Arteries of the trunk Flashcards

1
Q

A. thoracica interna

A
  • arises from the lower side of a. subclavia
  • descends along the anterior internal surface of thoracic cavity
  • behind the cartilages of the upper six ribs in the distance of about 1,5 cm from the border of the sternum.
  • at the level of costae 7 the divides into two terminal branches:
  1. arteria epigastrica superior:
    - penetrates diaphragm
    - at the level of the umbilical ring it communicates with arteria epigastrica inferior from arteria iliaca externa
    - supplies musculus rectus abdominis.
  2. arteria musculophrenica:
    - makes its way obliquely downward and laterally, supplies the diaphragm and the lower intercostal spaces (rami intercostals anteriores)

Side branches:
1. rr. intercostales anteriores supply the upper intercostal spaces and communicate with arteria intercostales posteriores from aorta thoracica for female – branches to the mammary gland

  1. a. pericardiacophrenica - supplies the mediastinal part of the pleura, the pericardium, the diaphragm;
  2. rr. bronchiales - supply the lower part of the trachea and the main bronchi;
  3. rami thymici – supply thymus;
  4. rami sternales – supply sternum;
  5. rami mediastinales – supply pleura mediastinalis
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2
Q

Blood circulation

A

circulus sanguinis minor / pulmonary circulation
- deoxygenated blood from ventriclus dexter is pumped into truncus pulmonalis and then via a. pulmonalis dextra et sinistra into the capillary networks of the lungs. From the lungs oxygenated blood flows back via venae pulmonales (4) into atrium sinistra

Truncus pulmonalis starts from ventriculus dexter behind art. sternoclavicularis sinistra.
x on the right side and behind – aorta ascendens
x on the left side – auricula sinistra
x below aortic arch it divides into artery pulmonalis dextra et sinistra

–> Arteria pulmonalis dextra runs to the right side behind aorta ascendens and vena cava superior to hilum pulmonis, where it divides into lobar and segmental arteries.

–> formed by the capillaries and venules of the lungs. Venae pulmonales leave the lung via hilum pulmonis.

Circulus sanguinis major/The systemic circulation:

  • supplies blood to all the organs
  • The oxygenated blood from ventriclus sinister is pumped into aorta and then via arteries into the capillary networks of the organs
  • The deoxygenated blood is returned into the atrium dexter from the lower limbs and the lower part of the trunk via vena cava inferior and from the head and neck, the upper limbs and the upper part of the trunk via vena cava superior.
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3
Q

Aorta

A
  • the main trunk of arterial vessels
  1. Aorta ascendes - behind truncus pulmonalis to the right
  2. Arcus aortae - backward and to the left
  3. Aorta descendes - T4 and divides into:

a. aorta thoracica- lies to the left of the column
- -> crosses oesophagus
- -> passes through hiatus aorticus diaphragm

b. aorta abdominalis - in front of vertebral column
- -> at L4 divides into a. iliac communes dextra et sinistra
- -> continuation “remnant”: a. sacralis mediana

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4
Q

Aorta ascendes

A
  • about 5 cm in lenght.
  • originates by ostium aortae at the upper part of ventriculus sinister at the level of costae sinister 3 behind sternum.
  • dilatation bulbus aortae at the
    origin place; formed by three sinus aortae.
  • curves obliquely upward, anteriorly and to the right as high as the upper border of cartilagines costales dexter 2 –> continues into arcus aortae.
  • surrounded by pericardium.

At the level of sinus aortae, aorta ascendens has two side branches:

  1. a. coronaria dextra
  2. et sinistra
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5
Q

Arteria coronaria dextra

A
  • > passes to the right from above sinus aorta and lies in sulcus coronarius
  • > curves around margo dexter to facies diaphragmatica
  • > passes from the right side to the left
  • > descends along sulcus interventricularis posterior as ramus interventricularis posterior to the apex
  • At apex cordis makes anasthomoses with r. interventricularis anterior from a. coronaria cordis sinistra
  • At the coronary groove makes anasthomosis with r. circumflexus from a. coronaria cordis sinistra.

supplies:

  • the right atrium and septum interatriale
  • the posterior wall and part of the anterior wall of ventriculus dexter
  • the posterior third of septum interventriculare
  • mm. papillares of ventriculus dexter, m. papillaris posterior of ventriculus sinister
  • part of the posterior wall of ventriculus sinister
  • nodus sinuatrialis, nodus atrioventricularis.
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6
Q

Arteria coronaria sinistra

A
  • from arcus aortae at sinus aortae level
  • divides into two branches:
  1. r. interventricularis anterior:
    - descends along sulcus interventricularis anterior to apex cordis –> communicates with r. interventricularis posterior from a. coronaria dextra
  2. r. circumflexus:
    - runs along sulcus coronarius at first to the left around facies pulmonalis
    - then to the right as far as sulcus interventricularis posterior and communicates with a. coronaria dextra

Because of anastomoses of both coronary arteries there are two arterial circles – horizontal one along sulcus coronarius and oblique one along sulcus interventricularis anterior et posterior.

A. coronaria sinistra supplies:

  • atrium sinistrum
  • ventriculus sinister (except a small part of the posterior wall)
  • part of the anterior wall of ventriculus dexter
  • the two anterior thirds of septum interventriculare
  • m. papillaris anterior of ventriculus sinister
  • fasciculus atrioventricularis
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7
Q

Vv. cordis

A

The veins of the heart (vv. cordis) drain blood directly into the hearts cavities. To them belong:

  1. sinus coronaries
    - The venous blood of the heart by veins of the heart is drained into it
    - lies in posterior part of the heart in sulcus coronarius and terminates in the right atrium by ostium sinus coronarii.
    - it receives 5 tributaries:
    • V. cardiaca magna –
  • Corresponds to the supply area of a. coronaria sinistra
  • > begins at apex cordis,
  • > ascends along sulcus interventricularis anterior
  • > curves to the left around facies pulmonalis cordis
  • > lies in sulcus coronarius and ends in there
    • V. cardiaca media
  • commences at apex cordis, ascends along sulcus interventricularis posterior, opens into the sinus coronarius
    • V. cardiaca parva
  • runs along sulcus coronarius between the right atrium and right ventricle, curves around margo dexter cordis and opens into the sinus coronarius
    • V. ventriculi sinistri posterior
  • drains the venous blood from the left ventricle and ends in the sinus coronarius
    • V. obliqua atrii sinistri
  • drains the venous blood from the left atrium, opens into the sinus coronaries
  1. vv. cardiac (cordis) anteriores
    - “transmural system”
    - located on facies sternocostalis
    - drain the venous blood from right ventricle anterior wall and open directly into the right atrium by means of small orifices.
  2. vv. cardiaca (cordis) minimae
    - “endomural system”
    - numerous, they arise in the wall/all parts of the heart
    - open mainly into the right atrium by foramina venarum minimarum, but could open also into the ventricle.
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8
Q

Cardiac innervation

A

Cardiac innervation is provided by two autonomus, interconnected plexuses:

  1. Plexus cardiacus superficialis – located between arcus aotae concave and truncus pulmonalis
  2. Plexus cardiacus profundus – located between the posterior surface of arcus aortae and bifurcatio tracheae

Vegetative/autonomic fibers spreads along the arteriae coronariae.

N. vagus (parasympathetic pregg and sensory neurons) with branches:

  • rr. cardiaci cervicales superiores (from pars cervicalis n. vagi)
  • rr. cardiaci cervicales inferiores (from n. laryngeus recurrens)
  • rr. cardiaci thoracici (from pars thoracica n. vagi)

Postgg parasympathetic neurons (ganglia intramuralia) in the atrial walls, septum interatriale and along arteriae coronariae.

Sympathetic innervation provides two types of neurons:
- pregg sympathetic neurons (perikaryon - nucleus intermediolateralis) T1-5
- post-ganglionic sympathetic neurons (perikaryon – ganglia trunci sympathici cervicales 1-3, ganglia trunci sympathici thoracici 1-5).
o Truncus sympathicus axons or branches:
- n. cardiacus medius (from ganglion medium)
- n. cardiacus cervicalis inferior (from ganglion inferius)
- rr. cardiaci thoracici (from I – V ganglia thoracica)

Cardiovascular clinical names:

  • RCA - a. coronaria cordis dextra
  • PDA - r. interventricularis posterior
  • LCA - a. coronaria cordis sinistra
  • LMCT - left main trunk common
  • RSS - ramus anterior interventricularis
  • CX - r. circumflexes
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9
Q

Arcus aortae

A

Arcus aortae is the continuation of aorta ascendens. It begins at the level of the art. sternocostalis dexter 2, runs upward, backward and to the left, then passes downward and at the level of T4
becomes continuation of aorta descendens.

  • anteriorly – thymus (for children) or remnants of thymus (for adults)
  • posteriorly – bifurcatio tracheae
  • superiorly – v. brachiocephalica sinistra
  • inferiorly – truncus pulmonalis division into a. pulmonalis dextra et sinistra

From the lower surface of arcus aorticus arise small branches for supplying adjacent organs:

  • rr. tracheales
  • rr. bronchiales

From the upper surface of arcus aortae start three blood vessels:

  1. truncus brachiocephalicus
    - truncus brachiocephalicus is the largest branch of arcus aortae, it has lenght about 2-3 cm
    - the trunk ascends obliquely upward, backward and to the right
    - at the level of art. sternoclavicularis dexter it divides into:
    i. a. carotis communis dextra
    ii. a. subclavia dextra.
  2. a. carotis communis sinistra
  3. a. subclavia sinistra
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10
Q

Aorta thoracica

A

passes in mediastinum posterius. It begins at the lower border of T4 and extends to the lower border of T12 at hiatus aorticus. At the commencement aorta thoracica is situated to the left from columna vertebralis, then it approaches to the median line.
- at its termination aorta thoracica lies directly in front of columna vertebralis
- at the level of T8 – T9 aorta thoracica is crossed by esophagus
- to the left from it lies pleura costalis
- to the right – v. azygos, ductus thoracicus
The side branches of aorta thoracica are divided into two groups – visceral and parietal.

Visceral branches:

  1. rr. bronchiales:
    - contents of radix pulmonis
    - supply the lungs, bronchi and pleura visceralis
  2. rr. oesophageales
    - supply the esophagus
    - upper branches communicate with rr. oesophagales of a. thyroidea inferior that supply cervical part of the oesophagus
    - lower branches communicate with rr. oesophageales from a. gastrica sinistra
    - supply abdominal part of the esophagus
  3. rr. pericardiaci
    - supply the posterior surface of pericardium
    - communicate with branches of a. pericardiacophrenica
  4. Rr. mediastinales
    - numerous vessels for supplying the lymphatic nodes, fibrous and fatty tissue in
    mediastinum posterius.

Parietal branches:

  1. aa. phrenicae superiores
    - supply the diaphragm and its coverings
  2. aa. intercostales posteriores
    - ten paires of those arteries
    - absent in spatium intercostale 1 et 2
    (muscles of those spaces are supplied by a. intercostalis suprema from truncus costocervicalis)
    - the last a. intercostale posterior passes below costae duodecima and is called a. subcostalis
    - each a. intecostales runs along the lower margin of the rib, lies in sulcus costae with v. intercostalis posterior above and n. intercostalis below it
    - gives off side branches:
    ** r. dorsalis
    » arises at the level of collum radii, runs backward
    » supplies deep muscles and skin of the back
    » from this branch starts r. spinalis
    > passes through foramen interverterbale to supply the spinal cord and the coverings

** r. collateralis
» originates near angulus costae, approaches the upper border of the rib below
» supplies muscles and skin
» r. collateralis and a. intercostalis posterior communicate with rr. intercostales anteriores from a. musculophrenica from a. thoracica interna

** r. cutaneus lateralis
» supply skin of the lateral and anterior parts of the trunk

** rr. mammarii laterales (for female) arise from aa. intercostale posteriores 4 - 6 to supply glandula mammae

  • Aa. intercostales posteriores supply:
  • mm. thoracici profundi
  • mm. dorsi profundi
  • mm. abdominalis regio epigastrici et mesogastrici
  • pleura
  • skin of the trunk (anterior and lateral parts)
  • the adjacent bones
  • the spinal cord and its coverings
    glandula mammae for female
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11
Q

Aorta abdominalis

A
  • Starts from hiatus aorticus diaphragmae until L4

Topographia:

Holotopia

  • regio epigastrica
  • region umbilicalis

Skeletotopia
- From T12 – L4

Syntopia
- located retroperitoneally
- descends along columna vertebralis left to
the midline

Posteriorly:
- columna vertebralis
Right side:
- v. cava inferior
Anteriorly:
- corpus pancreatis
- pars ascendens duodeni
- radix mesenterii
Left side:
- truncus sympaticus

Visceral branches are divided into two groups – the unpaired and paired branches.
Unpaired visceral branches of aorta abdominalis: 3
1. truncus coeliacus
2. a. mesenterica superior
3. a. mesenterica inferior

Paired visceral branches of aorta abdominalis: 4

  1. a. suprarenalis media
  2. a. renalis
  3. a. testicularis
  4. a. ovarica

–> so 7 visceral Branches!

Parietal branches: 2

  1. aa. phrenicae inferiores
  2. aa. lumbales
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12
Q

truncus coeliacus

A

just below hiatus aorticus diaphragmae (Th12), is about 1-3cm long; divides into 3 arteries:

  1. a. gastrica sinistra
    - rr. Gastici descends along curvatura minor of gaster supplying it
    - rr. oesophagealis supplies pars abdominalis oesophagei
    - a. gastrica sinistra communicates with a. gastrica dextra (from a. hepatica communis)
  2. a. splenica s. a. lienalis
    - runs left behind gaster along the upper border of pancreas
    - It terminates at hilum splenicum –> rr. splenici, supplies splen s. lien
    - Side branches:
    * * rr. pancreatici – supply corpus et cauda pancreatis
    * * aa. gastricae breves – supply fundus gastricae
    * * a. gastroomentalis sinistra s. gastroepiploica sinistra – descends along curvatura major of gaster
    - -> communicates with a. gastroomentalis dextra s. a. gastroepiploica dextra (from a. gastroduodenalis)
    - -> rr. gastrici supply gaster
    - -> rr. epiploici supply omentum majus
  3. a. hepatica communis
    - Runs to the liver and gives one side branch (a. gastrica dextra), and 2 terminal arteries (a. hepatica propria and a. gastroduodenalis)
  • a. gastrica dextra
  • passes along curvatura minor of gaster
  • communicates with a. gastrica sinistra (from truncus coeliacus)
  • rr. gastici supply gaster

Terminal branches:

    • a. hepatica propria
  • passes together with ductus choledochus and v. portae hepatis in lig. Hepatoduodenale
  • R. dexter et sinister supply hepar
  • R. dexter gives a. cystica to vesica biliaris

** a. gastroduodenalis
- divides to 2 branches:
> a. gastroomentalis dextra s. a. gastroepiploica dextra
o ascends along curvatura major of gaster
o communicates with a. gastroomentalis sinistra s. gastroepiploica sinistra (from a. splenica s. a. lienalis)
- rr. gastrici supply gaster
- rr. epiploici supply omentum majus

> a. pancreaticoduodenalis superiores
o lies between duodenum and caput pancreatis supplying them
o communicates with a. pancreaticoduodenalis inferior (from a. mesenterica superior)

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13
Q

A. mesenterica superior

A
  • Arises from aorta abdominalis at L1
  • Goes between caput pancreatis et pars ascendens duodeni
  • descends between the layers of radix mesenterii and terminates as a. ileocolica to supply caecum and terminal part of ileum
  • a. ileocolica gives of small branch:
    o a. appendicularis to appendix vermiformis
  • a. iliacus
  • a. colicus

Side branches of a. mesenterica superior:

  1. aa. jejunales et aa. Ileales
    - Supply jejunum and ileum
    - They run between the layers of the mesentery and there are numerous anastomotic arches between them (12-18)
  2. a. pancreaticoduodenalis inferior
    - goes upward and supplies duodenum and caput pancreatis
    - communicates with aa. pancreaticoduodenalis superiores (from a. gastroduodenalis)
  3. a. colica dextra – supplies colon ascendens
    - R. descendens
    - > Follow colon ascendens and makes anastomosis with a. iliocolica
    - R. ascendens
    - > Anastomosis with a. colica media
  4. a. colica media – supplies proximal 2/3 of colon transversum
    - R. dexter
    - -> Anastomosis with a. colica dextra
    - R. sinister
    - -> Anastomosis with a. colica sinistra : called ”anastomosis magna s. arcus marginalis coli”

Communication between branches of a. mesenterica superior et inferior is called arcus marginalis coli / anastomoses magna
» It is formed by r. sinister of a. colica media (a. mesenterica superior) and r. ascendens of a. colica sinistra (a. mesenterica inferior).

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14
Q

A. mesenterica inferior

A
  • arises from aorta abdominalis at L3
  • descends into the cavitas pelvis
  • terminates as a. rectalis superior, which supplies the upper third of rectum
  • gives 2 side branches:
  1. a. colica sinistra
    - supplies colon descendens and regio flexurae lienalis coli transversi
    * R. descendens
    - -> anastomosis with aa. Sigmoidee
    * R. ascendens
    - -> Anastomosis with r. sinister of a. colica media
    - Participates in formation of arcus marginalis coli
  2. aa. sigmoideae
    - run between layers of mesocolon sigmoideum and supplies colon sigmoideum
    - Aa. sigmoideae superiores have anastomosis with r. descendens from a. colica sinistra
    - Aa. sigmoideae inferiores have anastomosis with a. rectalis superior
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15
Q

a. suprarenalis media

A
x arise from aorta abdominalis at L1
x supplies glandula suprarenalis
x glandulae suprarenales recieve additionally blood supply from
o a. suprarenalis superior
 branch of a. phrenica inferior
o a. suprarenalis inferior
 branch of a. renalis
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16
Q

a. renalis

A
  • arises from aorta abdominalis at L2
  • supplies ren
  • rr. ureterici supply upper 1/3 of the ureter
  • gives a side branch:
    –> a. suprarenalis inferior
    supply glandula suprarenalis
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17
Q

a. testicularis

A
  • arises from aorta abdominalis at L2 or L3 and runs retroperitoneally on the posterior
    abdominal wall, crosses ureter
  • It passes through canalis inguinalis, is a component of funiculus spermaticus
  • supplies testis and epididymis
  • rr. ureterici supply the middle 1/3 of ureter
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18
Q

a. ovarica

A
  • arises from aorta abdominalis at L2 or L3 and runs retroperitoneally along the posterior abdominal wall, crosses ureter
  • goes laterally and crosses linea terminalis
  • In pelvis major artery goes within lig. suspensorium ovarii thus reaching hilum ovarii
  • anastomoses with r. ovaricus (from a. uterina) and supplies the ovary
  • Rr. ureterici supply the middle 1/3 of ureter
  • Rr. tubarii supply tuba uterina
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19
Q

aa. phrenicae inferiores

A
  • arises from aorta abdominalis at Th12
  • supplies the lower surface of the diaphragm
  • gives off aa. suprarenales superiores to glandula suprarenalis
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20
Q

aa. lumbales

A
  • 4 pairs: each artery gives off r. ventralis et dorsalis
  • R. ventalis supplies mm. abdominalis posteriores et laterales including the abdominal wall
  • R. dorsalis supply mm. profundi dorsi and cutis on the appointed region
    –> Gives off r. spinalis which goes through foramen intervertebrale entering canalis
    spinalis
    –> Supplying meninges and medulla spinalis
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21
Q

A. iliaca communis

A

Aorta abdominalis terminates at bifurcation aortae and divides into a. iliaca communis dextra et sinistra.

Topographia:
Holotopia
- region umbilicalis

Skeletotopia
- From L4 to art. sacroiliaca dx. et sin

Syntopia

  • A. iliaca communis dx. et sin. are only about 5 cm in long arteries
  • Run along medial border of m. psoas major
Anteriorly
- ureter
Laterally
- m. psoas major
Posteriorly
- V. iliaca communis

Terminal branches:

  • A. iliaca externa et interna
  • Gives off rr. ureterici for blood supply to pars distalis ureter
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22
Q

A. Iliacae Externaea

A

Topographia:
Skeletotopia
- From art. sacroiliaca a. iliaca externa descends to linea terminalis along medial border of m. psoas major
- Leaves pelvis by continueing to lacuna vasorum
- After leaving lacuna vasorum continues as a. femoralis

Syntopia
- proximally a. iliaca externa is facing v. iliaca externa anteriorly, but distally v. iliaca externa is laterally

  • Gives off two main side branches:
    1. A. epigastrica inferior
  • ascends obliquely between layers of vagina m. recti abdominis and supplies muscles of the anterior wall of the abdominal cavity
  • Runs within plica umbilicalis lateralis anastomosis with a. epigastrica superior
  • Supply anterior wall of mm. abdominalis

Gives off side branches:

a. r. pubicus
- -> Goes along ramus superior ossis pubis
- -> Anastomosis (”corona mortis”) with r. pubicus from a. obturatioria

b. A. cremasterica (male)
–> goes to canalis inguinalis
Supplies:
* m. cremasterica
* coverings of funiculus spermaticus

c. A. ligamenti teretis uteri
- -> Goes to canalis inguinalis
- -> Supplies lig. teres uteri

  1. A. circumflexa ilium profunda
    - passes along lig. inguinale et crista iliaca
    - communicates with r. iliacus from a. iliolumbalis
    - Supply mm. abdominalis and mm. cinguli membri inferioris
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23
Q

A. Iliacae Internae

A

Topographia
Skeletotopia
- From art. sacroiliaca descends down crossing linea terminalis and arriving to pelvis minor.
- Runs along paries lateralis pelvis minoris at the level of foramen ischiadicum major where branchers further.
- Side branches are divided into visceral (for organs) and parietal (for muscles) branches

Visceral branches:

  1. A. umbilicalis
  2. Aa. vesicalis inferiores - Supply fundus vesica urinaria, prostata (male), anterior wall of vagina (female)
  3. A. ductus deferentis / A. uterina
  4. A. rectalis media - Supply middle 1/3 of rectum
  5. A. pudenda interna

Parietal branches:

  1. A. iliolumbalis
  2. Aa. sacrales laterales
  3. A. obturaoria
  4. A. glutea superior
  5. A. glutea inferior
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24
Q

A. umbilicalis

A
  • Ascends along the anterior wall of cavitas abdominalis to anulus umbilicalis
  • A. umbilicalis runs prenatally in plica umbilicalis medialis

Side branches:

  1. Aa. vesicales superiores
  2. Supply apex et corpus vesica urinaria
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25
Q

A. ductus deferentis / A. uterina

A

Male:

  • Accompanies ductus deferens
  • Supply ductus deferens, vesiculae seminales and lower 1/3 of ureter

Female:

  • Runs along the lateral wall of cavitas pelvis
  • turns medially, passes along lig. cardinale uteri s. lig. transversum cervicis to cervix uteri
  • ascends along lateral side of uterus
  • Supply uterus

Gives off branches:

  1. r. tubarius – supply tubae uterinae
  2. r. ovaricus – directs to ovarium along lig. latum uteri, anastomoses with a. ovarica
  3. r. vaginales – supply vagina
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26
Q

A. pudenda interna

A
  • Leaves cavitas pelvis through foramen ischiadicum majus via foramen infrapiriforme
  • Terminates at organa genitalia externa and supply them
    o A. dorsalis penis
    o A. dorsalis clitoridis
    o A. profunda penis
    o A. profunda clitoridis
    o Rr. scrotales posteriors
    o Rr. labiales posteriors
  • side branches:
    1. A. rectalis inferior: supply lower 1/3 of rectum
    2. A. perinealis: supply muscles of the perineum
    Gives off:
    x Rr. scrotales posteriores
    x Rr. labiales posteriores
  1. A. urethralis: supply urethra
  2. A. bulbi penis / A. bulbi vestibule
    supply genitalia externa
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27
Q

A. iliolumbalis

A
  • Ascends and crosses linea terminalis in cavitas pelivis, enterns pelvis major
  • Supply muscles of the posterior and anterior wall of cavitas abdominalis

Gives off:

  1. R. ilicus
    - Anastomosis with a. circumflexa ilium profunda (from a. iliaca externa)
  2. R. lumbalis
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28
Q

Aa. sacrales laterales

A
  • Descends along facies pelvina ossis sacri

- Supply mm. cinguli membri inferioris and the perineum

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29
Q

A. obturaoria

A
  • Supply medial group of mm. membri inferioris liberi and m. obturatorius externus

Gives off:

  1. r. acetabularis
    - Runs as lig. capitis femoris inside art. coxae
    - Supply caput femoris
  2. r. pubicus
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30
Q

A. glutea superior

A
  • Leaves cavitas pelvis through foramen ischiadicum majus via foramen suprapiriforme
Supply:
o M. gluteus minimus
o M. gluteus medius
o M. tensor fasciae latae
o Art. Coxae
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31
Q

A. glutea inferior

A
  • Emerges through foramen ischiadicum majus via foramen infrapiriforme
Supply:
o M. gluteus maximus
o M. piriformis
o M. obturatorius internus
o Mm. gemelli (= m. gemellus superior et inferior)
o M. quadratus femoris
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32
Q

Venous system

A

The blood flow in veins is from the periphery to the center. Veins of the systemic circulation could be
divided into four systems due their fusion:

  1. veins of the heart, which terminate directly into the right atrium
  2. cava superior system joins the veins of the head, neck, upper limb and thorax, which terminate into v. cava superior
  3. cava inferior system joins the veins of the lower limb, abdomen and pelvis, which
    terminate into v. cava inferior
  4. portal system contains v. portae hepatis
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33
Q

V. brachiocephalica

A
  • drains the head, neck and upper limb
  • formed by union of v. jugularis interna and v. subclavia behind art. sternoclavicularis
  • 3 cm
  • commences at the level of art. sternoclavicularis dx.
    » descends straight downward to costae prima and joins the v. brachiocephalica sinister

V. brachiocephalica sinistra:

  • twice longer (about 6 cm long)
  • oblique course behind manubrium sterni.

crosses:

    • n. phrenicus sinister
    • n. vagus sinister
    • a. subclavia sinister
    • a. carotis communis sinister
    • trachea
    • truncus brachiocephalicus

tributaries:
1. V. thyroidea inferior

  1. V. vertebralis
  2. V. cervicalis profunda - starts from plexus venosus vertebralis externus and drains the occipital region
  3. Vv. thoracicae internae- drains the same parts of the body as artery supplies
  4. V. intercostalis suprema dextra et sinistra - drains the upper 1 – 2 spatium intercostale
  5. V. intercostalis superior sinistra - drains the upper 3 – 4 spatium intercostale of left side
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34
Q

V. thyroidea inferior

A
  • drains plexus thyreoideus impar, which lies in the lower part of glandula thyroidea
  • anastomoses with plexus thyroideus
  • plexus thyroideus impar drains the adjacent organs: larynx, trachea (the upper parts), oesophagus and thymus
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35
Q

V. cava superior

A
  • drains the upper part of the trunk above the diaphragm
  • formed by union of v. brachiocephalica dextra et sinistra behind synchondrosis costae primae dextra
  • lies in mediastinum superius
  • runs from cartilagines costae prima to cartilagines costae 3
  • Lower part is within the pericardium

Left
* aorta

right

  • pars mediastinalis pleurae parietalis
  • n. phrenicus
  • vasa pericardiacophrenica

posteriorly

  • bronchus principalis dexter
  • a. pulmonalis dexter
  • vv. pulmonales dexter

anteriorly
* thymus

  • It has only one tributary – vena azygos
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36
Q

V. azygos

A
  • upward continuation of v. lumbalis ascendens dx. from the abdominal cavity
  • passes through muscles of the diaphragm
  • ascends in mediastinum posterius to the right of the vertebral column
  • at the level of the T4 v. azygos arches forward above the root of the right lung to end in v. cava superior from behind
  • V. azygos has visceral and parietal tributaries

Visceral tributaries:

  1. Vv. oesophageales drain plexus venosus oesophageus
  2. Vv. bronchiales drain the bronchi, lungs and pleura
  3. Vv. pericardiacae drain the posterior side of pericardium
  4. Vv. mediastinales drain the lymphatic nodes of mediastinum

Parietal tributaries:

  1. Vv. phrenicae superiores drain the diaphragm
  2. Vv. intercostales posteriores dextrae drain 8 lower spatium intercostale on the right side
  3. V. intercostalis superior dextra drains 3 – 4 upper spatium intercostale on the right side
    - it is also an anastomotic tributary to v. brachiocephalica dextra
  4. V. hemiazygos
    - starts like v. azygos, but on the left side as v. lumbalis ascendens sin
    - At the level of the Th8 – Th9 it crosses columna verterbralis to join v. azygos
    - lies posteriorly to aorta, oesophagus and ductus thoracicus
  • has its own tributaries:
    a. vv. intercostales posteriores sinistrae:
  • drain 4 – 5 lower intercostal spaces
    b. v. hemiazygos accessoria:
  • formed by union of 6 – 7 vv. intercostales posteriores sinistra
  • into the upper direction – v. hemiazygos accessoria communicates with v. brachiocephalica sinistra or with v.
    intercostalis superior sinistra
  • into the lower – opens into v. hemiazygos
  • Vv. intercostales posteriores are the most important tributaries of v. azygos, v. hemiazygos et v. hemiazygos accessoria.
    –> They drain:
  • walls of the thoracic cavity
  • deep muscles of the back
  • plexus venosus vertebralis externus et internus
    –> Their anterior ends communicate with vv. intercostales anteriores (v. thoracica
    interna)
37
Q

V. iliaca interna

A
  • drains the walls and organs of the pelvic cavity
  • formed by fusion of visceral and parietal tributaries
    Visceral tributaries of v. iliaca interna:
    1. V. rectalis media
    2. Vv. Vesicales
    3. Vv. uterinae (for females)
    4. V. pudenda interna

There are group of veins, which originate from the different venous plexus of the pelvic cavity and drain the corresponding organs.

Venous plexus of the pelvic cavity for male:
o plexus venosus rectalis
o plexus venosus vesicalis
o plexus venosus prostaticus

Venous plexus of the pelvic cavity for female:
o plexus venosus rectalis
o plexus venosus vesicalis
o plexus venosus uterinus
o plexus venosus vaginalis
  • -> Plexus venosus rectalis lies in posterior and lateral walls of the rectum and it is drained into three directions:
    1. v. rectalis superior – drains the upper part of the plexus to v. mesenterica inferior’
    2. v. rectalis media dx. et sin. – drain the middle part of the plexus to v. iliaca interna
    3. v. rectalis inferior dx. et sin. – drain the lower part of the plexus via v. pudenda interna to v. iliaca interna

–> Plexus venosus vesicalis (male) is fused with plexus venosus prostaticus
o both together from the largest venous plexus in the pelvic cavity
o Plexus venosus vesicalis is at basis vesicae urinariae
o plexus venosus prostaticus is at the lateral and posterior parts of the prostata
o Plexus venosus prostaticus receives tributary – v. dorsalis profunda penis
- the biggest vein of the penis, lies between aa. dorsales penis
x drains glans penis et corpora cavernosa penis

o Plexus venosus prostaticus is drained to plexus venosus vesicalis via vv. vesicales to v. iliaca interna

–> Plexus venosus vesicalis (female) surrounds fundus vesicae and urethra feminina upper part
- it drains the urethra and the upper part of the vagina
o receives tributary – v. dorsalis clitoridis, which drains the clitor
o drained by vv. vesicales to v. iliaca interna

  • -> Plexus venosus uterinus et plexus venosus vaginalis are developed in the lateral and posterior parts of the uterus and vagina
  • drain also tuba uterina et lig. latum uteri
  • drained by vv. uterinae to v. iliaca interna
  • V. pudenda interna starts as v. profunda penis (male) or v. profunda clitoridis (female)
    o receives following tributaries, which drain the corresponding organs:
    v. bulbi penis (male)
    v. bulbi vestibuli (female)
    v. urethralis
    v. perinealis
    v. rectalis inferior

Parietal tributaries of v. iliaca interna:
1. V. iliolumbalis
o drains posterior wall of the abdominal cavity, the abdominal and pelvic muscles
2. Vv. sacrales laterales ascends along facies pelvica ossis sacri
o together with v. sacralis mediana forms plexus venosus sacralis
o drain abdominal muscles and pelvic lymphatic nodes
3. V. obturatoria drains the medial compartment of the muscles of the thigh
4. V. glutea superior drains m. gluteus medius et minimus, m. tensor fasciae latae
5. V. glutea inferior drains m. gluteus maximus

38
Q

V. iliaca externa

A
  • starts at lacuna vasorum as continuation of v. femoralis and drains the lower limb
  • ascends along linea terminalis and has tributaries:
    o V. epigastrica inferior starts at the region of the umbilicus and accompanies the
    corresponding artery
  • anastomoses with v. epigastrica superior (v. thoracica interna) and vv. paraumbilicales (v. portae)

o V. circumflexa ilium profunda runs along crista iliaca, drains the abdominal and pelvic
muscles in the region of crista iliaca

39
Q

V. iliaca communis

A
  • runs together with corresponding artery

- begins at the level of art. sacroiliaca by junction of v. iliaca externa and v. iliaca interna

40
Q

V. cava inferior

A
  • returns blood from all structures of the body below the diaphragm
  • It is about 14 cm long, 2 cm in diameter
  • starts at the level of the L5 by junction of v. iliaca communis dextra et sinistra
  • ascends anteriorly to columna vertebralis and to the right according aorta
  • It passes hepar and lies in sulcus venae cavae, runs through foramen venae cavae and in the thoracic cavity is covered by pericardium
  • opens into atrium dexter at the level of T8 – T9
Anteriorly
o hepar
o caput pancreatis
o pars horizontalis duodeni
o radix mesenterii
posteriorly
o pars lumbalis diaphragmatis
o m. psoas major dexter
o truncus sympathicus dexter
o a. renalis dexter
o aa. lumbales dexter

Visceral tributaries:
1. V. renalis dextra et sinistra
x V. renalis sinistra is longer and receives tributaries:
a. v. suprarenalis sinistra
drains glandula suprarenalis
b. v. testicularis sinistra (male) or v. ovarica sinistra (female)

  1. V. suprarenalis dextra
    x drains the glandula suprarenalis dexter
  2. V. testicularis dextra (for male) or v. ovarica dextra (for female)
    - they join v. cava inferior directly at the acute angle
    - V. testicularis or v. ovarica originates from the network of blood vessels
    – plexus pampiniformis
    o Plexus pampiniformis for male surrounds testis et epididymis and is content of funiculus spermaticus.
    –> The plexus continues till canalis inguinalis ostium internum and then transforms into the vein
    o Plexus pampiniformis for female surrounds ovarium, lies in mesovarium and continues as the vein in lig. suspensorium ovarii
    x V. testicularis sinistra or v. ovarica sinistra drains the corresponding organ and joins v. renalis sinistra at the right angle
  3. Vv. hepaticae (3 – 4)
    x short, lie in sulcus venae cavae and drain hepar

Parietal tributaries:

  1. Vv. phrenicae inferiores
    - drain inferior surface of the diaphragm
  2. Vv. Lumbales
    - 4 pairs and drain the posterior and lateral walls of the abdominal cavity and deep muscles of the back
    - vv. lumbales communicate with plexus venosus vertebralis externus et internus and v. lumbalis ascendens dextra et sinistra.
41
Q

Vena portae hepatis

A

Vena portae hepatis is additional part of v. cava inferior system. It returns blood from the unpaired abdominal organs:

  • gastrointestinal tract
  • gallbladder
  • pancreas
  • spleen

It does not drain the liver. It begins behind caput pancreatis in front of v. cava inferior at the level of L2 by junction of 3 roots:

v. splenica
v. mesenterica superior
v. mesenterica inferior

  • ascends behind pars superior duodeni in omentum minus, it lies in front of foramen omentale (foramen epiploicum) as content of lig. hepatoduodenale together with a. hepatica propria and ductus choledochus.
  • ends in porta hepatis by division into r. dexter et sinister, then they divide into smaller branches, end in sinusoids and form rete mirabile venosum.
  • V. portae and its tributaries together are
    called the portal system and it has some differences to compare with the caval systems:
    ** blood passes through two sets of capillaries
    o capillaries in the walls of the digestive organs
    o capillaries in the sinusoids of the liver
    ** blood contains different substances absorbed from digestive system
    o nutritions and toxins, insulin, destroid components of the blood cells from the spleen.
V. portae hepatis tributaries:
x v. cystica
x v. gastrica dextra
x v. gastrica sinistra
x v. prepylorica
x vv. Pancreaticoduodenales
x vv. Pancreaticae
x vv. paraumbilicales – from plexus surrounding the umbilicus
V. mesenterica superior tributaries:
x vv. jejunales et ileales
x v. colica dextra
x v. colica media
x v. ileocolica
x v. gastroomentalis dextra

V. splenica tributaries:
x v. gastroomentalis sinistra
x vv. gastricae breves
x vv. Pancreaticae

V. mesenterica inferior tributaries:
x v. colica sinistra
x vv. Sigmoideae
x v. rectalis superior

42
Q

Anastomoses of the great veins

A

The drainage areas of the great veins are not very strict. If there is an obstruction on one way of the blood flow, the blood may be returned by another way. Alternative pathways for venous drainage are
called anastomoses.

There are two groups of anastomoses:

  1. cava – caval anastomoses:
    a. plexus venosus umbilicalis
    (b. v. thoracoepigastrica)
    c. vv. lumbales
    (d. plexus venosus vertebralis internus et externus)
  2. porto – caval anastomoses – these anastomoses are important in case of portal obstruction. The return of blood through the liver to the right side of the heart in many reasons could become restricted. Among the reasons could be mentioned compression of the portal venules in the liver by fibrosis or by tumor and by trombosis of the portal vein itself. As a result of it the hydrostatic pressure in the regional veins of the portal system rises and the anastomotic veins could distend
    and become prominent as varicose veins. Then venous blood flow in the case of portal obstruction will bypass the liver via porto – caval anastomoses. Porto – caval anastomoses are:

a. plexus venosus oesophageus
i. distended veins of the lower part of the oesophageal plexus – oesophageal
varices – may rupture and produce an extreme severe bleeding

b. plexus venosus rectalis
i. distended veins in the rectum are known as hemorrhoids – however the
portal obstraction is rare cause of this common condition

c. plexus venosus umbilicalis
i. distended veins — varicosity of the paraumbilical veins radiating from the
umbilicus as the result of portal hypertension is known as a “caput
medusae” after a snake – like hair of the mythical gorgon Medusa

43
Q

plexus venosus umbilicalis - cava cava

A

2 pathways:
1. V. epigastrica superior > thoracica interna > brachiocephalica > cava superior

  1. v. epigastrica inferior > iliaca externa > iliaca communis > cava inferior
44
Q

v. thoracoepigastrica

A

2 pathways:

  1. v. axillaries > subclavian > brachiocephalica > cava superior
  2. V. circumflex ilium superficially > v. femoralis > v. iliaca externa > v. iliaca communis > cava inferior
45
Q

vv. lumbales

A
  1. v. lumbalis ascendes > v. azygos/hemiazygps > cava superior
  2. straight to cava inferior
46
Q

plexus venosus vertebralis internus et externus

A
  1. vv. intercostale posteriores > v. azygos, v. hemiazygos > cava superior
  2. vv. fumbles > cava inferior
47
Q

plexus venosus oesophageus

A
  1. Vv. oesophagei > v.azygos/hemiazygos > cava superior

2. Vv. gastric > v. portae

48
Q

plexus venosus rectalis

A

3 pathways:

  1. v. rectalis superior > mesenterica inferior > portae
  2. v. rectalis inferior > pudenda interna > iliaca interna > iliaca communis > cava inferior
  3. v. rectalis media > iliac interna > iliaca communis > cava inferior
49
Q

plexus venosus umbilicalis- porto cava

A

3 pathways :
1. vv. paraumbilicales > v. portae

  1. v. epigastrica superior > v. thoracica interna > v. brachiocephalica > cava superior
  2. v. epigastrica superficialis > v. femoralis > v. iliaca communis > cava inferior
50
Q

Diaphragma

A

Innervation:
- n. phrenicus – through centrum tendineum

blood supply

  • a. pericardiacophrenica from a. thoracic interna
  • aa. phrenicae inferior et superior
  • a. musculophrenica
  • vv. phrenicae superiores et inferiores
  • Foramen venae cavae – v. cava inferior
  • Hiatus oesophageus – plexus oesophageus –> truncus vaginalis anterior et posterior
  • Hiatus aorticus – aorta descendens, ductus thoracicus
  • Trigonum sternocostale – a., v. epigastrica superior
  • Crus mediale, crus intermedium – n. splanchnicus major, minor et imus, v. azygos et v. hemiazygos
  • Crus intermedium, crum laterale – truncus sympathicus
51
Q

Trachea

A

Pars thoracica

  • Innervation:
    rr. tracheales (n. vagus)
    rr. tracheales (truncus sympathicus)
  • Blood supply:
    aa. tracheales (arcus aortae)
    rr. bronchiales (a. thoracica interna)
    vv. tracheales (plexus venosus thyreoideus – vv. brachiocephalicae)
52
Q

Bronchi

A

Innervation:
rr. bronchiales (truncus sympathicus)
rr. bronchiales (n. vagus)
Together make plexus pulmonalis, which inervates bronchi.

Blood supply:

rr. bronchiales (aorta thoracica)
rr. bronchiales (a. thoracica interna)
rr. bronchiales (arcus aortae)
vv. bronchiales (v. azygos)

53
Q

Pulmones

A

Innervation:
rr. bronchiales (truncus sympathicus)
rr. bronchiales (n. vagus)
Together make plexus pulmonalis, which inervates pulmones, arbor bronchialis, arbor alveolaris.

Blood supply:

rr. bronchiales (aorta thoracica)
vv. bronchiales (a. azygos)

54
Q

Pleura

A

Pleura visceralis innervation and blood supply is the same as pulmones inervation and blood supply.

Pleura parietalis:
- Pleura costalis
Innervation:
nn. intercostales (nn. spinales thoracici anterior branches)

Blood supply:
a. intercostalis suprema (a. axillaris)
aa .intercostales post (aorta thoracica)
rr. intercostales ant (a. thoracica interna)
rr. intercostales ant (a. thoracica suprema)
vv. intercostales posteriores (v. azygos, v. hemiazygos, v. hemiazygos accessoria)
vv. intercostales ant (v. thoracica interna)

  • Pleura diaphragmatica
    Innervation:
    n. phrenicus (plexus cervicalis)
    Blood supply:
    aa. phrenicae superiores (aorta thoracica)
    a. pericardiacophranica (a. thoracica interna)
    a. musculophrenica (a. thoracica interna)
    vv. phrenicae sup (a. azygos)
    vv. pericardiacophrenicae (v. thoracica interna)
  • Pleura mediastinalis
    Innervation:
    n. phrenicus (plexus cervicalis)
    Blood supply:
    a. pericardiacophrenica (a. thoracica interna)
    rr. mediastinales (a. thoracica interna)
    vv. pericardiacophrenicae (v. thoracica interna)
55
Q

Oesophagus

A

Innervation:

Pars thoracica:

rr. oesophagei (plexus oesophageus – n.vagus)
rr. oesophagei (nn.mediastinales – rr.viscerales – truncus sympathicus thoracal part)

Pars abdominalis:
rr.oesophagei (plexus oesophageus – n.vagus)
plexus gastricus superior (plexus coeliacus)

Blood supply:

Pars thoracica:
rr.oesophagei (aorta thoracica)
plexus venosus oesophageus – vv.oesophageae – v.azygos – v.cava superior

Pars abdominalis:

a. gastrica sinistra (truncus coeliacus)
v. gastrica sinistra (v.porta)

56
Q

Ventriculus s. gaster

A

Innervation:
Plexus gastricus anterior n.vagi
Plexus gastricus posterior n.vagi
Plexus gastricus superior (plexus coeliacus)
Plexus gastricus inferior (plexus coeliacus)

Blood supply:

a. gastrica sinistra (truncus coeliacus)
a. gastrica dextra (a.hepatica communis)
aa. gastricae breves (a.lienalis)
a. gastroepiploica sinistra (a.lienalis)
a. gastroepiploica dextra (a.gastroduodenalis)
vv. gastricae (v.porta)
v. prepylorica (v.porta)
vv. gastricae breves (v.lieanlis – v.portae)
v. gastroepiploica sinistra (v.lienalis- v.porta)
v. gastroepiploica dextra (v.mesenterica sup – v.porta)

57
Q

Intestinum tenue

A

Innervation:
Duodenum
- Plexus hepaticus, Plexus mesentericus superior, Plexus gastricus inferior

Jejunum et ileum
- Plexus mesentericus superior (plexus coeliacus)

Blood supply:
Duodenum
- a.pancreaticoduodenalis superior (a.gastroduodenalis)
- a.pancreaticoduodenalis inferior (a.mesenterica superior)
- vv.pancreaticoduodenales (v.portae)

Jejunum et ileum

  • aa.jejunales et ilei (a.mesenterica superior)
  • vv.jejunales et ilei (v.mesenterica superior – v.portae)
58
Q

Intestinum crassum

A

Innervation:
Caecum, Appendix vermiformis, Colon ascendens, Colon transversum 2/3
- Plexus mesentericus superior (plexus coeliacus)

Colon transversum Last 1/3, Colon descendens, Colon sygmoideum,
– plexus mesentericus inferior (plexus intermesentericus)

Rectum upper 1/3
- Plexus rectalis superior (plexus mesentericus inferior – plexus intermesentericus)
Rectum mideal 1/3
- Plexus rectalis inferior (plexus hypogastricus inferior)
Rectum lower 1/3
- Plexus rectalis inferior (plexus hypogastricus inferior)
n.rectalis inferior (n. pudendus)

Blood supply

Caecum

  • a.iliocolica (a.mesenterica superior)
  • v.iliocolica (v.mesenterica superior – v.porta)

Appendix vermiformis

  • a.appendicularis (a.iliocolica)
  • v.appendicularis (v.iliocolica – v.mesenterica superior – v.porta)

Colon ascendens

  • A.colica dextra (a.mesenterica superior)
  • v.colica dextra ( v.mesenterica superior – v.portae)

Colon transversum

  • 2/3 – a.colica media (a.mesenterica superior)
  • v.colica media (v.mesenterica superior – v.portae)
  • Last 1/3 – a.colica sinistra (a.mesenterica inferior)
  • v.colica sinistra (v.mesenterica inferior – v.portae)

Colon descendens

  • a. colica sinistra (a.mesenterica inferior)
  • v.colica sinistra (v.mesenterica inferior – v.portae)

Colon sygmoideum

  • Aa.sygmoideae (a.mesenterica inferior)
  • Vv.sygmoideae (v.mesenterica inferior – v.portae)

Rectum upper 1/3

  • a.rectalis superior (a.mesenterica inferior)
  • plexus venosus rectalis (v.rectalis superior- v.mesenterica inferior – v.portae)

Rectum medial 1/3

  • a.rectalis media dextra et sinistra (a.iliaca interna)
  • plexus venosus rectalis (v.rectalis media – v.iliaca interna – v.iliaca communis – c.cava inferior)

Rectum lower 1/3

  • a.rectalis inferior dextra et sinistra (a.pudenda interna – a.iliaca interna)
  • plexus venosus rectalis (v.rectalis inferior – v.pudenda interna )
59
Q

Hepar

A

Innervation
rr.hepatici (n.vagus)
plexus hepaticus (plexus coeliacus)

Blood supply

a. hepatica propria (a.hepatica communis – truncus coeliacus)
vv. hepaticae (v.cava inferior)

60
Q

Vesica biliaris

A

Innervation:
rr.hepatici (n.vagus)
plexus hepaticus (plexus coeliacus)

Blood supply

a. cystica (a.hepatica propria – a.hepatica communis)
v. cystica (v.portae)

61
Q

Pancreas

A

Innervation
Plexus hepaticus (plexus coeliacus)
Plexus mesentericus superior (plexus coeliacus)
Plexus lienalis (plexus coeliacus)

Blood supply

a. pancreaticoduodenalis superior (a.gastroduodenalis)
a. pancreaticoduodenalis inferior (a.mesenterica superior)
rr. pancreatici (a.lienalis)
vv. pancreaticae (v.portae)
vv. pancreaticodiodenales (v.portae)

62
Q

Spleen

A
Innervation
Plexus lienalis (plexus coeliacus)

Blood supply

a. lienalis (truncus coeliacus)
v. lienalis (v.portae)

63
Q

Peritoneum

A

Lamina visceralis – inervation and blood supply the same as organs have

Lamina parietalis
Innervation
nn.phrenici
nn.intercostales
nn.iliohypogastrici
nn.ilioinguinales

Blood supply

aa. et vv. phrenicae inferiores
aa. et vv. musculophrenicae
aa. et vv. epigastricae superiores
aa. et vv. epigastricae inferiores
aa. et vv. lumbales
aa. et vv. circumflexae ilium profundae
aa. et vv. iliolumbales

64
Q

Ren

A

Innervation
rr.renales n.vagi (plexus gastricus posterior)
plexus renalis (plexus coeliacus)

Blood supply

a. renalis (aorta abdominalis)
v. renalis (v.cava inferior)

65
Q

Ureter

A

Upper 1/3
Innervation
Plexus renalis (plexus coeliacus)

Blood supply

rr. ureterici (a.renalis)
vv. uretericae (v.renalis – v.cava inferior)

Medial 1/3
Innervation
Female plexus ovaricus (plexus coeliacus)
Male Plexus testicularis (plexus coeliacus)

Blood supply
Female
vv.uretericae – v.ovarica dx – v.cava inferior
vv.uretericae – v.ovarica sin – v.renalis sin – v.cava inferior
Male
vv.uretericae – v.testicularis dx – v.cava inferior
vv.uretericae – v.testicularis sin – v.renalis sin – v.cava inferior

Lower 1/3
Innervation
Plexus uretericus (plexus hypogastricus inferior)

Blood supply

rr. ureterici (a.uterina female or a.ductus deferentis male)
vv. uretericae (vv.vesicales – v.iliaca interna – v.iliaca communis – v.cava inferior)

66
Q

Vesica urinaria

A
Innervation
Plexus vesicalis (plexus hypogastricus inferior)

Blood supply
aa.vesicales superiores (a.umbilicalis)
aa.vesicales inferiores (a.iliaca interna)
Plexus venosus vesicalis (vv.vesicales – v.iliaca interna – v.iliaca communis – v.cava inferior)

67
Q

Urethra masculina

A
Innervation
Plexus urethralis (plexus hypogastricus inferior)
Blood supply
Pars prostatica
Branches from a.rectalis media (a.iliaca interna)
Branches from aa.vesicales inferiores (a.iliaca interna)
Pars membranacea
a.urethralis (a.pudenda interna)
Pars spongiosa
a.urethralis (a.pudenda interna)
a.bulbi penis (a.pudenda interna)

V.urethralis; v.dorsalis penis; v.profunda penis – all from v.pudenda interna – v iliaca interna –
v.iliaca communis – v.cava inferior

68
Q

Urethra feminina

A
Innervation
Plexus urethralis (plexus hypogastricus inferior)

Blood supply

a. urethralis (a.pudenda interna)
v. urethralis (v.pudenda interna – v.iliaca interna)

69
Q

Testis and epididymidis

A
Innervation
Plexus testicularis (plexus coeliacus)
Blood supply
a.testicularis (aorta abdominalis)
a.ductus deferentis (a.iliaca interna)
Plexus venosus pampiniformis -> v.testicularis (dx -> v.cava inferior; sin – v.renalis sin – v.cava
inferior)
70
Q

Ductus deferens

A
Innervation
Plexus deferentialis (plexus hypogastricus inferior)

Blood supply
a.ductus deferentis (a.iliaca interna)
vv.ductus deferentis (plexus venosus vesicalis – vv.vesicales – v.iliaca interna – v.iliaca
communis – v.cava inferior)

71
Q

Vesicula seminalis

A
Innervation
Plexus deferentialis (plexus hypogastricus inferior)

Blood supply
a.ductus deferentis (a.iliaca interna)
aa.vesicales inferiores (a.iliaca interna)
vv.ductus deferentis (plexus venosus vesicalis – vv.vesicales – v.iliaca interna – v.iliaca
communis – v.cava inferior)

72
Q

Prostata

A
Innervation
Plexus prostaticus (plexus hypogastricus inferior)
Blood supply
rr.prostatici (a.rectalis media)
rr.prostatici (aa.vesicales inferiores)
Plexus prostaticus (plexus venosus vesicalis – vv.vesicales – v.iliaca interna – v.iliaca communis
– v.cava inferior)
73
Q

Glandula bulbourethralis

A

Innervation
Plexus hypogastricus inferior

Blood supply

a. bulbi penis (a.pudenda interna)
vv. bulbi penis (v.pudenda interna – v.iliaca interna – v.iliaca communis – v.cava inferior)

74
Q

Penis

A
Skin, fascia
Innervation
n.dorsalis penis (n.pudendus)
Blood supply
a.dorsalis penis (a.pudenda interna)
aa.pudendae externae branches
v.dorsalis penis superficialis (vv.pudendae externae – v.saphena magna – v.iliaca
externa)
Corpora cavernosa and spongiosa
Innervation
nn.cavernosi penis (plexus hypogastricus inferior)
Blood supply
a.dorsalis penis (a.pudenda interna)
a.profunda penis (a.pudenda interna)
a.bulbi penis (a.pudenda interna)
v.dorsalis penis, v.profunda penis and v.bulbi penis (plexus venosus prostaticus –
v.pudenda interna)

M. ischiocavernosus and m. bulbospongiosus
Innervation
nn.perineales (n.pudendus)
Blood supply
a.perinealis (a.pudenda interna)
v.perinealis (v.pudenda interna – v.iliaca interna)

75
Q

Scrotum

A

Innervation

nn. scrotales anteriores (n.ilioinguinalis)
nn. scrotales posteriores (n.pudendus)

Blood supply

rr. scrotales anteriores (aa.pudendae externae)
rr. scrotales posteriores (a.perinealis – a.pudenda interna)
vv. scrotales posteriores (v.perinealis- v.pudenda interna )

76
Q

Ovarium

A
Innervation
Plexus ovaricus (plexus coeliacus)

Blood supply
a.ovarica (aorta abdominalis)
r.ovaricus (a.uterina)
plexus venosus pampiniformis (v.ovarica dx – v.cava inferior; v.ovarica sin – v.renalis sin – v.cava inferior)

77
Q

Tuba uterina

A
Innervation
Plexus uterovaginalis (plexus hypogastricus inferior)

Blood supply
r.tubarius (a.ovarica – aorta abdominalis)
r.tubarius (a.uterina)
Plexus venosus pampiniformis (v.ovarica dx – v.cava inferior; v.ovarica sin – v.renalis sin)

78
Q

Uterus

A
Innervation
Plexus uterovaginalis (plexus hypogastricus inferior)

Blood supply
a.uterina (a.iliaca interna)
Plexus venosus uterinus et vaginalis
vv. uterinae superiores (plexus venosus pampiniformis – v.ovarica dx. – v.cava inferior or v.ovarica sin – v.renalis sin)
vv. uterinae mediae (v.iliaca interna)
vv. uterinae inferiores (v.pudenda interna – v.iliaca interna)

79
Q

Vagina

A
Innervation
Plexus uterovaginalis (plexus hypogastricus inferior)

Blood supply
a.vaginalis (a.uterina)
aa.vesicales inferiores (a. iliaca interna)
Branches from a.pudenda interna
Plexus venosus vaginalis (vv.vaginales – v.iliaca interna)

80
Q

Labia majora pudendi, labia minora pudendi, vestibulum vaginae

A

Blood supply

rr. labiales anteriores (aa.pudendae externae)
rr. labiales posteriores (a.perinealis –a.pudenda interna)
vv. labiales posteriores (v.perinealis – v.pudenda interna)

81
Q

Glandulae vestibulares majores

A

Innervation
Plexus bulbi vestibuli (plexus hypogastricus inferior)

Blood supply

a. bulbi vestibuli (a.pudenda interna)
vv. bulbi vestibuli (v.pudenda interna – v.iliaca interna))

82
Q

Bulbus vestibuli

A

Innervation
Plexus bulbi vestibuli (plexus hypogastricus inferior)

Blood supply

a. bulbi vestibuli (a.pudenda interna)
vv. bulbi vestibuli (v.pudenda interna – v.iliaca interna )

83
Q

Clitoris

A

Innervation
Skin n.dorsalis clitoridis (n.pudendus)
Corpora cavernosa nn.cavernosi clitoridis (plexus hypogastricus inferior)

Blood supply

a. dorsalis clitoridis (a.pudenda interna)
a. profunda clitoridis (a.pudenda interna)
v. dorsalis clitoridis (v.pudenda interna – v.iliaca interna)
v. profunda clitoridis (v.pudenda interna – v.iliaca interna)

84
Q

Mediastinum ; its lymph nodes

A
  • It connects with neck region through apertura thoracis superior. Connected to spatium Interfaciale pretracheale et prevertebrale

sternum - anteriorly
pars thoracica columna vertebralis - posteriorly
pleura parietalis pars mediastinalis - laterally
diaphragm - inferiorly

  • two parts: mediastinum superius et inferius. –> an imaginary plane from T4 to angulus sternum
  • -> inferius has 3 parts: mediastinum anterius, medium et posterius.

Nodi lymphoidei:

  1. parasternales
  2. intercostales
  3. diaphragmatici superiores
  4. mediastinales posteriores
  5. bronchopulmonales
  6. tracheobronchiales superiores et inferiores
85
Q

Mediastinum posterius

A

between pericardium and columna vertebralis

organs
o Oesophagus

nerves
o n. vagus (plexus oesophagealis)
o truncus sympathicus dx. et sin.
o nn. splanchnici
o truncus vaginalis anterior et
posterior

blood vessels
o aorta thoracica with branches
o v. azygos et v. hemiazygos
o v. Hemiazygos accessoria

lymphatics
o ductus thoracicus
o nodi lymphoidei mediastinales

86
Q

Mediastinum medium

A
o cor et pericardium
o n. Phrenicus dx. et sin.
o aorta ascendens
o truncus pulmonalis
o final part of v. cava superior et inferior
o v. azygos
o vv. pulmonales
o a.,v. pericardiacophrenica (a,v. thoracica interna)
o nodi lymphatici mediastinales
87
Q

Mediastinum anterius

A
  • between sternum and pericardium.
  • Mostly loose connective tissue.

o thymus
o a., v. thoracica interna (a.,v. subclavia)
o lig. sternopericardiacum dx.et sin
o nodi lymphatici

88
Q

Mediastinum superius

A

Retrosternal structures:
o Thymus
o v. brachiocehalica dx. et sin.
o v. cava superior

Prevertebral structures:
o Trachea
o Oesophagus
o n. laryngeus recurrens sin.
o ductus thoracicus
o nodi lymphoidei tracheobronchiales
Medial structures
o arcus aortae with branches
o lig. arteriosum (ductus arteriosus)
o n. phrenicus dx. et sin. (in front of radix pulmonis)
o n. vagus dx. et sin. (behind of radix pulmonis)
o aorta thoracica with branches
o v. Azygos
o truncus sympathicus dx. et sin.
o nn. splanchnici