Parietal branches aa. intercostales post. (VAN) a. subcostalis a. phrenica sup. • Visceral branches: rr. bronchiales rr. oesophagei rr. pericardiaci AORTA THORACICA AORTA ABDOMINALIS Parietal branches a. phrenica inf. (a. suprarenalis sup.) 4 aa. lumbales a. sacralis mediana (a. lumbalis ima, rr. sacrales) Visceral branches - paired a. suprarenalis media a. renalis r. uretericus a. suprarenalis inf. rr. praepelvici r. retropelvicus a. testicularis (a. ovarica) rr. ureterici (r. tubarius) AORTA ABDOMINALIS AORTA ABDOMINALIS Visceral branches – unpaired truncus coeliacus Th12 a. mesenterica sup. L1 a. mesenterica inf. L3 TRUNCUS COELIACUS a. gastrica sin. a. hepatica communis a. hepatica propria a. gastrica dx. r. dexter (a. cystica) r. sinister a. gastroduodenalis a. gastroepiploica dx. a. pancreaticoduodenalis. sup. a. lienalis rr. pancreatici a. gastroepiploica sin. aa. gastricae breves rr. lienales ARTERIA LIENALIS ARTERIA MESENTERICA SUP. a. pancreaticoduodenalis inf. aa. jejunales et ilei (10-18) a. ileocolica a. colica dx. a. colica media a.colica sinistra b. aa. sigmoideae a. rectalis sup. • anastomosis magna (Halleri) ARTERIA MESENTERICA INFERIOR ARTERIA ILIACA COMMUNIS (bifurcatio aortae L4) A. iliaca externa A. iliaca interna Parietal branches a. Iliolumbalis a. sacralis lat. a. obturatoria (r. pubicus - corona mortis) a. glutaea sup. a. glutaea inf. a. pudenda interna ARTERIA ILIACA INTERNA a. rectalis inf. a. perinealis – rr. scrotales post. (rr.labiales post.) a. penis (a. clitoridis) a. profunda penis (clitoridis) a. dorsalis penis (clitoridis) ARTERIA PUDENDA INTERNA Scan0005 Visceral branches aa. vesicales sup. (a. umbilicalis) a. vesicalis inf. a. rectalis media ♂ a. ductus deferentis ♀ a. uterina ARTERIA ILIACA INTERNA křížení urteru a a ARTERIA UTERINA r. uretericus a. vaginalis ant. et post. rr. uterini r. tubarius r. ovaricus a. epigastrica inf. r. pubicus (corona mortis) a. cremasterica (a. ligamenti teretis) a. circumflexa ilium profunda ARTERIA ILIACA EXTERNA ARTERIES OF THE LOWER EXTREMITY a. femoralis (lacuna vasorum, trigonum femorale, canalis adductorius, hiatus tendineus) a. poplitea (fossa poplitea) a. tibialis anterior (a. dorsalis pedis) a. tibialis posterior (malleolus medialis, a. plantaris medialis, a. plantaris lateralis) A. femoralis LACUNA VASORUM FOSSA POPLITEA FOSSA ILIOPECTINEA CANALIS ADDUCTORIUS ARTERIA FEMORALIS A. epigastrica spf. A. circumflexa ilium spf. Aa. pudendae ext. A. profunda femoris Rr. musculares A. genus descendens A. circumflexa femoris medialis (r. superficialis et profundus) A. circumflexa femoris lat. (r. ascendens et descendens) A. perforans prima (a. nutritia femoris sup.) A. perforans secunda A. perforans tertia (a. nutritia femoris inf.) ARTERIA PROFUNDA FEMORIS 795 A. suralis medialis et lateralis A. genus superior medialis et lateralis A. genus media A. genus inferior medialis et lateralis A. tibialis ant. A. tibialis post. ARTERIA POPLITEA Passes through membrana interossea cruris Between m. tibialis ant. and m. extensor digitorum longus Distally between m. tibialis ant. and m.extensor hallucis longus A. tibialis anterior A. recurrens tibialis post. A. recurrens tibialis ant. Rr. musculares A. malleolaris ant. med. et lat. A. dorsalis pedis ARTERIA TIBIALIS ANTERIOR Aa. tarseae med. A. tarsea lat. (a. digitalis dorsalis V.) A. arcuata (3 aa. metatarseae dorsales, aa. digitales dorsales) R. plantaris prof. A. metatarsea dorsalis prima - aa. digitales dorsales ARTERIA DORSALIS PEDIS sejmout0030 795 tumblr_m9xebnSasx1rav4bho1_500 under arcus tendineus m. solei On the deep group of flexors Behind medial ankle into planta pedis A.tibialis posterior R. circumflexus fibulae A. peronea (fibularis) Rr. musculares A. nutritia tibiae Rr. malleolares med. Rr. calcanei med. A. plantaris lat. A. plantaris med. ARTERIA TIBIALIS POSTERIOR arcus plantaris (4 aa. metatarseae plantares, aa. digitales plantares) A.PLANTARIS LATERALIS ARTERIA PLANTARIS MEDIALIS ramus superficialis et profundus Veins v. cava superior v. cava inferior 3 Is created by venae brachiocephalicae in the level of the 1st sternocostal right joint Behind the 3rd sternocostal joint is opened into the right atrium Descens caudally in the superior mediastinum VENA CAVA SUPERIOR • • VENA BRACHIOCEPHALICA Is created by the confluens vena jugularis interna and vena subclavia behind articulatio sternoclavicularis (angulus venosus). On both sides open the big lymphatic ducts here (on the left ductus thoracicus, on the right ductus lymphaticus dexter). m028 1) Collateral tributaries from thyroid gland Vena vertebralis Vena thoracica interna Veins from mediastinum 2) Main tributaries Vena jugularis interna Vena subclavia VENA JUGULARIS INTERNA Brings the blood from basis cranii interna, facial part of the head and neck zily_sinusduraematris_PRACOVNIVERZE Intracranial tributaries Extracranial tributaries Intracranial tributaries venae cerebri venae emissariae venae diploicae venae ophtalmicae zily_sinusduraematris_PRACOVNIVERZE Extracranial tributaries Vena facialis Vena lingualis Vena retromandibularis is created by confluens vena temporalis superficialis and vena maxillaris plexus pterygoideus zily_oblicej_hloubka vena jugularis externa vena jugularis anterior VENA SUBCLAVIA It is continuation of vena axillaris, the border is the first rib, Has only little tributaries and is located in front of the fissura scalenorum!!! Flows into v. brachiocephalica (angulus venosus) It is the continuation at the level of the attachement of musculus pectoralis major (collum chirurgicum humeri) of paired vena brachialis Has a lot of collateral tributaries: Venae thoracoepigastricae Vena cephalica (in sulcus bicipitalis lateralis and in trigonum deltoideopectorale) VENA AXILLARIS VENA JUGULARIS INTERNA image575 Two venous systems– deep and superficial 1) Deep veins: Are paired Are located along arteries Are named accoarding these arteries VENAE MEMBRI SUPERIORIS 2) Superficial veins: (rete venosum dorsale et palmare manus) Vena basilica from rete venosum dorsale manus as vena salvatella Vena cephalica On the thumb side rete venosum dorsale manus as vena cephalica pollicis zily_hk_prehled vena cephalica On the radial side into vena axillaris vena basilica On the ulnar side into vena brachialis V oblasti loketní jamky jsou spojeny pomocí vena mediana cubiti v. cava inferior v. iliaca comm. sin. v. iliaca comm. dx. v. iliaca ext. v. iliaca int. pelvis abdomen L4-5 VENA CAVA INFERIOR vena-cava-inferior Gray505 It is opened into the right atrium Is created on the right side of L4 by vena iliaca communis dextra et sinistra a) Parietal tributaries Venae iliacae communes From the abdominal wall From the diaphragma b) Visceral tributaries From testes(ovaries) From kidneys and suprarenal glands Venae hepaticae vena-cava-inferior hepar+inferior •VENAE ILIACAE COMMUNES •SINISTRA ET DEXTRA • • • external_iliac_vein1343164872649 Is created in front of the left and right articulatio sacroiliaca by confluence vena iliaca interna and vena iliaca externa Vena iliaca interna Is created from the venous plexuses of the lesser pelvis over foramen ischiadicum majus a) Parietal tributaries From the pelvic wall b) Visceral tributaries Venous plexuses around the organs in the lesser pelvis external_iliac_vein1343164872649 Vena iliaca externa Is the continuation of vena femoralis Starts under the medial part of ligamentum inguinale in lacuna vasorum VENAE MEMBRI INFERIORIS •Two systems – deep and superficial veins •Both systems are connected through • • • • • • •Deep veins •Accompany same named arteries, •Are paired. •The biggest one is vena femoralis, •Its continuation in the pelvis is •vena iliaca externa vv.perforantes http://1.bp.blogspot.com/_nX5mPZfZaZ4/TIzTwnbQAPI/AAAAAAAAPCA/0zNX8hUUAMI/s1600/varices.jpg https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcQnYmEQQDbiiPzqnGq0U7PGHhMxmWqp_VReFlwpjqzppUp -Eepc Varices Povrchové (podkožní) žíly dolní končetiny Vena saphena parva Behind the lateral ankle It is the tributary of vena poplitea Vena saphena magna In front of the medial ankle It is the tributary of vena femoralis rete venosum plantare et dorsale pedis VENA PORTAE •Function portal circulation •Blood flows from the unpaired organs of the abdominal cavity into the liver •Confluence of vena mesenterica superior and vena lienalis behind caput pancreatis at the level of the body of L2 • • Tributaries: a) main tributaries Vena mesenterica superior Vena lienalis vena mesenterica inferior b) Other tributaries From the gaster and esophagus Venae paraumbilicales •Small connections between •vena portae and venae cavae sup. et inf., • •They are important during the pathological states when is the higher blood pressure in the vena •portae , they are wider and serve for blood flow from vena •portae into caval veins • • obr010 Portocaval anastomoses Between the esophagus and stomach Connections around the umbilicus ( „caput Medusae“) Connections around rectum https://www.youtube.com/watch?v=24slqqkwOFg Cavocaval anastomoses • • Vena cava superior and inferior are connected with the special venous systems, which are along the vertebral column. These veins receive the blood from the retroperitoneum, posterior abdominal wall, intercostal spaces, vertebral column and posterior mediastinum. They have imperfectly developed valves – blood can flows in both directions 1. Vena azygos (vena hemiazygos) - into vena cava superior 2. Plexus venosi vertebrales v. hemiazygos accessoria v. lumbalis asc. dx. vv. lumbales v. subcostalis dx. v. azygos v. hemiazygos Th 4 Th 7-9 Fetal circulation •V.umbilicalis – its a tributary of v.portae and through •ductus venosus of v.cava •inferior •Aa.umbicales – branches of a.illiaca interna •Foramen ovale •Ductus arteriosus • •Maternal blood and blood of the foetus do not mix!!!! zily_fetalniobeh https://www.youtube.com/watch?v=75fj1eoUZco Lymphatic system • • ■ lympha 1,5-2l/day ■ lymphatic vessels (vasa lymphatica) ■ lymphatic nodes (nodi lymphatici) ■ lymphatic organs tonsillae lien thymus capillaries (vasa lymphocapillaria) Lymphatic net (rete lymphocapillare) collector vessels(collectores lymphatici) trunks (trunci lymphatici) folliculi lymphatici - jsou ve slizničním vazivu např. v trávicí trubici, HCD, močových cestách. Nejdou to stálé útvary mohou se přestavovat. Jsou jednotlivé nebo seskupené ve větší útvary. Stavba podobná jako uzlíky v mízní uzlině – obsahují retikulum s makrofágy a lymfocyty. Mají cévní zásobení a obsahují mízní kapiláry, ze kterých míza odtéká do okolních mízních cév orgánu. Funkce 1) je obdobná jako v kůře mízních uzlin (vychytávání antigenů makrofágy a reakce B a T lymfocytů) 2) účinkují i v lokální obraně – lymfocyty uzlíků reagují na antigeny na sliznici a protilátky produkované v imunitní reakci přechází na povrch sliznice. Tonsily – imunologická bariéra kontrolující polykanou potravu a vdechovaný vzduch. Slezina – plní funkce jak v krevním oběhu, tak i v lymfatickém systému a obraně organismu. Thymus – jeho funkcí je 1) diferenciace lymfocytů v imunokompetentní T-lymfocyty a udržování potřebného počtu těchto lymfocytů v krevní cirkulaci a v příslušných na thymu závislých okrscích periferních lymf. tkání a orgánů. T-lymf. jsou schopné reagovat na antigenní stimuly buď přímo, nebo ovlivněním B-lymf a makrofágů. V období kolem narození a brzy po narození je thymus nezbytný pro normální vývoj lymfatických tkání v orgánech a mízních uzlinách. Jeho ztráta v tomto období vede k neschopnosti reakcí buněčné imunity. 2) kontrola lymfopoesy v thymu i dalších lymf. orgánech (proliferace, diferenciace) Diferenciací v thymu získávají T-lymf. schopnost rozpoznat mezi tělu vlastními a tělu cizímu bb¨, dále schopnost zabíjet bb, ovlivňovat B-lymf …… Lymphatic system Starts on periphery Directs only centripetally V organismu - okolo in the body - 450 lymphatic nodes Serves for the transport of water and metabolities from the tissues back to the blood System - superficial - deep Function – drainage-transport - immunological Lymph vessels •Starts blindly on the periphery •Thinner wall than veins •More valves •Lymph nodes • • •Vasa lymfocapilaria •Rete lymfocapilare •Vasa lymfatica •Truncus lymfaticus • • Tissues without lymphatic system: Hair, nails, epidermis, cornea, corpus vitreum, lens, cartilages, nerve tissue, bone marrow nodi lymphatici • •hilus •cortex •medulla •Convex part- „afferent““ •– vasa afferentia •Concave hilus- „eferent“ •– vas efferens • • •inflammation – swelling with pain •tumor – swelling without pain • • obr 9-3 Funkce uzliny • • a) production of lymphocytes, • b) filtration of lympha, • c) through production of T and B lymphocytes nodes protect body lymfografie Pánevní lymfografie Limph1 When the lympha can´t flow is created lymphedema( Elefantiasis 17elefant •2 ducts: •(irregular division of the body) • •ductus thoracicus –pars abdominalis –pars thoracia –pars cervicalis –(sinister) –¾ of the body •ductus lymphaticus dx. • ¼ of the body • • •cisterna chyli • miza_kmeny tr. subclavius sin. tr. intestinalis tr.lumbalis dx. tr. jugularis sin. tr. bronchomediast. sin. tr. lumbalis sin. ductus thoracicus L1-2 tr. jugularis dx. tr. subclavius dx. tr. bronchomediast. dx. ductus lymphaticus dx. Lymphatic nodes of the head •N. l. parotidei •N.l. retroauriculares •N.l. occipitales •N.l. submandibulares •N.l. submentales • N.l. cervicales profundi et superficiales Mízní uzliny hlavy lymfa-2 nodi lymphatici retropharyngei •Lymphatic nodes of the neck • •n.l. cervicales –anteriores –laterales: – •n.l.cervicales superficiales •- along v.jugularis externa • • •n.l.cervicales profundi •along v. jugularis int. • (Woodova uzlina) •along n. accessorius •Along a.transversa colli (supraclavicular) miza_hlavakrk miza_axilla nodi lymphatici centrales laterales subscapulares pectorales (Sorgius) interpectorales apicales (infraclaviculares) 40 nodes 6 groups Nodi axillares L09 lymfa prsu plexus areolaris plexus subareolaris, plexus circumareolaris Mammary lymphatic drainage Several directions: -nodi lymph. axillares -nodi parasternales -nodi supraclaviculares Epigastric pathway Intercostal pathway Mízní uzliny hrudní n.l.mediastinales anteriores et posteriores (heart, perikardium, lungs, esophagus, diaphragma, hepar) n.l.parasternales (thoracic wall, diaphragma, abdominal wall) (intercostal spaces, spinal canal) n.l.intercostales Lymphatic nodes of the thorax Bronchomediastinal trunck, thoracic duct (right lymph duct) Lungs All lymph flows to the right– truncus bronchomediastinalis dx. (ductus lymphaticus dexter) To the left side only superior lobe of the left lung Nodi iliaci ext. (urinary bladder, penis, clitoris, wall of the pelvis) Nodi iliaci int. (wall of pelvis, organs- parauterini, paravesicales,pararectales) Nodi iliaci sacrales (rectum, prostate, cervix uteri, fornix vaginae) Nodi lumbales (abdominal wall, paired abdominal organs, ovary, testes) Nodi iliaci comm. Truncus lumbalis dx.et sin. Cisterna cyli L13 lymfa retroperotoneum Lymphatic nodes of the abdomen and pelvis Truncus lumbalis dx.et sin. Cisterna cyli Nodi lymphatici coeliaci Truncus intestinalis Lymphatic nodes of the unpaired abdominal organs Nodi lymphatici coeliaci Truncus intestinalis míza_břicho1 nodi lymphatici coeliaci • gastrici • gastroepiploici • hepatici • pancreaticoduodenales • pancreatici • lienales • mesenterici • ileocolici • colici • mesenterici inferiores truncus intestinalis Výsledek obrázku pro nodi lymphatici mesenterici Lymphatic system of the upper limb •Superficial system •Collectors: •medial •(nodi lymf.cubitales •superf.) •lateral •anterior • •Deep system- alongside artetries •arcus lymphaticus •palmaris spf. et prof. •nodi lymf. cubitales prof., •brachiales nodi axillares Mízní systém HK Lymphatic system of lower limb •Superficial – collectors: •lateral •medial (nodi lymf.inguinales •spf.) •posterior (nodi lymf.poplitei) •Deep – alongside arteries •nodi lymf.inguinales prof. Mízní systém DK nový-13 nodi lumbales http://simple-health-secrets.com/wp-content/uploads/2013/07/Elephantiasis-1.jpg Thank you for your attention