Навчальний посібник рекомендований для студентів медичних
жүктеу/скачать 2,76 Mb. Pdf көрінісі
|
Korenkov Topographic Anatomy (1)
part of trachea. The vena brachiocephalica sinistra, n. phrenicus and n. vagus sinister are located in front of aortic arch. Mediastinal pleura adheres to the left lateral surface, and v. cava superior is located on the right. There are trachea, esophagus and ductus thoracicus behind the aortic arch. There is n. laryngeus recurrens sinister below and behind the aortic arch. Truncus brachiocephalicus, a. carotis communis sinistra, a. subclavia sinistra originate from the bulging part of aorta from right to left. The truncus brachiocephalicus goes in front and outside from the trachea, then goes up and rightward attaching to the vena brachiocephalica sinistra behind. On the level of articulatio sternoclavicularis it gives off a. subclavia dextra and a. carotis communis dextra. A. carotis communis sinistra begins on the left and deeper from truncus brachiocephalicus. It goes up and outside crossing trachea in front and from the left. A. subclavia sinistra goes on the left from trachea. Nonspecific aortoarteritis, the aortic arch syndrome (Takayasu’s syndrome) is characterired by inflammational and destructive changes of aortic wall and large vessels which depart from it, their constriction and thrombosis. The syndrome manifests as chronic cerebral and upper limbs ischaemia. 38 PERICARDIUM Pericardium is an isolated sack with heart and large blood vessels in it. It consists of two layers: superficial fibrous pericardium (pericardium fibrosum) and inner serous pericardium (pericardium serosum). The pericardium fibrosum passes into vascular layer. The pericardium serosum is divided into two layers: visceral pericardium (lamina visceralis) which is the part of epicardium and covers myocardium, and parietal pericardium (lamina parietalis) which grows together with internal surface of pericardium fibrosum and covers it from inside. Cavitas pericardiaca is formed between lamina visceralis and lamina parietalis which contains a small amount of serous fluid. In tuberculosis, rheumatism or injury the amount of fluid (pericardial effusion) in pericardial cavity can increase. Herewith diastole is getting worse, the heart beat is disturbed what results in cardiac tamponade. The pericardium looks like ill-formed, flattened cone, the basis of which is located on diaphragm, and its top – on ascending part of aorta. Pericardium has five walls: anterior (sternocostal), two lateral (mediastinal), posterior and diaphragmal. Sternocostal part of pericardium is directed to the front, adheres to corpus sterni and to the 4th and 5th intercostal spaces. In lateral segments and sometimes from above, the frontal pericardial wall is covered by mediastinal edges of parietal (right and left) pleuras. Free part of pericardium complies with left ribs ends from the 5th to the 7th rib cartilages, left inferior 1/3 of corpus sterni and upper 1/3 of ensisternum. The pericardium can be exposed here without danger of possible pleura damage. It is called “security 39 triangle” of Wojnicz – Sianożęcki. The lig. sternopericardiaca go from the frontal part of pericardium to sternum, and are attached to sternum at the level of the 2nd rib. Lateral parts of pericardium are covered by mediastinal pleuras, in adipose tissue of which n. phrenicus and vasa pericardiacophrenicae are located. The inferior wall of pericardium is located on diaphragm and is fixed with ligaments to it. V. cava inferior penetrates into pericardial cavity through the right segment of inferior wall. Dorsal wall of pericardium adheres to the inferior part of trachea and organs of mediastinum posterius – esophagus, v. azygos, ductus thoracicus, thoracic part of aorta, n. vagus sinistra, and lymph nodes of mediastinum posterius. The aa. and vv. pulmonales go through the dorsal wall of pericardium, and aorta and v. cava superior pass from above. The parietal lamina of pericardium serosum passes into visceral lamina (epicardium). In the area of arterial and venous transition zones the recessus of pericardium are formed. Besides them we can distinguish more significant gaps – pericardial sinuses. We can recognize sinus transversus pericardii and sinus obliquus pericardii. жүктеу/скачать 2,76 Mb. Достарыңызбен бөлісу:
|