave, visceral surface, fades visceralis; a sharp lower edge, mar go inferior, separating the upper and lower surfaces in front, and a slightly convex back, pars posterior, of the diaphragmatic surface.

On the lower edge of the liver there is a notch of the round ligament, incisuraligamenti teretis; to the right is a small notch corresponding to the adjacent bottom of the gallbladder.

The diaphragmatic surface, fades diaphragmatica, is convex and corresponds in shape to the dome of the diaphragm.

From the highest point there is a gentle slope to the lower sharp edge and to the left, to the left edge of the liver; a steep slope follows the back and right parts of the diaphragmatic surface. Above, to the diaphragm, there is a sagitally located peritoneal falciform ligament of the liver, lig. falciforme hepatis, which follows from the lower edge of the liver back for about 2/3 of the width of the liver; behind the sheets of the ligament diverge to the right and left, passing into the coronary ligament of the liver, lig. coronarium hepatis.

The falciform ligament divides the liver, respectively, into its upper surface into two parts - the right lobe of the liver, lobus hepatis dexter, which is large and having the greatest thickness, and the left lobe of the liver, lobus hepatis sinister, is smaller. On the upper part of the liver, a small cardiac impression, impressio cardiaca, is visible, formed as a result of the pressure of the heart and corresponding to the tendon center of the diaphragm.

On the diaphragmatic surface, the upper part is distinguished, pars superior, facing the tendon center of the diaphragm; anterior part, pars anterior, facing anteriorly, to the costal part of the diaphragm, and to the anterior wall of the abdomen in the epigastric region (left lobe); the right part, pars dextra, directed to the right, towards the lateral abdominal wall (respectively, the middle axillary line), and the back part, pars posterior, facing the back.

Visceral surface, fades visceralis, flat, slightly concave, corresponds to the configuration of the underlying organs. There are three grooves on it, dividing this surface into four lobes.

Two grooves have a sagittal direction and stretch almost parallel to one another from the anterior to the posterior edge of the liver; approximately in the middle of this distance, they are connected, as if in the form of a crossbar, by a third, transverse, furrow.

The left sulcus consists of two sections: the anterior, extending to the level of the transverse sulcus, and the posterior, located posterior to the transverse. The deeper anterior section is the gap of the round ligament, fissura lig. teretis (in the embryonic period - the groove of the umbilical vein), begins on the lower edge of the liver from the notch of the round ligament, incisura lig. teretis, it contains a round ligament of the liver, lig. teres hepatis, running in front and below the navel and enclosing the obliterated umbilical vein. The posterior section of the left furrow is the gap of the venous ligament, fissura lig. venosi (in the embryonic period - the fossa of the venous duct, fossa ductus venosi), contains a venous ligament, lig. venosum (obliterated venous duct), and stretches from the transverse groove back to the left hepatic vein. The left groove in its position on the visceral surface corresponds to the line of attachment of the falciform ligament on the diaphragmatic surface of the liver and, thus, serves here as the boundary of the left and right lobes of the liver. At the same time, the round ligament of the liver is laid in the lower edge of the falciform ligament, in its free anterior area.

The right sulcus is a longitudinally located fossa and is called the fossa of the gallbladder, fossa vesicae felleae, which corresponds to a notch on the lower edge of the liver. It is less deep than the groove of the round ligament, but wider and represents the imprint of the gallbladder located in it, vesica fellea. The fossa extends backwards to the transverse furrow; its continuation posterior to the transverse sulcus is the sulcus of the inferior vena cava, sulcus venae cavae inferioris.

The transverse groove is the gate of the liver, porta hepatis. It contains its own hepatic artery, a. hepatis propria, common hepatic duct, ductus hepaticus communis, and portal vein, v. portae. Both the artery and the vein divide into main branches, right and left, already at the gates of the liver.

These three furrows divide the visceral surface of the liver into four lobes of the liver, lobi hepatis. The left furrow delimits on the right the lower surface of the left lobe of the liver; the right furrow delimits on the left the lower surface of the right lobe of the liver.

The middle section between the right and left sulci on the visceral surface of the liver is divided by a transverse sulcus into anterior and posterior. The anterior section is the square lobe, lobus quadratus, the posterior is the caudate lobe, lobus caudatus.

On the visceral surface of the right lobe of the liver, closer to the anterior edge, there is a colonic depression, impressio colica; behind, to the very rear edge, are: to the right - a vast depression from the right kidney adjacent here, renal depression, impressio renal is; to the left - duodenal (duodenal) depression adjacent to the right furrow, impressio duodenalis; even more posteriorly, to the left of the renal impression, is the impression of the right adrenal gland, adrenal impression, impressio suprarenalis.

The square lobe of the liver, lobus quadratus hepatis, is limited to the right by the fossa of the gallbladder, to the left by the fissure of the round ligament, in front by the lower edge, and behind by the gates of the liver. In the middle of the width of the square lobe there is a recess in the form of a wide transverse groove - an imprint of the upper part of the duodenum, a duodenal impression continuing here from the right lobe of the liver.

The caudate lobe of the liver, lobus caudatus hepatis, is located posterior to the gates of the liver, bounded in front by the transverse groove of the gates of the liver, on the right - by the groove of the vena cava, sulcus venae cavae, on the left - by the gap of the venous ligament, fissura 1 ig. venosi, and behind - the back of the diaphragmatic surface of the liver. On the anterior portion of the caudate lobe, on the left, there is a small protrusion - the papillary process, processus papillaris, adjacent behind the left side of the gate of the liver; on the right, the caudate lobe forms the caudate process, processus caudatus, which goes to the right, forms a bridge between the posterior end of the gallbladder fossa and the anterior end of the groove of the inferior vena cava and passes into the right lobe of the liver.

The left lobe of the liver, lobus hepatis sinister, on the visceral surface, closer to the anterior edge, has a bulge - the omental tubercle, tuber omentale, which faces the lesser omentum, omentum minus. On the posterior edge of the left lobe, immediately next to the gap of the venous ligament, there is an impression from the adjacent abdominal part of the esophagus - the esophageal impression, impressio esophageale.

To the left of these formations, closer to the back, on the lower surface of the left lobe there is a gastric impression, impressio gastrica.

The back of the diaphragmatic surface, pars posterior fades diaphragmaticae, is a fairly wide, slightly rounded area on the surface of the liver. It forms a concavity according to the place of attachment to the spine. Its central section is wide, and narrows to the right and left.

Accordingly, the right lobe has a groove in which the inferior vena cava is laid - the groove of the vena cava, sulcus venae cavae. Closer to the upper end of this groove in the substance of the liver, three hepatic veins, venae hepaticae, flowing into the inferior vena cava are visible. The edges of the vena cava are interconnected by a connective tissue ligament of the inferior vena cava.

The liver is almost completely surrounded by the peritoneal lining. The serous membrane, tunica serosa, covers its diaphragmatic, visceral surfaces and the lower edge. However, in places where the ligaments approach the liver and the gallbladder adjoins, there remain areas of various widths that are not covered by the peritoneum.

The largest area not covered by the peritoneum is located on the back of the diaphragmatic surface, where the liver is directly adjacent to the back wall of the abdomen; it has the shape of a rhombus - extraperitoneal field, area nuda.

According to its greatest width, the inferior vena cava is located. The second such site is located at the location of the gallbladder. The peritoneal ligaments arise from the diaphragmatic and visceral surfaces of the liver.

Syntopy of the liver

At the top, the upper part of the diaphragmatic surface of the liver is adjacent to the right and partially to the left dome of the diaphragm, in front of it, the front part is adjacent sequentially to the costal part of the diaphragm and to the anterior abdominal wall; behind the liver is adjacent to the X and XI thoracic vertebrae and the legs of the diaphragm, the abdominal esophagus, the aorta and the right adrenal gland. The visceral surface of the liver is adjacent to the cardial part, the body and the pylorus of the stomach, to the upper part of the duodenum, the right kidney, the right bend of the colon and to the right end of the transverse colon. The gallbladder also adjoins the internal surface of the right lobe of the liver.

The internal structure of the liver

The structure of the liver. The serous membrane, tunica serosa, covering the liver, is underlain by the subserous base, tela subserosa, and then by the fibrous membrane, tunica fibrosa. Through the gates of the liver and the posterior end of the gap of the round ligament, together with the vessels, connective tissue penetrates into the parenchyma in the form of the so-called perivascular fibrous capsule, capsula fibrosa perivascularis, in the processes of which there are bile ducts, branches of the portal vein and its own hepatic artery; along the vessels, it reaches the inside of the fibrous membrane. This is how a connective tissue frame is formed, in the cells of which there are hepatic lobules.

A lobule of the liver, lobulus hepaticus, 1-2 mm in size, consists of hepatic cells - hepatocytes, hepatocyti, forming liver plates, laminae hepaticae. In the center of the lobule is the central vein v. centralis, and around the lobule are interlobular arteries and veins, aa. interlobulares et w. interlobulares, from which interlobular capillaries originate, vasa capillaria interlobularia.

Interlobular capillaries enter the lobule and pass into the sinusoidal vessels, vasa sinusoidea, located between the liver plates. In these vessels, arterial and venous (from v. portae) blood is mixed. Sinusoidal vessels drain into the central vein. Each central vein flows into the sublobular or collecting veins, vv. sublobidares, and the latter - in the right, middle and left hepatic veins, w. hepaticae dextrae, mediae et sinistrae.

Between the hepatocytes lie the bile ducts, canaliculi biliferi, which flow into the bile ducts, ductuli biliferi, and the latter, outside the lobules, are connected to the interlobular bile ducts, ductus interlobulares biliferi. Segmental ducts form from the interlobular bile ducts.

Segmental structure of the liver

Based on the study of intrahepatic vessels and bile ducts, a modern understanding of the lobes, sectors and segments of the liver has developed. The branches of the portal vein of the first order bring blood to the right and left lobes of the liver, the border between which does not correspond to the external border, but passes through the gallbladder fossa and the groove of the inferior vena cava.

Branches of the second order provide blood flow to the sectors: in the right lobe - to the right paramedian sector, sector paramedianum dexter, and the right lateral sector, sector lateralis dexter, in the left lobe - to the left paramedian sector, sector paramedianum sinister, left lateral sector, sector lateralis sinister, and the left dorsal sector, sector dorsalis sinister.

The last two sectors correspond to segments I and II of the liver. The other sectors are each divided into two segments, so that there are 4 segments in the right and left lobes.

The lobes and segments of the liver have their own bile ducts, branches of the portal vein and their own hepatic artery. The right lobe of the liver is drained by the right hepatic duct, ductus hepaticus dexter, which has anterior and posterior branches, d. anterior et r. posterior, the left lobe of the liver is the left hepatic duct, ductus hepaticus sinister, consisting of medial and lateral branches, g. medial is et lateralis, and the caudate lobe is the right and left ducts of the caudate lobe, ductus lobi caudati dexter et ductus lobi caudati sinister.

The anterior branch of the right hepatic duct is formed from the ducts of the V and VIII segments; the posterior branch of the right hepatic duct - from the ducts of the VI and VII segments; lateral branch of the left hepatic duct - from the ducts of II and III segments. The ducts of the square lobe of the liver flow into the medial branch of the left hepatic duct - the duct of the IV segment, and the right and left ducts of the caudate lobe, the ducts of the I segment can flow together or separately into the right, left and common hepatic ducts, as well as into the posterior branch of the right and into the lateral branch of the left hepatic duct. There may be other options for connecting the three segmental ducts. Often the ducts of the III and IV segments are interconnected.

The right and left hepatic ducts at the anterior edge of the gate of the liver or already in the hepatoduodenal ligament form the common hepatic duct, ductus hepaticus communis.

The right and left hepatic ducts and their segmental branches are not permanent formations; if they are absent, then the ducts that form them flow into the common hepatic duct. The length of the common hepatic duct is 4-5 cm, its diameter is 4 mm. Its mucous membrane is smooth, does not form folds.

gallbladder structure

The gallbladder, vesica fellea (biliaris), is a bag-shaped reservoir for bile produced in the liver, it has an elongated shape with wide and narrow ends, and the width of the bladder gradually decreases from the bottom to the neck. The length of the gallbladder ranges from 8 to 14 cm, the width is 3-5 cm, and the capacity reaches 40-70 cm3. It has a dark green color and a relatively thin wall.

In the gallbladder, the bottom of the gallbladder, fundus vesicae felleae, is distinguished - its most distal and widest part; body of the gallbladder, corpus vesicae felleae, - the middle part and neck of the gallbladder, collum vesicae felleae, - the proximal narrow part, from which the cystic duct departs, ductus cisticus. The latter, connecting with the common hepatic duct, forms the common bile duct, ductus choledhus communis.

The gallbladder lies on the visceral surface of the liver in the fossa of the gallbladder, fossa vesicae felleae, which separates the anterior section of the right lobe from the quadrate lobe of the liver. Its bottom is directed forward to the lower edge of the liver in the place where a small notch is located, and protrudes from under it; the neck is turned towards the gate of the liver and lies along with the cystic duct in the duplication of the hepatoduodenal ligament.

At the place of transition of the body of the gallbladder into the neck, a bend is usually formed, so the neck is lying at an angle to the body. The gallbladder, being in the fossa of the gallbladder, adjoins to it with its upper surface, devoid of peritoneum, and connects to the fibrous membrane of the liver. Its free surface, facing down into the abdominal cavity, is covered with a serous sheet of the visceral peritoneum, passing to the bladder from the adjacent areas of the liver.

The gallbladder can be located intraperitoneally and even have a mesentery. Usually, the bottom of the bladder protruding from the liver notch is covered with peritoneum on all sides.

The structure of the gallbladder. The wall of the gallbladder consists of three layers (with the exception of the upper extraperitoneal wall): the serosa, tunica serosa vesicae felleae, the muscular membrane, tunica muscularis vesicae felleae, and the mucous membrane, tunica mucosa vesicae felleae. Under the peritoneum, the wall of the bladder is covered with a thin loose layer of connective tissue - the subserous base of the gallbladder, tela subserosa vesicae felleae, on the extraperitoneal surface it is more developed.

The muscular membrane of the gallbladder, tunica muscularis vesicae felleae, is formed by one circular layer of smooth muscles, among which there are also bundles of longitudinally and obliquely arranged fibers.

The muscular layer is less pronounced in the bottom area and stronger in the cervical region, where it directly passes into the muscular layer of the cystic duct. The mucous membrane of the gallbladder, tunica mucosa vesicae felleae, is thin and forms numerous folds, plicae tunicae mucosae vesicae felleae, giving it the appearance of a network. In the region of the neck, the mucous membrane forms several oblique spiral folds, plicae spirales, one after the other. The mucous membrane of the gallbladder is lined with a single-row epithelium; in the neck in the submucosa there are glands.

Topography of the gallbladder. The bottom of the gallbladder is projected on the anterior abdominal wall in the corner formed by the lateral edge of the right rectus abdominis muscle and the edge of the right costal arch, which corresponds to the end of the 9th costal cartilage. Syntopically, the lower surface of the gallbladder is adjacent to the anterior wall of the upper part of the duodenum; on the right, the right flexure of the colon adjoins it.

Often the gallbladder is connected to the duodenum or to the colon by a peritoneal fold.

pancreas structure

The pancreas, pancreas, is a large gland located on the back wall of the abdomen behind the stomach, at the level of the lower thoracic (XI) and upper lumbar (I, II) vertebrae.

The bulk of the gland performs an exocrine function - this is the exocrine part of the pancreas, pars exocrina pancreatis; the secret secreted by it through the excretory ducts enters the duodenum.

The exocrine part of the pancreas has a complex alveolar-tubular structure. Around the main duct of the gland are macroscopic pancreatic lobules, lobuli pancreatis, its parenchyma, consisting of a number of orders of smaller lobules. The smallest structures - pancreatic acini, acinipancreatici, consist of glandular epithelium. Groups of acini are combined into segments of the seventh order, they form the smallest excretory ducts. The lobules of the gland are separated by connective tissue interlobular septa, septi interlobares.

Between the lobules lie pancreatic islets, insulaepancreaticae, representing the endocrine part of the pancreas.

The pancreas is located almost transversely, crossing the front of the spine, and 73 of it is located to the right, i.e., to the right of the spinal column (in the horseshoe of the duodenum), and 2/3 - to the left of the median plane of the body, in the epigastric region and in the left hypochondrium region. It is projected onto the abdominal wall 5-10 cm above the level of the umbilical ring.

In the pancreas, there are three sections located sequentially from right to left: the head, caput pancreatis, the body, corpus pancreatis, and the tail, cauda pancreatis. All departments are surrounded by a pancreatic capsule, capsula pancreatis.

There are anterior and posterior surfaces of the pancreas, and in the body - also the lower surface and three edges: anterior, upper and lower.

The length of the pancreas is 16-22 cm, the width is 3-9 cm (in the region of the head), the thickness is 2-3 cm; weight - 70-80 g. The gland has a grayish-pink color, almost the same as the parotid salivary gland. The head of the gland is located at the level of the 1st lumbar vertebrae, and the body and tail go obliquely to the left and up, so that the tail is in the left hypochondrium, at the level of the XII ribs.

The head of the pancreas, caput pancreatis, is the widest part; its right edge is bent down and forms a hook-shaped process, processus uncinatus, directed to the left. When the head passes into the body of the gland, it narrows somewhat; this area is commonly called the neck of the pancreas.

The right half of the body has a slight upward and forward curve, the left half forms a downward curve; the tail of the gland is directed upwards. At the lower edge of the neck of the gland there is a pancreatic notch, incisura pancreatis, which separates the uncinate process and continues along the posterior surface of the neck up and to the right in the form of an oblique groove, in which the superior mesenteric artery and the superior mesenteric vein lie (the latter merges here with the splenic vein and continues like a portal vein).

The duodenum passes through the head of the pancreas, covering it in the form of a horseshoe: with its upper part it is adjacent to the head of the gland from above and partly in front, with its descending part it covers the right edge, and with its horizontal (lower) part - the lower edge.

In the upper half of the gap between the head of the pancreas and the descending part of the duodenum descends the common bile duct, ductus choledochus. The posterior surface of the head of the pancreas adjoins the right renal vein, renal artery and inferior vena cava; in the region of the neck, with the left edge of the uncinate process, it is adjacent to the right crus of the diaphragm and to the abdominal aorta.

The front surface of the head of the pancreas is covered with a sheet of parietal peritoneum; its middle is crossed by the root of the mesentery of the transverse colon, which is why the upper part of the head bulges into the cavity of the stuffing bag, bursa omentalis, and adjoins through the peritoneum to the posterior surface of the stomach (to its pyloric part). The lower part of the head covered with the peritoneum, as well as the lower part of the duodenum adjacent to it, is located below the root of the mesentery of the transverse colon and faces the right sinus of the lower floor of the abdominal cavity, where loops of the small intestine are located near it.

The body of the pancreas, corpus pancreatis, lies at the level of the 1st lumbar vertebra. It has a trihedral (prismatic) shape. It distinguishes three surfaces: anterior, posterior and lower, and three edges: upper, anterior and lower.

The anterior surface, fades anterior, faces anteriorly and somewhat upwards; it is limited by the front edge, margo anterior, and from above by the upper edge, margo superior. Back surface, fades posterior, facing backwards; it is limited by the upper and lower edges, margines superior et inferior. The narrow lower surface, fades inferior, faces downwards and is bounded by the front and bottom edges.

The mesentery of the transverse colon and the sheets of the greater omentum, omentum majus, fused with it, are attached to the anterior edge. The top of the sheets along the anterior margin passes upwards into the parietal peritoneum, which covers the anterior surface of the pancreas.

The anterior surface of the body of the gland faces the posterior wall of the stomach. The right part of the body adjacent to the head is located in front of the spine (2nd lumbar vertebra), protrudes forward and upward, forming an omental tubercle, tuber omentale. This tubercle lies at the level of the lesser curvature of the stomach, faces the lesser omentum and is in contact here with the same tubercle of the left lobe of the liver, tuber omentale hepatis. The posterior surface of the body of the gland adjoins the abdominal aorta, the celiac plexus, and the left renal vein; to the left - to the left adrenal gland and left kidney. On this surface, in special grooves, the splenic artery passes, and below, immediately under the upper edge, near the middle of the posterior surface, the splenic vein. The lower surface of the body of the pancreas is located below the mesentery of the transverse colon. In the middle of the stretch, a duodenal-skinny bend, flexura duodenojejunalis, is adjacent to it. To the left, loops of the small intestine and a section of the transverse colon adjoin the lower surface. The lower surface is separated from the rear by a blunt lower edge.

The anterior surface is separated from the posterior by a sharp upper edge along which the splenic artery passes. In the region of the omental tubercle, from the upper edge towards the lesser curvature of the stomach, there is a peritoneal fold, in which the left gastric artery passes.

The tail of the pancreas, caudapancreatis, goes up and to the left and, moving away from the back wall of the abdomen, enters between the sheets of the gastro-splenic ligament, lig. gastrolienale; the splenic vessels here bypass the upper edge of the gland and go in front of it. The tail of the gland reaches the visceral surface of the spleen and adjoins it with its end below and behind the gate.

Below it is adjacent to the left bend of the colon.

The pancreatic duct, ductus pancreaticus, runs from the tail to the head, located in the thickness of the substance of the gland at the middle of the distance between the upper and front edges, closer to the posterior than to the anterior surface. Along the path of the duct, ducts from the surrounding lobules of the gland flow into it. At the right edge of the head, the duct connects with the common bile duct into the hepatic-pancreatic ampulla, ampulla hepatopancreatica, at the top of the major duodenal papilla, papilla duodeni major.

Before connecting to the common bile duct, the layer of circular muscle bundles of the pancreatic duct thickens, forming the sphincter of the pancreatic duct, i.e. sphincter ductus pancreatici, which is actually part of the sphincter of the hepatopancreatic ampulla.

In the region of the upper part of the head, there is often an additional pancreatic duct, ductus pancreaticus accessorius, which opens with a separate mouth above the main one at the top of the small duodenal papilla, papilla duodeni minor.

An accessory pancreas, pancreas accessorium, is rarely found, which is a separate nodule, most often located in the wall of the stomach or the initial section of the small intestine and not connected with the main pancreas.

The tail of the pancreas is in contact with the spleen, lien (splen), an organ of the circulatory and lymphatic systems.

Department of Operative Surgery and
topographic anatomy
Discipline "Topographic
anatomy and operative
surgery"

Holotopia of the stomach

The stomach is located
almost entirely on the left
half of the abdomen
cardia, fundus, body part
projected on the left
hypochondrium, distal
body part and
pyloric department - in
proper epigastric
areas.

Localization
visceral
pain
Cardia
Pylorus
Duodenum

Skeletonopia of the stomach

Cardia lies behind
attachments to the chest
cartilage VI-VII ribs (on
2.5 cm to the left of the edge
sternum). Her projection
posteriorly corresponds to X XI thoracic vertebrae.
The fundus of the stomach reaches
the lower edge of the V rib along
left midclavicular
lines.

Skeletonopia of the stomach
lesser curvature
corresponds
arcuate line
around the xiphoid
process on the left and below.

Skeletonopia of the stomach

Great curvature
corresponds to the arc from
lower edge of the fifth
ribs on the left
midclavicular
lines up to the eighth
ribs and on to
middle right
rectus abdominis
(further hidden under
liver).

Skeletonopia of the stomach

The pyloric part lies on
midline or 1.5
- 2.5 cm to the right of it.
Gatekeeper level (when
supine position)
matches the line
passing horizontal
mid distance
between jugular notch and
the top edge of the symphysis.
Line skeletopically
corresponds to the front
margin of the VIII costal cartilage
or the bottom edge of the first
lumbar vertebrae.

Syntopy of the stomach

Anterior wall of the stomach
covered on the right
liver (1). Left -
costal part
diaphragms (2). Part
front wall
stomach adjacent to
anterior abdominal
wall (3).

Syntopy of the stomach

To the back wall of the stomach
adjacent organs,
separated by parietal
peritoneum (pancreas)
gland (7), diaphragm (4),
left adrenal gland (5),
upper pole of the left
kidney(6)), colon
(8) and spleen (6).

vagus nerves
(parasympathetic
fibers) pass through
front (a - left) and
rear (b - right)
the walls of the stomach.
With branches of sympathetic
nerve vagal
twigs form
plexus in
subserosal layer.

Scheme of regional lymph nodes of the stomach (Japanese Gastric Cancer Association, 1998)

gastrostomy

Gastrostomy

I. Tubular (temporary) gastrostomy
gastrostomy canal is formed from the anterior
walls of the stomach, while the fistula channel is lined
serous membrane of the stomach and granulation
cloth. Such a channel has the shape of a tubular fistula,
(gastrostomy according to Witzel, according to Strain-Senno-Kader).

Gastrostomy

II. Labiform (permanent) gastrostomy gastrostomy canal is formed by
extraction into the wound of the anterior wall of the stomach in the form
cone and suturing it to the abdominal wall. At
this channel of the gastric fistula throughout
lined with mucous membrane (Topraver stoma).

Gastrostomy

Gastrostomy according to Witzel

rubber tube
surrounded by a wall
stomach. At the end
tube superimposed
semi-purse suture.

Gastrostomy according to Witzel

Wall dissection
stomach in
center
semi-purse-string
seam.

Gastrostomy according to Witzel

Immersion
tubes in
hole in
wall of the stomach.

Gastrostomy according to Witzel

overlay
second row
nodal
seromuscular
seams.

Gastrostomy according to Witzel

Capturing in
seam clampholder for
getting them through
additional
incision.

Gastrostomy according to Witzel

breeding
rubber tube
through
additional
incision.

Gastrostomy according to Witzel

hemming
thread holders
to the skin.

Gastrostomy according to Stamm-Kader

front wall
stomach
rendered in the form
cone.

Gastrostomy according to Stamm-Kader
On the wall of the stomach
three
purse-string
silk seams.
scalpel
open
lumen of the stomach.

Gastrostomy according to Stamm-Kader
Into the cavity of the stomach
introduced
rubber tube.
First purse-string
the seam is tied.

PERCUTANEOUS
ENDOSCOPIC
gastrostomy
Various
methods of percutaneous
gastrostomy without
use
endoscopy with
nasogastric tube
or insufflation
stomach under
fluoroscopic
control and through
direct percutaneous
insertion of a catheter.

Gastrostomy

Holding
skinny loops
guts through
hole in
mesentery
transverse
colon
intestines.

RESECTION OF THE STOMACH BY THE METHOD OF BILLROTH II

The imposition of pulps on the duodenum and
stomach. Transection of the duodenum.

RESECTION OF THE STOMACH BY THE METHOD OF BILLROTH II

Treatment of the stump of the duodenum. Way
Moynigen - Mushkatin. The imposition of a twisted seam on
intestinal stump. Removing the pulp from the stump of the intestine and tightening
twist seam.

RESECTION OF THE STOMACH BY THE METHOD OF BILLROTH II

A continuous twist seam is tied. On the stump of the intestine
a purse-string suture was placed.
Immersion of the stump of the duodenum in the purse-string
the seam.
The imposition of serous-muscular sutures on the stump of the intestine.

RESECTION OF THE STOMACH BY THE METHOD OF BILLROTH II

Way
Chamberlain -
Finsterer.
Pulp overlay
on the stomach
his lines
intersections.

RESECTION OF THE STOMACH BY THE METHOD OF BILLROTH II

Way
Chamberlain -
Finsterer.
clipping
part to be removed
stomach.

RESECTION OF THE STOMACH BY THE METHOD OF BILLROTH II

Upper suturing
parts of the stump
stomach.
overlay
twirl suture in GASTROMAC RESECTION ACCORDING TO BILROTH II METHOD Gastric resection Complications after gastric resection (antrumectomy with
vagotomy)
dumping syndrome
Hypoglycemic syndrome
Afferent loop syndrome (after Billroth-2 resection)
Reflux gastritis
Post-resection chronic pancreatitis
Ulcer recurrence and its complications
Cancer of the stomach stump
Metabolic disorders (loss of body weight,
mineral metabolism disorder)
Anemia

Resection of the stomach

Complications after organ-preserving operations
(vagotomy with and without gastric drainage)
dumping syndrome
Hypoglycemic syndrome
Post-vagotomy dysphagia
gastric stasis
Reflux gastritis
Hyperacid gastroduodenitis
Post-vagotomy diarrhea
Recurrent peptic ulcer
Cholelithiasis
Cancer of the operated stomach

VAGOTOMY

Vagotomy

Proximal selective vagotomy
The main content of this operation
are:
the intersection of all the branches of the wandering
nerves leading to the fundus
stomach, i.e. to the zone of parietal cells;
preservation of innervation of the pyloroanthral
parts of the stomach.

Vagotomy

vagotomy.
The patient must be in the operating room
table in the hyperextension position and for
facilitate manipulation of the foot end
the operating table is lowered by 15-20°.
The upper middle is performed
laparotomy.
After the revision, the large omentum carefully
retracted to the left. The left lobe is assigned
liver to the right and up.

Vagotomy

Proximal reticulum gastric
vagotomy.
The boundaries of the antrum are determined
stomach and the line of intersection of the nerve
branches that innervate the stomach. From
anatomical landmarks on the small
curvature of the stomach most easily
discoverable are finite
branches n. Latarjet, which are clearly visible when
pulling the stomach down and to the left.

2. The caecum and appendix. Projection on the anterior abdominal wall topography, covering the peritoneum.

3. The stem part of the brain. Distribution of gray and white matter. Functions.

Ticket number 6

1. Development of anatomy in the 19th century (P.A. Zagorsky, D.N. Zernov, N.I. Pirogov, P.F. Lesgaft).

2. Salivary glands: topography, structure, excretory ducts, blood supply and innervation.

3. Pyramidal tracts. Topography of the pyramidal tracts in various parts of the brain.

Ticket number 7

1. N.I. Pirogov. The essence of his discoveries in anatomy and methods for studying topographic anatomy.

2. Teeth (structure, timing of eruption, formula, blood supply, innervation). Bite. Milk and permanent teeth.

3. Hind brain, bridge. Features of the structure and function. Topography of gray and white matter.

Ticket number 8

1. The first Russian anatomists of the 18th century: A.P. Protasov, e.O. Mukhin, N.M. Maksimovich-Ambodik.

2. Small intestine: divisions, structure, blood supply, innervation, lymph outflow from the small intestine.

3. Facial nerve, nuclei, place of exit from the brain, from the skull, branches and their area of innervation.

Ticket number 9

1. Bone as an organ: its development, structure, growth. Classification of bones.

2. Salivary glands: topography, structure, excretory ducts, blood supply and innervation.

3. Lobes of the brain. Furrows and convolutions of the cerebral hemispheres. analyzer centers.

Ticket number 10

1. The influence of physical culture and sports on the structure of the musculoskeletal system. Periosteum, endosteum.

2. Language: structure, papillae, muscles. Functions. Blood supply and innervation of the tongue.

3. Rhomboid fossa. External structure and projection of cranial nerve nuclei onto it.

Ticket number 11

1. Vertebral column: formation of bends, structure, movements. Vertebral connections.

2. Rectum. Topography, departments, relation to the peritoneum, blood supply and innervation

3. The stem part of the brain. Distribution of gray and white matter. Functions.

Ticket number 12

2. Esophagus: skeletopy, syntopy, parts, wall structure, blood supply and innervation.

3. Neuron, neuroglia. Nerve fibers, nerves, nodes.

Ticket number 13

1. Bones of the facial skull. Eye socket. nasal cavity. Messages.

2. Large intestine: sections, their topography, structure, relation to the peritoneum, blood supply and innervation.

3. Medulla oblongata. External and internal structure. Topography of gray and white matter.

Ticket number 14

1. Temporal bone, its canals, anatomical formations passing through the canals. Messages of the tympanic cavity.

2. The structure of the stomach, topography, its blood supply and innervation.

3. General characteristics of the nervous system. Classification of neurons, the concept of synapse. Reflex arc (draw a diagram of a 3-neuron reflex arc).

Ticket number 15

1. Temporal bone (parts, their structure, canals). Messages of the tympanic cavity with important clinical significance.

2. Duodenum: skeletopy, syntopy, wall structure, parts, ducts opening into the intestinal lumen, covering with peritoneum.

3. Midbrain. External and internal structure (topography of gray and white matter).

Ticket number 16

1. Temporal, infratemporal and pterygopalatine fossae. Their messages and content.

2. Liver: its development, topography, structure, ligaments, blood supply and innervation. Gallbladder, bile ducts.

3. III, IV, VI pairs of cranial nerves.

Ticket number 17

1. Sphenoid bone, its parts, openings (list the vessels, nerves passing through the openings and canal)

3. The diencephalon (its parts, structure, nuclei, functions). III ventricle.

Ticket number 18

1. The nasal cavity. Paranasal sinuses. Their meaning, development in ontogenesis, messages.

2. Pancreas: development, skeletotopy, topography, structure, blood supply, innervation.

3. telencephalon. Commissural and projection fibers of the cerebral hemispheres. Functional characteristics of the conductors in the inner capsule.

Ticket number 19

1. Eye socket: walls, nerves lying within it.

2. Larynx. Skeletotopia. Cartilages of the larynx. Joints, muscles, vocal cords. Blood supply and innervation of the larynx.

3. The cerebral cortex (structure, localization of centers).

Ticket number 20

1. Internal base of the skull (holes and their meaning). Formations passing through the holes.

2. Trachea and bronchi. Skeletotopia, structure, bronchial and alveolar tree.

Ticket number 21

2.Light. Development, topography, structure, blood supply, innervation. Structural and functional unit of the lung (draw a diagram).

3. Pathways of pain and temperature sensitivity

Ticket number 22

1. Temporomandibular joint.

2. Covering the organs of the digestive tract with the peritoneum. Anatomical formations of the peritoneum: ligaments, mesentery, retroperitoneal space.

3. Extrapyramidal system (basal nodes, internal capsule): structural features and functions. Conducting paths.

Ticket number 23

1. Ribs and sternum: structure, variations and anomalies. Connections of the ribs with the sternum and spinal column. Rib cage. constitutional features.

2. Features of covering the abdominal organs with the peritoneum. Floors of the peritoneal cavity.

3. Trigeminal nerve, its branches and zones of their innervation. The exit points of the branches of the trigeminal nerve on the face.

Ticket number 24

1. Bones of the upper limb.

2. Pleura: parts, topography, pleural cavity, sinuses of the pleura.

3. Motor pathways. General characteristics. Pyramidal, extrapyramidal pathways.

Ticket number 25

1. Hand (structure of bones, muscles, blood vessels, nerves).

2. Kidneys (skeletotopy, syntopy), structure. Structural and functional unit of the lung (draw a diagram).

3. Spinal nerves. Formation of the spinal nerve, branches.

Ticket number 26

1. Pelvic bones and their connections. Taz in general. Age and gender characteristics and dimensions of the female pelvis, which are important in obstetric and gynecological practice.

2. Mediastinum: definition, boundaries, departments, organs of the mediastinum.

3. Ways of proprioceptive sensitivity of the cortical direction (Goll and Burdakh).

Ticket number 27

1. Femur, lower leg bones.

2. Kidney. Internal structure. Structural and functional unit of the kidney (draw a diagram). segments of the kidney. Blood supply and innervation.

3. Trigeminal nerve. General characteristics. Nuclei, trigeminal node, site of exit from the brain, branches, exit from the skull.

Ticket number 28

1. Bones of the foot. Joints of the bones of the foot. Foot as a whole. Arches of the foot and their meaning.

2. Kidneys: development, skeletotopia, topography, structure. Fixing apparatus of the kidney. Blood supply and innervation.

3. General characteristics of sensitive pathways. Give examples.

Ticket number 29

1. Methods for joining bones. Continuous, semi-continuous and discontinuous. The structure of ligaments (give examples).

2. Testicle, epididymis, scrotum, spermatic cord. Structure. Shells of the egg. Ways of excretion of the seed. Intrasecretory part of the testis.

3. Shells of the brain. Intershell spaces. The ventricles of the brain. Circulation of the cerebrospinal fluid.

Ticket number 30

1. Classification of bone joints. Give examples.

2.Ureters, bladder, topography, structural features. The male urethra, its sections, bends, narrowing, the structure of the walls.

3.Cranial nerves. Addition features. Classification. exit points from the brain. Rhomboid fossa.

Ticket number 31

1. The structure of the joint. Classification of joints according to the shape of the articular surfaces and function. Give examples.

2. Prostate gland, seminal vesicles, bulbourethral glands. Topography, structure, blood supply, innervation.

3. Glossopharyngeal, accessory and hypoglossal nerves. Nuclei, exit from the brain, skulls, branches and their area of innervation.

Ticket number 32

1. Shoulder joint. Structure, form, movement. Muscles that produce movement in the shoulder joint. Blood supply, innervation.

2. Sex glands of mixed secretion: ovary, testicle. Ovary: topography, structure, blood supply, hormones, intrasecretory part.

3. General characteristics of the autonomic nervous system. Parasympathetic division of the autonomic nervous system (centers, peripheral part). The concept of the metasympathetic nervous system.

Ticket number 33

1. Elbow joint: structure, movements, muscles that set it in motion. Blood supply, innervation.

2. External female genital organs. Blood supply, innervation.

3. Vegetative nodes of the head.

Ticket number 34

1. Wrist joint and joints of the hand. Structure, Muscles that set them in motion. Blood supply, innervation.

2. Fallopian tubes, ovary. Structure, functions, relation to the peritoneum, blood supply and innervation. Ligaments of the uterus and ovaries.

Ticket number 35

1. Connections of the pelvic bones.

2. Internal female genital organs: uterus, fallopian tubes (topography, structure, ligaments, blood supply and innervation).

3. Eyeball. Shells. Refractive media of the eye and features of their structure. Accommodation

Ticket number 36

1. Hip joint: structure, muscles that set it in motion. Blood supply, innervation

2. Perineum, muscles and fascia. Urogenital and pelvic diaphragms.

3. Border sympathetic trunk, departments, structural features, branches.

Ticket number 37

1. Knee joint: structure, muscles that set it in motion, ligaments. Blood supply, innervation.

2. Organs located retroperitoneally. Adrenal glands, topography, structure, functions. Chromaffin bodies (paraganglia).

3. Sympathetic department of the autonomic nervous system (plexus of the head, neck, chest cavity).

Ticket number 38

1. Ankle joint. The structure, the muscles that set it in motion. Blood supply, innervation.

2. Branchiogenic group of endocrine glands (thyroid, parathyroid, thymus). Structure, functions, innervation.

3.Cervical plexus, formation, topography, branches and zones of innervation.

Ticket number 39

1. General anatomy of muscles. Structure and function of muscles. Examples. Auxiliary devices of muscles. Muscle as an organ.

2. Endocrine glands (general characteristics). Classification of endocrine glands. Pituitary.

3. Brachial plexus, formation, topography, branches, innervation of the muscles of the upper limb.

Ticket number 40

1. The structure of the muscle. Auxiliary devices and muscle work (lever of the 1st and 2nd kind)

3. Lumbar plexus. Formation, topography, branches and areas of their innervation.

Ticket number 41

Ticket number 42

Ticket number 43

Ticket number 44

3.Auxiliary apparatuses of the eye (structural features, functions). Innervation of the lacrimal gland.

Ticket number 45

Ticket number 46

Ticket number 47

3. Middle ear (tympanic cavity, auditory tube, mastoid cells).

Ticket number 48

2. Aorta and its departments. Branches of the aortic arch and its thoracic part.

Ticket number 49

Ticket number 50

1. Muscles of the shoulder. Fascia, grooves, canals, neurovascular formations of the shoulder

2. Internal carotid and vertebral arteries. Blood supply to the brain.

Ticket number 51

Ticket number 52

Ticket number 53

Ticket number 54

Ticket number 55

Ticket number 56

Ticket number 57

Ticket number 58

Ticket number 59

Ticket number 60

3. Spino-cerebellar tracts (paths of Gowers and Flexig).

Ticket number 61

1. External base of the skull. Structure and communications of the pterygopalatine fossa. Wing knot.

2. Veins of the lower limb.

3. Spinal nerves. Formation of the spinal nerve, branches.

Ticket number 62

1. Internal base of the skull (holes and their meaning). Formations passing through the holes.

3. Gray and white matter of the cerebral hemispheres. Localization of functions in the cerebral cortex.

Ticket number 63

1. Classification of bone joints. Give examples.

2. Inferior vena cava. The main venous collectors of the pelvis and lower limb.

3. Vegetative nodes of the head.

Ticket number 64

2. Venous anastomoses: cava-caval, porto-caval, porto-caval-caval.

3. External and middle ear, walls, tympanic membrane, auditory ossicles, musculo-tubal canal. Anatomical messages of the middle ear.

Ticket number 65

1. Femur, lower leg bones.

2. Fetal circulation.

3.Cranial nerves. Addition features. Classification. exit points from the brain. Rhomboid fossa.

Ticket number 66

1. Bones of the upper limb.

2. Lymph node as an organ (structure, functions). Topography of lymph nodes in the body.

3. Vagus nerve, nuclei, exit from the brain, skulls, departments, branches and their area of innervation.

Ticket number 67

1. Anatomy of the abdominal muscles. Their functions. Vagina rectus abdominis. White line of the abdomen. Weaknesses of the anterior wall of the abdominal cavity.

2. Lymphatic vessels and regional lymph nodes of the lower limb. The contribution of domestic scientists to the development of the doctrine of the lymphatic system.

2. Stomach: skeletopy, syntopy, wall structure, parts, topography, blood supply, innervation.

stomach, ventriculus (s. gaster), located in the upper left (2/3) and right (1/3) of the abdominal cavity; its long axis goes from above to the left and from behind to the right down and forward and is almost in the frontal plane.

The stomach is made up of several departments :

Input, bottom (vault);

Day off.

Upper edge of the stomach forming the border between the front and rear walls, has an arcuate concave shape; it is shorter and forms lesser curvature of the stomachcurvatura ventriculi minor.

bottom edge, constituting the lower border between the walls of the stomach, has a convex shape, it is longer; This - greater curvature of the stomach,curvatura ventriculi major.

stomach wall consists of three shells :

- external - peritoneum (serous membrane);

Medium - muscular;

Internal - mucous.

The muscular layer of the stomachtunica muscularis, consists from three layers :

-- outer - longitudinal;

Medium - circular;

Deep - oblique.

Distinguish gastric glands(own), glandulae gastricae (propriae), located in the area of the bottom and body and consisting of the main and parietal cells, and pyloric glands,glandulae, below her.

Fundus of the stomach located under the dome of the left half of the diaphragm.

Lesser curvature and superior anterior surface adjacent to the lower surface of the left lobe of the liver. Inferoanterior surface of the body and pylorus adjacent to the costal part of the diaphragm and to the anterior abdominal wall, respectively, the region of the epigastrium.

Large curvature the left area adjoins the visceral surface of the spleen; for the rest of the length (to the right), it is adjacent to the transverse colon.

Innervation: plexus gastrici. Blood supply to the stomach occurs from the side of the lesser curvature of the right and left gastric arteries, aa. gastricae dextra et sinistra; from the side of the greater curvature - from the right and left gastroepiploic arteries, aa. gastroepiploicae dextraj et sinistra; in the bottom area - from short gastric arteries, aa. gastricae breves (from a. lienalis).

Lymphatic drainage from the walls of the stomach occurs in the regional lymph nodes located along the lesser and greater curvature.

Rice. 22. Skeletotopia of the stomach:

1 - pars cardiaca - cardiac part

2 - ostium cardiacum - cardiac opening;

3 - fundus ventriculi - fundus of the stomach;

4 - corpus ventriculi - the body of the stomach;

5 - pars pylorica - pyloric part;

6- -ostium pyloricum - pyloric opening);

7 - duodenum - duodenum

Rice. 23. Syntopy of the stomach (front and back view):

A- front wall:

1 - facies hepatica - hepatic surface,

2 - fades diaphragmatica - diaphragmatic surface,

3 - facies libera - free surface

b- back wall:

1 - facies lienalis - splenic surface,

2 - fades suprarenalis - adrenal surface,

3 - facies renalis - renal surface,

4 - facies pancreatica,

5 - facies colica - intestinal surface

From the stomach, food enters the small intestine (intestinum tenue), where further mechanical, chemical processing of food and absorption takes place. The length of the small intestine v corpse is about 7 m, in a living person - from 2 to 4 m. The small intestine is divided into three sections according to function and structure: duodenum (duodenum), jejunum (jejunum) and ileum (ileum).

Skeletotopia- bottom of the stomach - concavity of the diaphragm in the left hypochondrium. Cardiac hole - on the left side of the body 11 or 10 gr.p. Pyloric opening - to the right of the intervertebral disc between the bodies 12g and 1 p.p. The greater curvature is the arc between the 9th and 10th pairs of ribs.

Syntopy: the front wall on the right is covered by the liver, on the left - the costal part of the diaphragm, part of the body and the pyloric section adjoins the anterior abdominal wall. Posterior wall - spleen, left supra-ocular, left kidney, pancreas, colon. The lesser curvature is covered by the left lobe of the liver. The greater curvature is the transverse colon.

blood supply- celiac trunk system. It has 2 arterial arches: on the lesser curvature (the left gastric artery from the celiac trunk and the right gastric artery from the hepatic are connected); on the large one (the right gastro-alnic artery from the gastroduodenal artery and the left one from the splenic). To the bottom of the stomach - short gastric arteries (branches of the splenic artery). The veins run along the lesser and greater curvatures. In the circumference of the inlet of the stomach, the veins anastomose with the veins of the esophagus - cava-caval anastomosis. innervation- sympathetic (from the solar plexus and accompany the vessels from the celiac artery) and parasympathetic fibers (vagus trunks) the tail of the pancreas (from the left side of the bottom, the greater curvature of the stomach), nodes located on the right gastroepiploic artery and under the pylorus, of the second order - celiac nodes.

Vagus nerve, nuclei, exit from the brain, skulls, departments, branches and their area of innervation.

Nervus vagus ( X pair of cranial nerves ) carries out parasympathetic innervation of the organs of the neck, chest and abdominal cavities, and also contains sensory and motor fibers. The vagus nerve begins with 10-15 roots, connecting with each other and heading to the jugular foramen, where the upper and lower nodes lie, in which the bodies of sensitive neurons are located. From the beginning of the nerve to the upper node, there is a head section, from which branches extend, innervating part of the hard shell of the brain in the region of the posterior cranial fossa, the skin of the external auditory canal and the auricle. In the neck, the nerve passes as part of the main neurovascular bundle of the neck between the common carotid artery and the internal jugular vein. Branches depart from the cervical region that innervate the mucous membrane and pharyngeal constrictor muscles, the muscles of the soft palate (except for the muscle that strains the palatine curtain), the mucous membrane and muscles of the larynx, trachea, esophagus, as well as the upper and lower cervical cardiac branches going to the cardiac plexus . Through the upper aperture of the chest, the vagus nerves penetrate into the chest cavity, they descend behind the roots of the lungs, pass along the anterior (left nerve) and posterior (right nerve) surfaces of the esophagus, on which they branch, connect with each other; forming the esophageal plexus. Two vagus trunks emerge from the latter (anterior and posterior), which enter the abdominal cavity through the esophageal opening of the diaphragm. The thoracic cardiac branches extend from the thoracic region to the cardiac plexus; bronchial branches, which, connecting with the branches of the sympathetic trunks, form the pulmonary plexus; esophageal branches forming the plexus of the same name. In the abdominal cavity, the trunks divide into terminal branches. The anterior gastric and hepatic branches depart from the anterior trunk, the posterior gastric and celiac branches from the posterior trunk. The latter are sent to the celiac plexus, through which they pass without switching at the nodes, from where, together with the sympathetic fibers of the specified plexus, they are sent to the abdominal organs (to the sigmoid colon).

X pair - vagus nerve (n. vagus).

This nerve is mixed. Its sensitive fibers transmit irritation from the dura mater, from the depths of the external auditory canal, from the mucous membrane of the pharynx, larynx, trachea, bronchi, lungs, gastrointestinal tract and other internal organs. Thus, viscerosensory stimuli, interoceptive signals, to a greater extent creating a general feeling of well-being of the body, are carried along the vagus nerve. Peripheral sensory nodes, analogues of the intervertebral nodes - the upper and lower nodes are located in the jugular foramen and below it. Through the jugular foramen, the vagus nerve, together with the IX and XI pairs of nerves, exits the cranial cavity. In the medulla oblongata, sensory fibers end in the nucleus, next to the nucleus of the glossopharyngeal nerve, in a solitary tract. From here, the impulses along the medial loop of the opposite side, through the optic tubercle and the posterior thigh of the internal capsule, enter the lower part of the posterior central gyrus. At the base of the brain, the nerve is located at the lower edge of the cerebellopontine angle.

The motor fibers of the X pair start from the lower parts of the nucleus, common with the glossopharyngeal nerve - the double nucleus, and go to the striated muscles of the pharynx, soft palate, larynx, epiglottis and upper esophagus.

Motor vegetative (parasympathetic) fibers to the smooth muscles of the trachea and bronchi, esophagus, stomach, small intestines and upper part of the large intestines, as well as secretory fibers to the stomach and pancreas, inhibitory fibers to the heart and vasomotor (to the vessels) start from the vegetative, dorsal nucleus of the vagus nerve, located directly under the floor of the fourth ventricle, not far from the nucleus of the hypoglossal nerve.

The region of this core is the vital center, in the event of which death can occur from respiratory paralysis or heart paralysis.

For the correct diagnosis of the disease, specialists often use such a thing as holotopia of the stomach. Which describes the correct location of a point or part of an organism. To investigate abnormalities or deviations in growth and development, it is important to know the reference placement of organs and how big the difference is in relation to the norm.

Holotopy and syntopy

The scheme of the holotopy of the stomach determines that 3 parts of the organ are in the left hypochondrium, and 1 part is in the epigastric region. The long axis is placed in the frontal plane. The bottom of the stomach is located under the left dome of the diaphragm. To determine the topography, criteria such as the syntopy of the stomach are used, which describe all the organs and systems with which it comes into contact. No less important is the skeletotopy of the stomach, indicating the location relative to the structure of the human skeleton.

Reasons for bias

A very rapid weight loss can provoke pathology.

The reasons for the change in the position of the viscera include:

congenital deformities and age;
general weakness of the musculoskeletal system;
excessive exercise and exhaustion;
sharp weight loss;
the birth of a child (especially several) or weakness of the abdominal floor in women;
pathological processes that cause a weakening of the tone of internal organs;
malnutrition;
displacement of the axes of the body.

Symptoms and diagnostic measures

The displacement of the organ has the following symptoms:

discomfort of internal organs, violation of its function;
spasms of muscles and blood vessels in the pathological area;
the spine and peripheral nerves suffer.

Violation can be diagnosed by palpation.

To diagnose displacements of the stomach, such procedures are used.

The fundus of the stomach is adjacent to the diaphragm, spleen and transverse colon. The pyloric part of the stomach can be adjacent to the left, square or right lobes of the liver, as well as to the gallbladder. The pylorus usually comes into contact with the square lobe of the liver, less often - only with the left and even more rarely - with the right lobe. Above and to the left, the anterior wall of the stomach is adjacent to the diaphragm, as well as to the transverse colon.

Posterior wall of the stomach adjoins the organs of the retroperitoneal space and is separated from them by an omental bag.

Almost throughout the posterior wall of the stomach is in contact with the body and tail of the pancreas. In most cases, the omental tubercle, tuber omentale, of the gland body protrudes 2–4 cm above the lesser curvature and comes into contact with the hepatogastric ligament. Slightly above the pancreas, the splenic vessels, the left kidney and the left adrenal gland are adjacent to the stomach. The left kidney is in contact with the fundus of the stomach only at the upper pole. Somewhat medially and above the left kidney, the left adrenal gland is adjacent to the cardial part of the stomach. The pyloric part of the stomach is adjacent to the head of the pancreas. Near the greater curvature, the posterior wall of the stomach is in contact with the mesentery of the transverse colon.

Left to stomach adjacent facies gastrica of the spleen, and below - the transverse colon and its mesentery.

"Atlas of operations on the abdominal wall and abdominal organs" V.N. Voilenko, A.I. Medelyan, V.M. Omelchenko

Gastro-pancreatic ligament, lig. gastropancreaticum, is located between the upper edge of the pancreas and the cardial part, as well as the fundus of the stomach. It is quite clearly defined if the gastrocolic ligament is cut and the stomach is pulled forward and upward. It can also be felt through the hepatogastric ligament. The length of the bundle is variable and ranges from 2-5 cm. On the right, it consists of two sheets ...

The left gastroepiploic vein flows into the splenic vein or its tributaries at the hilum of the spleen. Short gastric veins, vv. gastricae breves, accompanying the arteries of the same name, pass in the gastrosplenic ligament and flow into the trunks of the splenic vein or into the left gastroepiploic vein. Pyloric veins are located on the border of the stomach and duodenum. The degree of development and the number of these veins are not constant. In some…

Pyloric-pancreatic ligament, lig. pyloropancreaticum, in the form of a duplication of the peritoneum, stretched between the pylorus and the right side of the body of the pancreas. It has the shape of a triangle, one side of which is fixed to the posterior surface of the pylorus, and the other to the anteroinferior surface of the body of the gland; the free edge of the ligament is directed to the left. Sometimes the connection is not expressed. The pyloric-pancreatic ligament contains small lymph nodes that can ...

Lymph nodes surrounding the stomach are divided into three groups: lymph nodes located along the lesser curvature along the left gastric artery; these lymph nodes receive lymph from the right two-thirds of the fundus and body of the stomach; lymph nodes located in the region of the gate of the spleen and the tail of the pancreas; lymph flows to these nodes from the left third of the fundus and body of the stomach ...

The deserized part of the stomach along the lesser curvature extends from the right semicircle of the abdominal esophagus to the pylorus. In the cardial part, its width reaches 1.5-4 cm, in the direction of the pylorus, it gradually narrows to 0.3-0.5 cm. and from above and to the left - by sheets of the gastro-splenic ligament. Higher…