home Audience 3 Branches of the thoracic and abdominal aorta. The value of the thoracic aorta in ensuring the vital activity of the organism. Examination of a patient with a respiratory disease. Pathological forms of the chest. Definition of respiratory excursion of the chest

Branches of the thoracic and abdominal aorta. The value of the thoracic aorta in ensuring the vital activity of the organism. Examination of a patient with a respiratory disease. Pathological forms of the chest. Definition of respiratory excursion of the chest

The thoracic part of the aorta is located in the posterior mediastinum, adjacent to the spinal column. The visceral (visceral) and parietal branches depart from it. Internal branches include:

bronchial branches, in the amount of 2-4, originate from the anterior surface of the aorta at the level of the discharge of the third intercostal arteries, enter the gates of the left and right lungs, forming an intraorganic bronchial arterial network that supplies blood to the bronchi, the connecting stroma of the lung, parabronchial lymph nodes, the walls of the pulmonary branches arteries and veins, pericardium and esophagus. In the lung, the bronchial branches anastomose with the branches of the pulmonary arteries;
esophageal branches- 3-4, length 1.5 cm and thin branches reach the wall of the thoracic esophagus. Depart from the thoracic aorta at the level of 4-8 thoracic vertebrae. Anastomose with the branches of the upper and lower thyroid, mediastinal, left coronary artery of the heart and the upper arteries of the diaphragm;
mediastinal (mediastinal) branches inconstant and varying in position. Often shared with pericardial branches. They supply blood to the posterior wall of the pericardium, tissue and lymph nodes of the posterior mediastinum. Anastomose with previous arteries;
pericardial branches- number 1-2, short and thin, start from the anterior surface of the aorta and supply blood to the posterior wall of the pericardium. Anastomose with the arteries of the esophagus and mediastinum.

Aorta. 1 - aortic arch (arcus aortae); 2 - ascending aorta (pars ascendens aortae); 3 - bronchial and esophageal branches (rami bronchiales et esophagales), 4 - descending part of the aorta (pars descendens aortae); 5 - posterior intercostal arteries (aa. intercostales posteriores); 6 - celiac trunk (truncus coeliacus); 7 - abdominal part of the aorta (pars abdominalis aortae); 8 - inferior mesenteric artery (a. mesenterica inferior); 9 - lumbar arteries (aa. lumbales); 10 - renal artery (a. renalis); 11 - superior mesenteric artery (a. mesenterica superior); 12 - thoracic aorta (pars thoracica aortae)

The parietal branches of the thoracic aorta are as follows:

superior phrenic arteries originate from the aorta. They supply blood to the lumbar part of the aorta and pleura. They anastomose with the lower intercostal arteries, with branches of the internal thoracic and lower phrenic arteries;
posterior intercostal arteries in the amount of 10 pairs, depart from the posterior wall of the aorta and are located in the 3-11 intercostal space. The last posterior intercostal artery, the subcostal artery, runs below the 12th rib and anastomoses with the lumbar arteries. The first and second intercostal spaces receive blood from the subclavian artery. The right intercostal arteries are somewhat longer than the left ones and pass under the pleura to the corners of the ribs behind the organs of the posterior mediastinum along the anterior surface of the vertebral bodies. The intercostal arteries at the head of the ribs give off dorsal branches to the skin and muscles of the back, spine and spinal cord with its membranes. From the corners of the ribs, the arteries penetrate between the external and internal intercostal muscles, located in the costal groove. From the 8th intercostal space and below, the arteries lie in the middle of the intercostal space below the corresponding rib, give lateral branches to the skin and muscles of the lateral part of the chest, and then anastomose with the anterior intercostal branches of the internal thoracic artery. From 4-6 intercostal arteries branch to the mammary gland. The upper intercostal arteries supply blood to the chest, the lower 3 - to the anterior abdominal wall and diaphragm. A branch departs from the right 3rd intercostal artery to the right bronchus, and branches supplying blood to the left bronchus begin from the left 1-5 intercostal arteries. The esophageal arteries originate from 3-6 intercostal arteries.

Thoracic aorta and its branches

Parietal and visceral branches depart from the thoracic part of the aorta (table), which supply blood to the organs lying mainly in the posterior mediastinum and the walls of the chest cavity.

Wall branches. The parietal (parietal) branches of the thoracic aorta include the paired superior phrenic and posterior intercostal arteries, which supply blood to the walls of the chest cavity, the diaphragm, and most of the anterior abdominal wall.

The superior phrenic artery (a.phrenica superior), steam room, starts from the aorta directly above the diaphragm, goes to the lumbar part of the diaphragm of its side and supplies its back with blood.

Posterior intercostal arteries (aa. intercostales posteriores), 10 pairs, III-XII start from the aorta at the level of III-XI intercostal spaces, XII artery - below the XII rib. The posterior intercostal arteries pass through the corresponding intercostal spaces.
Each of them gives off branches: posterior, medial and lateral, cutaneous and spinal, which supply blood to the muscles and skin of the chest, abdomen, thoracic vertebrae and ribs, spinal cord and its membranes, diaphragm.

The dorsal branch (r. dorsalis) departs from the posterior intercostal artery at the level of the rib head, goes posteriorly, to the muscles and skin of the back (medial and lateral skin branches - rr. cutanei medialis et lateralis). The spinal branch (r. spinalis) departs from the spinal branch, which, through the adjacent intervertebral foramen, goes to the spinal cord, its membranes and roots of the spinal nerves and supplies them with blood. From the posterior intercostal arteries depart lateral cutaneous branches (rr. cutanei laterales), supplying the skin of the side walls of the chest. From IV-VI of these branches to the mammary gland of its side, the branches of the mammary gland (rr. mammarii laterales) are sent.

internal branches. The visceral (visceral) branches of the thoracic aorta are sent to the internal organs located in the chest cavity, to the mediastinal organs. These branches include bronchial, esophageal, pericardial and mediastinal (mediastinal) branches.

Bronchial branches (rr. bronchiales) depart from the aorta at the level of the IV-V thoracic vertebrae and the left main bronchus, go to the trachea and bronchi. These branches enter the gates of the lungs, accompanying the bronchi, supply blood to the trachea, bronchi and lung tissues.

Esophageal branches (rr. oesophagei) start from the aorta at the level of IV-VIII thoracic vertebrae, go to the walls of the esophagus and supply blood to its thoracic part. The lower esophageal branches anastomose with the esophageal branches of the left gastric artery.

Pericardial branches (rr. pericardiaci) depart from the aorta behind the pericardium and go to its posterior section. Blood supply to the pericardium, lymph nodes and tissue of the posterior mediastinum.

Mediastinal branches (rr. mediastinales) depart from the thoracic aorta in the posterior mediastinum. They supply blood to the connective tissue and lymph nodes of the posterior mediastinum.

The branches of the thoracic aorta anastomose widely with other arteries. So, the bronchial branches anastomose with the branches of the pulmonary artery. The spinal branches (from the posterior intercostal arteries) anastomose in the spinal canal with the same-named branches on the other side. Along the spinal cord is an anastomosis of spinal branches originating from the posterior intercostal arteries, with spinal branches from the vertebral, ascending cervical and lumbar arteries. I-VIII posterior intercostal arteries anastomose with anterior intercostal branches (from the internal thoracic artery). IX-XI posterior intercostal arteries form connections with branches of the superior epigastric artery (from the internal mammary artery).

Two groups of branches depart from the thoracic aorta: visceral (rr. viscerales) and parietal (rr. parietales) (Fig. 401).

401. Scheme of the structure of the intercostal arteries and their anastomoses.

1-r. dorsalis;
2-r. spinalis;
3-a. intercostalis anterior;
4-r. cutaneus lateralis;
5-a. thoracica interna;
6 - aorta.

Visceral branches of the thoracic aorta: 1. Bronchial branches (rr. bronchiales), in the amount of 2-4, originate from the anterior surface of the aorta at the level of the discharge of the third intercostal arteries, enter the gates of the right and left lungs, forming an intraorgan bronchial arterial network that supplies bronchi, connective tissue stroma of the lung, parabronchial lymph nodes, walls of the branches of the pulmonary arteries and veins, pericardium and esophagus. In the lung, the bronchial branches anastomose with the branches of the pulmonary arteries.

2. Esophageal branches (rr. esophagei), 3-4 in number, 1.5 cm long and thin branches reach the wall of the thoracic esophagus. Depart from the thoracic aorta at the level of ThIV - ThVIII. Anastomose with the branches of the upper and lower thyroid, mediastinal, left coronary artery of the heart and superior arteries of the diaphragm.

3. Pericardial branches (rr. rericardiaci), 1-2 in number, short and thin, start from the anterior surface of the aorta and supply blood to the posterior wall of the pericardium. Anastomose with the arteries of the esophagus and mediastinum.

4. Mediastinal branches (rr. mediastinales) are unstable and vary in position. Often shared with pericardial branches. They supply blood to the posterior wall of the pericardium, tissue and lymph nodes of the posterior mediastinum.

Anastomose with previous arteries.

Parietal branches of the thoracic aorta: 1. Posterior intercostal arteries (aa. intercostales posteriores), numbering 9-10 pairs, depart from the posterior wall of the aorta and are located in the third - eleventh intercostal space. The last posterior intercostal artery is subcostal (a. subcostalis), goes below the XII rib and anastomoses with the lumbar arteries. The first and second intercostal spaces receive blood from the subclavian artery due to a. intercostalis suprema. The right intercostal arteries are somewhat longer than the left ones and pass under the pleura to the corners of the ribs behind the organs of the posterior mediastinum along the anterior surface of the vertebral bodies. The intercostal arteries at the head of the ribs give off dorsal branches (rr. spinales) to the skin and muscles of the back, spine and spinal cord with its membranes. From the corners of the ribs, the arteries penetrate between the external and internal intercostal muscles, located in the costal groove. Anterior to the linea axillaris posterior, starting from the eighth intercostal space and below, the arteries lie in the middle of the intercostal space below the corresponding rib, give lateral branches to the skin and muscles of the lateral part of the chest, and then anastomose with the anterior intercostal branches of the internal thoracic artery. From IV, V, VI intercostal arteries depart branches to the mammary gland.

The upper intercostal arteries supply blood to the chest, the lower three to the anterior abdominal wall and diaphragm. A branch departs from the right III intercostal artery to the right bronchus, and branches supplying blood to the left bronchus begin from the left I-V intercostal arteries.

The esophageal arteries originate from III-VI intercostal arteries.

2. The superior phrenic arteries (aa. phrenicae superiores) originate from the aorta above the hiatus aorticus. They supply blood to the lumbar part of the diaphragm and pleura. They anastomose with the inferior intercostal arteries, branches of the internal thoracic and inferior phrenic arteries.

The thoracic aorta is the largest artery in the body that carries blood from the heart.

It is located in the chest, which is why it is called the chest.

The structure of the thoracic aorta

The thoracic aorta is located in the posterior mediastinum and is adjacent to the spinal column.

The splanchnic branches of the thoracic aorta include:

Esophageal branches, which in the amount of 3-6 are directed to the wall of the esophagus. They branch into ascending branches, anastomosing with the left ventricular artery, and also descending, anastomosing with the inferior thyroid artery.
Bronchial branches, which in the amount of 2 or more branches with the bronchi. They supply blood to lung tissue. Their terminal branches approach the bronchial lymph nodes, esophagus, pericardial sac and pleura.
Pericardial-bag or pericardial branches, which are responsible for supplying blood to the posterior surface of the pericardial sac.
Mediastinal or mediastinal branches, small and numerous, which nourish the mediastinal organs, lymph nodes and connective tissue.

The group of parietal branches of the thoracic aorta consists of:

Posterior intercostal arteries in the amount of 10 pairs. 9 of them pass in the intercostal spaces, from the 3rd to the 11th. The lower arteries lie under the twelfth ribs and are called hypochondria. Each artery divides into a spinal branch and a dorsal branch. Each intercostal artery at the heads of the ribs branches into an anterior branch that feeds the rectus and broad abdominal muscles, intercostal muscles, the mammary gland, skin of the chest, and a posterior branch that supplies blood to the muscles and skin of the back, as well as the spinal cord.
The upper phrenic arteries of the thoracic aorta in the amount of two pieces, which provide blood to the upper surface of the diaphragm.

Arteries of the thoracic cavity

Most common diseases of the thoracic aorta

The most common diseases of the thoracic aorta are aneurysm and atherosclerosis of the thoracic aorta.

Atherosclerosis of the thoracic aorta develops, as a rule, earlier than other forms of atherosclerosis, but for a long time it may not manifest itself in any way. Often it develops simultaneously with atherosclerosis of the coronary arteries of the heart or atherosclerosis of the head vessels of the brain.

The first symptoms of atherosclerosis, as a rule, appear already at age, when the walls of the aorta are already largely destroyed. Patients complain of recurring burning pain in the chest (aortalgia), increased systolic pressure, difficulty swallowing, dizziness.

Often less specific signs of atherosclerosis of the thoracic aorta are too early aging and the appearance of gray hair, wen on the face, a light stripe along the outer edge of the iris, strong hair growth in the ears.

One of the most dangerous complications of atherosclerosis is an aortic aneurysm.

A thoracic aortic aneurysm is a condition in which the weak part of the aorta bulges or expands. The pressure of the blood going through the aorta leads to its bulging.

Aneurysms pose a serious danger not only to health, but also to the life of the patient, as the aorta can rupture, which will lead to internal bleeding and death. Up to 30% of patients with ruptured aneurysms admitted to the hospital survive. This is why a thoracic aortic aneurysm needs to be treated to avoid rupture.

Approximately half of patients with aneurysm do not have any symptoms of the disease. Most people complain of pain in the lower back and chest, in the neck, back and jaw. There is difficulty breathing, coughing, hoarseness.

With a large aneurysm, the aortic heart valve may be involved in the process, resulting in heart failure.

The most common causes of thoracic aortic aneurysms are:

Congenital diseases of the connective tissue (Marfan syndrome, Ehlers-Danlos syndrome), cardiovascular system (coarctation of the aorta, heart defects, tortuosity of the isthmus of the aorta).
Acquired diseases such as atherosclerosis, or after operations on aortic cannulation sites, aortic patches or suture lines of prosthetic anastomoses.
Inflammatory diseases (infection of the aortic prosthesis, non-infectious and infectious aorthritis).

Found a mistake in the text? Select it and press Ctrl + Enter.

The liver is the heaviest organ in our body. Its average weight is 1.5 kg.

According to many scientists, vitamin complexes are practically useless for humans.

Falling off a donkey is more likely to break your neck than falling off a horse. Just don't try to disprove this claim.

According to studies, women who drink several glasses of beer or wine a week have an increased risk of developing breast cancer.

Our kidneys are able to purify three liters of blood in one minute.

The human stomach copes well with foreign objects and without medical intervention. It is known that gastric juice can dissolve even coins.

In addition to people, only one living creature on planet Earth suffers from prostatitis - dogs. These are really our most faithful friends.

74-year-old Australian James Harrison donated blood about 1,000 times. He has a rare blood type whose antibodies help newborns with severe anemia survive. Thus, the Australian saved about two million children.

During a sneeze, our body completely stops working. Even the heart stops.

When lovers kiss, each of them loses 6.4 calories per minute, but in the process they exchange almost 300 different types of bacteria.

There are very curious medical syndromes, such as compulsive swallowing of objects. In the stomach of one patient suffering from this mania, 2500 foreign objects were found.

Scientists from Oxford University conducted a series of studies in which they came to the conclusion that vegetarianism can be harmful to the human brain, as it leads to a decrease in its mass. Therefore, scientists recommend not to completely exclude fish and meat from your diet.

If your liver stopped working, death would occur within a day.

The well-known drug "Viagra" was originally developed for the treatment of arterial hypertension.

An educated person is less prone to brain diseases. Intellectual activity contributes to the formation of additional tissue that compensates for the diseased.

This question worries many men: after all, according to statistics in economically developed countries, chronic inflammation of the prostate gland occurs in 80-90% of men.

Branches of the thoracic aorta

Two groups of branches depart from the thoracic aorta: visceral (rr. viscerales) and parietal (rr. parietales) (Fig. 401).

401. Scheme of the structure of the intercostal arteries and their anastomoses.

3-a. intercostalis anterior;

4-r. cutaneus lateralis;

5-a. thoracica interna;

Anastomose with previous arteries.

The esophageal arteries originate from III-VI intercostal arteries.

Thoracic aorta

The superior phrenic arteries, aa .. phrenicae superiores, number 2, depart from the anterior wall of the lower aorta and go to the upper surface of the lumbar diaphragm.
Posterior intercostal arteries (III-XI), aa. Nine of them lie in the intercostal spaces, from the third to the eleventh inclusive, and the lowest ones go under XII ribs; they are called subcostal arteries, aa .. subcostales. The right intercostal arteries are slightly longer than the left ones, since aorta in this place it is located asymmetrically, on the left surface of the vertebral stem. Having reached the heads of the ribs, each intercostal artery splits into two branches: a smaller one - the dorsal branch, r. dorsalis, and a more powerful one - the anterior branch, or the intercostal artery itself.

a) The dorsal branch, g. dorsalis, goes under the neck ribs between its ligaments (lig. costotransversarium) on the back (dorsal) surface of the body; through the intervertebral foramen gives to the spinal cord a spinal branch, g. spinalis, which in the spinal canal anastomoses with the vessels of the same name lying above and below and with the same branch of the opposite side, forming an arterial ring around the spinal cord. It also supplies blood to the membranes of the spinal cord and vertebrae. The terminal trunks of the posterior branches go further posteriorly, giving rise to muscular branches. Then each of the terminal trunks is divided into two branches: the medial skin branch, Mr. cutaneus medialis, which supplies the skin in the region of the spinous processes and on its way gives a number of small muscle branches to m. longissi-mus and m.. semispinalis; and a lateral cutaneous branch, g. cutaneus latera-lis, which supplies blood to the skin of the lateral parts of the back, and also gives muscle branches to m. iliocostalis.

b) The anterior branch of the intercostal artery, which, as indicated above, is its own intercostal artery, goes slightly upward and lies on the inner surface of the external intercostal muscle, being here covered only by the thoracic fascia and the parietal pleura.

Further, in the area of \u200b\u200bthe corners of the ribs, the own intercostal artery splits into the lower costal branch, which is actually its continuation (called the intercostal), and the upper costal branch. Larger, lower costal, lies in the sulcus costae; thinner, upper costal, follows the upper edge of the underlying ribs. Starting from the corners of the ribs, both branches go along the intercostal space between the external and internal intercostal muscles and anastomose from the intercostales anteriores a. thoracicae intemae (see a. subclavia), and the first intercostal artery anastomoses with a. intercostalis suprema. The terminal branches from VII to XII intercostal arteries cross the edge of the costal arch and exit between the layers of the broad abdominal muscles, supplying them with blood and rectus abdominal muscles and anastomosing with the branches of the upper and lower epigastric arteries, aa .. epigastricae superior et inferior. In its course, the intercostal artery gives three types of branches: lateral cutaneous branches, rr. cutanei laterales. that pierce the intercostal or wide abdominal muscles and exit into the subcutaneous layer; medial cutaneous branches, rr. cutanei mediates, and branches of the mammary gland, rr. mammarii. which depart from the IV, V and VI intercostal arteries.

All materials posted on our resource are obtained from open sources on the Internet and are published for informational purposes only. In the event that a corresponding request is received from the copyright holders in writing, the materials will be immediately removed from our database. All rights to the materials belong to the original sources and / or their authors.

Trunk arteries. The thoracic part of the aorta.

The thoracic aorta (thoracic aorta), pars thoracica aortae (aorta thoracica), is located in the posterior mediastinum, directly on the spinal column.

The upper sections of the thoracic aorta are located on the left side of the spinal column, then the aorta will mix slightly to the right and pass into the abdominal cavity, located somewhat to the left of the midline. To the right of the thoracic part of the aorta, the thoracic duct, ductus thoracicus, and unpaired vein, v. azygos, on the left - semi-unpaired vein, v. hemiazygos, in front - the left bronchus. The upper third of the esophagus is located to the right of the aorta, the middle third is in front, and the lower third is on the left.

Two types of branches depart from the thoracic aorta: parietal and splanchnic branches.

1. Superior phrenic arteries, aa. phrenicae superiores, only two, depart from the anterior wall of the lower part of the aorta and go to the upper surface of the lumbar part of the diaphragm, anastomosing in its thickness with the branches of the lower phrenic arteries from the abdominal part of the aorta.

2. Posterior intercostal arteries (III-XI), aa. intercostales posteriores, are quite powerful vessels, only 10 pairs, depart from the posterior surface of the thoracic aorta along its entire length. Nine of them lie in the intercostal spaces, from the third to the eleventh inclusive, and the lowest ones go under the XII ribs and are called hypochondral arteries, aa. subcostales.

The right posterior intercostal arteries are somewhat longer than the left ones, since the thoracic aorta is located on the left surface of the spinal column.

Each posterior intercostal artery in its course gives off a dorsal branch, r. dorsalis, and she goes a little up and goes along the inner surface of the external intercostal muscle; covered only by the thoracic fascia and the parietal pleura. Passes in the furrow of the overlying rib.

In the region of the corners of the ribs, a rather powerful collateral branch departs from the posterior intercostal artery, r. collateralis. It goes downward and anteriorly, goes along the upper edge of the underlying rib, passing between the external and internal intercostal muscles and supplying their lower sections with blood.

Starting from the corners of the ribs, a. intercostalis posterior and r. collateralis go along the intercostal space between the external and internal intercostal muscles and anastomose with rr. intercostales anteriores a. thoracicae internae (from a. subclavia), and the first intercostal artery anastomoses with a. intercostalis suprema. The terminal branches of the intercostal arteries, from the 7th to the 12th, cross the edge of the costal arch and exit between the layers of the broad abdominal muscles, supplying them and the rectus abdominis muscles. They anastomose with branches of the superior and inferior epigastric arteries, aa. epigastricae superior et inferior.

The posterior intercostal artery gives the lateral cutaneous branch, r. cutaneus lateralis, which pierces the intercostal or broad abdominal muscles and enters the subcutaneous layer, as well as the branches of the mammary gland, rr. mammarii, which originate from the 4th, 5th and 6th intercostal arteries.

The dorsal branch departs from the initial section of the posterior intercostal artery, r. dorsalis, which goes under the neck of the rib, between its ligaments, to the back (dorsal) surface of the body; through the intervertebral foramen, the spinal branch approaches the spinal cord, r. spinalis, which in the spinal canal anastomoses with the vessels of the same name lying above and below and with the branch of the same name on the opposite side, forming an arterial ring around the spinal cord. It also supplies blood to the membranes of the spinal cord and vertebrae.

The terminal trunks of the posterior branches go further posteriorly, giving off muscular branches. Then each of the terminal trunks is divided into two branches - medial and lateral. Medial cutaneous branch, r. cutaneus medialis, supplies the skin in the region of the spinous processes and on its way gives a number of small branches to the longest and semispinalis muscles. Lateral cutaneous branch, r. cutaneus lateralis, supplies blood to the skin of the lateral sections of the back, and also gives branches to the iliocostal muscle.

1. Bronchial branches, rr. bronchiales, only two, rarely 3 - 4, depart from the anterior wall of the initial part of the thoracic aorta, enter the gates of the lungs and branch out along with the bronchi.

The terminal branches of the bronchial branches go to the bronchopulmonary lymph nodes, pericardium, pleura and esophagus.

2. Esophageal branches, rr. esophageales, only 3 - 6, go to the area of the esophagus, where it contacts the aorta, and branch out here into ascending and descending branches. In the lower sections, the esophageal branches anastomose with the left gastric artery, a. gastrica sinistra, and in the upper ones - with the lower thyroid artery, a. thyroidea inferior.

3. Mediastinal branches, rr. mediastinales, - numerous small branches that start from the anterior and lateral walls of the aorta; blood supply to the connective tissue and lymph nodes of the mediastinum.

4. Pericardial branches, rr. pericardiaci, - small vessels, the number of which varies, are sent to the posterior surface of the pericardium.

Thoracic aorta anatomy

Two groups of branches depart from the thoracic aorta: visceral, rami viscerates, and parietal, rami parietales (Fig. 153).

Rice. 153. Vessels and nerves of the posterior wall of the left half of the chest cavity (the lung is turned away). 1 - truncus synipathicus; 2-v. hemiazygos; 3- aorta descendens; 4-v. hemiazygos ace; 5-a. et v. intercostales posteriores, n. intercostalis; 6 - n. vagus; 7-a. subclavia; 8 - plexus brachialis

Visceral branches of the thoracic aorta. The largest branches of the thoracic aorta are as follows.

Bronchial branches, rami bronchioles, which in the amount of 3-4 originate from the anterior surface of the aorta at the level of the outlet of the III intercostal arteries, enter the gates of the right and left lungs. An arterial plexus is formed around the intraorgan bronchi, which supplies blood to the bronchi, connective tissue stroma of the lung, parabronchial lymph nodes, walls of the upper pulmonary arteries and veins. Bronchial branches anastomose with branches of the pulmonary arteries.

Esophageal branches, rami esophagei, pericardial, rami pericardiaci, and mediastinal, rami mediastinals, are smaller and supply blood to the corresponding formations.

Parietal branches of the thoracic aorta. 1. Posterior intercostal arteries, aa. intercostales posteriores, in the amount of 9-10 pairs, depart from the posterior wall of the aorta and are located in the III-XI intercostal spaces. The last posterior intercostal artery is the subcostal, a. subcostalis, goes below the XII rib and anastomoses with the lumbar arteries. I and II intercostal spaces receive blood from the subclavian artery due to a. intercostalis suprema. The right intercostal arteries are somewhat longer than the left and pass under the pleura behind the organs of the posterior mediastinum. The intercostal arteries at the heads of the ribs give dorsal branches to the skin and muscles of the back, spine and spinal cord with its membranes. The continuations of the posterior intercostal arteries are located under the parietal pleura, and from the corners of the ribs they penetrate between the external and internal intercostal muscles to the costal groove. Anterior to the linea axillaris posterior, starting from the eighth intercostal space and below, the arteries lie in the intercostal spaces below the corresponding rib, give off lateral branches to the skin and muscles of the lateral part of the chest, and then anastomose with the anterior intercostal branches of the internal thoracic artery. Branches to the mammary gland depart from the IV, V and VI intercostal arteries. The upper intercostal arteries supply blood to the chest, the lower three to the anterior abdominal wall and diaphragm.

2. Superior phrenic arteries, aa. phrenicae superiores, paired, originate from the aorta above the hiatus aorticus. They supply blood to the lumbar part of the diaphragm. They anastomose with the inferior intercostal arteries, branches of the internal thoracic and inferior phrenic arteries.

The abdominal aorta, aorta abdominalis, is located to the left of the midline; length cm; initial diameter mm. It is covered by the parietal peritoneum, stomach, pancreas and duodenum. It is crossed by the root of the mesentery of the small and transverse colon, the left renal and splenic veins, around the abdominal aorta are autonomic nerve plexuses,

lymphatic vessels and nodes. In the region of the hiatus aorticus behind the aorta lies the beginning of the thoracic lymphatic duct, and the inferior vena cava is adjacent to it on the right. At level IV of the lumbar vertebra, the abdominal aorta divides into paired common iliac arteries and an unpaired median sacral artery. From the abdominal aorta, the splanchnic and parietal branches begin (Fig. 154).

Rice. 154. Abdominal aorta and its branches (according to Kishsh - Sentagotai). 1 - aorta thoraeica; 2 - esophagus; 3, 35 - a. a. phrenica inferiores; 4, 36 - diaphragma; 5 - glandula suprarenalis sinistra; 6, 34 - a. a. suprarenales superiores; 7 - truncus coeliacus; 8-a. suprarenalis media; 9-a. suprarenalis inferior; 10-a. renalis; 11-a. mesenterica superior; 12 - ren sinister; 13 - truncus sympathicus; 14, 31 - a. a. et v. v. testiculares; 15-a. mesenterica inferior; 16 - aorta abdominalis; 17 - m. quadratus lumborum; 18-a. iliaca communis sinistra; 19-a. rectalis superior; 20, 30 - ureteri; 21-a. et v. sacrales medianae; 22, 27 - a. et v. iliacae externae; 23-a. iliaca interna; 24-v. saphena magna; 25-a. et v. femorales; 26 - funiculus spermaticus; 28 - m. psoas major; 29-v. iliaca communis dext., 32, 38 - v. cava inferior; 33-v. renalis; 37-vv. hepaticae

Internal branches of the abdominal aorta. 1. The celiac trunk, truncus coeliacus, 9 mm in diameter, 0.5-2 cm long, departs ventrally from the aorta at the level of the XII thoracic vertebra (Fig. 155). Under the base of the celiac trunk is the upper edge of the body of the pancreas, and on the sides of it is the celiac nerve plexus. Behind the parietal peritoneum, the celiac trunk divides into 3 arteries: the left gastric, common hepatic, and splenic.

Rice. 155. Celiac trunk and its branches. 1-lig. teres hepatis; 2-a. cystica; 3 - left lobe of the liver; 4, 16 - ductus choledochus; 5-v. portae; 6-v. cava inferior; 7-a. gastric sinistra; 8 - truncus coeliacus; 9 - aorta abdominalis; 10 - stomach; 11 - pancreas; 12-a. gastroepiploica sinistra; 13-a. gastroepiploica dextra; 14-a. lienalis; 15-a. hepatica communis; 17 - ductus cysticus; 18 - ductus hepaticus communis; 19 - right lobe of the liver; 20 - vesica fellea

Left gastric artery, a. gastrica sinistra, initially passes behind the parietal peritoneum, goes up and to the left to the place where the esophagus enters the stomach, where it penetrates the thickness of the lesser omentum, turns 180 °, descends along the lesser curvature of the stomach towards the right gastric artery. Branches depart from the left gastric artery to the anterior and posterior walls of the body and the cardial part of the stomach, anastomosing with the arteries of the esophagus, the right gastric artery and the short arteries of the stomach.

Common hepatic artery, a. hepatica communis, goes to the right of the celiac trunk, located behind and parallel to the pyloric part of the stomach. At the beginning of the duodenum, the common hepatic artery divides into the gastroduodenal artery, a. gastroduodenalis, and proper hepatic artery, a. hepatica propria. From the latter originates the right gastric artery, a. gastrica dextra. The proper hepatic artery at the hilum of the liver divides into right and left branches. The cystic artery departs from the right branch to the gallbladder, a. cystica. A. gastroduodenalis, penetrating between the pyloric part of the stomach and the head of the pancreas, is divided into two arteries: the upper pancreas-duodenum, a. pancreaticoduodenalis superior, and the right gastroepiploic artery, a. gastroepiploica dextra. The latter passes in the omentum along the greater curvature of the stomach and anastomoses with the left gastroepiploic artery. A. gastrica dextra is located on the lesser curvature of the stomach and anastomoses with the left gastric artery.

Splenic artery, a. lienalis, passes behind the stomach along the upper edge of the pancreas and at the gate of the spleen is divided into 3-6 branches. Depart from it: branches of the pancreas, rami pancreatici, short gastric arteries, aa. gastricae breves, - to the bottom of the stomach, left gastroepiploic artery, a. gastroepiploica sinistra, - to the greater curvature of the stomach and the greater omentum, anastomosing with the right gastroepiploic artery.

2. Superior mesenteric artery, a. mesenterica superior, unpaired, departs from the anterior surface of the aorta at the level of the 1st lumbar vertebra (Fig. 156). The beginning of the artery is located between the head of the pancreas and the lower horizontal part of the duodenum. At the lower edge of the latter, the artery enters the root of the mesentery of the small intestine at the level of the II lumbar vertebra. The superior mesenteric artery gives off the following branches: the inferior pancreatic-duodenal artery, a. pancreaticoduodenalis inferior, anastomosing with the upper artery of the same name; arteries of the jejunum and ileum, aa. jejunales et ilei, going in the mesentery to the loops of the jejunum and ileum; ileocecal artery, a. iliocolica, - to the caecum; it gives the artery of the appendix, a. appendicular is, which is located in the mesentery of the process. The right colonic artery departs from the superior mesenteric artery to the ascending colon, a. colica dextra, to the transverse colon - middle colonic artery, a. colica media, which goes in the thickness of the mesocolon. These arteries anastomose with each other.

Rice. 156. Arteries and veins of the small and large intestines in front; loops of the small intestine are retracted to the left; the transverse colon is retracted upward; the visceral sheet of the peritoneum is partially removed (according to R. D. Sinelnikov). 1 - omentum majus; 2-a. colica sinistra; h - a. mesenterica superior; 4-v. mesenterica superior; 5 - aa. et vv. jejunales; 6 - a.a. intestinales; 7 - appendix vermiformis; 8-a. appendicularis; 9-a.a. et vv. ilei; 10 - colon ascendens; 11-a. et v. iliocolicae; 12-a. colica dextra; 13 - ascending branch a. colicae dextrae; 14-a. et v. colica media; 15 pancreas; 16 - right branch a. colica mediae; 17 - colon transverse

3. Inferior mesenteric artery, a. mesenterica inferior, unpaired, like the previous one, starts from the anterior wall of the abdominal aorta at the level of the III lumbar vertebra. The main trunk of the artery and its branches are located behind the parietal sheet of the peritoneum. It is divided into three large arteries: the left colon, a. colica sinistra - to the descending colon; sigmoid arteries, aa. sigmoideae, - to the sigmoid colon; upper rectal, a. rectalis superior, - to the rectum. All arteries anastomose with each other. The anastomosis between the middle and left colonic arteries is especially important, as it connects the beds of the superior and inferior mesenteric arteries.

4. Inferior phrenic artery, a. phrenica inferior, steam room, is separated immediately after the exit of the aorta through the diaphragmatic opening. A special branch departs from it to the adrenal gland - the superior adrenal artery, a. suprarenalis superior, supplying blood to the diaphragm and adrenal gland; anastomoses with the upper arteries of the same name, the lower intercostal and internal thoracic arteries (see Fig. 154).

5. Middle adrenal artery, a. suprarenalis media, steam room, branches off from the lateral surface of the aorta at the level of the lower edge of the 1st lumbar vertebra. In the thickness of the adrenal gland, it anastomoses with the superior and inferior adrenal arteries.

6. Renal artery, a. renalis, steam room, 7-8 mm in diameter (see Fig. 154). The right renal artery is 0.5-0.8 cm longer than the left. In the sinus of the kidney, the artery divides into 4-5 segmental arteries, which form an intraorgan branching system. At the hilum of the kidney, the inferior adrenal arteries depart from the renal arteries, aa. suprarenales inferiores, supplying blood to the adrenal gland and fatty capsule of the kidney.

7. Testicular artery, a. testicularis, steam room, branches off at the level of the II lumbar vertebra behind the root of the mesentery of the small intestine (see Fig. 154). Branches of the fatty membrane of the kidney and ureter depart from it in the upper part. In women, this artery is called the ovarian, a. ovarica; supplies blood to the corresponding gonad.

8. Lumbar arteries, aa. lumbales, paired, in the amount of 4-5 branches branch off from the posterior wall of the abdominal aorta. They supply blood to the muscles and skin of the back, the spinal cord with its membranes.

9. Median sacral artery, a. sacralis mediana, is an unpaired branch of the aorta (see Fig. 154). It departs from the aorta at the site of its division into two common iliac arteries. Supplies blood to a sacrum, surrounding muscles and a rectum.

Pelvic arteries (human anatomy)

The abdominal aorta at the level of the IV lumbar vertebra is divided into two common iliac arteries, aa. iliacae communes, 1.3-1.4 cm in diameter, following the medial edge of m. psoas major. At the level of the upper edge of the sacroiliac joint, these arteries divide into the external and internal iliac arteries.

Internal iliac artery, a. iliaca interna, steam room, lies on the lateral wall of the small pelvis. At the upper edge of the large sciatic foramen, the artery is divided into parietal and visceral branches (Fig. 157).

Rice. 157. Parietal and splanchnic arteries of the left side of the male pelvis. The bladder and rectum are turned to the right and down. 1 - branches a. circumflexae ilium profundae to m. transverse abdominis; 2, 6 - a. epigastric inferior; 3 - branches to m. iliacus; 4-a. testicularis; 5-a. circumflexa ilium profunda; 7-a. obturatoria; 8-a. umbilicalis; 9-a. vesicalis superior; 10 - additional branch to the bubble; 11-a. vesicalis inferior; 12 - ductus deferens sinister; 13 - vesicula seminalis; 14-a. recta-lis media and its branch a. ductus deferentis; 15-a. glutea inferior; 16-a. pudenda interna; 17-a. sacralis lateralis; 18-a. glutea superior; 19-a. iliaca externa; 20-a. iliaca interna; 21-a. iliaca communis sinistra; 22-a. iliaca communis dextra

The parietal branches of the internal iliac artery are as follows:

1. Iliac-lumbar artery, a. iliolumbalis, passes behind n. obturatorius, a. iliaca communis and under m. psoas major is divided into two branches: lumbar, ramus lumbalis, and iliac, ramus iliacus. The first vascularizes the lumbar muscles, spine and spinal cord, the second - the ilium and the muscle of the same name.

2. Lateral sacral artery, a. sacralis lateralis, steam room, is located near the anterior sacral openings, through which its branches penetrate into the sacral canal.

3. Obturator artery, a. obturatoria, steam room, penetrates through the obturator canal into the medial part of the thigh between m. pectineus and m. obturatorius externus. It supplies blood to the pubis, the adductor muscles of the thigh, the ischium and the head of the femur. In 1/3 of cases, the obturator artery departs from a. epigastrica inferior and goes along the lower edge of the fossa inguinalis medialis, which must be taken into account during operations for inguinal hernias.

4. Superior gluteal artery, a. glutea superior, steam room, penetrates into the gluteal region through the foramen suprapiriforme. Supplies blood to the small and medium gluteal muscles.

5. Inferior gluteal artery, a. glutea inferior, steam room, goes to the back of the pelvis through the foramen infrapiriforme. It supplies blood to the gluteus maximus muscle and the sciatic nerve. All parietal branches of the internal iliac artery anastomose with each other.

The visceral branches of the internal iliac artery are as follows.

1. Umbilical artery, a. umbilicalis, steam room, is located under the parietal peritoneum on the sides of the bladder, then rises into the umbilical cord and reaches the placenta. After birth, part of it from the navel is obliterated. From the initial section of the artery to the apex of the bladder, the superior vesical artery departs, a. vesicalis superior.

2. Inferior cystic artery, a. vesicalis inferior, steam room, goes down and forward, enters the wall of the bottom of the bladder. It also supplies blood to the prostate gland, seminal vesicles, and vagina.

3. Artery of the vas deferens, a. ductus deferentis, steam room, supplies blood to the duct.

4. Uterine artery, a. uterina, steam room, penetrates the base of the broad uterine ligament and at the cervix gives a branch to the upper part of the vagina, then rises up and in the thickness of the wide uterine ligament gives branches to the cervix and body of the uterus. Its final branch accompanies the fallopian tube and ends at the hilum of the ovary.

5. Middle rectal artery, a. rectalis media, steam room, enters the lateral surfaces of the organ. Anastomoses with the superior and inferior rectal arteries.

6. Internal pudendal artery, a. pudenda interna, steam room, is the final branch of the visceral trunk. Through the foramen infrapiriforme, it enters the posterior surface of the pelvis, and then through the foramen ischiadicum minus enters the fossa ischiorectalis, where it gives off branches to the perineum, rectum and external genital organs (a. perinei. a. dorsalis penis, a. rectalis inferior).

External iliac artery, a. iliaca externa, steam room, has a diameter of mm, m. psoas major reaches the lacuna vasorum, where, at the lower edge of the inguinal ligament, it continues into the femoral artery (see Fig. 157). In the pelvic cavity, the external iliac artery gives 2 branches:

1. Inferior epigastric artery, a. epigastrica inferior, steam room, starts 1-1.5 cm above lig. inguinale, located behind the parietal peritoneum medially to the deep inguinal ring, near which the spermatic cord crosses the artery. Here begins a. cremasterica to the muscle that suspends the testicle. The inferior epigastric artery near the lateral edge of the rectus abdominis reaches the umbilicus. It anastomoses with the superior epigastric, lumbar, and inferior intercostal arteries.

2. Deep artery surrounding the ilium, a. circumflexa ilium profunda, steam room, begins distal to the beginning of the inferior epigastric artery. Accompanies the inguinal ligament, reaches the iliac crest. It supplies blood to the transverse and internal oblique muscles of the abdomen. It forms a connection with the superficial artery surrounding the ilium and the iliac-lumbar artery.

Topography.

Holotopia: chest cavity

Skeletotopia: at the level of IV-XII thoracic vertebrae

Syntopy: Posterior mediastinal organ, left lung root, left vagus nerve and left atrium in front, esophagus on the right, semi-azygous vein and left intercostal veins behind and on the left, paired vein and thoracic duct behind and on the right

Dermatotopia: sternum

Not covered by pericardium

The thoracic descending aorta gives off the following branches.

Visceral:

1. Rami bronchiales - bronchial - enter the lungs accompanied by the bronchi, carry arterial blood for the lymph nodes and lung tissue and merge with the branches of the pulmonary arteries.

2. Rami esophageales - esophageal - to the walls of the esophagus.

3. Rami mediastinals - mediastinal - to the lymph nodes and connective tissue of the posterior mediastinum.

4. Rami pericardiaci - pericardial - to the pericardium.

Parietal:

1) Posterior intercostal - aa. intercostales posteriores, 10 pairs - to the CM and back muscles, to the parietal peritoneum, to the muscles, ribs, skin and mammary gland

2) Ah. phrenicae superiores, superior phrenic arteries, branch on the superior surface of the diaphragm.

Topography.

Holotopia: abdomen

Skeletotopia: from the diaphragm to the level of IV-V lumbar vertebrae

Syntopia: Above and in front of the aorta are the pancreas, the ascending part of the duodenum, below - the upper part of the root of the mesentery of the small intestine. Along the left edge of the aorta are the lumbar region of the left sympathetic trunk and the intermesenteric plexus, on the right - the inferior vena cava. The cellular tissue contains parietal left lumbar lymph nodes and intermediate lumbar lymph nodes.

Dermatotopia: epigastric, umbilical region

Retroperitoneally

Parietal (parietal) branches of the abdominal aorta:

Inferior phrenic arteries, aa. phrenicae inferiores dextra et sinistra.

Lumbar arteries, aa. lumbales, paired, supply blood to the lower sections of the anterolateral wall of the abdomen, the lumbar region and the spinal cord.

Median sacral artery, a. sacralis mediana, - supplies blood to m. iliopsoas, sacrum and coccyx.

Visceral paired and unpaired branches of the abdominal aorta usually depart in this order:

Celiac trunk, truncus coeliacus. Blood supply to the stomach, liver, spleen, pancreas.

Middle adrenal artery, a. suprarenalis media, steam room, goes to the adrenal gland.

Superior mesenteric artery, a. mesenterica superior, gives off branches to the pancreas and duodenum. Further branches, supplying blood to the small intestine and the right half of the colon.

Renal arteries, aa. renales. Blood supply to the kidneys.

Arteries of the testicle (ovary), aa. testiculares (aa. ovaricae), paired, supply blood to the ovaries and testicles

Inferior mesenteric artery, a. mesenterica inferior, supplies blood to the left half of the colon.

External carotid artery, a. carotis externa, is located within the carotid triangle immediately after the bifurcation gives off several branches.

Branches of the external carotid artery.

Superior thyroid artery, a. thyroidea superior. Blood supply to the larynx and thyroid gland.

Ascending pharyngeal artery, a. pharyngea ascendens, supplies blood to the pharyngeal wall and dura mater.

Lingual artery, a. lingualis, blood supply to the tongue

The facial artery, a facialis, supplies blood to the skin and muscles of the face, soft and hard palate.

Occipital artery, a. occipitalis, blood supply to the occipital region.

Posterior auricular artery, a auricularis posterior, Blood supply to the auricle, tympanic cavity

Superior temporal artery a. temporalis superficialis, skin and muscles of the temporal region

Maxillary artery a. maxillaris, supplies the upper jaw, hard, soft palate.

Located in the neck and inside the skull, a continuation of the external carotid artery

Branches of the internal carotid artery (a. carotis internae).

1. Sleepy-tympanic branches penetrating into the tympanic cavity.

2. A. ophthalmica, ophthalmic artery. Branches a. ophthalmica:

o to the hard shell of the brain;

o to the lacrimal gland a. lacrimalis;

o to the eyeball aa. ciliares, terminate in the choroid of the eye;;

o to the muscles of the eyeball;

o to ages aa. palpebralis laterales et mediales;

o to the mucous membrane of the nasal cavity aa. ethmoidales anterior et posterior;

o a. supraorbitalis;

o a. dorsalis nasi descends to the bridge of the nose.

4. 3.A cerebri anterior, anterior cerebral artery, blood supply to the cerebral cortex.

5. A. cerebri media, the middle cerebral artery supplies blood to the outer surface of the frontal, temporal and parietal lobes.

6. A. chorioidea, choroid plexus artery, ventricular blood supply.

7. A. communicans posterior, posterior communicating artery, posterior lobes of the brain.

The subclavian arteries are located under the 5th fascia. The right subclavian artery originates from the brachiocephalic trunk, and the left one from the aortic arch.

Topography.

Holotopia: chest cavity

Skeletotopia: clavicle, 5-7 cervical vertebrae

Syntopy: Right venous angle, anterior vagus nerve, right phrenic nerve, medially passes right common carotid artery. Anterior to the left subclavian artery is the internal jugular vein and the origin of the left brachiocephalic vein. Medial to the subclavian artery are the esophagus and trachea. The thoracic duct runs between the left subclavian and common carotid arteries.

The subclavian artery is conditionally divided into four sections:

o chest;

o interstitial;

o supraclavicular department;

o subclavian.

1. Internal thoracic artery, a. thoracica interna. Blood supply to the thoracic organs

2. The thyroid trunk, truncus thyrocervicalis, gives off four branches:

o Inferior thyroid artery, a. thyroidea inferior. From the lower medial part of the arch of the inferior thyroid artery, branches extend to all organs of the neck. In the walls of the organs and in the thickness of the thyroid gland, these branches anastomose with the branches of other arteries of the neck and the branches of the opposite lower and upper thyroid arteries;

o Ascending cervical artery, a. cervicalis ascendens;

o Subscapular artery, a. suprascapularis, blood supply to the subscapularis;

o Transverse artery of the neck, a. transversa colli.

3. Costo-cervical trunk, trancus costocervicalis. It is divided at the spine into two branches: the upper intercostal, a. intercostalis suprema, and deep cervical artery, a. cervicalis profunda, penetrating into the muscles of the back of the neck.

Blood supply to the brain

1. The carotid arteries form the carotid pool.

2) The vertebral arteries form the vertebrobasilar basin. They supply blood to the posterior regions of the brain. As a result of fusion, the vertebral arteries form the main artery, a. basilaris

3) Near the base of the skull, the main arteries form a circle of Willis, from which the arteries depart, which supply blood to the brain tissue, the following arteries participate:

anterior cerebral artery

anterior communicating artery

posterior communicating artery

posterior cerebral artery

4) The circle of Zakharchenko is formed by two spinal arteries and two anterior spinal arteries

Venous outflow

a) The sinuses of the dura mater receive blood from the internal and external veins of the brain.

b) The jugular veins carry blood away from the neck and head

Blood supply to the spinal cord.

1) The anterior spinal artery supplies the ventral surface of the spinal cord. A large number of "central arteries" depart from it. The central arteries supply the anterior horns, the base of the posterior horns, Clark's columns, the anterior columns, and most of the lateral columns of the spinal cord.

2) The two posterior spinal arteries supply blood only to 2-3 upper cervical segments, while the rest of the spinal cord is powered by the radicular-spinal arteries,

3) Anterior and posterior radicular-spinal arteries. Blood from the anterior enters the anterior spinal artery, and from the posterior to the posterior spinal artery.

The spinal cord has a highly developed venous system. The main venous channels, which receive the blood of the veins from the substance of the spinal cord, run in the longitudinal direction, similarly to the arterial trunks.

Branches of the axillary artery:

A. subscapularis, subscapular artery, supplies the muscles of the scapula.

· Ah. circumflexae humeri anterior et posterior, anterior and posterior arteries that go around the shoulder. Both arteries surrounding the shoulder supply blood to the shoulder joint and the deltoid muscle, where they anastomose with the thoracoacromial artery.

· A. axillaris, the axillary artery, is the main main vessel of the upper limb. Its branches in the area of the shoulder girdle form anastomoses with arteries from the systems of the subclavian and brachial arteries, which serve as collateral pathways for the blood supply to the upper limb.

Topography: In the first section (clavicular-thoracic triangle), the clavicular-thoracic fascia is adjacent to the axillary artery in front, the medial bundle of the brachial plexus, the anterior serratus muscle, from above and laterally - the posterior and lateral bundles of the brachial plexus, from below and medially - the axillary vein.

In the second section (thoracic triangle), the pectoralis minor muscle is located in front, laterally - the lateral bundle of the brachial plexus, behind - the subscapularis muscle, medially - the medial bundle of the brachial plexus and the axillary vein.

In the third section (inframammary triangle), the superficial formation is the axillary vein, lateral-muscular-cutaneous nerve, biceps; in front - median nerve; medial - medial cutaneous nerves of the shoulder and forearm and ulnar nerve; behind - radial nerve and axillary nerve.

Brachial artery, A. brachialis, gives the following branches:

1. A. profunda brachii, deep artery of the shoulder, collateral circulation of the shoulder

2. A. collateralis ulnaris superior, superior ulnar collateral artery, anastomoses with the posterior recurrent ulnar artery, blood supply to the shoulder joint.

3. A. collateralis ulnaris inferior, the lower ulnar collateral artery anastomoses with the anterior recurrent ulnar artery. Blood supply of the elbow joint

Shoulder blood supply:

The blood supply is carried out by the anterior and posterior circumflex humeral arteries, the acromial branch of the suprascapular artery (from the thyroid trunk), the acromial branch of the thoracoacromial artery (from the clavicular-thoracic part of the axillary artery).

radial artery, a. radialis.

Holotopy: upper limb

Skeletopia: radius and ulna

Syntopy: Continuations of the brachial artery, in front of the fascia and skin, medially - brachioradialis muscle and pronator round, lie in the radial and ulnar grooves

Branches of the radial artery:

A. recurrens radialis, recurrent radial artery, forms a collateral

Muscular branch - to the surrounding muscles.

Ramus carpeus palmaris, palmar carpal branch. From the anastomosis on the palmar surface of the wrist, a deep network of the wrist is formed.

Ramus palmaris superficialis, the superficial palmar branch, enters the superficial palmar network.

Ramus carpeus dorsalis, the dorsal carpal branch, forms a network on the back of the wrist, which also receives branches from the interosseous arteries.

A. metacarpea dorsalis prima, the first dorsal metacarpal artery, goes on the back of the hand to the radial side of the index finger and to both sides of the thumb.

A. princeps pollicis, the first artery of the thumb, departs from the radial to both sides of the thumb and to the radial side of the index finger

Ulnar artery, a. ulnaris, Branches of the ulnar artery:

· A. recurrens ulnaris, recurrent ulnar artery, in the circumference of the elbow joint, an arterial network is obtained.

A. interossea communis, the common interosseous artery, goes to the interosseous membrane

Ramus carpeus palmaris, the palmar carpal branch, goes towards the same-named branch of the radial artery, with which it anastomoses.

Ramus carpeus dorsalis, dorsal carpal branch,

· Ramus palmaris profundus, a deep palmar branch, penetrates under the tendons and nerves of the palm and together with a. radialis is involved in the formation of a deep palmar arch.

Blood supply of the elbow joint carried out through the ulnar arterial network, formed by the branches of the brachial, radial and ulnar arteries. Venous outflow goes through the veins of the same name.

There are two networks in the wrist area: one is palmar, the other is dorsal.

The palmar is formed from the junction of the palmar carpal branches of the radial and ulnar arteries and branches from the anterior interosseous. The palmar network of the wrist is located on the ligamentous apparatus of the wrist under the flexor tendons; its branches feed the ligaments of the wrist joint.

The dorsal is formed from the connection of the dorsal carpal branches of the radial and ulnar arteries and branches from the interosseous; located under the extensor tendons and gives branches: a) to the nearest joints, b) to the second, third and fourth interosseous spaces; at the base of the fingers, each of them divides into branches towards the fingers.

On the palm there are two arcs - superficial and deep.

· Arcus palmaris superficialis, superficial palmar arch, located under the aponeurosis of the palm. From the convex distal side of the superficial arch, four common palmar digital arteries depart.

· Arcus palmaris profundus, deep palmar arch, located deep under the flexor tendons at the bases of the metacarpal bones and ligaments. From the convex side of the deep arch, three palmar arteries of the metacarpus depart to three interosseous spaces, starting from the second, which at the interdigital folds merge with the ends of the common palmar digital arteries.

The superficial and deep arterial arches are an important functional adaptation: due to the grasping function of the hand, the vessels of the hand are often subjected to compression. In violation of the blood flow in the superficial palmar arch, the blood supply to the hand does not suffer, since blood delivery occurs in such cases through the arteries of the deep arch. Articular networks are the same functional adaptations.

common iliac artery(a. iliaca communis).

The right and left arteries represent two terminal branches into which the aorta splits at the level of the IV lumbar vertebra. From the place of bifurcation of the aorta, they go to the sacroiliac joint, at the level of which each is divided into two terminal branches: a. iliaca interna for the walls and organs of the pelvis and a. iliaca externa mainly for the lower limb.

internal iliac artery(a. iliaca interna).

iliaca interna, starting at the level of the sacroiliac joint, descends into the small pelvis and extends to the upper edge of the large sciatic foramen. Covered by the peritoneum, the ureter descends in front; behind lies v. iliaca interna.

Parietal branches a. iliacae internae:

· A. iliolumbalis, iliac-lumbar artery.

A. sacralis lateralis, lateral sacral artery, supplies blood to the piriformis muscle and nerve trunks of the sacral plexus.

· A. glutea superior, superior gluteal artery, exits the pelvis to the gluteal muscles, accompanying the gluteus maximus.

A. obturatoria, obturator artery. Penetrates the hip joint and nourishes the ligament of the femoral head and the head of the femur.

· A. glutea inferior, inferior gluteal artery, leaving the pelvic cavity, gives muscle branches to the gluteal and other nearby muscles.

Visceral branches of the internal iliac artery (a. iliaca interna).

A. umbilicalis, umbilical artery2. Ureteric branch - to the ureter

· Ah. vesieales superior et inferior: The superior vesical artery supplies the ureter and the fundus of the bladder, and also gives branches to the vagina (in women), the prostate, and the seminal vesicles (in men).

· A. ductus deferentis, the artery of the vas deferens (in men), goes to the efferent duct and, accompanied by it, extends to the testicles.

· A. uterina, uterine artery (in women), gives a branch to the walls of the vagina. Gives branches to the fallopian tube and to the ovary.

A. rectalis media, the middle rectal artery, branches in the walls of the rectum, also gives branches to the ureter and bladder, prostate gland, seminal vesicles, in women - to the vagina.

7.A. pudenda interna, the internal pudendal artery, in the pelvis gives only small branches to the nearest muscles and roots of the sacral plexus, mainly supplies blood to the urethra, perineal muscles and vagina (in women), bulbourethral glands (in men), external genital organs.

External iliac artery(a. iliaca externa).

A. iliaca externa, starting at the level of the sacroiliac joint, stretches down and forward along the edge of the psoas muscle to the inguinal ligament.

1. A. epigastrica inferior, the lower epigastric artery, it gives off two branches: a) the pubic branch to the pubic symphysis, anastomosing with the obturator artery, and b) the artery of the muscle that lifts the testicle to the muscle of the same name and the testicle.

2. A. circumflexa ilium profunda, the deep artery that surrounds the ilium, feeds the transverse abdominal muscle and the iliac muscle.

Topography of the femoral artery

A. femoralis is a direct continuation of the external iliac artery. At the level of the subcutaneous fissure, the artery is covered in front by its sickle-shaped edge and lies outward from the vein of the same name.

Branches of the femoral artery, a. femoralis:

1. A. epigastrica superficialis, superficial epigastric artery, blood supply to the umbilical region.

2. A. circumflexa ilium superficialis, the superficial artery enveloping the ilium, goes to the skin in the region of the anterior superior iliac spine.

3. Ah. pudendae externae, the external genital arteries, are sent to the external genitalia - to the scrotum or to the labia majora.

4. A. profunda femoris, the deep artery of the thigh, is the main vessel through which the thigh is vascularized.

5. Muscular branches of the femoral artery - to the muscles of the thigh.

6. A. genus descendens, the descending artery of the knee joint, supplies the wide medial muscle; participates in the formation of the arterial network of the knee joint.

The following arteries are involved in the blood supply to the hip joint:

ascending branch of the lateral circumflex artery

Deep branch of the medial circumflex artery

round ligament artery

branches of the inferior and superior gluteal arteries;

branches of the external iliac and inferior hypogastric arteries.

Topography:

Popliteal artery, a. poplitea, lies in the popliteal fossa medially and deeper than the tibial nerve, closest to the femur.

Branches of the popliteal artery

In the popliteal fossa a. poplitea gives off muscular branches, as well as five genicular arteries.

Superior genicular arteries, lateral and medial

Middle knee artery, a. media genus (unpaired), it immediately goes forward and branches in the posterior wall of the capsule of the knee joint and in its cruciate ligaments.

Inferior genicular arteries, lateral and medial

All these arteries, except for the middle one, form deep and superficial arterial networks in the anterior region of the knee joint.

blood supply The knee joint is carried out by the branches of the popliteal artery, which form the knee articular network, the lateral and medial superior genicular arteries, the lateral and medial inferior genicular arteries, as well as the descending genicular, anterior and posterior tibial recurrent arteries. Directly into the synovial membrane and to the cruciate ligaments, the middle genicular artery approaches. The outflow of venous blood occurs through the veins of the same name into the popliteal and femoral veins.

Leg arteries:

A. tibialis anterior, anterior tibial artery, is one of the two terminal branches of the popliteal artery.

Branches of the anterior tibial artery, a. tibialis anterior:

A. recurrens tibialis posterior, posterior recurrent tibial artery, to the knee joint and to the joint between the fibula and tibia.

A. recurrens tibialis anterior, anterior recurrent tibial artery, goes to the lateral edge of the patella, participating in the formation of rete articulare genus.

· Ah. malleolares anteriores medialis et lateralis, the anterior ankle arteries, lateral and medial, are involved in the formation of the medial and lateral ankle network.

A. tibialis posterior, posterior tibial artery, is a continuation of the popliteal artery. In the lower third of the lower leg lies between the long flexor of the fingers and the long flexor of the thumb, medial to the Achilles tendon. It divides on the sole into two branches: the lateral and medial plantar arteries.

a. peronea (fibularis), peroneal artery, departs from the posterior tibial artery and ends at the calcaneus. A. tibialis posterior and a. peronea branch out to nearby bones, muscles, joints, and skin along the way. A. fibularis gives off two important branches for the development of collateral circulation: the common branch and the perforating branch. The first anastomoses with the posterior tibial artery, the second with the anterior tibial artery. It gives off lateral ankle and calcaneal branches, which are involved in the formation of arterial networks of the lateral ankle and calcaneal region.

The ankle joint is supplied with blood from the medial and lateral ankle branches. Venous outflow occurs in the deep veins of the lower leg of the same name.

Foot arteries.

On the back of the foot the dorsal artery of the foot passes, which is a continuation of the anterior tibial artery, located on the bones and having medially from itself the tendon of the long extensor of the thumb, and laterally, the short extensor of the fingers. The dorsal artery of the foot gives off the following branches:

· Ah. tarseae mediales, medial tarsal arteries - to the medial edge of the foot.

A. tarsea lateralis, lateral tarsal artery.

A. arcuata, the arcuate artery, anastomoses with the lateral tarsal and plantar arteries; gives off three dorsal arteries of the metatarsus - the second, third and fourth; each of the metatarsal arteries gives off perforating branches, anterior and posterior.

A. metatarsea dorsalis prima, the first dorsal metatarsal artery, gives off a branch to the medial side of the thumb.

5. Ramus plantaris profundus, a deep plantar branch, is involved in the formation of the plantar arch

On the sole of the foot there are two plantar arteries - aa. plantares medialis et lateralis, which represent the terminal branches of the posterior tibial artery. a. plantaris medialis gives branches to adjacent muscles, joints and skin.

Branches of the lateral plantar artery:

a) branches to adjacent muscles and skin;

b) aa. metatarseae plantares (four), plantar arteries of the metatarsus, have two types of anastomoses on the foot in the area of the metatarsus: 1) plantar branch and 2) perforating branch.

Vena cava superior, superior vena cava

Topography.

Holotopia: chest cavity

Skeletotopia: line 1 right rib - upper edge of rib 3

Syntopia: Right ascending aorta and right mediastinal pleura, posteriorly trachea, root of the right lung, bronchus, right pulmonary artery and vein, anteriorly right lung, left aortic arch. It is formed from the confluence of the right left brachiocephalic vein. Enters the right atrium

Dermatotopia: right edge of the sternum

The unpaired and semi-azygous veins are the main venous trunks of the posterior mediastinum. They penetrate into it from the retroperitoneal space through the gaps in the diaphragm. The intercostal and esophageal veins flow into them.

The unpaired vein runs along the right side of the vertebral bodies in front of the right posterior intercostal arteries, to the right of the thoracic duct and behind the esophagus. At the level of the IV thoracic vertebra, the unpaired vein crosses the right main bronchus and flows into the superior vena cava.

At the top left there is a non-permanent accessory semi-unpaired vein, v. hemiazygos accessona, which flows into the unpaired vein at the level of VII-VIII thoracic vertebrae. The unpaired and semi-unpaired veins bypass the inferior vena cava, carrying blood into the superior vena cava, and in the retroperitoneal space they anastomose with the veins of the inferior vena cava system. As a result, cavo-caval anastomoses are formed.

Brachiocephalic veins

Brachiocephalic veins, vv. brachiocephalicae, surrounded by fiber and brachiocephalic lymph nodes, are located immediately behind the tissue of the thymus. These are the first large vessels encountered in the study of the upper mediastinum. vv. brachiocephalicae dextra et sinistra are formed behind the corresponding sternoclavicular joints as a result of the fusion of the internal jugular and subclavian veins.

Topography.

Holotopia: chest cavity

Skeletotopia: sternoclavicular joints

Syntopia: The organ of the upper mediastinum. Left brachiocephalic vein - below the aortic arch, behind the right - the brachiocephalic trunk, behind the left left common carotid artery and left subclavian artery. Right brachiocephalic vein - below the cartilage of the 1st rib, in front of the sternocleidomastoid, sternohyoid and sternothyroid muscles

Dermatotopia: cartilage of the first rib

The inferior and proper thyroid arteries, which are formed from the dense venous plexus at the lower edge of the thyroid gland, flow into the brachiocephalic veins, thymus veins, vertebral veins, cervical and internal thoracic veins.

Venous outflow from the neck and head is carried out through two large paired vessels - the external and internal jugular veins. The external jugular vein is located closer to the surface of the body. The vein receives blood from the back of the head behind the auricle, from the skin of the neck above the scapula, the skin of the chin and the front of the neck. It flows into the subclavian or internal jugular vein.

Of particular importance is the internal jugular vein. In the dura mater of the brain there is a system of venous vessels with strong walls, into which the veins flow, draining blood from the brain. They connect with each other, forming a system of venous sinuses of the dura mater. Ultimately, the blood is collected in two sigmoid sinuses, which take the form of the right and left internal jugular veins. In the future, these veins include tributaries that drain venous blood from the skin and muscles, the walls of the nasal and oral cavities, the pharynx, larynx, salivary glands, and thyroid gland. The internal jugular vein eventually joins with the subclavian.

The veins of the brain are divided into superficial and deep. Superficial veins located in the pia mater collect blood from the cortex and white matter, deep veins - from the white matter of the hemispheres, basal ganglia, ventricular walls and choroid plexuses. The veins of the dura mater pass along with the arteries in the thickness of the membrane and form a significant venous network.

All veins carry blood to the venous blood collectors - the venous sinuses of the dura mater, located between its two leaves. The main ones are: the superior longitudinal sinus, passing along the upper edge of the large crescent process; the lower longitudinal sinus, located along the lower free edge of the large falciform process with the cerebellum; transverse sinus - the widest of all, located on the sides of the internal occipital bone thickening; cavernous sinus, located on the sides of the Turkish saddle. Between the left and right cavernous sinus, the intercavernous sinuses pass transversely - anterior and posterior, forming a circular sinus around the pituitary gland.

The outflow of blood from the cranial cavity occurs through the internal jugular vein, partly through the vertebral vein and emissaries - venous graduates located inside the flat bones of the skull and connecting the venous sinuses of the dura mater with the diploic veins and with the external veins of the head. The venous outflow from the deep structures of the brain has much less contact with the subarachnoid space than the venous outflow from the surface of the brain.

V. cava inferior, the inferior vena cava, is the thickest venous trunk in the body, lies in the abdominal cavity next to the aorta, to the right of it. The tributaries flowing directly into the inferior vena cava correspond to the paired branches of the aorta. They are divided into parietal veins and veins of the viscera.

Topography.

Holotopia: abdomen

Skeletotopia: line 4 of the lumbar vertebra - atrium

Syntopia: Organ of the posterior mediastinum. It is formed from the confluence of two common iliac veins. From below, it is attached to the psoas muscle, lies on the lumbar part of the diaphragm, in the groove of the vena cava on the liver. Enters the right atrium

Dermatotopia: umbilical region, epigastric region

Parietal veins draining into the inferior vena cava:

o right and left lumbar veins, four on each side, correspond to the arteries of the same name, take anastomoses from the vertebral plexuses; they are interconnected by longitudinal trunks;

The inferior phrenic veins empty into the inferior vena cava where it passes in the sulcus of the liver.

Veins of the viscera that empty into the inferior vena cava:

o testicular veins in men (ovarian in women) begin in the testicles and braid the arteries of the same name in the form of a plexus;

o vv. renales, renal veins, go ahead of the arteries of the same name, almost completely covering them;

o Right and left adrenal vein;

o vv. hepaticae, hepatic veins, empty into the inferior vena cava where it runs along the posterior surface of the liver; The hepatic veins carry blood out of the liver, where blood enters through the portal vein and the hepatic artery.

To the parietal venous tributaries include lumbar veins (3-4) on each side, collect blood from the venous plexus of the spine, muscles and skin of the back; anastomose with the ascending lumbar vein; inferior phrenic veins (right and left) - blood comes from the lower surface of the diaphragm; drain into the inferior vena cava.

In the group of visceral tributaries the testicular (ovarian) veins enter, collect blood from the testicle (ovary); renal veins - from the kidney; adrenal - from the adrenal glands; hepatic - carry blood away from the liver.

Venous blood from the lower extremities, walls and organs of the pelvis is collected in two large venous vessels: the internal iliac and external iliac veins, which, having joined at the level of the sacroiliac joint, form the common iliac vein. Both common iliac veins then merge into the inferior vena cava.

Portal vein, v. portae also brings blood to the liver. It collects blood from all unpaired abdominal organs. The portal vein is formed from the confluence of the superior mesenteric and splenic veins. The place of their confluence is located behind the head of the pancreas. Lies in the retroperitoneal space to the right of the aorta.

The pancreaticoduodenal vein, the prepyloric vein and the right and left gastric veins flow into the portal vein, the inferior mesenteric vein flows into the splenic vein.

From under the head of the pancreas, the portal vein goes up behind the duodenum and enters the gap between the sheets of the hepatoduodenal ligament. There it is located behind the hepatic artery and the common bile duct. At a distance of 1.0-1.5 cm from the gate of the liver or at the gate, it is divided into the right and left branches. In the liver, the portal vein is divided into two branches: the right and left, each of them, in turn, is divided into segmental and smaller ones. Inside the lobules of the liver, they branch into wide capillaries (sinusoids) and flow into the central veins, which pass into the sublobular veins. The latter, connecting, form three or four hepatic veins. Thus, blood from the organs of the digestive tract passes through the liver, and then only enters the system of the inferior vena cava.

Location of portocaval anastomoses:

1) Esophagus, stomach

3) Near the umbilical ring

4) Vagina

Porto-caval anastomoses are:

o anastomoses between the veins of the stomach (system v. portae) and veins of the esophagus (system v. cava superior);

o anastomoses between the upper (v. portae) and middle (v. cava inferior) veins of the rectum;

o between the umbilical veins (v. portae) and the veins of the anterior abdominal wall (v. cava superior and inferior);

o anastomoses of the superior and inferior mesenteric, splenic veins (v. portae) with retroperitoneal veins (renal, adrenal, testicular or ovarian veins, and others flowing into v. cava inferior).

Location of cavocaval anastomoses:

5) Anterior abdominal wall

6) Posterior abdominal wall

Cavocaval anastomoses:

1) On the posterior abdominal wall in the lumbar region (lumbar veins from the inferior vena cava), ascending lumbar veins (from the superior vena cava)

2) Anterior abdominal wall (superior epigastric vein, sternosternal vein (from superior vena cava), inferior epigastric vein, superficial epigastric vein (from inferior vena cava))

The veins of the upper limb are divided into deep and superficial.

Superficial or saphenous veins, anastomosing with each other, form a wide-loop network, from which larger trunks separate in places. These stems are:

V. cephalica, the lateral saphenous vein of the arm, begins in the radial region of the rear of the hand, reaches the elbow along the radial side of the forearm, anastomosing here with the main vein.

V. basilica, the medial saphenous vein of the hand, begins on the ulnar side of the rear of the hand, goes in the medial part of the anterior surface of the forearm to the elbow bend, anastomosing here with the lateral saphenous vein of the hand.

V. intermedia cubiti, the intermediate vein of the elbow, is an oblique anastomosis connecting v. basilica and v. cephalica.

Deep veins accompany arteries of the same name, usually two each. Thus, there are two brachial, ulnar, radial, interosseous veins. Both brachial veins at the lower edge of the pectoralis major merge together and form the axillary vein, which in the axillary fossa lies medial and anterior to the artery of the same name, partly covering it. Passing under the clavicle, it continues further in the form of the subclavian vein. In v. axillaris the thoracoacromial vein, lateral thoracic, subscapular, circumflex shoulder vein empties

The veins of the lower limb are divided into deep and superficial, or subcutaneous, which pass independently of the arteries.

deep veins the feet and lower legs are double and accompany the arteries of the same name.

The popliteal vein is a single trunk located in the popliteal fossa posteriorly and somewhat laterally from the artery of the same name.

The femoral vein is single, initially located laterally from the artery of the same name, then passes to the posterior surface of the artery, and even higher - to its medial surface and passes into the vascular lacuna. The tributaries of the femoral vein are all double.

Of the saphenous veins of the lower limb, the largest are two trunks: v. saphena magna and v. saphena parva.

Vena saphena magna, the great saphenous vein of the leg, originates on the dorsal surface of the foot from the venous network of the dorsum of the foot and the venous arch of the dorsum of the foot. Having received several tributaries from the side of the sole, it goes up the medial side of the lower leg and thigh. In the upper third of the thigh, it bends and goes to the subcutaneous fissure. In this place v. saphena magna flows into the femoral vein. Of the other subcutaneous tributaries of the femoral vein, mention should be made of the superficial epigastric vein, the superficial vein around the ilium, the external pudendal vein, accompanying the arteries of the same name. They pour partly into the femoral vein, partly into v. saphena magna.

V. saphena parva, the small saphenous vein of the leg, begins on the lateral side of the dorsal surface of the foot, goes around the lateral ankle from below and behind and rises along the surface of the lower leg; first it goes along the Achilles tendon, and then up in the middle of the back of the lower leg. Having reached the lower angle of the popliteal fossa, v. saphena parva flows into the popliteal vein. V. saphena parva is connected by branches to v. saphena magna.

The lymphatic system is an integral part of the vascular system and represents, as it were, an additional channel of the venous system, in close connection with which it develops and with which it has similar structural features (the presence of valves, the direction of lymph flow from tissues to the heart).

Its main function is transport, resorption and drainage functions, as well as the formation of lymphopoiesis, a barrier role.

The lymphatic system contains:

I. Ways conducting lymph: lymphocapillary vessels, lymphatic vessels, trunks and ducts.

II. Places of development of lymphocytes:

1. bone marrow and thymus;

2) lymphoid formations in the mucous membranes:

A) single lymphatic nodules, folliculi lymphatici solitarii;

B) collected in groups of folliculi lymphatici aggregati;

C) the formation of lymphoid tissue in the form of tonsils, tonsillae;

Accumulations of lymphoid tissue in the appendix;

3) pulp of the spleen;

4) lymph nodes, nodi lymphatici.

The lymphatic system is a system of tubes closed at one end (peripheral) and opening at the other end (central) into the venous bed.

The lymphatic system is anatomically composed of the following parts:

The closed end of the lymphatic channel begins with a network of lymphocapillary vessels penetrating the tissues of organs in the form of a lymphocapillary network.

Lymphatic capillary vessels pass into the intraorgan plexus of small lymphatic vessels.

The latter leave the organs in the form of larger efferent lymphatic vessels, interrupted on their further path by lymph nodes.

Large lymphatic vessels flow into the lymphatic trunks and further into the main lymphatic ducts of the body - the right and thoracic lymphatic ducts, which flow into the large veins of the neck.

Lymphocapillary vessels carry out: 1) absorption, resorption from the tissues of colloidal solutions of protein substances that are not absorbed into the blood capillaries; 2) drainage of tissues additional to the veins, 3) removal of foreign particles from tissues under pathological conditions, etc.

Lymph capillary vessels represent a system of endothelial tubes penetrating almost all organs, except for the brain, spleen parenchyma, epithelial skin, etc. Lymph capillary vessels constitute one of the links of the microvasculature. The lymphocapillary vessel passes into the initial, or collecting, lymphatic vessel, which passes into the outlet lymphatic vessel.

The thoracic duct, ductus thoracicus, begins at the confluence of the right and left lumbar trunks. At the beginning, the thoracic duct has an extension, cisterna chyli.

Topography.

Skeletotopia: the beginning is between the XI thoracic and II lumbar vertebrae, the end is at the level of the VII cervical vertebra

Syntopia: Behind the spinal column, on the right is the thoracic part of the aorta, behind the esophagus and the aortic arch. The left bronchomediastinal, subclavian and jugular trunks flow into the upper part. flows into the left internal jugular vein or into the angle of its connection with the left subclavian.

Dermatotopia: umbilical region, epigastric region, chest region

Thus, the thoracic duct collects about 3/4 of the entire lymph, almost from the entire body, with the exception of the right half of the head and neck, the right arm, the right half of the chest and the cavity and lower lobe of the left lung. From these areas, lymph flows into the right lymphatic duct, which flows into the right subclavian vein.

The thoracic duct and large lymphatic vessels are supplied with a vascular wall, it has nerves in its walls - afferent and efferent.

The right lymphatic duct, ductus lymphaticus dexter, is formed from the fusion of three trunks: the right jugular trunk, which receives lymph from the right region of the head and neck, the right subclavian trunk, which carries lymph from the right upper limb, and the right bronchomediastinal trunk, which collects lymph from the walls and organs of the right half of the chest and lower lobe of the left lung. Quite often it is absent, in which case the three trunks listed above independently flow into the subclavian vein.

Topography.

Holotopia: chest and abdomen

Skeletotopia: 1 right rib

Syntopia: within the clavicular-thoracic triangle. It flows into the right subclavian vein, into the right venous angle

Dermatotopia: chest area

Lymph from the head and neck is collected in the right and left jugular lymphatic trunks, which flow: the right - into the right lymphatic duct or into the right venous angle and the left - into the thoracic duct or into the left venous angle. Before getting into the named duct, the lymph passes through the regional lymph nodes.

These nodes include the following:

Occipital, nodi lymphatici occipitales.

Mastoid, nodi lymphatici mastoidei,

Parotid (superficial and deep), nodi lymphatici parotidei (superficiales et profundi).

Submandibular, nodi lymphatici submandibulares,

Facial, nodi lymphatici faciales. Submental, nodi lymphatici submentales,

There are two groups of lymph nodes in the neck: anterior cervical and lateral cervical.

Anterior cervical lymph nodes are divided into superficial and deep, among the latter there are: preglottal, thyroid, pretracheal and paratracheal.

Lateral nodes make up the surface and deep groups. Deep nodes form chains along the internal jugular vein, supraclavicular nodes and pharyngeal nodes.

Of the deep cervical lymph nodes, the jugular-bigastric and jugular-scapular-hyoid lymph nodes deserve special attention. Lymph flows into the pharyngeal nodes from the mucous membrane of the nasal cavity and its accessory air cavities, from the hard and soft palate, the root of the tongue, and also the middle ear. From all these nodes, lymph flows to the cervical nodes.

Lymphatic vessels:

skin and muscles of the neck - to the superficial cervical lymph nodes;

larynx - to the anterior deep cervical lymph nodes; the lymphatic vessels of the mucous membrane below the glottis go in two ways: anteriorly - to the preglottis and posteriorly - to the paratracheal;

thyroid gland - to the thyroid; from the isthmus - to the anterior superficial cervical nodes;

From the pharynx and palatine tonsils, lymph flows to the pharyngeal and deep lateral cervical nodes.

From the tissues and organs of the girdle of the upper limb and the entire free upper limb, the lymph is collected in the subclavian trunk, truncus subclavius, of this side, which flows into the right lymphatic duct or the right venous angle, and the left into the thoracic duct or into the left venous angle. Regional lymph nodes of the upper limb in the form of two large clusters lie near its large joints: the elbow and shoulder.

Axillary nodes, nodi lymphatici axillares, are located in the tissue of the axillary fossa. Among them are superficial and deep. The superficial lymphatic vessels of the upper limb are composed of two groups:

medial vessels go to the axillary nodes;

The lateral superficial vessels drain into the superficial axillary nodes. The superficial lymphatic vessels of the belt of the upper limb and shoulder also flow into the axillary nodes.

Deep lymphatic vessels of the upper limb, carrying lymph from the bones, joints and muscles of the hand and forearm, flow into the deep elbow lymph nodes, from where the lymph reaches the deep axillary nodes. Along the way, the deep lymphatic vessels of the shoulder join them. Thus, the group of axillary nodes becomes a confluence of lymph from a large part of the body: the free upper limb, the girdle of the upper limb and the chest.

The lymph nodes of the lower limb are located in the following places:

1. In the popliteal fossa - nodi lymphatici popliteales.

2. In the inguinal region - nodi lymphatici inguinales. They are divided into superficial and deep:

a) superficial inguinal nodes, nodi lymphatici inguinales superficiales, are located on the broad fascia of the thigh;

b) deep inguinal nodes, nodi lymphatici inguinales profundi, lie under the broad fascia.

Superficial lymphatic vessels the lower limbs flow into two groups of collectors, going to the superficial inguinal nodes (medial group) and to the popliteal nodes (posterolateral group).

In the posterolateral group of collectors and popliteal nodes, lymph is drained from the skin, subcutaneous tissue and superficial fascia of a small area of the leg. From the rest of the leg, it flows into the medial group of collectors and further into the inguinal nodes. The superficial lymphatic vessels of the upper third of the thigh enter the inguinal nodes, where the superficial vessels of the gluteal region, the anterior wall of the abdomen and the external genital organs also flow.

deep lymphatic vessels the feet and legs flow into the popliteal nodes, from where the lymph reaches the deep inguinal nodes.

The efferent vessels of the inguinal nodes run along the external iliac artery and vein to the external, then common iliac lymph nodes, from where the lymph enters the lumbar nodes and trunks.

Blood and lymphatic vessels are always filled with blood or lymph, which include formed elements. Their function and structure are diverse. Among such reactions, immunological ones are especially distinguished, which are aimed at neutralizing foreign substances and cells. These reactions are carried out mainly due to the activity of lymphocytes and macrophages.

The organs of the immune system include: bone marrow, thymus, lymphoid group and single lymphatic nodules of the ileum and appendix, lymph nodes, spleen. The central organ of the immune system is the thymus gland.

The organs of the immune system protect the body (immunity) from genetically alien cells and substances that come from outside or are formed in the body.

thymus function.

Lymphocytes (T-lymphocytes) acquire properties in the thymus that provide protective reactions against cells that, due to various damages, become alien to the body. The epithelial cells of the lobules produce a hormone that regulates the transformation of lymphocytes in the thymus itself.

The spleen is a richly vascularized lymphoid organ. In the spleen, the circulatory system enters into close relationship with the lymphoid tissue, due to which the blood here is enriched with a fresh supply of leukocytes developing in the spleen. The blood passing through the spleen is freed from obsolete erythrocytes and from pathogenic microbes that have entered the bloodstream, suspended foreign particles, etc.

The structure of the spleen. In addition to the serous cover, the spleen has its own connective tissue capsule. The capsule continues into the body into the trabeculae. Between them is the pulp of the spleen. The pulp shows splenic lymph nodes. The pulp consists of reticular tissue with granules of pigment.

Topography.

Holotopia: abdomen

Skeletotopia: at the level from IX to XI ribs

Syntopy: The outer surface of the spleen is adjacent to the costal part of the diaphragm. In front, the spleen is in contact with the posterior and lateral surface of the bottom and body of the stomach, behind and below - with the lumbar part of the diaphragm and the upper pole of the left kidney and adrenal gland, in front and below - with the left bend of the intestine and with the tail of the pancreas.

Dermatotopia: left hypochondrium

Covering with peritoneum - intraperitoneally (except for the gate)

blood supply: splenic artery, a. splenica (lienalis), the largest branch of the celiac trunk. The splenic artery at the hilum of the spleen is divided into 2 branches: upper and lower, which enter the parenchyma of the organ and are divided into smaller ones.

Innervate spleen branches of the splenic plexus. The splenic plexus is formed by the branches of the left nodes of the celiac plexus and the branches of the vagus nerves, as well as the branches of the left adrenal and left diaphragmatic plexuses.