2nd Exam theory - kallo

Question 1

1. Fossa temporalis

Answer 1

2 4 3 2

Paries anterior
 Facies temporalis ossis frontalis
 Facies temporalis ossis zygomatici

Paries medialis
 Facies temporalis ossis frontalis
 Facies temporalis alae majoris ossis sphenoidalis
 Facies temporalis ossis parietalis
 Facies temporalis ossis temporalis
o Linea temporalis superior
o Linea temporalis inferior

Paries lateralis
 Arcus zygomaticus
 Processus zygomaticus ossis temporalis
 Processus temporalis ossis zygomatici

Communications 2

Fossa infratemporalis
Foramen zygomaticotempoale –> orbita

Question 2

2. Fossa infratemporalis

Answer 2

7

Paries anterior
 Facies infratemporalis maxillae Paries medialis
 Lamina lateralis processus pterygoidei ossis sphenoidalis

Paries superior
 Facies infratemporalis alae majoris ossis sphenoidalis

Paries lateralis
( Arcus zygomaticus)
 Ramus mandibulae

Communications
 Fissura orbitalis inferior -> orbita
 Fissura petrotympanica -> cavum tympani
 Fissura sphenomaxillaris (border between fossa infratemporalis and fossa pterygopalatina) -> fossa
pterygopalatina
 Foramina alveolaria -> canales alveolares maxillae
 Foramen ovale -> fossa cranii media
 Foramen spinosum -> fossa cranii media
 Foramen mandibulae (in mandibula!) -> canalis mandibulae

Question 3

3. Fossa pterygopalatina

Answer 3

6

Paries medialis
 Lamina perpendicularis ossis palatini

Paries anterior
 Facies infratemporalis maxillae

Paries posterior
 Processus pterygoideus

Paries superior
 Facies maxillaris alae majoris ossis sphenoidalis

Communications
 Foramen sphenopalatinum -> meatus nasopharyngeus cavi nasi
 Foramen rotundum -> fossa cranii media
 Fissura orbitalis inferior -> orbita
 Fissura sphenomaxillaris -> fossa infratemporalis
 Canalis pterygoideus (in the root of proc. pterygoideus ossis sphenoidalis) -> basis cranii externa
 Canalis palatinus major (os palatinum) -> foramen palatinum majus -> cavum oris

Question 4

4. Orbita

Answer 4

7

Auditus orbitae
Margo supraorbitalis ossis frontalis
Margo infraorbitalis maxillae et ossis zygomatici

Apex orbitae
Paries medialis
 Processus frontalis maxillae
 Os lacrimale
 Lamina orbitalis ossis ethmoidalis
 Corpus ossis sphenoidalis

Paries superior
 Pars orbitalis ossis frontalis
 Facies orbitalis alae minoris ossis sphenoidalis
 Facies orbitalis ossis zygomatici
o Fossa glandulae lacrimalis

Paries inferior
 Facies orbitalis maxillae
o Sulcus infraorbitalis

Communications
 Canalis opticus -> fossa cranii media
 Fissura orbitalis superior -> fossa cranii media
 Foramen ethmoidale anterius -> fossa cranii anterior
 Foramen ethmoidale posterius -> cavum nasi
 Canalis nasolacrimalis -> cavum nasi (meatus nasi inferior)
 Canalis infraorbitalis -> foramen infraorbitale -> facies anterior maxillae
 Fissura orbitalis inferior -> fossa pterygopalatina, fossa infratemporalis

Question 5

5. Cavitas nasi ossium

Answer 5

11

Paries superior
 Lamina cribrosa Paries inferior
 Palatum osseum

Paries lateralis
 Facies nasalis maxillae
 Os lacrimale
 Concha nasalis inferior
 Labyrinthus ethmoidalis
 Lamina perpendicularis ossis palatini
 Lamina medialis processus pterygoidei

Paries medialis (septum nasi)
 Lamina perpendicularis ossis ethmoidalis
 Vomer

Paries posterior
 Facies anterior corporis ossis sphenoidalis
 Choanae

Paries anterior
 Os nasale
 Apertura piriformis (os nasale, incisura nasalis maxillae)

 Meatus nasi superior -> cellulae ethmoidales

 Meatus nasi medius -> cellulae ethmoidales
 Meatus nasi medius -> hiatus sinus maxillaris -> sinus maxillaris
 Meatus nasi medius -> apertura sinus frontalis -> sinus frontalis

 Meatus nasi inferior -> canalis nasolacrimalis -> orbita

 Meatus nasi communis -> apertura piriformis
 Meatus nasi communis -> cribrae ethmoidales -> fossa cranii anterior
 Meatus nasi communis -> canalis incisivus -> cavum oris

 Meatus nasopharyngeus -> apertura sinus sphenoidalis -> sinus sphenoidalis
 Meatus nasopharyngeus -> foramen sphenopalatinum -> fossa pterygopalatina
 Meatus nasopharyngeus -> choana -> basis cranii externa

Question 6

6. Fossa cranii anterior

Answer 6

2

Borders
 Squama frontalis
 Ala minor ossis sphenoidalis
 Sulcus prechiamaticus

Base formations
 Lamina cribrosa ossis ethmoidalis
 Pars orbitalis ossis frontalis
 Ala minor ossis sphenoidalis

Structures
 Crista galli
 Crista frontalis
 Impressiones digitatae
 Juga cerebralia

Communications
 Cribrae ethmoidales -> cavum nasi (meatus nasi communis)
 Foramen ethmoidale anterius -> orbita

Question 7

7. Fossa cranii media

Answer 7

9

Borders
 Sulcus prechiasmaticus
 Ala minor ossis sphenoidalis
 Pars squamosa ossis temporalis
 Sulcus sinus petrosi superioris
 Dorsum sellae

Base formations
 Corpus ossis sphenoidalis
 Ala major ossis sphenoidalis
 Pars squamosa ossis temporalis
 Facies anterior parti petrosae

Structures
 Sulcus prechiasmaticus
 Sella turcica
 Tuberculum sellae
 Fossa hypophysialis
 Dorsum sellae
 Sulcus caroticus
 Impressiones digitatae
 Juga cerebralis
 Sulci arteriosi
 Tegmen tympani
 Eminentia arcuata
 Impressio trigemini

Communications
 Canalis opticus -> orbita
 Fissure orbitalis superior -> orbita
 Foramen rotundum -> fossa pterygopalatine
 Foramen ovale -> fossa infratemporalis
 Foramen spinosum -> fossa infratemporalis
 Canalis caroticus -> basis cranii externa
 Foramen lacerum -> basis cranii externa
 Hiatus canalis n. petrosi majoris -> canalis nervi facialis -> foramen stylomastoideum or meatus acusticus internus
 Hiatus canalis n. petrosi minoris -> canaliculus tympanicus -> cavum tympani -> fossula petrosa

Question 8

8. Fossa cranii posterior

Answer 8

8

Borders
 Dorsum sellae
 Sulcus sinus petrosi superioris
 Sulcus sinus transversi
 Protuberantia occipitalis interna

Base formations
 Os occipitale
 Facies posterior partis petrosae ossis temporalis
 Pars mastoidea ossis temporalis
 Angulus mastoideus ossis parietalis

Structures
 Clivus
 Sulcus sinus petrosi inferioris
 Sulcus sinus sigmoidei
 Crista occipitalis interna

Communications
 Foramen magnum -> canalis vertebralis
 Canalis hypoglossi -> basis cranii externa
 Canalis condylaris -> basis cranii externa
 Foramen jugulare -> basis cranii externa
 Foramen mastoideum (mastoideuksen takana) -> basis cranii externa
 Porus et meatus acusticus internus -> canalis nervi facialis -> foramen stylomastoideum -> basis cranii externa
 Canaliculus cochleae -> auris interna
 Canaliculus vestibule -> auris interna

Question 9

9. Mimetic muscles around eye and on calvaria

Answer 9

Eye region muscles
M. corrugator supercillii, “thinking”
o. glabella
i. the skin of the eyebrows
f. vertical folds in forehead
–> penetrates orbicularis oculi and venter frontalis os occipitale

M. orbicularis oculi
Pars orbitalis (c) – acts as a sphincter, attach to medial palpebral ligament
Pars palpebralis (a) – closes the eyelid
Pars lacrimalis (at the medial corner) – expands the lacrimal sack –> tears

Calvaria region muscles
- M. occipitofrontalis, divided into venter occipitalis and venter frontalis, “what money?” The white tendon is called galea aponeurotica.
Venter occipitalis
o. linea nuchae superior
i. galea aponeurotica

venter frontalis
o. galea aponeurotica
i. the skin of the eyebrows
f. elevation eyebrowns, wrinkles forehead

Question 10

10. Mimetic muscles around on the mouth

Answer 10

Mouth region muscles

M. levator labii superioris
Medial fibers are knows as M. levator labii superioris alaeque nasi.
o. margo infraorbitalis maxillae
i. skin of the upper lip
f. elevation of upper lip

M. levator anguli oris, “self-confidence, smile”, deep muscle o. fossa canina
i. skin at the angle of the mouth
f. elevatio of the corner of the mouth
–> lies deep to m. orbicularis oris

M. orbicularis oris, two pars; pars marginalis, pars labialis, “kissing muscle”. Pars marginalis is the outer part and pars labialis is the inner/lip part.
o. maxilla and mandibular
i. skin around the lips
f. closes the mouth and pucker the lips

M. zygomaticus, “real smile, laughter, pleasure”. Major and minor. Minor is upper and major is lower.
o. os zygomaticus
i. skin at the angle of the mouth
f. elevatio the angle of the mouth

M. risorius, “dimples, laughing muscle”, old people do not have this muscle anymore
o. fascia masseterica
i. skin at the angle of the mouth
f. reacts the angle of the mouth to produce smile
Fake smile if only used this muscle because without m. zygomaticus major and minor which elevates the lips and causes “crow’s feet” around the eyes using m. orbicularis oculi.
Makes nasolabial folds.

M. buccinator, “satisfaction”
o. processus alveolaris maxillae et mandibulae
raphe pterygomandibularis (Band of CT between hamulus pterygoideus and mandibular behind molar teeth.)
i. skin at the angle of the mouth, fibers of the m. orbicularis oris
f. reduce the volume of the mouth, tube instrument players (blowing)

M. depressor labii inferioris, “perserevance”
o. basis mandibule below foramen mentale
i. skin of the lower lip
f. moves lower lip downward

M. depressor anguli oris, “sadness”
o. basis mandibulae
i. skin at the angle of the mouth
f. depression the angle of mouth

M. mentalis “doubt”
o. processus alveolaris mandibulae, juga alveolaria
i. skin of the chin
f. elevatio and wrinkles the skin of the chin

Question 11

11. Masticatory muscles

Answer 11

Origo and insertio are in the bone.

M. temporalis, “eating”
o. planum temporale
i. processus coronoideus mandibulae
f. elevatio mandibula
posterior fibers – move mandibula backward

M. masseter, “closing of the mouth”
o. arcus zygomaticus
i. tuberositas masseterica mandibulae
f. elevatio mandibula

M. pterygoideus lateralis
o. facies infratemporalis alae majoris lamina lateralis processus pterygoidei
i. fovea pterygoidea mandibulae
f. bilateral – moves mandibula forward, depression mandibula unilateral – moves mandibula the opposite side

M. pterygoideus medialis, two pars
o. fossa pterygoidea ossis sphenoidalis
i. tuberositas pterygoidea mandibulae
f. bilateral – moves mandibula forward, elevatio mandibula unilateral – moves mandibula to the opposite side

Question 12

12. Art. temporamandibularis movements of

Answer 12

Art. temporomandibularis (art. ellipsoidea)

Caput mandibulae
Fossa mandibularis
Tuberculum articulare
–> Discus articularis
–> Capsula articularis
–> Lig. laterale (from arcus zygomaticus to collum mandibulae)

frontal axis: depressio/elevatio
Vertical axis: right and left / opposite sides

luxation: articulate surfaces are not correctly

Elevatio mandibula
 M. temporalis
 M. masseter
 M. pterygoideus medialis

Depressio mandibula
 M. mylohyoideus
 Venter anterior m. digastrici
 M. geniohyoideus
 Platysma

Forward movement of mandibula
 M. pterygoideus medialis et lateralis

Backward movement of mandibula
 Posterior fibers of m. temporalis

Lateral movement of mandibula
 Unilateral contraction of m. pterygoideus medialis et lateralis

Question 13

13. Fascias of the head

Answer 13

Fasciae capitis

Fascia temporalis: Covers m. temporalis. Attached to linea temporalis superior and galea aponeurotica. Over the muscle it splits into two plates. Lamina superficialis ends at the outer surface of arcus zygomaticus. Lamina profunda ends at the inner surface of arcus zygomaticus. Fat tissue between the plates.

Fascia masseterica: Covers m. masseterica. Extends from arcus zygomaticus to the lower border of basis mandibule. Anteriorly continues into fascia parotidea and posteriorly into fascia buccopharyngea.

Fascia parotidea: Surrounds parotid gland. Attach to arcus zygomaticus and the cartilage of external ear.

Fascia buccopharyngea: Covers m. buccinators and continues into pharynx.

Question 14

14. Suprahyoid muscles

Answer 14

M. mylohyoideus
o. linea mylohyoidea
i. os hyoideum
f. moves mandibular down (if os hyoideum is
fixed) or os hyoideum up (if mandibular is fixed) in case of swallowing

M. digastricus (venter anterior)
o. fossa digastriga
i. tendon connected with os hyoideum
f. moves mandibular down (if os hyoideum is fixed) or os hyoideum up (if mandibular is fixed)

M. digastricus (venter posterior)
o. incisura mastoidea
i. tendon connected with os hyoideum
f. elevatio and moves of hyoideum backwards

M. stylohyoideus
o. processus styloideus
i. os hyoideum
f. elevatio and moves of hyoideum backwards

M. geniohyoideus
o. spina mentalis
i. os hyoideum
f. depressio mandibular and elevatio os hyoideum

Question 15

15. Infrahyoid muscles

Answer 15

M. sternohyoideus
o. manubrium sterni
i. os hyoideum
f. depressio os hyoideum

M. sternothyreoideus, (deeps to m. sternohyoideus)
o. manubrium streni
i. cartilago thyreoidea of larynx
f. depressio larynx

M. thyreohyoidus
o. cartilago thyreoidea of larynx
i. os hyoideum
f. depressio os hyoideum, elevatio larynx

M. omohyoideus
Venter superior:
o. os hyoideum
i. continues into tendon
venter inferior:
o. margo superior scapulae
i. continues into tendon
f. depressio os hyoideum and moves it a little bit laterally

Question 16

16. Mm. laterales colli,mm. profundi colli

Answer 16

f. bilateral – flexio capitis and colli
unilateral – lateroflexio colli to the same side
If vertebral column is fixed these muscles act as inspiration muscles.

M. scalenus anterior (closest to neck)
o. PT C 3-6
i. tuberculum musculi scalene anterioris costae prima

M. scalenus medius
o. PT C 2-7
i. facies superior costae I (behind sulcus a. subclaviae)

M. scalenus posterior (lowest and most far to the neck)
o. PT C 5-7
i. costa secunda

Musculi profundi colli
f. bilateral – flexio colli
unilateral – lateroflexio colli to the same side

M. longus capitis
o. PT C 3-6 (same as m. scalene anterior)
i. pars basilar is ossis occipitals

M. longus colli
o. PT C 2-5
corpus vertebrae cervicalis C5-7
Vertebrae thoracicae T1-3
i. tuberculum anterius atlantis
corpus vertebrae C2-4
PT C6

M. rectus capitis anterior
o. PT atlantis
i. pars basilar is os occipitalis

M. rectus capitis lateralis
o. PT atlantis
i. processus jugularis os occipitalis

Question 17

17. Fascia colli

Answer 17

Surrounding connective tissue fascias around the muscles and spaces between the fascias.

Lamina superficialis surrounds the neck from all sides. Makes 2 separate fibrous sheats for m. sternocleidomastoideum and m. trapezius.

Superiorly it attaches to:
basis mandibula
processus mastoideus
linea nuchalis superior
protuberantia occipitalis externa

Inferiorly it attaches to:
manubrium sterni (outer surface)
clavicula
acromion
spina scapula

Posteriorly it gives a sagittal septum which joins with ligamentum nuchae and processus spinosi cervical vertebralis.

Anteriorly it attaches to os hyoideum and above it it splits into 2 laminas/plates. Lamina superficialis attaches to external basis mandibula. Lamina profunda attaches to internal basis mandibula. Space between these two laminas is called spatium submandibulare. Submandibular salivary gland is located there.

Lamina pretrachealis is located in anterior region of the neck. It is trapezium-like in shape. It makes a sheat for infrahyoid muscles, organs such as larynx, glandular thyoidea, parotidea, pharynx, beginning of oesophagus. Upper border is os hyoideum. Inferior border incisura jugularis (internally manubrium sterni and clavicle). Laterally it covers m. omohyoideus.

Between lamina superficialis and lamina pretrachealis there is a closed space called spatium suprasternale. –> fat tissue and superficial veins.

Lamina prevertebralis covers lateral and deep muscles of the neck. Superiorly it is attached to basis externa
cranium. Inferiorly it is attached to thoracic cavity as fascia endothoracica. Ends on ps. C7.

Between lamina pretrachealis and lamina prevertebralis there is an open space called spatium retropharyngeum
which connects with mediastinum superius. (possible site for infection)

Question 18

18. Topography of the neck

Answer 18

Trigonum colli medium
Borders are:
Basis mandibulae
m. sternocleidomastoideus dextra
m. sternocleidomastoideus sinistra

Trigonum colli mediale/anterior
Trigonum colli mediale includes 3 smaller triangles:
1. Trigonum submandibulare
2. Trigonum omohyoideum s. caroticum
3. Trigonum omotracheale
Borders are:
Basis mandibulae
m. sternocleidomastoideus midline

1. Trigonum submandibulare
   borders are:
   basis mandibulae
   venter anterior m. digastrici
   venter posterior m. digastrici
2. Trigonum omohyoideum s. caroticum
   Borders are:
   Venter posterior m. digastrici
   Venter superior m. omohyoidei
   m. sternocleidomastoideus
3. Trigonum omotracheale s. trigonometry musculare (infrahyoid muscles also trachea)
   Borders are:
   Venter superior m. omohyoidei
   m. sternocleidomastoideus midline

Trigonum colli laterale
Trigonum colli laterale is divided into 2 smaller triangels:
1. Trigonum omotrapezoideum
2. Trigonum omoclaviculare borders are:
m. sternocleidomastoideus
m. trapezius
clavicula

1. Trigonum omotrapezoideum
   Borders are:
   m. sternocleidomastoideus
   m. trapezius
   venter inferior m. omohyoidei
2. trigonum omoclaviculare
   borders are:
   m. sternocleidomastoideus
   venter inferior m. omohyoidei
   clavicula

Spatia intermuscularia
There are 2 spatia:

1. Spatium antescalenum
   Borders are:
   m. sternohyoideus
   m. sternothyreoideus
   m. scalenus anterior
   costa prima
   vena subclavia
2. Spatium interscalenum
   Borders are:
   m. scalenus anterior
   m. scalenus medius
   costa prima
   arterie subclavia/nerves of plexus brachialis

Question 19

19. Cavitas oris ( vestibulum oris,cavitas oris propria)

Answer 19

Consists of two parts: Vestibulum oris and Cavitas oris propria

Vestibulum oris:
Slip-like space between:
- The lips – labia: –> formed by m. Orbicularis oris
Boarded by:
o Labium superius et labium inferius
- connected at angulus oris by commisura labiorum
- Labium superior reaches the external nose and laterally sulcus nasolabialis -> in the middle of the upper lip a groove is present – philtrum
- Labium inferior extend into the lower direction to the chin and the sulcus mentolabialis

• The cheeks – bucca
• Processus alveolaris mandibulas et maxillae
  –> Covered by the gum – gingiva
  –> the teeth – dentes

Communicates with the surface of the body by the oral opening – rima oris

Communicates with cavitas oris propria, when the jaws are closed through narrow clefts between opposing teeth and by an aperture on both sides behind the molars.

The lips
 The lips are covered externally by skin and internally by mucosa
 The vermilion boarder, is the transitional zone from skin to the mucosa
 The mucosa contains glandulae labiales
 The inner surface of each lip is connected in the midline to the corresponding gum by frenulum labii
superioris and frenulum labii inferioris

Bucca
 Forms the sides of the face and continues into the lips
 The base is formed by m. buccinator
o covered by fascia buccopharyngea
 Corpus adiposum buccae lies on m. buccinator
 Externally covered by skin and internally covered by mucous membrane
 At the level of the 2nd upper molar tooth in the mucous membrane is papilla ductus parotidei

Gingiva
 Composed of dense fibrous tissue, closely connected to the periosteum of processus alveolaris mandibula et maxillae and surrounding the necks of the teeth
 There are no glands in the mucous membrane of the gum

Cavitas oris propria
 Limited laterally and anteriorly by processus alveolaris maxillae et mandibule and by the teeth
 posteriorly it communicates with the pharynx by isthmus faucium
 Roofed with the hard (palatum durum) and soft palate (palatum molle)
 The floor is composed of three muscles:
o m. mylohyoideus
o venter anterior m. digastrici
o m. geniohyoideus
 Glandula submandibularis is situated beneath the muscles
 On the upper surface of the muscles lies glandula sublingualis, covered by the mucous membrane
 Medially to Plica sublingualis is caruncula sublingualis

Question 20

20. Dentes

Answer 20

Two sets of teeth:
o Dentes decidui20 – 6-8 months (primary milk teeth) o Dentes permanentes  32 – 6-12 years
o Dens serotinus  17-24 years (wisdom tooth)
- Dens inscivus – for biting
- Dens caninus – tearing and gripping
- Dens premolaris – chewing movement
- Dens molaris – chewing
 Corona dentis = crown
 Radix dentis = root
 Cervix dentis = neck
 Cavitas dentis
 Cavitas coronae
 Cavitas radices dentis
 Foramen apicis dentis for Bv and nerves
 Pulpa dentis is soft part

Question 21

21. Lingua

Answer 21

Takes part in chewing, sucking, contains sense organs for taste and touch and is involved in speech production

• two parts:
  1. Corpus linguae - central part
  –> anterior part of the body is the apex linguae
  2. Radix linguae – posterior part, connected to os hyoideum
• On corpus linguae is the upper part – dorsum linguae and the lower part – facies inferior linguae
• Margo linguae is between the dorsum and the lower surface
• Sulcus medianus linguae is in the middle of the dorsum
• Sulcus terminalis linguae is between the dorsum and the root
• Foramen caecum linguae is in the middle of sulcus terminalis linguae
• Tonsilla lingualis is on the root

 The mucous membrane of the tongue contains numerous glands – glandulae linguales
 The mucous membrane forms three folds from the root of the tongue toward the epiglottis:
o Plica glossoepiglottica mediana
o Plica glossoepiglottica lateralis dextra et sinistra
 2 depressions between them - vallecula epiglottica

• The mucous membrane of the tongue contains numerous glands – glandulae linguales
• The mucous membrane forms three folds from the root of the tongue toward the epiglottis:
  1. Plica glossoepiglottica mediana
  2. and 3. Plica glossoepiglottica lateralis dextra et sinistra
  –> 2 depressions between them - vallecula epiglottica
• The mucosa forms a fold in the midline of the lower surface of the tongue – frenulum linguae
  –> connects the tongue with the gum of mandibula

Numerous papilla linguales on the dorsum of the tongue
o Papillae filiformes – across the dorsum of the tongue, a rough surface
o Papillae fungiforme – around the margin and the tip of the tongue, contain taste buds
o Papillae vallate – 7-11, arranged frontally of sulcus terminalis, contains taste buds
o Papillae foliate – transverse folds of the mucosa at the margin and the tip of the tongue,

Extrinsic muscles:
M. Genioglossus
 o. Spina mentalis mandibula
 i. Root of the tongue
 f. Pulls the tongue forward and downward

M. Styloglossus
 o. Processus styloideus
 i. Root of the tongue
 f. Pulls the tongue backward and downward

M. Hyoglossus
 o. Os hyoideum
 I. Root of the tongue
 f. Pulls the tongue backward and downward

Intrinsic muscles run perpendicular to each other and their main function is to change the shape of the
tongue:
M. Longitudinalis superior et inferior
 from apex linguae
 shortens the tongue

M. Verticalis linguae
 connects radix linguae with the lower surface of the tongue
 flattens toung

M. Transversus linguae
 from median fibrous septum
 passes laterally to the sides of the tongue
 narrows the tongue

Question 22

22. Glandulae salivariae

Answer 22

 Glandulae salivariae minores are scattered in the mucous membrane of the oral cavity and tongu
o glandulae labiales
o glandulae buccales
o glandulae palatinae
o glandulae linguales
 Glandulae salivariae majores:
o glandula parotidea
o glandula sublingualis
o glandula submandibularis

Glandula parotidea
 Largest salivary gland
 Pars superficialis – lies in front of the external ear on m. masseter
 Pars profunda – is situated in the retromandibular fossa
 Fascia parotidea surrounds the parotid gland
 Ductus parotidus starts at the gland’s anterior boarder, crosses m. masseter and runs through m. Buccinator and opens into the vestibulum oris on papilla parotidea

Glandula submandibularis
 Lies in trigonum submandibulare
 Surrounded by lamina superficialis fasciae cervicales / fasciae colli superficiales
 Opens on caruncula sublingualis

Glandula sublingualis
 The mucous membrane covers the gland and forms plica sublingualis
 The gland has several ducts, but the main duct – ductus sublingualis major opens on caruncula sublingualis together with ductus submandibulare
 Ductus sublinguales minores open by small openings directly on plica sublingualis

Question 23

23. Pharynx

Answer 23

Placed behind the nasal and oral cavities and the larynx

The airway and food passage crosses the pharynx

Cavitas pharyngis is divided into 3 parts:
1. Pars nasalis pharynges s. nasopharynx
2. Pars oralis pharynges s. oropharynx
3. Pars laryngea pharynges s. laryngopharynx

Wall structure:

Tunica mucosa
o glandulae pharyngeales in mucous membrane
o Pars nasalis pharynges s. nasopahrynx: respiratory epithelium
o Pars oralis et laryngea: stratified squamous epithelium

Fascia pharyngobasilaris –> soft skeleton of the pharynx between mucous and muscular layer.
–> Transforms into tela submucosa toward the oesophagus.

Tunica muscularis
Tunica adventitia

Nasopharynx – s. Pars nasalis pharynges
- Lies behind cavitas nasi from basis cranii externa  palatum molle (soft palate)
- Skeletotopically: C1 to C2
- attached to basis cranii externa and forms fornix pharynges
- Anteriorly nasopharynx comminucates via choana with cavitas nasi
- Between the superior and posterior walls of pharynx is tonsilla pharyngealis
- In the lateral wall of pharynx is ostium pharyngeum tubae auditivae
–> This opening leads via tubae auditivae to the cavitas tympani
- equalizing the air pressure on both sides of membrana tympanica

• Torus tubarius – a protube of cartilage from tubae auditivae
• Recessus pharyngeus – small recess behind the opening of tubae auditivae
• Below the pharyngeal opening is tonsilla tubaria

Oropharynx – s. Pars oralis pharyngis
- From palatum molle –> epiglottis
- Skeletotopically: C3 to C4
- Anteriorly it communicates with cavitas oris through isthmus faucium

Laryngopharynx – s. Pars laryngea pharyngis
Lies behind larynx
 from epiglottis  oesophagus
 Skeletotopically: C5 to C6
 Two openings: the aditus laryngis and oesophagus

Tonsils of the pharynx
- Tonsillae tubariae (one on each side)
- Tonsilla pharyngealis (single at the top of the pharynx)
- Tonsilla palatina (paired)
- Tonsilla lingualis (single)
Anulus lymphoideus pharyngis (Waldeyer’s throat ring)

Muscles of pharynx
(constrictors, elevatio pharynx):
M. Constrictor pharyngis superior
o. Processus pterygoideus
rhaphe pterygomandibularis
linea mylohyoidea
margo linguae

M. Constrictor pharyngis medius
o. Os hyoideum

M. Constrictor pharyngis inferior
o. Cartilago thyroidea
cartilago cricoidea

i. Raphe pharynges
f. Narrows the pharyngeal space and elevatio pharynx

(levatores, elevatio pharynx):
M. Stylopharyngeus
o. Processus styloideus

M. Palatopharyngeus
o. Palatine aponeurosis

i. Lateral wall of pharynx
f. Elevatio pharynx

Topography of pharynx
Holotopically: Cervical region
Skeletotopically: Basis cranii externa –> C6

Syntopically:
- Anteriorly:
cavitas nasi
cavitas oris
cavitas larynges

• Laterally: BV, nerves
• Posteriorly:
  mm. profundi colli
  fascia prevertebralis of fascia cervicales
  columna vertebralis
• Posteriorly there is spatium retropharyngeum and it extends laterally to spatium parapharyngeum
• Both spaces continue into mediastinum superius

Question 24

24. Oesophagus

Answer 24

• Canal about 23-25cm
• Extending from pharynx to gaster

3 parts:
1. Pars cervicalis
-> extend to the level of apertura thoracis superior
2. Pars thoracica
-> apertura thoracis superior to hiatus esophageus
diaphragm
3. Pars abdominalis
-> below hiatus esophageus diaphragm to the ostium
cardiacum

3 narrow spaces:
1. Constricto pharyngooesophagealis
-> Oesophagus entrance, behind cartilago cricoidea
2. Constricto broncoaortica
-> Trachea and r. Aorta, aorta thoracica (Th4-Th5)
3. Constricto phrenica s. Diaphragmatica
-> Passage through diaphragma, beginning of pars
abdominalis

Tunica mucosa
o forms longitudinal folds

Tela submucosa
o contains glandulae oesophageae

Tunica muscularis
o longitudinal and circular layers

Tunica adventitia or tunica serosa
-> Tunica adventitia covers cervical and thoracic part
-> the abdominal part is covered by tunica serosa (peritoneum)

Topography:
Holotopically:
- cervical region
- mediastinum superior and posterior
- cavitas abdominalis

Skeletotopically: C6 - Th11

Syntopically:
Posteriorly: columna vertebralis (aorta crosses at Th8-9)
Anteriorly:
- trachea
- bronchus principalis sinister
- pericardium
- hepar
Laterally:
- BV, nerves
- lobuli glandula thyroidea
- pleura parietalis pars mediastinalis,
- hepar

Question 25

25. Gaster

Answer 25

• Fragments of food are chemically broken down by the gastric juice
• Receives, stores, mixes, and digests ingested food products to form liquid chime.
  2 orifices (openings)
  1. Ostium cardiacumStomach communicates with oesophagus 2. Ostium pyloricumStomach communicates with duodenum

2 curves
1. Curvatura minor: The lesser concave border
2. Curvatura major: the greater convex border (4-5 times longer)

Incisura angularis
incisura cardialis

2 walls:
o Paries anterior
o Paries posterior

4 portions:
1. Pars cardiaca: entrance to the stomach
2. Fundus gastricus: left side above
3. Corpus gastricum
4. Pars pylorica: exit of the stomach
- incisura angularis marks the
beginning
- Antrum pyloricum
- Canalis pyloricus

The wall has 4 layers:
1. Tunica mucosa
- plicae gastricae (= folds)
–> at curvatura minor go parallerly: functional gastric canal
–> areae gastricae (= small elevations in mucous membrane)
–> foveolae gastricae (= openings of the glands)
–> glandulae gastricae

2. Tela submucosa
   - Loose CT connection between tunica mucosa and tunica muscularis
   - Mucosa form changeable folds –> Adjust to the volume of the stomach (Prevent the mucosa from rupturing due to changes in volume)
3. Tunica muscularis
   - Fibrae obliquae inner smooth muscle layer
   - Stratum circulare middle layer
   –> forms m. sphicter pyloricus at the ostium pyloricum
   - Stratum longitudinale external layer along the curvatures
4. Tunica serosa
   - Surrounds the stomach (intraperitoneal organ)
   - Continues to the adjacent organs as 4 LIGAMENTS
5. Lig. Hepatogastricum (hepar to gaster)
6. Lig. Gastrophrenicum (crus sinister of diaphragm to fundus gastricus)
7. Lig. Gastrosplenicum (curvatura major to splenic hilum)
8. Lig. Gastrocolicum (curvatura major to colon transversum)

Topography:
Holotopically: Regio epigastrica, Regio hypochondriaca sinistra

Skeletotopically:
- Ostium cardiacum: T11
Ostium pyloricum: L1

Syntopically:
- anterior wall:
Hepar
Diaphragm
Anterior abdominal wall

• Posterior wall:
  Diaphragm
  Splen/Lien
  Glandula suprarenalis Ren sinistra
  Pancreas
  Mesocolon transversum

Question 26

26. Duodenum

Answer 26

C-shaped and winds around caput pancreas

Has 4 parts:
o Pars superior
o Pars descendens
o Pars inferior s. Pars horizontalis
o Pars ascendens

Pars superior
o starts at ostium pyloricum –> crosses columna vertebralis from left to right at the level of L1 –> continues with flexura duodeni superior into the next part
o In the beginning it has a dilated duodenal cap – bulbus s. Ampulla

Pars descendens
o descends along the right side of columna vertebralis to the level of L3 –> forms flexura duodeni inferior –> continues to the next part

Pars inferioris s. Pars horizontalis
o crosses columna vertebralis from the right to left at the level of L3 –> passes the on to the last part

Pars ascendens
o runs upward obliquely to L2 –> forms flexura duodenojejunalis –> continues then into jejunum

Holotopically
- Duodenum regio epigastrica (upper part) and in regio umbilicalis (lower part)

Skeletopically
- Pars superior duodeni – 1st lumbar vertebra
- Pars descendens duodeni – from the 1st to the 3rd lumbar vertebra
- Pars horizontalis duodeni – 3rd lumbar vertebra
- Pars ascendens duodeni – from the 3rd to the 2nd lumbar vertebra

Syntopically
- Duodenum:
Posteriorly:
* abdominal aorta
* vena cava inferior
* the descending part faces ren dexter and glandula suprarenalis dexter

Medially: caput pancreas
Anteriorly:
* colon transversus
* Hepar

Tunica mucosa
o forms plicae circulares with villi intestinales
–> In duodenum there is only one fold – plica longutudinales duodeni (in the descending
part of duodenum)
–> the fold ends at papilla duodeni major, which is formed by the enlargement ampulla hepatopancreatica for the common opening of bile and pancreatic ducts
o glandulae duodenales s. glandulae intestinales

Tela submucosa (loose connective tissue)
o noduli lymphoidei solitarii are scattered in all parts of small intestine

Tunica muscularis (two layers)
o External longitudinal
o inner circular
 In the descending part of duodenum
they from a sphincter, surrounding the
hepatopancreatic ampulla.

o The duodenum is a retroperitoneal organ

Question 27

27. Jejunum et ileum

Answer 27

• Involved in the fold of peritoneum – mesenterium intestinale
• Mesenterium is a peritoneal fold which attach jejunum and ileum to the posterior abdominal wall by radix mesenterii
• jejunum and ileum are mobile intraperitoneal coils attached to the posterior abdominal wall by radix
  mesenterii (radix mesenterii from flexura duodenojejunalis to ileocaecal junction/art. sacroiliaca dextra)
• No strict boarder
  o Jejunum is wider, more vascular and deeper in color than ileum
  o Ileum is much narrower and thinner
  o Jejunum is 2/5 and Ileum is 3/5 of their total common length

holotopy:
- Jejunum regio umbilicalis and regio lateralis sinistra
- Ileum regio lateralis dextra, regio inguinalis dextra, regio pubica and pelvis minor

Syntopy:
Posteriorly: organs of the retroperitoneal space

On the right: colon ascendes

Anteriorly: covered by omentum majus

Inferiorly: descend into pelvis minor

Tunica mucosa
o forms plicae circulares with villi intestinales

Tela submucosa (loose connective tissue)
o noduli lymphoidei solitarii are scattered in all parts of small intestine
o in the end part of ileum are also noduli lymphoidei aggregati

Tunica muscularis (two layers)
o External longitudinal
o inner circular

Tunica serosa (peritoneum) covers jejunum and ileum
completely, making them intraperitoneal organs.

Question 28

28. Intestinum crassum

Answer 28

Average length 100-150 cm
- Important for vital absorbtion and reabsorbtion of water and plasma electrolytes
- Residence for endemic bacterial flora
–> Produce also K and B12-vitamins
- Final process of chyme into faeces for defecation
- Caecum et Appendix Vermiformis

Colon:
o Colon Ascendens
o Colon Transversum
o Colon Descendens
o Colon Sigmoideum
o Rectum
o Canalis Analis

tunica mucosa
- Glandulae intestinales s. cryptae intestinales secrete lubricating mucus
- Lymphatic drainage is well developed in intestinum crassum. In tunica mucosa – noduli lymphoidei
solitari, in appendix vermiformis – noduli lymphoidei aggregati appendicis vermiformis
- Plicae semilunares coli
- well developed in colon, poorly in caecum, not present in
appendix vermiformis and rectum.

tela submucosa
- Lamina propria, mucosae et tela submucosa are very well vascularized with capillaries, venous drainage
is eventually to vena mesenterica superior and finally to venae portae hepatis.

tunica muscularis s. muscularis externa
- Three longitudinal muscle layers in muscularis externa of caecum et colon –> form taeniae coli.
= longitudinal muscle layers, which are reduced to 3 bands.
 Taenia libera is free
 Taenia omentalis attachment of omentum majus
 Taenia mesocolia attachment of mesocolon trnaversum
- Taeniae coli are shorter than intestinum crassum – creating haustra coli

tunica serosa (intraperitoneal) / tunica adventitia (retroperitoneal)
- has fatty protrusions – appendices epiploicae s. appendices omentales

Caecum and appendix:
 Caecum is 6-8 cm in lenght, 7-7,5 cm in diameter
(the widest part of intestinum crassum)
 Locates in regio inguinalis dextra
 Caecum communicates with Ileum via ostium
ileale
o one-way valve formed by tunica mucosa
foldings
 communicates with appendix vermiformis via ostium appendicis vermiformis

Colon Ascendens
- 12-20 cm in lenght, smaller in diameter than Caecum
- Locates in regio lateralis dextra
- Goes up untill reaches inferior surface of Hepar  formates bending to the left flexura coli
dextra s. flexura coli hepatica and continues as colon transversum

Colon Transversum
- 30-80 cm in length
- The most motile portion of intestinum crassum
- starts from regio hypochondriaca dextra  passes transversally with downward convexity in
regio umbilicalis  reaching regio hypochondriaca sinistra
- In regio hypochondriaca sinistra makes turn down at flexura coli sinistra s. flexura coli splenica.
- Colon transversum is within peritoneum
–> Fixed to posterior abdominal wall by mesocolon transversum
–> Lig. Gastrocolicum and omentum majus attach to tenia omentalis coli transversi

Colon Descendens
- 10-15 cm in length
- starts at flexura coli sinistra s. flexura coli splenica with direction downwards
- Locates in regio lateralis sinistra
- At the level of crista iliaca sinistra becomes colon sigmoideum

Colon Sigmoideum
- Average 40 cm in length
- Continuation of colon descendens at crista iliaca sinistra
- Locates in regio inguinalis sinistra
- Formates an angled loop and is located in fossa iliaca sinistra
- At the level of art. sacroiliaca dextra continues as rectum

Rectum:
- 13-20 cm in length
- Locates in regio hypogastrica and pelvis minor
- shape called flexura sacralis (correspond the shape of os sacrum)
- In the lower portion of rectum the diameter expands creating ampulla recti (final storage of faeces)
–> When ampulla recti is filled with faeces the need for deficatio is induced due to pressure on m.
sphincter ani internus

Canalis analis:
- Continuation from ampulla recti
- 2-3 cm in length
- penetrates perineum and has flexura perinealis
- Anus is the terminal portion of canalis analis
- Plicae transversae recti
- Columnae anales
- Sinus anales
- Plexus venosus rectalis (in mucosa et
submucosa)
- M. sphincter ani internus
- M. sphincter ani externus
- M. levator ani

Topography:
Holotopia
- Cavitas abdominis caecum , appendix vermiformis et colon
- Pelvis minor rectum et canalis analis

Skeletotopia
- Caecum fossa iliaca dextra, vertebra Lumbalis V
- Colon ascendens vertebra L V  cartilagines costarum IX-X, vertebra L II
- Colon transversum skeletotopia is impossible to describe due to large positional variations
(Sobotta)
- Colon descendens cartilagines costarum IX – X, vertebra Lumbalis II –> crista iliaca sinistra
- Colon sigmoideum crista iliaca sinistra –> art. sacroiliaca dextra
- Rectum art. sacroiliaca dextra –> os coccygis

Syntopia
- Caecum et colon ascendens
Medially: intestinum tenue

• Flexura coli dextra
  Superiorly:
• hepar
• fundus vesicae biliaris

Posteriorly ren dexter

-Colon transversum
Superiorly:
* gaster
*pars superior duodeni
* pancreas

Inferiorly: intestinum tenue

• Flexura coli sinistra
  Superiorly:
• splen s. lien
• cauda pancreatic
  Posteriorly: ren sinister
• Colon descendens et sigmoideum
  Medially: intestinum tenue

Rectum
Posteriorly:
* os sacrum
* os coccygis

Laterally: plexus venosus rectalis

Anteriorly in males:
* vesica urinaria
* Prostate
* ductus deferens
* glandula vesiculosa

Anteriorly in females
* uterus
* vagina

Question 29

29. Hepar

Answer 29

Main function; exocrine gland responsible for the production of bile

Secondary functions;
o Thermoregulation
o metabolism of carbohydrates, proteins and fats
o production of erythrocytes during the fetal period

• Margo Inferior - Thin, sharp border projecting downwards
• Area Nuda - bare, not covered by peritoneum
• Facies diaghragmatica
  o Superior convex surface projected towards diaphragm
  –> Lig. falciforme
• divides the liver into lobus hepatis dexter et sinister
  –> lig. cononarium
• borders Area Nuda and forms the two attaching ligaments on either end –> lig. triangulare dexter et sinister

Facies Visceralis
* Inferior surface, directed towards the abdominal organs
* liver can be divided into 4 lobes
- The right lobe is bordered by the right sagittal groove
- The left lobe is bordered by the left sagittal groove
- The transverse groove lies between the two sagittal grooves
–> separates lobus quadratus and lobus caudatus
–> lobus quadratus lies anteriorly while lobus caudatus lies posteriorly

Tunica fibrosa and Tunica Serosa (peritoneum) cover the liver
–> The peritoneum covers the liver from 3 sides, but does not cover area nuda
–> It also forms the attaching ligaments of the liver, which can be divided into 2 groups:

1. Ligaments extending to the diaphragm;
   - Lig. Falciforme: b. diaphragm and upper surface of the liver
   - Lig. Coronarium: from area nuda to diaphragm, with two attaching ends
   - Lig. Triangulare Dexter et Sinister
2. Ligaments extending from porta hepatis towards the organs;
   - Lig. Hepatogastricum: to curvatura minor gaster
   - Lig. Hepatoduodenale: to the superior portion of duodenum
   - Lig. Hepatorenale: to ren dexter

Nutrition entrance to liver and the formations within the sagittal grooves :
- Porta hepatis is located within the transverse groove and contains;
o Ductus hepaticus communis
o Vena portae heptis
o Arteria hepatica propria
o nerves and lymphatic vessels

Formations within the sagittal grooves;
* Fossa vesicae biliaris: depression for the gall bladder
* Sulcus venae cavae: groove for the vena cavae
* Fissura ligamentum teres: Lig. teres hepatis lies within
* Fissura ligamentum venosi: Lig. venosum

Holotopically:
regio hypchondriaca dextra
regio epigastrica
regio hypochondriaca sinister

Syntopically:
impressio cardiaca
impressio Oesophageale
impressio gastrica
impressio duodenalis
impressio colica
impressio renalis
impressio suprarenalis

Skeletopically: upper border on the right side:
–> intersection of linea medioclavicularis dextra and the 4th intercostal space
–> turns downwards towards the left, near the 5th intercostal space

The lower border:
 intersection of linea axillaris media and 10th rib
 curves along arcus costales
 junction between cartilagines costarum 9th and 8th
 border crosses regio epigastrica
 reaches the left side where the cartilage of the 7th and 8th rib join
 ends in 6th intercostal space

Posteriorly:
between 9th and 11th thoracic vertebrae

Question 30

30. Gall bladder and bile ducts

Answer 30

Vesica Biliaris:
storage of bile
- in fossa vesica biliaris, on the visceral side of the right lobe

It is composed of;
o fundus vesicae biliaris
o corpus vesicae biliaris
o collum vesicae biliaris

The mucus membrane lines the gallbladder and forms the mucosal folds
o Mucous glands are scattered in the mucosa

Tunica muscularis: one circular layer which forms musculus sphincter ampullae at the region of ampulla hepatopancreatica

Tunica Serosa (peritoneum) covers the gall bladder from the lower surface

Tunica adventitia covers the upper surface

There is no submucosa!

Bile pathway:
- Bile is excreted via ductus hepaticus sinister et dexter
- They join at the porta hepatis to form Ductus hepaticus communis
- Ductus hepaticus communis joins with Ductus cycticus  form ductus choledochus
- Ductus choledochus runs along lig. hepatoduodenale together with portae arteria hepatica
- crosses the superior part of the duodenum and caput pancreas
- pierces the posterior wall of the pars descendens duodenum –> form plica longitudinalis duodeni
- with ductus pancreaticus to form ampulla hepatopancreatica –> opens into papilla duodeni major

Question 31

31. Pancreas

Answer 31

• Produces the pancreatic juice –> drains into the duodenum

Exocrine portion (pancreas is primarly an exocrine gland)
- Acinar cells: Enzymatic components (trypsinogen, chymotrypsinogen, elastase, pancreatic lipase….) (regulated by cholecystokinin)
- Centroacinar cells: bicarbonate (regulated by secretin)

Endocrine portion (only 2% of total mass)
- The cells of Langerhans (beta cells) produce insulin –> the blood stream for sugar metabolism
- Alpha cells produce glucagon –> raises the concentration of glucoce in blood stream –> causes the liver (hepar) to convert stored glycogen into glucose

• Lies transversely across the posterior wall of the abdominal cavity
• Peritoneum covers the anterior side = retroperitoneal organ
• Caput pancreatis – head of pancreas, curve of duodenum
• Corpus pancreatis – crosses the vertebral column
• Cauda pancreatis – reaches the visceral surface of the spleen

The body (corpus pancreatis) and the tail (cauda pancreatis) are TRIANGULAR on cross section –> 3 surfaces
1. Anterosuperior
2. Anteroinferior
3. Posterior

3 borders
- Superior
- Anterior
- Inferior

Ductus pancreaticus – through the pancreas
- joins the bile duct to form ampulla hepatopancreatica
- opens at papilla duodeni major
- Frequently there is ductus pancreaticus accessories
–> Excretes pancreatic juice from caput pancreatic
–> opens into the duodenum by papilla duodeni minor

Holotopically:
Regio epigastrica
Regio hypochondrica sinistra

Skeletotopically:
Caput pancreas at L2
Corpus pancreas crosses columna vertebralis at the level of L1
Cauda pancreatis at 10th costae

Syntopically:
- Caput pancreas surrounded by Duodenum and crossed by mesocolon transversum anteriorly

Posteriorly:
Vena cava inferior
Vena portae hepatis
Corpus and cauda pancreatis face:
Anteriorly
* Gaster
* Mesocolon transversum

Posteriorly
* Aorta abdominalis
* Ren sinister

Inferiorly
* Coils of jejunum
* Flexura coli sinistra

Cauda pancreatis reaches lien s. splen

Question 32

32. Splen

Answer 32

• Organ for the destruction of erythrocytes
  –> Red pulp filtrates RBC’s
• Produces leucocytes
  –> White pulp synthesizes antibodies
• Durin fetal life and shortly after it creates erythrocytes

Facies diaphragmatica – convex, smooth, directed upward to diaphragma

Facies visceralis – with hilum splenicum (entrance and exit of vessels and nerves)

Margo superior – projected forward
Margo inferior – more rounded, projected posteriorly

Tunica fibrosa surrounds the spleen (capsule)

Tunica serosa (peritoneum) covers from all sides –> intraperitoneal
–> forms 2 LIGAMENTS (= double fold of peritoneum)
1. Lig. Gastrosplenicum – from hilum splenicum to curvaura major (gaster)
2. Lig. Phrenicosplenicum – from facies diaphragmatica to diaphragm

Topography:
Holotopically: Regio hypochondriaca sinistra

Skeletotopically:
* Superior border at costae IX
* Hilum splenicum at costae X
* Inferior border at costae XI

Syntopically:
* facies diaphragmatica: Diaphragma
* Facies visceralis:
Gaster
Ren sinister
Glandula suprarenalis
Colon
Cauda pancreatis

Question 33

33. Peritoneum (epigastrium)

Answer 33

Bursa omentalis walls:
- S: heaps, diaphragm
- A: omentum minus, lig. gastrocolicum, lig. phrenicolicum, lig. gastorenale
- I: colon transversum, mesocolon
- P: peritoneum parietale, retroperitoneal organs

Foramen omentale walls:
- S: lobus caudatus
- A: lig. hepaticduodenale
- I: pars superior duodeni
- P: peritoneum parietale, inferior venae cava
- left lateral: lig. hepatorenale

Omentum majus:
–> curvatura major
- lig. gastrophenicum
- lig. gastrosplenicum
- lig. gastrocolicum

Omentum minus
- lig. hepatoduodenale
- lig. hepatogastricum

Recessus superior
recessus splenicus
Recessus inferior

Retroperitoneal organs:
->Covers only anterior side
- duodenum
- pancreas
- ren
- glandula suprarenalis
- empty vesica urinaria
- ureter

Mesoperitoneal:
Covers all but posterior side
- hepar
- vesical biliaris

Intraperitoneal:
Covers all sides
- oesophagus (pars abdominalis)
- gaster
- Splen s. lien

• serous covering of cavitas abdominalis

2 parts:
1. Peritoneum parietale
2. Peritoneum viscerale
–> between these parts is cavitas peritonealis with serous fluid to lubricate organs

• Between cavitas peritonealis and posterior abdominal wall is spatium retroperitoneale

Question 34

34. Peritonium (mesogastrium et hypogastrium)

Answer 34

Hypogastrium:
Female:
- Excavatio rectouterine
- Excavatio vesicouterina

Male: Excavatio rectovesicalis

Mesogastrium:

Canalis lateralis dexter (recessus subhepaticus, pelvis minor)
Canalis lateralis sinister (recessus subphrenicus, pelvis major)
Sinus peritonei dexter
Sinus peritonei sinister
–> divided by: Radix mesenterii from flexura duodenajejunalis L2 to iliocecal junction/art. sacroiliaca dextra

Recessus subphrenicus
Recessus subhepaticus (lig. falciforme divides into 2 parts) b. diaphragmatica and facies diaphragmatica hepatis
Recessus ileocaecales superior et inferior
recessus retrocaecales
Recessus intersigmoideus
Recessus duodenajejunalis superior et inferior

IQ: in mesogastrium in anterior abdominal wall peritoneum makes
plica umbilicalis mediana
plica umbilicalis lateralis and medialis
–> in between fossa supravesicalis, fossa inguinalis medialis and lateralis

• serous covering of cavitas abdominalis
  2 parts:
  1. Peritoneum parietale
  2. Peritoneum viscerale
  –> between these parts is cavitas peritonealis with serous fluid to lubricate organs
• Between cavitas peritonealis and posterior abdominal wall is spatium retroperitoneale
• Peritoneum parietale continues into peritoneum viscerale and forms:
  o Mesocolon
  o Mesenterii
  o Ligamenta
  o Omenta
  o Folds
• Mesocolon and mesenterii are peritoneal folds that attach organs to the posterior abdominal wall
  –> allow movement
  –> contain BV, nerves and lymph vessels
  o Mesenterii connects jejunum and ileum to the posterior abdominal wall by radix mesenterii
  o Radix mesenterii passes obliquely downward from flexura duodenojejunale at 2nd LV to
  ileocaecal junction
  o Mesocolon transversum fix colon transversum
  o Mesocolon sigmoideum fix colon sigmoideum
  o Mesoappendix is for appendix vermiformis

Retroperitoneal organs:
Covers only anterior side
- empty vesica urinaria (preperitoneal)
- ureter

Mesoperitoneal organs:
Covers all but posterior side
- colon ascendes
- colon descendes
- rectum (middle 1/3)
- full vesica urinaria
- uterus

Intraperitoneal:
Covers all sides
- jejunum
- ileum
- caecum
- appendix
- colon transversum
- colon sigmoideum
- rectum (upper 1/3)
- tuba uterine

Question 35

35. Atrium et ventriculus dexter cordis

Answer 35

• atrium and ventriculus dexter pump blood through circulus sanguinis minor
• contain venous blood
• right part is directed forward

Atrium dextrum:
6 walls:
- Paries anterior
o auricular dextra
o mm. pectinate

• Paries lateralis
  o mm. pectinati
• Paries superior
  o ostium venae cavae superioris by which vena cava superior opens into atrium
  –> this vein returns blood from upper part of body (above diaphragm)
• Paries posterior
  o ostium venae cavae inferioris guarded by valvula venae cavae inferioris
  –> by this valve during fetal life the blood from vena cava inferior is directed toward
  foramen ovale
  o sinus venarum cavarum
   posterior part in right atrium between v. cava superior and inferior)
• Paries medialis
  o Formed by septum interatriale
  o Depression fossa ovalis which is limited by limbus fossae ovalis
  –> Site of foramen ovale in feta life for venous blood flow from right atrium to the left
  atrium (pulmonary circulation could be passed by)

o foramina venarum minimarum
–> orifices of venae cordis minimae (returns blood directly from the layers of heart ́s wall)

• Paries inferior
  o ostium atrioventriculare dextrum
  –> communication between arium and ventricle
  o ostium sinus coronarii of sinus coronarius cordis
  –> opening between medial and posterior wall (below fossa ovalis)
  –> protected by valvula sinus coronarii
  
  • sinus coronarius cordis returns venous blood from the wall of the heart
  • lies in sulcus coronarius

Ventriculus dexter
- Ostium atrioventriculare dextrum (for inflow)

o Closed by valva atrioventricularis dextra. s. valvula tricuspidalis
 3 cusps: formed by doubling endocardium (inner layer of the wall)
 Cuspis anterior
 Cuspis posterior
 Cuspis septalis

o surrounded by annulus fibrosus, which is attached to one margin of each cusp
 other 2 margins are free –> connected by chordae tendineae to mm. papillares
 chordae tendineae prevent turning cusps into atrial direction
o extend from one cusp to 2 mm. papillares

o valva atrioventricularis dextra is closed in systole (contraction of ventricle), open in diastole
(relax of ventricle)

• Ostium trunci pulmonalis (for outflow)
  o Closed by valva trunci pulmonalis
   3 valvulae semilunares
   formed by doubling of endocardium
   bases are attached to anulus fibrosus, surrounding ostium trunci pulmonalis
   free margins are directed upward, contain in its middle thickening nodulus
  valvulae semilunaris
   in between valves and wall of pulmonary trunk is sinus trunci pulmonalis

o conus arteriosus is the place where trunci pulmonalis starts
o in diastole sinuses are fulfilled by the blood and valves are closed
o valve trunci pulmonalis is open in systole

Question 36

36. Atrium ventriculus sinister cordis

Answer 36

• atrium and ventriculus sinister pump blood through circulus sanguinis major
• contain arterial blood
• left part backward (left rotation)

Atrium sinistrum:

(smaller, thicker, 5 openings)

• Paries anterior
  o auricular sinistra
  o mm. pectinati
• Paries posterior
  o ostia venarum pulmonalium (4x) from venae pulmonales
   no valves
• Paries medialis
  o septum interatriale
• Ostium atrioventriculare sinistrum is orifice between left atrium and left ventricle

Ventriculus sinistrum:

(3 times thicker than ventriculus dexter)

• Ostium atrioventriculare sinistrum (for inflow)
  o closed by vavla atrioventricularis sinistra s. valvula bicuspidalis s. mitralis
   cuspis anterior et posterior
   both formed by endocardium
   anchored to mm. papillares by chordae tendineae
• Ostium aortae (for outflow)
  o closed by valve aortae (structure similar to pulmonary valve)
   3 valvulae semilunares with sinus aortae
• Both openings surrounded by anulus fibrosus
• Trabeculae carneae + mm. papillares (2x) form chordae tendineae
  o chordae tendineae connect mm. papillares with both cusps

Question 37

37. Wall structure of the heart

Answer 37

1. Endocardium – inner layer, covers all structures of the wall
   o Continuation of tunica interna s. tunica intima of great vessels
   o Duplication of endocardium form heart valves
    Atrium dextra
   –> Valvula venae cavae inferioris
   –> Valvula sinus coronorii
    Ventriculus dexter
   –> Valva atrioventricularis dextra s. valvula tricuspidalis
   –> Valva trunci pulmonalis
    Ventriculus sinister
   –> Valva atrioventricularis sinistra s. valvula bicuspidalis s. mitralis
   –> Valva aortae
2. Myocardium – middle layer, muscular layer  4x anuli fibrosis (skeleton where muscle fibers
   are attached)
   o Atrium: 2 layers
3. external circular (surrounds both atria)
   2.internal longitudinal (separate each atrium)

o Ventriculus: 3 layers
1. External longitudinal (surround both ventricles)
2. internal longitudinal (surround both ventricles)
3. fibers from external and internal layers run toward apex where they form vortex
cordis

o middle circular (separate for each ventricle)
o Myocardium forms mm. papillares, mm. pectinati, trabeculae carneae

3. Epicardium – external layer, formed by lamina visceralis pericardii serosi
   o continues into lamina parietalis pericardii serosi at great vessels of heart

Question 38

38. Heart topography

Answer 38

skeletotopia:

• Upper border (basis cordis)
  o along 3rd rib
• Right border
  o parallel to sternal margin 1,5 cm to the right
  o from sternal junction of 3rd to 5th rib
• Lower border
  o obliquely from cartilage of 5th rib to intercostal space of 5th (here is apex cordis)
• Apex cordis
  o 5
  th intercostal space
  o 1,5 cm medially from linea medioclavicularis sinistra / 11 cm to the left from sternal margin
• Left border
  o apex cordis (5th intercostal space) to 3rd rib junction between cartilage and osseous part
• Ostium atrioventricularis
  o On the line extending from sternal junction of 3rd rib (on the left) to sternal junction 6th rib (on
  the right)
• Ostium aortae + Ostium trunci pulmonalis
  o On the line extending from sternal junction of 3rd rib (on the left) to sternal junction of 4th rib (on the right)
  –> Ostium aortae at level of 3rd intercostal space (behind sternum on midline)
  –> Ostium trunci pulmonalis at level of 3rd rib sternal junction (on the left)

Auscultation sites of valves
- Aortic valve
o 2nd intercostal space, right site of sternum

• Pulmonary valve
  o 2nd intercostal space, left site of sternum
• Tricuspid valve
  o 5th intercostal space, right site of sternum (on processus xyphoideus)
• Bicuspid valve
  o 5th intercostal space, 1,5 cm medially from linea medioclavicularis

Holotopy: mediastinum medium

Syntopia:
Anteriorly:
- Sternum
- Cartilagines costales

Posteriorly:
- Organs of mediastinum posterius
- Oesophagus
- BV, nerves

Laterally:
- Pleura parietalis pars mediastinalis

Inferiorly:
- centrum tendineum diaphragmae

Superiorly:
- great BVs

Question 39

39. Impulse conduction system

Answer 39

1. Nodus sinuatrialis – between auricular dextra and ostium vena cavae superioris
   a. generates impulses
   b. spred throughout 2 atria and to nodus atrioventricularis
2. Nodus atrioventricularis – in septum interatriale beneath fossa ovalis, near cuspis septalis
   a. Continues into fasciculus atrioventricularis
3. Fasciculus atrioventricularis
   a. truncus (upper part) lies in fibrous part of interventricular sept
   b. at upper muscular part of interventricular sept divides into crus dextrum (3) et sinistrum (2)
   i. run till mm. papillares

Circulus sanguinis major = systemic circulation

Oxygenated blood from left ventricle –> aorta –> via arteries into capillary network of organs –> desoxygenated
blood –> vena cava inferior (legs and lower trunk) / vena cava superior (head, arm, upper trunk) –> atrium
dexter

Circulus sanguinis minor = Pulmonary circulation

Deoxygenated blood from right ventricle –> truncus pulmonalis –> a. pulmonalis dextra et sinistra –> capillary
network of lungs –> oxygenation in lungs –> venae pulmonales (4) –> atrium sinistra

Question 40

40. Heart valve projection space

Answer 40

a

Question 41

41. Cavitas nasi

Answer 41

regio olfactoria with the sense parts
regio respiratoria with respiratory epithelium (inferior concha) and olfactory epithelium (superior concha) mucosa which are separated by concha nasalis media

Paries superior
 Lamina cribrosa Paries inferior
 Palatum osseum

Paries lateralis
 Facies nasalis maxillae
 Os lacrimale
 Concha nasalis inferior
 Labyrinthus ethmoidalis
 Lamina perpendicularis ossis palatini
 Lamina medialis processus pterygoidei

Paries medialis (septum nasi)
 Lamina perpendicularis ossis ethmoidalis
 Vomer

Paries posterior
 Facies anterior corporis ossis sphenoidalis
 Choanae

Paries anterior
 Os nasale
 Apertura piriformis (os nasale, incisura nasalis maxillae)

 Meatus nasi superior -> cellulae ethmoidales

 Meatus nasi medius -> cellulae ethmoidales
 Meatus nasi medius -> hiatus sinus maxillaris -> sinus maxillaris
 Meatus nasi medius -> apertura sinus frontalis -> sinus frontalis

 Meatus nasi inferior -> canalis nasolacrimalis -> orbita

 Meatus nasi communis -> apertura piriformis
 Meatus nasi communis -> cribrae ethmoidales -> fossa cranii anterior
 Meatus nasi communis -> canalis incisivus -> cavum oris

 Meatus nasopharyngeus -> apertura sinus sphenoidalis -> sinus sphenoidalis
 Meatus nasopharyngeus -> foramen sphenopalatinum -> fossa pterygopalatina
 Meatus nasopharyngeus -> choana -> basis cranii externa

Question 42

42. Larynx

Answer 42

• passage of air and the production of sound (voice box)
• The skeleton is formed by cartilagines larynges
• There are 3 single cartilages:
  o Cartilago thyroidea
  –> Consists of 2 plates, the anterior borders are fused with each other forming prominentia laryngea
  (Adam’s Apple’)

o Cartilago epiglottica
–> Leaf shaped
–> projects obliquely upwards behind cartilago thyroidea

o Cartilago cricoidea
–> Ring shaped

There are 3 paired cartilages:
o Cartilago arytenoidea
–> Pyramidal in shape
–> at the upper border of the cricoid cartilage

o Cartilago corniculata
–> two small conical nodules
–> lie on top of cartilago arytenoidea

o Cartilago cuneiformis
–> placed in the posterior parts of the ary-epiglottic folds of the mucous membrane

Synovial joints:
Articulatio cricothyroidea
- Between cartilago cricoidea and cartilago thyroidea
- Flexio cartilago thyroidea –> movements of the vocal cord (frontal axis)

Articulatio cricoarytenoidea
- Between cartilago cricoidea and cartilago arytenoidea
- This articulation allows the space between the vocal cords to expand or narrow (vertical axis)

Syndesmoses:
Membrana thyrohyoidea
- Membrane between os hyoideum and the cartilago thyroidea
- Lig. cricothyroideum medianum is the thickest part

Lig. cricotracheale
- between cartilgo cricoidea and trachea
- Joins larynx to trachea

Cavitas larynges:
- From aditus laryngis to the lower border of cartilago cricoidea (–> continues into the trachea)

bordered by:
o epiglottis
o plica aryepiglottica
o incisura interarytenoidea

• cavity has an hourglass shape and is divided into 3 parts:
  1. Vestibulum larynges (upper)
  
  • from aditus laryngis to plicae vestibulares

2. Glottis (middle)
   - between plicae vestibulares and plicae vocals
   - At each side there is ventriculus larynges (acts as a resonator)
3. Cavitas infraglottica (lower)
   - From plicae vocales to the entrance of trachea

The upper surface of cavitas laryngis is lined with stratified squamous epithelium:
- variable points becomes ciliated pseudostratified columnar epithelium
- Mixed mucous and serous glands are found in the lamina propria which covers membrana fibroelastica larynges
–> 2 areas can be distinguished;

1. Membrana quadrangularis; Located in vestibulum laryngis
   - The upper border forms plica aryepiglottica
   - thicker lower border forms (false vocal cords) – lig. vestibulare
2. Conus elasticus; Located in cavitas infraglottica
   - The thick upper border forms (true vocal cords) – lig. vocale

Plica vestibulares: The mucous membrane that covers lig. vestibulare
- forms Rima vestibuli: The narrow distance between the right and left folds

Plica vocalis: The mucous membrane that covers lig. vocale
- forms rima glottidis s. rima vocalis: The narrow space between both plicae vocalis

The voice is formed by the vibrations of the vocal folds made by an air stream expelled from the lungs

Musculi laryngis, 2 primary muscles:
M. cricothyroideus
- Moves art. cricothyroidea: flexio cartilago thyroidea –> stretch
the vocal cords

M. Vocalis
- Control the tension in the vocal cords

PLUS the extrinsic muscles such as suprahyoid (digastrica, mylohyoid, stylohyoid, genihyoid = elevation), (stylopharungeus, elevate) and infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid)

Holotopically: cervical region

Skeletopically: C4– 5 to C6– 7

Synoptically:
Anteriorly:
- Isthusmus glandulae thyroideae
- mm. recti colli
- fascia colli
- subcutis and cutis

Posteriorly: laryngopharynx

Laterally:
- BV and nerves
- lobuli glandulae thyroideae

Question 43

43. Trachea

Answer 43

• 9-15 cm long tube, 2- 2.5 cm in diameter
• from Larynx –> bifurcation tracheae
  
  • carina tracheae
• 16- 20 cartilagines tracheales
  o reinforce trachea
  o anteriorly: ligg. anularia
  o posteriorly: paries membranaceus
  –> connective tissue and m. trachealis
• tunica mucosa
  o folliculi lymphatici tracheales
  o glandulae tracheales
• tunica submucosa
• tunica adventitia

Holotopia:
- Regio colli
- mediastinum superius

Skeletotopia: C6-7 –> T4-5

Syntopia:

regio colli
- anteriorly:
> mm. recti colli
> fasciae colli
> subcutis, cutis
> isthmus glandulae thyroidea
- laterally:
> BV, nerves
> lobi glandulae thyroidea
- posteriorly:
> oesophagus

mediastinum superius
- anteriorly: thymus
- laterally: pleura mediastinalis
- posteriorly: oesophagus

Question 44

44. Arbor bronchialIis et arbor alveolaris

Answer 44

(Bronchus principalis dexter et sinister
- start at T4-5

bronchus principalis dexter:
o wider, shorter (2.5 cm long)
o continuous with course of trachea
o enters lung at Th 5
o divides into 3 bronchi lobares

bronchus principalis sinister:
o smaller, longer (5 cm long)
o divides into 2 bronchi lobares)

Entering pulmo: form arbor bronchialis –> arbor alveolaris

Arbor bronchialie (air conducting portion)
- Bronchus principalis dexter et sinister
- Bronchus lobaris
> Dexter: 3
> Sinister:2
- Bronchus segmentalis
- Bronchus intersegmentalis
- Bronchiolus

Arbor alveolaris (respiratory portion)
- Bronchiolus respiratorius
- Ductus alveolaris
- Sacculus alveolaris
- Alveoli pulmonis – gas exchange
Functional unit: acinus pulmonalis

Question 45

45. Pulmones topography

Answer 45

Holotopia cavum thoracis; on both sides of mediastinum

Syntopia
- facies costales: sulci costales
- facies diaphragmatica: to diaphragm
- facies mediastinalis: depressions of heart and BV

Skeletotopia:
apex pulmonis
- lies behind mm. scaleni (1-3cm above clavicula)
- posteriorly: proc. spinosus C7
- anterior border:
> apex pulmonalis
> obliquely downward, forward
> crosses art. sternoclavicularis from
behind
> anterior borders approach
> descend from costae 2–4

> below curves:
left lung
- curve along 4th costae
> linea parasternalis sinistra (cardiac notch)
> downward
> linea medioclavicularis/6th costae

   right lung:
       > 4th costae
       > linea parasternalis dextra/upper margin of 6 th costae
       > coninues to lower border

Lower border:
- linea medioclavicularis/6th costae
- linea axillaris anterior/7th costae
- linea axillaris posterior/9th costae
- linea scapularis/10th costae
- linea paravertebralis/proc. transversus Th 11

posterior border:
along linea paravertrabralis –> apex

Question 46

46. Pulmones structure

Answer 46

essential organ for respiration
- gas exchange between inhaled air and blood
- conical shape
- apex pulmonis
> rounded
> extends upwards into root of neck
- basis pulmonis
> broad concave
> on surface of diaphragm

4 surfaces:
- facies costales
* smooth & convex
* projects into inner surface of ribs
- facies diaphragmatica
* towards diaphragm
* concave
- facies interlobaris
* numerous surfaces between lobes
- facies mediastinalis
* towards mediastinum
- hilum pulmonis
- bronchus principalis, a. pulmonalis, vv. pulmonales, nerves, lymph vessels –> form radix pulmonis (root of lung)
* On the right side: highest structure is bronchus principalis
* On left side: highest structure is a. pulmonalis

Each lung has 2 borders:
- margo inferior
* thin, sharp
* separates facies costales et facies mediastinalis from facies diaphragmatica
- margo anterior
* thin, sharp
* right lung: almost vertical
* left lung: incisura cardiaca pulmonis sinistra
> limited below: lingual pulmonis sinistri

right lung: 3 lobes
1. lobus superior
2. lobus medius pulmonis dextri
3. lobus inferior

left lung: 2 lobes
1. lobus superior
2. lobus inferior

• fissura obliqua
  > both lungs
  > posterior part: Th 3 –> downward & forward over facies costales –> 6th costae (cartilage bone-connection)
• fissura horizontalis pulmonis dextri
  > only right lung
  > linea axillaris media –> horizontally along 4th costae to sternum
  > separates superior and middle lobe

lobes consist of conical segmenta bronchopulmonalia:
- anatomical, physiological, surgical unit
- base: projected to external surface of lung
- apex: to hilum pulmonalis
- center: arteria et bronchus segmentalis
- branches of veins –> lie in connective tissue surrounding the segment
- Right lung: 10 segments
- Left lung: 9 (0r 10) segments
- Each segment consists of lobuli

Pulmo dexter - lobus segments
lobus superior
- segmentum apicale
- segmentum posterius
- segmentum anterius

lobus medius
- segmentum laterale
- segmentum mediale

lobus inferior
- segmentum superius
- segmentum basale mediale
- segmentum basale anterius
- segmentum basale laterale
- segmentum basale posterius

Pulmo sinister - lobus segments
lobus superior
- segmentum apicoposterius
- segmentum anterius
- segmentum lingulare superius
- segmentum lingulare inferius

lobus inferior
- segmentum superius
- segmentum basale mediale
- segmentum basale anterius
- segmentum basale laterale
- segmentum basale posterius

Question 47

47. Pleura

Answer 47

1. pleura pulmonalis s. pleura visceralis
   o covers the surface of the lung
   o goes into the fissures between lobes
2. pleura parietalis
   a. pars costalis
   - lines inner surface of ribs and intercostal spaces

b. pars diaphragmatica
- covers superior surface of diaphragm

c. pars mediastinalis
- sagitally from sternum to columna vertebralis

At apex pulmonis pleura parietalis arches over the lung as cupula pleurae

Cavitas pleuralis between pleura pulmonalis and pleura parietalis
–> fluid decreases friction between pleuras

pleura parietalis pars mediastinalis: the continuation of the costal and diaphragmatic pleura of each side that passes from the vertebral column and sternum covering the sides of the mediastinum.

recessus costodiaphragatica
o horizontally between pars costales and pars diaphragmatica

recessus costomediastinalis
o vertically behind sternum between pars costalis and pars mediastinalis

recessus vertebromediastinalis
o vertically in front of columna vertebralis between pars costalis and pars mediastinalis

recessus phrenicomediastinalis
o sagitally in left pleural cavity between pars diaphragmatica and pars mediastinalis

Question 48

48. Mediastinum

Answer 48

(space between two pleural cavities)

Bordered by:
anteriorly – sternum
Posteriorly – vertebra thoracici
Laterally – pleura parietals pars mediastinalis
Inferiorly – diaphragm

• Connects neck region via apertura thoracis superior
• Spatium retropharyngeum
• Spatium parapharyngeum

1. Mediastinum superius
   a. Plate from angulus sternum to 4th thoracic vertebra —> plana transversalia
   i. Seperates mediastinum superius from mediastinum inferius
   
   • Thymus
   • Trachea
   • Oesophagus
   • BV, nerves, lymph vessels
2. Mediastinum inferius
   a. Anterius
   i. Between sternum and pericardium
   
   • BV, lymph vessels

b. Medium
i. Cor and pericardium

c. Posterior
i. Between pericardium and columna vertebralis
- Oesophagus
- BV, nerves, lymph vessels

Question 49

49. Ren structure, topography

Answer 49

Extremitas superior
Extremitas inferior
Margo lateralis
Margo medialis
Hilum renalis
Capsula adiposa (protects from concussion and cooling, around kidney)
Capsula fibrosa (dense CT covering)

Fascia renalis surrounds capsula adipose and it consists of 2 plates: Both plates are fused together at upper
extremity and laterally. Medially and inferiorly it is open for ureter and BV.
1. Lamina prerenalis, (anterior lamina) –> Medial over kidney‘s surface, renal vessels, aorta abdominalis, v. cava inferior
2. Lamina retroreanlis, (posterior lamina) –> Medial connected to Columna vertebralis
* Ineriorly plates do not connect and continue into retroperiotoneal rissue.
* Peritoneum covers kidneys from the anterior side (=retroperitoneal organ)

Cortex
- Soft, granular, 4-5mm wide
- Parts extend into medulla as columnae renales

Medulla
- 12-15 pyramides renales (base towards the cortex), columnae renales between pyramids. Several apices fuse to form papilla renalis

Gl. Suprarenalis
Hilum renale
Sinus renalis (pelvis renalis is located here)
Pelvis renalis (togerher with fat and BV)
Calyces renales
Foramina papillaria (on the renal papilla)
- Surrounded by: calces renales minors, which unite to form 2-3 calces renales majors. These fuse and form pelvis renalis.

Finestructure:
Corpusculum renis
Portio nephroni proximalis
Ansa nephroni
Portio nephroni distalis
Pars intercalate

Skeletopia
Ren dextrum (lower)
- Th12 – L3
- Costa 12 crosses upper third
- L2 Hilium

Ren sinistra (higher)
- Th11 – L2
- Costa 12 crosses middle third
- L1 Hilium

Syntopia
Facies posterior
- M. psoas major
- Pars lumbalis diaphragmae
- M. quadratus lumborum

Facies anterior ren dexter
- Glandula suprenalis
- Hepar
- Pars descendens duodeni
- Colon (flexura dextra)
- jejunum

Facies anterior ren sinister
- Glandula suprenalis
- Splen s. Lien
- Gaster
- Pancreas
- Colon descendens
- jejunum

Holotopically
Regio lateralis

Question 50

50. Vesica urinaria

Answer 50

s. cystis

Located in the subperitoneal space
Apex vesicae
Corpus vesicae
Fundus vesicae
–> consists 3 openings:
Ostium ureteris dextrum et sinistrum
Ostium urethrae internum
** Openings border Trigonum vesicae
** Plica interureterica is between ostium ureteris dextrum et sinistrum

Empty vesica urinaria
- Behind symphysis pubica
- Tunica serosa posterior and lateral sides (lies preperitioneally), upper surface covered by peritoneum
parietale

Distended vesica urinaria
- Directed upward and forward above symphysis pubica, Oval-shape.
- Tunica serosa covers also apex vesicae (lies mesoperioneally)

Histology:
• Tunica mucosa
• Tela submucosa
• Tunica muscularis
• Tunia adventitia (anterior)/ serosa
• Plicae vesicae (empty)
• Gll. Vesicales
• 3 muscle layers ( m. detrusor vesicae)
- external and internally longitudinal
- middle layer circular (m. sphincter vesicae)

Topography:
Holotopia
- Pelvis minor

Skeletopia
- Behind symphsis pubica

Syntopia
males
- Anterior: symphysis pubica
- Posterior ductus:
* deferentes dextra et sinistra
* vesiculae seminales dextra et sinistra
* rectum
* excavatio rectovesicales with coils of ileum and part of colon
* sigmoidem
- Lateral: plexus venosus
- Inferior: prostate

females
- Anterior: symphysis pubica
- Posterior: uterus, excavatio vesicouterina
- Lateral: plexus venosus
- Inferior: vagina

Question 51

51. Ureter

Answer 51

Convey urine from ren to vesica urinaria. ~ 30cm long. Commences pelvis renalis ( = munuaisallas).
Descendens along posterior abdominal wall, anteriorly to m. psoas major –> crosses linea terminalis, continues
into pelvis minor.
- Male: crosses ductus deferens
- Female: passes between layers of lig. latum uteri together with lig. cardinale uteri and a. uterina

3 parts
1. Pars abdominalis (in retroperitonel space)
Ureter dexter
- Anterior upper third
** Pars descendens duodeni
- Middle third
** A. et v. testicularis (male)
** A. et. v. ovarica (femle)
- Lower third
** Radix mesenterii

Ureter sinister
- Anterior upper third
** Flexura duodenojejunalis
- Middle third
** A. et v. testicularis (male)
** A. et. v. ovarica (female)
- Lower third
** Mesocolon sigmoideum

2. Pars pelvina, in pelvis minor
   - Linea terminalis until vesica urinaria
3. Pars intramuralis, transverses the wall of the urinary bladder
   - Through wall of vesica urinaria. Opens into its fundus by ostium ureteris

Narrowings:
Upper narrowing - Hilum renale/exit from renal pelvis

Middle narrowing - Level of linea terminalis/crossing a. iliaca
communis or a. iliaca dextra

Lower narrowing - Wall of vesica urinaria

Histology
• Tunica mucosa
• Tela submucosa (not well developed)
• Tunica muscularis
- Upper 2/3 internal longitudinal, external circular
- Lower 1/3 external and internal longitudinal, middle circular
• Tunica adventitia (from all sides)
• Transitional epithelium
• Gll. Urtericae (glandulae?)
• Situaited retroperitoneally

Question 52

52. Urethra masculina et urethra feminina

Answer 52

Masculina:
- Eliminating urine and sperm, ~20 cm
- From Ostium urethrae internum (vesica urinaria) to ostium urethrae externum

Pars prostatica
- Through prostata from base to apex
* Colliculus seminalis
* Utriculus prostaticus
–> Ductus ejaculatorii enter on colliculus
seminalis and prostatic ducts on both
sides

Pars membranacea
- From Apex prostea to bullbus penis.
- Transverse the pelvis floor.
* M. sphincter urethrae

Pars spongiosa
- From Pars membranacea to Ostium
urethrae externum.
- Located in corpus spongiosum penis.
- At bulbus penis ductus glandulae bulbourethralis opens into the urethra

Narrowings
- Upper narrowing: Ostium urethrae internum
- Middle narrowing: Pars membranacae
- Lower narrowing: Ostium urethrae externum

Enlargements
- Upper enlargement: Pars prostacia
- Middle enlargement: Regio bulbus penis
- Lower enlargement: End of pars spongiosa (fossa navicularis urethrae)

Curves
- Curvatura infrapubica: Below symphysis pubica
* Transition from Pars prostatica to pars membranacea
- Curvatura prepubica: Uncostant curve. In the middle of pars spongiosa. Disappears when Penis is
lifted

• Tunica mucosa
- Lacunae urethrales
- Gll. Urethrales open in lacunae
- Fossa navicularis region valvula fossae navicularis

• Tunica muscularis
- presented in Ostium urethrea internum (m. sphincter vesicae)
- Pars membranacea (m. sphincter urethre)

Feminina:
- 3-5 cm
- Extends from ostium urethrae internum
- Passes through diaphgrama urogenitalis
- Terminates by ostium urethrae externum in vestibulum vaginae
- Behind symphysis pubica
- Embedded into anterior wall of vagina

Histology
• Tunica muscosa
Lacunae urethrales Gll. Urethreales
• Tunica muscularis
External circular layer
Internal longitundinal layer
• Tunica adventita

Question 53

53. Testis et epididymis structure

Answer 53

o Paired glandular organ producing spermatozoa and sex hormones
o Oval shape, 4-4,5 cm long and weighs about 20-30g
o Situated into the scrotum in the saggital plane.
o Poles
o Extremitas superior (17)
o Extemitas inferior (18)
o Surfaces
o Facies lateralis (19)
o Facies medialis
o Margins
o Margo anterior (21)
o Margo posterior (close to the epididymis) (22)
o Tunica albuginea (24)

 connective tissue capsule of the testis

o Mediastinum testis (25)
 connective tissue mass projecting into the interior of the testis from the posterior margin
of the tunica albuginea

o Septula testis (26)
 Connective tissue partitions radiating out from the mediastinum to the tunica albuginea,
divide into lobules
o Parenchyma of testis (27)

 specific testicular tissue made up of seminiferous tubules

o Lobuli testis (28)
 Compartmentalized lobules of testicular parenchyma formed by the septa, 200-300

o Tubuli seminiferi contorti (29)
 convoluted tubules where spermatogenesis take place

o Tubuli seminiferi recti (30)
 short straight tubules extending from the convoluted seminiferous tubules to the rete
testis

o Rete testis (31)
 Network of canals within the mediastinum testis, they connect the straight seminiferous
tubules with the efferent ductules

o Ductuli efferentes testis (30)
 ductulus between the rete testis and the duct of the epididymis

epididymis:
o Caput epididymis (2)
- upper enlarged part, ductuli efferentes testis enters
o Corpus epididymis (3)
- central part, consists of ductus epididymis. (6)
o Cauda epididymis (4)
- lower part, consists of ductus epididymis. (6)
o Ductus epididymis (6)
- continuous with ductus deferens(13)
o Ductus deferens (13)
- spermatic duct between the epididymis and the spermal
vesicle.

Question 54

54. Testis et epididymis coverings

Answer 54

o Tunica vaginalis testis:
- Lamina visceralis; fuses with tunica albuginea
- Lamina parietale
-  between layers is a space with serous fluid, sinus epididymidis
o Fascia spermatica interna (continuation of fascia transversalis)
o Musculus cremasterica
o Fascia cremasterica
o Fascia spermatica externa (continuation of fascia abdominalis superficialis)
o Tunica dartos
o Cutis
 There is a space between the layers and a pouch at the lateral surface
- sinus epididymis.

Question 55

55. Ductus deferens, funiculus spermaticus

Answer 55

Topographical division:
o Pars scrotalis
- behind the testis in the scrotum
o Pars funicularis
- extremitas superior testis  anulus inguinalis superficialis
o Pars inguinalis
- passes through the inguinal canal
o Pars pelvina
- anulus inguinalis profundus  ampulla ductus deferentis.

Ampulla ductus deferentis fuses with ductus excretorius vesiculae seminalis and form ductus ejaculatorius.

Ductus deferens histology
o Tunica mucosa:
- Arranged in 3-5 longitudinal folds
o Tunica muscularis:
- Arranged in three smooth muscle layers; external and
internal layers are longitudinal and the middle layer is
circula.
o Tunica adventitia
- Formed by loose connective tissue

Funiculus spermaticus
o A bundle formed by
- ductus deferens (pars scrotalis, pars funicularis and pars
inguinalis)
- blood vessels, nerves and lymphatics in the center
 which are surrounded by covering of the testis
from periphery
 fascia spermatica interna
 m. Cremaster
 fascia cremasterica
 fascia spermatica externa
o Extends from cauda epididymis to anulus inguinalis profunda

o Contents:
- Parts of ductus deferens: pars scotalis, pars funicularis and pars inguinalis.
- Blood vessels and nerves
- Covering of the testis, epididymis and ductus deferens:
 fascia spermatica interna
 m. Cremaster
 fascia cremasterica
 fascia spermatica externa

Question 56

56. Vesicula seminalis, prostata, glandula bulbo urethralis

Answer 56

o Paired, placed posteriorly to the base of the urinary bladder
o Situated extraperitoneally
o Secretes fluid to be added to the secretion of the testis.
o Each sac is pyramidal in shape and consists of a single convoluted tube, its end becomes constricted
into ductus excretorius.
o Ductus excretorius and ampulla ductus deferentis joins to form ductus ejaculatorius.
o Ductus ejaculatorius passes through the prostata and opens on colliculus seminalis into urethra.

Prostata:
- lies on diaphragma urogenitale
o Partly glandular and partly muscular body
o Situated in the pelvic cavity around the beginning of the urethra behind
symphysis pubica.
o The prostatic part of the urethra runs through the prostata.
o Has two parts: apex prostatae et basis prostatae
o Has right and left lobes: lobi prostatae dexter et sinister
 Between the lobes anteriorly is isthmus prostatae

Surfaces:
Facies anterior
Facies posterior
Facies inferolateralis dexter et sinister
Prostata parenchyma
o Consists of glands with ductuli prostatici
- open into the prostatic part of urethra. (24)
o The secretion of these glands forms sperm together with secretions of the
testis, the seminal vesicles and the bulbourethral glands.
o Substantia muscularis: smooth muscular tissue in the central part around
the urethra.

Prostata topography
Holotopia: Pelvis minor
Sceletotopia: Behind symphysis pubica
Syntopia: Posterior rectum
Lateral venous plexus
Superior fundus vesicae urinariae
Inferior diaphragm urogenitalis

Glandula bulbourethralis
o Two small, round and lobulated bodies, about the size of a pea, placed in the perineum.
o Lies close above bulbus penis
o The excretory duct, ductus glandulae bulbourethralis, of the gland opens at the beginning part of pars
spongiosa urethrae
o The secret of the gland is added to spermatozoa and secrets of the rest of the glands to form sperm.

Question 57

57. Organa genitalia masculina externa

Answer 57

Penis

Bodies:
o Corpus cavernosum penis (8)
- cavernous body divided into two halves by the septum of the penis, serves only for erection.
Their posterior ends are sharp crura penis, and they fuse with os pubis and os ischii.

M. ischiocavernosus = m. erector penis
o. ramus ossis ischii
i. tunica albuginea clitoridis
f. erectio clitoridis

o Corpus spongiosum penis (9)
- urethra passes through it and the anterior expanded end forms glans penis.
- The posterior end lies between bulbus penis.

M. bulbospongiosus = m. ejaculatorius seminis
o. centrum tendineum
i. fascia clitoridis
f. narrowing of vestibulum vaginae

Portions:
o Pars fixa penis
- includes radix penis and upper part of the corpus penis, situated below the perineum and is
fused with os pubis and os ischii

o Pars mobilis penis
- rest part of the penis

Parts:
o Radix penis (28)
- covered by skin and muscles, fixed to the inferior part of the subpubic angle.
o Corpus penis (29)
- movable part of penis and has two subparts: dorsum penis (anterior surface) and facies
urethralis (posterior or lower surface)

o Glans penis
- expanded end of the corpus spongiosum penis.

Corpora cavernosa
o Covered by tunica albuginea coporum cavernosum (11)
o Forms septum penis (13)
o From tunica albuginea into bodies enter trabeculae

corporis cavernosi (14)
o Cavernae corporis cavernosi (16)  bloodfilled spaces

Corpora spongiosum
o Covered by tunica albuginea corporis spongiosi (12)
o Trabeculae corporis spongiosis (15)
o Cavernae corporis spongiosi (17) blood-filled space

Above tunica albuginea are
o Fascia penis profunda (21)
o Fascia penis superficialis (20)
o Subcutis(only present in the corpus penis region) and cutis

Penis structure
o The skin is thin and can slide across the penis, but it is firmly attached to the glans penis.
o At the region of the glans penis the skin forms a fold (foreskin) – preputium penis, which embraces the
glans penis.
o At the lower surface the glans penis and the foreskin are connected by the vertical fold (frenulum) –
frenulum preputii.

Glans
*Corona glandis (2)
- Rounded border
*Collum glandis (4)
- neck of glans, constricted portion behind the corona.
*Septum glandis (3)
- median part of the glans
-> Through the corpus spongiosum runs the spongy part of urethra, terminating on the glans penis by a
slit-like external orifice of the urethra.

Scrotum
o Cutaneous and muscular pouch
o Contains testis, epididymis and commencement of funiculus spermaticus.
o Consists of 2 layers
Layers:
1. Cutis (1) - outer
- Very thin skin generally thrown into fold. Contains sebaceous glands and hair
2. Tunica dartos (4) - inner
- Layer of connective tissue with elastic fibres and smooth muscles
o Septum scroti (3)
- Divides the scrotal pouch into two cavities

Question 58

58. Ovarium

Answer 58

• Lies in peritoneal cavity, but is NOT covered by peritoneum, pelvis minor. ~ 5-8 g, 3-5 cm.
• Almos vertically positioned ovarium is attached to uterus by lig. latum uteri
• Extremitas tubaria et uterina
• Facies medialis et lateralis
• Margo liber –> free, convex, looking backward
• Margo mesovaricus
• Is attached to the posterior part of lig. latum uteri by mesovarium
• Mesovarium is a fold of peritoneum
• Between 2 layers of mesovarium is blood vessels and nerves, which pass to hilum ovarii

Ovarium is fixed by 3 strucrutes:
1. Lig. ovarii proprium
* from ovarium to uterus , lies within lig. latum uteri
2. Lig . Suspensorum ovarii
* From ovarium to lateral wall of pelvis minor
* Contains blood vessels and nerves
3. Mesovarium
* Part of lig. latum uteri

• Surface is coverd by tunica albuginea
• Medulla ovarii
• Nerves, BV, lymph vessels
• Cortex ovarii
• 50 000 - 80 000 follicles in each organ
• Folliculi ovarici vesiculosi mature periodically once in 28 days (after puberty to the age of 45)
• Corpus luteum –> corpus albicans

Question 59

59. Tuba uterina

Answer 59

s. salpinx

 ~ 10-12 cm long
 Extends from lateral wall of pelvis minor to uterus
 Intraperitoneal in the upper part of lig. latum uteri (mesosalpinx, which is a part of lig. latum uteri,
surrounds tuba uterine)
 2 openings:
1. Ostium abdominale tubae uterinae
 Communicates with cavitas peritonealis
2. Ostium uterinum tubae uterinae
 Communicates with cavitas uteri

 4 parts:
1. Infundibulum tubae uterinae
 Abdominal end. Opens to cavitas peritonealis
 Surrounded by 1-1,5 cm long fimbriae tubae uterinae
o One of them is fimbria ovarica reaching extremitas tubaria ovarii

2. Ampulla tubae uterinae
    Oval shape enlargement, place for fertilization
3. Isthmus tubae uterinae
    Narrow part close to uterus
4. Pars uterinae
    Penetrates wall of uterus and opens to cavitas uteri by ostium uterinum tubae uterinae

Tunica mucosa
o Ciliated epithelium, producing fluid flowing towards uterus . Mucosa has plicae tubariae folds.
Tunica muscularis
o Inner circular muscle layer
o Outer longitudinal muscle layer
o Peristaltic movement for oocyte transport to uterus and antiperistaltic movement for spermatozoa
Tela subserosa
o Loose connective tissue
Tunica serosa
o Intraperitoneal covering, except at mesosalpinx, where perotineum folds to formate passway for blood
and lymph vessels and nerves.

Question 60

60. Uterus

Answer 60

s. metra

 Hollow pear-shaped muscular organ, 7-8 cm in lenght and 40-50 g in weight
 Mesoperitoneal organ
 Syntopia
o Anteriorly: vesica urinaria, Excavatio vesicouterina
o Posteriorly: rectum, Excavatio rectouterina

3 parts:
1. Fundus uteri
 Above ostium uterinum tubae uterinae dextrae et sinistrae
2. Corpus uteri
 2 walls:
i. Facies vesicalis - facing vesica urinaria
ii. Facies intestinalis, separated from rectum by coils of intestinum tenue
 Lower part is narrow, isthmus uteri
3. Cervix uteri
 Lower portion lies in vagina, divided into:
i. Portio supravaginalis cervicis – upper part above vagina
ii. Portio vaginalis cervicis – lower part inside vagina

 Margo uteri dexter et sinister (border of uterus)
o Lig. latum uteri starts from the border and extends to pelvic walls
 Cavitas uteri
o Antero-posteriorly flattened, sagittally triangular
o Basis cavi uteri, between ostium uterinum tubae uterinae d. et s.
o Apex cavi uteri, projects down, continues as canalis cervicis uteri
o Canal opens into vagina by ostium uteri externum
  bordered by:
 labium anterius
 labium posterius

(Tunica mucosa s. endometrium
 Lining of cavitas uteri et canalis cervicis uteri
 Glandulae uterinae et plicae palmatae in anterior and posterior walls of canalis cervicis uteri
 Endometrium, except lamina basalis endometrii, is desquamated during mestruation
Tunica muscularis s. myometrium
 Internal longitudinal, middle circular, outer longitudinal muscle layers
Tunica serosa s. perimetrium
 Mesoperitoneal covering by peritoneum)

Question 61

61. Uterus fixating apparatus of uterus

Answer 61

Structures fixing the uterus:
M. levator ani:

1. M. pubococcygeus
   o. ramusinferiorossispubis
   i. os coccygis
2. M. puborectalis –> fibers laterally from m. pubovaginalis toward rectum
   o.symphysispubica
   i. rectum
3. M. iliococcygeus
   o. spinaischiadica
   i. os coccygis
   f. stabilies pelvic organ

 Lig. teres uteri
o Starts from upper part of uterus  lies between layers of lig. latum uteri  through canalis
inguinalis  reaching mons pubis

 Lig. latum uteri
o Dublication of peritoneum in planum frontale
o from margo uteri to walls of cavitas pelvis
o Superior part surrounds tubae uterinae , inferior part fuses with perineum
o Has topographical subdivision into 3 parts:
1. Mesosalpinx – surrounding tubae uterinae
2. Mesovarium – attaching to margo mesovaricus ovarii
3. Mesometrium – lower portion, laterally to uterus

 Lig. cardinale uteri s. lig. transversum cervicis
o from cervix uteri to lateral wall of pelvis minor
 Lig. pubocervicale
o from cervix uteri to fundus vesicae urinariae and symphysis pubica ossis pubis
 Lig. Rectouterinum
o from cervix uteri to rectum and os sacrum
o in plica rectouterina

Normal position is anteflexio 70 – 100 ̊ and anteversio 90 – 100 ̊.

Question 62

62. Vagina

Answer 62

 ~8-12 cm in lenght, bordered by uterus et ositum vaginae
 Ostium vaginae
o Partly closed by hymen (mucosal fold)
o After first coitus hymen is broken and becomes caranculae hymenales
 Paries anterior vaginae
 Paries posterior vaginae
 Upper parts of vagina surrounds portio vaginalis cervicis uteri
o Between portio vaginalis cervicis uteri and the inner surface of vagina wall is Fornix vaginae
 Posterior part of Fornix vaginae is higher
 Mucosa on the inner surface of vagina forms rugae vaginales
o medial part higher to lateral part
 In paries anterior et paries posterior these rugae vaginales form two longitudinal colums – columna
rugarum anterior et columna rugarum posterior

Tunica muscularis
 Smooth muscles fibers, with inner circular and outer longitudinal layers

Tunica adventitia
 Loose connective tissue connecting to surrounding organs

Question 63

63. Organa genitalia feminina externa

Answer 63

s. vulva s. pudenda feminina

Mons pubis
 Round eminence anteriorly to symphysis pubica, superiorly to labia majora
 Triangular in shape, adipose tissue, becomes covered by hair after puberty
Labium majus pudendi dextrum et sinistrum
 Longitudinal cutaneous folds, sagitally downwards and backwards from mons pubis
 Rima pudendi between labia majora
 Outer surface is pigmented and has hair covering
 Inner surface is smooth non-pigmented with sebaceous glands
 Glandula vestibularis major dextra et sinistra
o Located in the base of labia majora between musculi perinei
o Ducts open to lateral part of ostium vaginae

Labium minus pudendi dextrum et sinistrum
 Sagittal cutaneous folds between labia majora
 Posterior ends join at midline
 Each anterior end divides to 2 portions:
1. Preputium clitoridis – fuses above glans clitoridis
2. Frenulum clitoridis – fuses below glans clitoridis
 Glandulae vestibulares minores in the inner surface
o Function is to moisten vestibulum vaginae
 Vestibulum vaginae
o Cleft between labia minora pudendi, behind glans clitoridis
o 2 openings in vestibulum vaginae:
1. Ostium urethrae externum
2. Ostium vaginae

Bulbus vestibule
 Unpaired organ, similar to corpus spongiosum penis with erectile tissue with venous blood
 Two lateral portions around ostium vaginae
o Median portion between glans clitoridis and ostium urethrae externum

Clitoris
 Similar to corpora cavernosa penis
 Erectile tissue with significant amount of nerve endings
 It has 3 parts:
1. Crus clitoridis dexter et sinister
 Connected to ramus inferior ossis pubis
2. Corpus clitoridis
3. Glans clitoridis
 Beneath anterior connection of
labium majus, hidden by preputium clitoridis

M. ischiocavernosus (=common name) in females: m. erector clitoridis
o. ramus ossis ischii
i. tunica albuginea clitoridis
f.erectio clitoridis

M. bulbospongiosus (=common name)
in females: m. sphincter vaginae
o. centrum tendineum
i. fascia clitoridis
f.narrowing of vestibulum vaginae

Question 64

64. Tunicae bulbi

Answer 64

3 tunicas:

tunica fibrosa consists of 3 parts:
- cornea – transparent
- limbus corneae – lateral border
- sclera – white part of eye
 lamina cribrosa sclerae – for nerves, vessels
 sulcus sclerae with sinus venosus sclerae (Schlemm ́s canal)

tunica vasculosa consists of 3 parts:
- iris
- corpus ciliare
- choroidea – a thin, highly vascular part, attached to the inner surface of sclera

Iris- controls the amount of light entering the eye, has an opening –pupilla. Contains the smooth muscle fibers controlling the size of pupilla.
** M. sphincter pupillae (inner)
** M. sphincter pupillae (outer)
** M. dilator pupillae (outer)
–> Also contains pigment melanin

• Corpus ciliare – is responsible for accommodation, it lies as a flat ring (next to iris), but looks triangular in cross section
   Orbiculus ciliaris – contains smooth muscle fibers – m. ciliaris
   Corona ciliaris with processus ciliares – from them to the lens extend thin fibers fibrae
  zonulares
   Capillaries of the processus produce solution of eye – humor aqueous

Tunica interna s. retina consists of 2 parts:
- Pars optica
- Pars caeca
- (pars ciliaris & pars iridiaca)

Pars optica contains:
 Rods (~100 million) for night vision, loss of them causes night blindness
 Cones (~6 million) for different colors and day vision
 From retina starts the optic nerve – discus nervi optici
 (“the blind spot”), also entrance of blood vessels
 “the fundus of the eye” – the whole surrounding area of the back eye
 Macula lutea, 4mm laterally to the disc with a small depression in it – only cones, the greatest
sharpness of the vision

There are 3 kinds of cones with different photosensitive pigment (photopsin) responding for different light
 yellowish-green
 bluish-green
 blue-violetish

–> The difference in signals received from 3 kinds allows the brain to perceive a wide range of different colors. Inability to perceive differences between some or all colors - color blindness.

Question 65

65. Bulbus oculi

Answer 65

Eyeball is approximately spherical
 Weight 7,5gr.
 2 poles
o anterior pole is the central point of the cornea
o posterior pole the central point of the sclera
 Axis bulbi externus – line joining anterior and posterior poles externally – 24mm
 Axis bulbi internus – line between internal surface of the cornea and the retina – 21.75mm
If internal axis is longer (~29 mm) - light produces image focus in front of retina = myopia (nearsightedness)
 Distance vision is blurred, near vision clear
 Correction with a minus lens
If internal axis Is less than normally (~ 20mm) - light is focused behind retina = hyperopia (farsightedness)
 Problems with near vision
 Correction with a plus lens
If front surface of the eye is not curved properly (or irregularly shaped lens) – light is focused in different focus = astigmatism

Eyeball consists of:

Tunica bulbi:
- tunica fibrosa – outer fibrous layer
- Tunica vasculosa – middle vascular layer
- Tunica interna s. retina – inner layer or retina

Nucleus bulbi
- lens
- Corpus vitreum
- Humor aqueous

Lens - made of transparent fibres
- covered by capsula lentis
- is connected with corpus ciliare (with m. ciliaris) by zonuta ciliaris (sunspensory ligaments)
- lens is flexible and its curvature is controlled by the ciliary muscle by changing the curvature of the
lens, we can focus the eye on objects at different distance from it – accommodation
- an opacity of the normally transparent lens leads to blurred vision - CATARACTA

Corpus viteum
- transparent jelly- like substance (99% water)
- occupies the posterior 4/5 of the eyeball
- is enclosed in the delicate vitreous membrane
- provides a cushioned support for the eye and clear path for light to travel to retina

Humor aqueous
- water-like fluid, fills the space between the posterior surface of cornea and anterior surface of vitreous body
- secreted by ciliary body processes
- flows into posterior chamber - camera bulbi posterior (between iris, zonula ciliaris)
–> then through narrow cleft between lens and iris - through pupilla - into anterior chamber - camera buibi anterior (between tenor surface of cornea and iris)
- humor aqueous is drained into sinus venosus sclerae (Schlemm’s canal)
- if normal humor production or absorption is disturbed, amount of fluid increases intraocular pressure rises, leads to compression of retina and damage of optic nerve — GLAUCOMA

Question 66

66. Organa oculi accessoria

Answer 66

Accessory visual structures are for protection and moving the eyeball:

Periorbita - lines the orbit like periostium
- Corpus adiposum orbitae - retrobulbar fat fills the orbit
» in it optic nerve and muscles are imbeded
- Vagina bulbi - connective tissue sheath
» surrounds eyeball from optic nerve to cornea
» separetes the eyeball from fat, provides free movements
- Palpebrae - eyelids
- tunica conjunctiva
- apparatus lacrimalis
- extrinsic muscles of the eyeball

Palpebrae - consist of the skeletal muscle – m. orbicularis oculi
- anterior surface of eyelid is covered by the skin
- posterior surface is covered by the conjunctiva there are two eyelids - palpebra superior et inferior
- rima palpebrarum - space between eyelids
- on free margin of eyelid are two parts:
» limbus anterior with eyelashes - cilia
» limbus posterior for openings of tarsal glands - gladulae tarsales (Meibomian glands)
* they secrete oily substance on the margin eyelid

Tunica conjunctiva - helps lubricate cornea; this membrane is divided into 2 parts:
1. palpebral conjunctiva
o covers posterior side of eyelid 2, bulbar conjunctiva
o covers sclera till cornea
+ conjunctival fornix (upper and lower) space between both parts of conjunctiva
+ conjuctival sac
+ plica semilunaris
+ caruncula lacrimalis - elevation in medial corner

Apparatus lacrimalis
- glandula lacrimalis secrets tears, tears flow through small excretory ducts to lacus lacrimalis
- lacus lacrimal, collects tears, is around caruncula lacrimalis
- punctum lacrimale - on small elevations papilla lacrimal placed on the medial pad eyelid’s free margin
- canaliculus lacrimalis — directs tears into lacrimal sac
- saccus lacrimalis — lies in the medial pat of optic cavity
- ductus nasolacrimalis - carrries into meatus nasi inferior

Question 67

67. Auris externa et interna

Answer 67

Auris externa consists of 2 parts:  Auricula
 meatus acusticus externus – terminates by membrana tympani

Functions:
- acoustic – sound transmission from the environment to tympanic membrane
- nonacoustic – protection of tympanic membrane and maintenance of a clear passage for sound
auricula – is formed by cartilage and covered by skin:
 lobulus auriculae
 helix
 anthelix
 tragus
 antitragus

Meatus acusticus externus – 2,5 cm long; lined by skin with modified sweat glands, producing cerumen (earwax); could be divided into 2 parts:
1. external part – formed by cartilage
2. internal 2/3 – formed by temporal bone

Nonacoustic protective functions:
- to prevent objects from entering ear canal because of:
** tortuous course – it passes upward in anterior direction, then turns slightly posteriorly and slightly descends
** arrangement of hairs and production of wax in cartilaginous part
- to heat air – protect the middle ear from sudden temperature changes

membrana tympani – a thin membrane that separates the external ear from the middle ear
- formed by connective tissue, covered by skin from outside and mucous from inside
- oval in shape with diameter 9 x 11 mm; lies obliquely with its external surface downward
- external surface is concave; at its center a small depression – umbo – on its internal surface attachment
place of the handle of malleus (one of the ear ossicles)

Function
- to transmit sound from the air to the ossicles of the middle ear (malleus connects eardrum and other ossicles)
divided into 2 parts:
1. pars tensa – thicker lower part formed by fibrous tissue, fixed in osseous groove of temporal
bone
2. pars flaccida – thin small upper part 2 mm wide, formed by skin and mucous only

Tympanic membrane could be examined by otoscope:
- examiner first straightens ear canal by gentle pulling the auricle upward and backward to look through
instrument to see inside the ear
- normal eardrum appears pinkish-grey in colour
- there is a cone of light reflecting off the surface of the eardrum (at the 5 o’clock position in right ear or at the 7 o’clock position in left ear)
- Perforation (ruptura) of eardrum – a hole in eardrum:
o perforations occur from infections or injuries or barotrauma
o self-inflicted damage with a cotton swab or other device inserted into the ear

Auris interna consists of
 Labyrinthus osseus – bony cavities
 Labyrinthus membranaceus – membranous ducts and sacs – within bony cavities

–> Between the bony and membranous labyrinths is space lined by the periostium and contains a clear fluid perilymph

Functions:
 enables hearing
 maintains the balance in the human body
Labyrinthus osseus has 3 parts:
 vestibulum
 canales semicirculares (3)
 cochlea

Vestibulum is 2mm wide; in lateral wall 2 openings:
 fenestra vestibuli – oval window closed by stapes
 fenestra cochleae – round window closed by membrana tympani secundaria
In vestibulum are 2 communications with the cranial cavity:
1. an internal opening of aquaeductus vestibule
2. an internal opening of canaliculus cochleae (near the round window)
–> it opens on posterior border of pars petrosa and communicates perilymphatic space of internal ear with subarachnoidal space (drainage)

Canales semicirculares (3):
1. canalis semicircularis anterior – in sagittal plane
2. canalis semicircularis posterior – in frontal plane
3. canalis semicircularis lateralis – in horizontal plane

Each canal has:
 crus ampulare with ampulla
 crus simplex
Crus commune – 2 simple limbs of anterior and posterior canals fuse

Cochlea contains:
- modiolus – in center
- canalis spiralis – twists 2,5 times around modiolus
- lamina spiralis winds around modiolus and divides canal into 2 parts, communication in helicotrema
o scala vestibule - above
o scala tympani - below

Labyrinthus membranaceus is lodged within labyrinthus osseus and filled by endolympha; it consists of several parts communicated with one another:
 utriculus
 sacculus
 ductus semicirculares (3)
 ductus cochlearis

Utriculus et sacculus:
 both lodged within vestibulum and connected by ductus utriculosaccularis
 both contain sensory areas of balance
 from connection starts ductus endolymphaticus
o small duct that passes in aquaeductus vestibuli and terminates by saccus endolymphaticus
 on posterior surface of pars petrosa (between two plates of dura mater encephali)
o by sac endolymph drains into (venous system) sinus petrosus inferior

Ductus semicirculares:
 crus membranaceus simlex
 crus membranaceus ampulare
 crus membranaceus commune
 each ampula contains sensory areas of balance

Sense of balance
Movements of the perilymph creates movements of the endolyph
→ they stimulate balance receptors
→ receptors in utriculus (lies horizontally) detect head movements in sagittal plane (up and down); receptors in sacculus (lies vertically) detect head movements in frontal plane (side to side); they are for static balance
→ in crus ampulare of semicircular ducts are receptors of kinetic balance; ducts are arranged at the right angle to each other (all planes represented); whenever the head begins or ceases to move, or whenever a movement of the head accelerates or decelerates, endolymph in semicircular ducts will change its speed → this change irritates receptors
→ receptor cells send impulses to the brain via vestibular nerve (part of n. vestibulocochlearis VIII), where they are interpreted as balance

Ductus cochlearis lies in canalis spiralis
 triangular in cross section
 connected to sacculus by ductus reuniens
 contains hearing receptor – organ Corti
 ductus cochlearis completely divides canalis spiralis into 2 scalas:
o scala vestibuli – upper, opens into vestibulum
o scala tympani – lower, terminates at fenestra cochleae
–> both spaces are communicated by helicotrema in upper part of cochlea

Sense of sound
Movements of the perilymph creates movements of the endolyph
→ they stimulate hearing receptors (organon Corti)
→ receptor cells send impulses to the brain via cochlear nerve (part of n. vestibulocochlearis VIII), where they are interpreted as sound

Question 68

68. Auris media

Answer 68

Auris media consists of 2 parts:
1. Cavitas tympani – contains a chain of 3 ossicles and 2 muscles
2. Tuba auditiva – connects tympanic cavity with nasopharynx (throat / pharynx)

Functions:
- helps transmit vibrations of eardrum to the internal ear (cochlea)
o vibrations have to be transferred from air outside to fluids inside
- uses hydraulic principles to minimize the loss of acoustic energy that would result from the transition

Thympanic cavity has 6 walls:
1. paries tegmentalis (superior wall)
2. paries jugularis (inferior wall)
3. paries caroticus (anterior wall)
a. with 2 openings (canalis musculotubarius)
4. paries mastoideus (posterior wall)
5. paries membranaceus (lateral wall)
6. paries labyrinthicus (medial wall) with 2 openings:
a. fenestra vestibuli – upper oval window
–> leads to the vestibular part of internal ear, closed by stapes
b. fenestra cochleae – lower round window
–> leads to scala tympani of internal ear, closed by membrana tympani secundariaSound transmission

ossicula auditus:
malleus – attached to internal surface of tympanic
membrane
incus
stapes – attached to oval window
- ossicles are joined by 2 synovial joints
- chain of ossicles is the sound–conducting apparatus
** transmits vibrations of tympanic membrane produced by sound waves to the fluid of internal ear
- small size of ossicles ensures that they easily vibrate to sound waves
- ossicles are shaped and aligned in such a way that they amplify the sound waves they transmit

Muscles of tympanic cavity are striated; they regulate the tension in the chain of ossicles:
m. tensor tympani
- pulls malleus, tenses tympanic membrane
- runs in semicanalis musculi tensoris tympani (canalis musculotubarius)
m. stapedius
 keeps stapes in fenestra vestibuli

tuba auditiva – connects middle ear to the throat
Functions:
 conducts air between tympanic cavity and the outside of body by throat and mouth
 helps maintain equal air pressure on both sides of the eardrum (necessary for normal hearing)

Auditory tube has 2 parts:
 cartilage part – 2/3, lies in pharyngeal wall
 bony part – 1/3, lies in semicanalis tubae auditivae (canalis musculotubarius)

Auditory tube has 2 openings:
 in the anterior wall of tympanic cavity
 in the lateral wall of pharynx

The sound wave enters ear canal and moves tympanic membrane medially
→ malleus moves medially, causes movements of incus and stapes
→ base of stapes (attached to oval window) moves medially and generates a wave of perilymh in scala vestibule
→ wave from scala vestibuli moves via helicotrema to scala tympani and causes outward bulging of membrana tympani secundaria in round window (to stop waves of perilymph)

Question 69

Intestinum Crassum et Peritoneum

Answer 69

Caecum
- Intraperitoneal organ – covered by
peritoneum
- No mesenterium

Appendix vermiformis
- Intraperitoneal organ
- Has mesenterium – mesoappendix
connecting ileum to appendix

Colon ascendens et descendens
o Mesoperitoneal organ – covered by peritoneum anteriorly, laterally and medially
o Posteriorly covered by tunica adventitia

Colon transversum
o Intraperitoneal organ
o Mesocolon transversum

Colon sigmoideum
o Intraperitoneal organ
o Mesocolon sigmoideum

Rectum
o Upper 1/3 intraperitoneal
o Middle 1/3 mesoperitoneal
–> anteriorly and laterally by peritoneum, posteriorly by tunica adventitia
o Lower 1/3 retroperitoneal
–> covered by tunica adventitia