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AO-Klasifikácia Faktúr →Zlomeniny

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AO-Klasifikácia Faktúr →Zlomeniny AO-klasifikácia faktúr →zlomeniny. AOP-syndróm – skr. syndroma adipositas–oligomenorrhoea–parotis. aorta – [g. aorté srdcovnica] srdcovnica. Začína sa z ľavej komory a vystupuje kraniálne aţ do výšky 2. pravého sternokostálneho kĺbu ako aorta ascendens, pokračovaním je oblúk arcus aortae, aorta descendens, aorta thoracia a aorta abdominalis. Aorta ascendens – začína sa v ľavej komore nad polmesiačikovitými chlopňami a skoro celá sa nachádza v perikarde. Je dlhá asi 4 – 5 cm, jej priemer je 22 – 30 mm. Ihneď nad chlop-ňami je následkom spätných nárazov krvi mierne vydutá do tzv. sinus aortae, výraznejšie u starších osôb. Oddiely a. obsahujúce sinus aortae sa nazývajú bulbus aortae. U starších osôb býva následkom nárazov krvi širší aj koncový úsek vzostupnej a. pred jej prechodom do oblúka, tzv. sinus maximus (quartus) aortae. Tu býva u starších osôb a. často rozširená. A. ascendens, ako aj začiatok arcus aortae majú špeciálne vasa vasorum pochádzajúce z vencovitých tepien (aa. cardiaortales). Tento úsek osobitne patogeneticky rizikový. Začiatok aorta ascendens je ešte obalený vo vagina serosa arteriarum, kt. tvorí na ventrálnom obvode a. priečnu krkvu podloţenú subseróznym tukovým väzivom (Concatova-Bacceli tuková krkva). Vnútri vagina arteriarum je aorta ascendens a začiatrok a. pulmonalis spojené tuhým väzivom (vincula aortae Rindfleischi). Výstup aorta ascendens kryje spredu začiatok a. pulmonalis, ventrálne a vpravo je auricula dextra, dorzálne je uloţený r. dexter a. pulmonalis. Kraniálne vpravo od a. je v. cava superior, vľavo kmeň a. pulmonalis. Z ventrálneho a ľavého sinus aortae sa začína a. coronaria cordis dextra et sinistra. Aorta ascendens a arcus aortae Arcus aortae – je dlhý asi 6 cm, začína sa za sternom vo výške úponu 2. chrupavky rebra vravo, ukladá sa pred bifurkáciu trachey, cez r. dexter a. pulmonalis a ľavostranný bronchus, potom na ľavú stranu paţeráka, smeruje sprava vpredu doľava dozadu a siaha k chrbtici k ľavej strane Th3. Ventrálne nad arcus aortae leţí v. brachiocephalica sinsitra. Do vrcholu konkavity oblúka a. sa pripína chorda ductus arteriosi. Pred arcus aortae zostupuje n. vagus sinister a vysiela n. recurrens vagi sinistri, kt. zahýba pod oblúk a. dozadu, do brázdy medzi tracheou a paţerákom. Rozšírený oblúk a. môţe preto stláčať n. recurrens a vyvolať ľavostrannú obrnu hrtanového svalstva. Obr. 1. Arcus aortae a tepny krku (pohľad zľava). 1 – arcus aortae; 4 – truncus brachiocephalicus; 5 – a. thyroidea ima; 6 – a. carotis communis; 7 – glomus caroticum; 8 – sinus caroticus; 8a – bifurcatio carotica; 9 – a. carotis externa; 10 – a. thyroidea superior; 11 – r. infrahyoideus; 12 – r. sternocleidomastoideus; 13 – a. laryngea superior; 14 – r. cricothyroideus; 15 – r. glandularis anterior; 16 – r. glandularis posterior; 16a – r. glandularis lateralis; 17 – a. pharyngea ascendens; 18 – a. meningea posterior; 19 – rr. pharyngeales; 20 – a. tympanica inferior (podľa Feneisa, 1996) Z konvexity oblúka a. vystupujú tri silné vetvy: 1. truncus brachiocephalis (a. anonyma) – dlhý asi 2 – 3 cm, vetví sa na a. carotis communis dextra a a. subclavia dextra; 2. a. carotis communis sinistra; 3. a. subclavia communis sinistra. Niekedy z truncus brachiocephalicus vystupuje aj a. carotis communis sinistra (asi v 10 %). Z konkavity oblúka a. vychádzajú tenké rr. bronchiales (prevaţne k ľavému bronchu). Aorta thoracalis – hrudníková a. je uloţená v zadnom mediastíne. Prebieha od ľavej strany Th3 a siaha aţ k Th12, kde prechádza cez hiatus aorticus bránice. Najprv je uloţená na ľavej strane chrbtice a na niekoľkých hrudných stavcoch podmieňuje mierne odtlačky (impressiones aorticae). Postupne sa dostáva do strednej čiary. Paţerák je uloţený najprv na jej pravom boku, kaudálnejšie je pred ňou. Vpravo od hrudníkovej a. je ductus thoracicus, ďalej v. thoracica longitudinalis dextra, vľavo v. thoracica longitudinalis sinistra. Ventrálne od hrudníkovej a. je radix pulmonis sinistri (a v ňom lymfatické uzliny), perikard (a v ňom ľavá predsieň) a paţerák. Z obidvoch strán je nad bránicou a. pokrytá medistínovou pleurou, vľavo vo väčšom rozsahu. Na ľavých pľúcach býva odtlačok a. K parietálnym vetvám a. thoracalis patria aa. interocostales a aa. phrenicae thoracales, k viscerálnym vetvám aa. bronchales, aa. oesophaceales a rr. pericardiaci (k dorzálnej stene perikardu). Aorta abdominalis – brušná a., siaha od hiatus aorticus bránice aţ po bifurkáciu na L4. Pred ňou je uloţená nervová spleť plexus coeliacus, pod ním pankreas, pars tranvsersa duodeni a v. renalis sinistra. K parietálnym vetvám brušnej a. patria párové aa. phrenicae abdominales a aa. lumbales, k viscerálnym vetvum párové aa. suprarenales, aa. renales, aa. spermaticae a nepárová a. coeliaca, a. mesenterica superior a a. mesenterica inferior. Aorta caudalis – starší názov aorta sacralis media, začína sa z dorzálnej strany bifurkácie a. (začiatok a. ilica communis sinistra). Prebieha v strednej čiatre po prednej strane kríţovej kosti po kostrč a vysiela parietálne vetvy – a. lumbalis ima (quinta) a rr. sacrales a viscerálne – prakticky nevýznamné rr. rectales idúce mezorektom k dorzálnej stene rekta. Z bifurkácie a. sa rozostupujú aa. iliacae communes. Obr. Aorta thoracica (vľavo) et abdominalis (vpravo) a ich vetvy. 1 – pars ascendens aortae; 2 – pars thoracica aortae; 3 – rr. brohciales; 4 – ; rr. oesophageales; 5 – rr. pericardiaci; 6 – rr. mediastinales; 7 – aa. phrenicae superiores; 8 – aa. intercostales; 9 – truncus brachiocephalicus; 10 – a. carotis communis sinistra; 11 – a. subclavia sinistra; 12 – ľavý hlavný bronchus; 13 – r. collateralis; 14 – paţerák; 15 – bránica; 16 – nadoblička; 17 – a. mesenterica superior; 18 – oblička; 19 – pars abdominalis aortae; 20 – a. phrenica inferior; 21 – aa. suprarenales; 22 – aa. lumbales; 23 – r. dorsalis; 24 – a. testicularis; 24a – a. mesenterica inferior; 25 – a. sacralis mediana; 26 – a. lumbalis ima; 27 – glomus coccygeum; 28 – truncus coeliacus; 29 – a. gastrica sinistra; 30 – rr. oesophageales (podľa Feneisa, 1996) aorto- – prvá časť zloţených slov z g. aorté srdcovnica. aortografia – [aortographia] rtg. znázornenie srdcovnice a veľkých tepien pomocou kontrastnej látky. Nepriama aortografia sa vykonáva pomocou kanyly, dlhej 16 – 18 cm, po povrchovej anestézii vľavo vedľa T12 po L3/4 v uhle 60°, príp. pomocou katétra zavedeného z a. femoralis al. a. axillaris (Seldingerova techika). Brušná aortografia sa vykonáva aj priamou punkciou aorty. Cielenou katetrizáciou sa môţu zobraziť i odstupujúce vetvy príslušnej časti aorty a nimi zásobované orgány (selektívna a superselektívna angiografia). Indikácie – chorobné stavy aorty a jej vetiev (napr. aterosklerotické), embolické a trombotické uzávery, stenózy a vydutiny, ochorenia orgánov hrudníkovej a brušnej dutiny, ako aj retroperitonea. Kontraindikácie – precitlivenosť na kontrastné látky, kardiopulmonálna insuficiencia, hepatopatie a nefropatie. Vyšetrenie sa vykonáva u hospitalizovaných pacientov, po jeho ukončení treba pacienta sledovať pre moţné komplikákácie (krvácanie, alergické reakcie, horúčka, zanesenie infekcie do krvného obehu a i.). Komplikácie sú častejšie pri priamej a. Ide zväčša o krvácanie z perforačného poškodenia steny aorty ihlou al. ruptúru s väčším retroperitoneálnym výronom a poškodenie stavcov a medzistavcových platničiek; →angiografia. aortogramma, tis, n. – [aorto- + g. gramma záznam] →aortogram. aortographia, ae, f. – [aortographia] →aortografia. aortolithos, tis, m. – [aorto- + g. lithos kameň] aortolit. aortomalacia, ae, f. – [aorto- + g. malakiá zmäknutie] aortomalácia, zmäknutie aorty. aortopathia, ae, f. – [aorto- + g. pathos choroba] →aortopatia. aortopatia – [aortopathia] nešpecifikované ochorenie aorty. aortorafia – [aortorrhaphia] chir. zošitie srdcovnice. aortorenalis, e – [aorto- + g. ren oblička] aortorenálny, týkajúci sa srdcovnice a obličiek, napr. aortorenálny by-pass. aortorrhaphia, ae, f. – [aorto- + g. rhafé šev] →aortorafia. aortosclerosis, is, f. – [aorto- + g. skléros tvrdý] →aortoskleróza. aortoskleróza – [aortosclerosis] aterosklerotické postihnutie srdcovnice; →ateroskleróza. aortotenosis, is, f. – [aorto- + stenosis zúţenie] →aortostenóza. aortostenóza – [aortostenosis] zúţenie srdcovnice, resp. polmesiačikovitých chlopní srdcovnice. Asi v 6 % ide o vrodené, vo zvyšku prípadov o získané ochorenia. Rozoznávajú sa tri formy: 1. valvulárna; 2. supravalvulárna; 3. subvalvulárna forma. Valvulárna forma – stenóza aortálnej chlopne, môţe byť následkom endokarditídy al. vrodená (tvorí asi 75 % všetkých vrodených chlopňových chýb s výraznou androtropiou). Býva často spojená s deformáciou dvojcípej chlopne. Hemodynamickým dôsledkom je zvýšenie tlakového zaťaţenia ľavej komory, kt. vyvíja úsilie udrţať artériový systolický tlak. Ľavá komora je hypertrofická a prítomná býva koronárna insuficiencia. Typická je malá tlaková ampitúda s oneskoreným vzostupom TK, pulsus parvus et tardus. Klin. priebeh býva často dlho asymptomatický a ochorenie sa neraz prejaví náhle záchvatmi mdloby al. synkopy, srdcovou insuficienciou, edémom pľúc, arytmiami (po ťaţšej telesnej námahe sa môţe náhle dostaviť nebezpečná komorová fibrilácia). Dg. sa stanovuje auskultačne: typické je zoslabenie 1. a 2. ozvy s paradoxným rozštiepením 2. ozvy pri ťaţkej stenóze, hlasný holosystlický, crescendovo-decrescendový šelest s maximom nad aortou a šírením sa do karotíd, predčasná systolická ozva (tzv. ejekčný klik). Na rtg sa zisťuje dilatácia ľavej komory (aortálne srdce), príp. ektázia aorta ascendens. Na EKG sú príznaky ľavokomorovej hypertrofie, kt.
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