The State Medical and Pharmaceutical University “Nicolae Testemitanu” Department of Human Anatomy HumanHuman AnatomyAnatomy Volum III Angiology, Peripheral Nervous System and Sense Organs Collected and elaborated by Lilian Globa Chisinau 2012 CZU: 611.9(075.8) H 42 Recommende to print by Central Methodological Council of SMPhU “Nicolae Testemițanu” Proceedings nr. 1 din 05.06.2012 Lilian Globa, lecturer, Department of Human Anatomy Reviewers: Ilia Catereniuc, PhD., university professor, Department of Human Anatomy Tamara Hacina , MD., assistant professor, Department of Human Anatomy Contents: Angiology 5 The blood vascular system 5 Development of vascular system 7 The heart 10 Chambers of the heart 11 Structure of the heart walls 14 The conducting system 14 The vessels of the heart 15 The arteries 15 The veins 16 Lymph drenage and innervations of heart 17 The pericardial sac 18 The topography of the heart 19 Auscultantion (hearing) of heart valves 19 The vessels of pulmonary (lesser) circulation 22 The arteries of pulmonary circulation 22 The veins of pulmonary circulation 22 The vessels of systemic (greater) circulation 23 The arteries of systemic circulation 23 The aorta 23 Branches of the ascending aorta 23 Branches of the arch of the aorta 23 The brachiocephalic trunk 24 The common carotid artery 24 The external carotid artery 24 The internal carotid artery 32 The subclavian artery 37 Arteries of the upper extremity 44 The axillary artery 44 The brachial artery 45 The radial artery 45 The ulnar artery 46 The arches and arteries of the hand 46 Branches of the descending aorta 47 Branches of the thoracic aorta 47 Branches of the abdominal aorta 48 The unpaired visceral branches 48 The paired visceral branches 50 The parietal branches of the abdominal aorta 51 The common iliac artery 51 The internal iliac artery 51 The external iliac artery 53 Arteries of the lower extremity 53 The femoral artery 53 The popliteal artery 54 The anterior tibial artery 55 The posterior tibial artery 55 The arteries and arches of the foot 56 Distribution of the arteries 57 Collateral blood circulation 60 The veins of systemic circulation 61 The system of vena cava superior 61 The innominate veins 61 The internal jugular vein 61 The veins of brain 62 The external jugular vein 64 The anterior jugular vein 64 The subclavian vein 64 The veins of the upper extremity 64 Vena azygos and vena hemiazygos 65 Vertebral venous plexuses 66 The system of vena cava inferior 66 The portal vein (system) 67 The common iliac veins 67 Porto-caval anastomoses 68 Cava-caval anastomoses 69 The external iliac vein 69 The veins of the lower extremity 69 Distribution of the veins 70 Specific features of blood circulation of the foetus 71 The lymphatic system 74 Lymphatic vessels 74 Lymph nodes 76 The lymphatic system in various parts of the body 77 Lymphatics of the lower extremity 77 Lymphatics the pelvis 77 Lymphatics the abdomen 78 Lymphatics the thoracic cage 79 Lymphatics of the upper extremity 79 Lymphatics the head and neck 80 The collateral flow of the lymph 82 Anatomy of the lymphatic system of a living person 82 The development of lymphatic system 83 Immune system 85 Central organs of immune system organs 86 Bone marrow 86 The thymus 86 Peripheral organs of immune system organs 87 Lymph nodes 87 The spleen 87 The tonsils 89 Aggregates of lymphoid follicles 89 Neurology 90 The peripheral nervous system The spinal nerves The posterior branches of the spinal nerves The anterior branches of the spinal nerves The cervical plexus The brachial plexus The anterior branches of the thoracic nerves The lumbar plexus The sacral plexus The coccygeal plexus The cranial nerves The olfactory (1st) nerves The optic (2nd) nerve The oculomotor (3rd) nerve The trochlear (4th) nerve The abducent (6th) nerve The trigeminal (5th) nerve The facial (7th) nerve The vestibulocochlearis (8th) nerve The glossopharyngeal (9th) nerve The vagus (10th) nerve The accessory (11th) nerve The hypoglossal (12th) nerve Peripheral innervation of the soma The vegetative (autonomic) nervous system' The sympathetic nervous system The sympathetic trunk The parasympathetic nervous system The vegetative innervation of organs' Unity of the vegetative and somatic parts of the nervous system Zakharyin-Head's areas or zones Aesthesiology The organ of vision The eyeball The coats of the eyeball The refracting media of the eye The accessory organs of the eye The ocular muscles The lacrimal apparatus The pathway of visual information The organ of gravitation and balance and the organ of hearing The organ of hearing The external ear The middle ear The internal ear The pathways of sound conduction The organ of gravitation and balance The pathways of the statokinetic analyser The organ of taste The organ of smell The skin The conducting tracts of the skin analyser The mammary glands The interoceptive analyser Appendix Bibliography ANGIOLOGY The vascular system consists of a network of tubes or canals through which circulate the body's fluids, blood and lymph. From Latin angiology means the science of the vessels. The vascular system, on the one hand, supplies the cells and tissues of the body with necessary nutrients and, on the other hand, removes and transports waste products produced by the vital activity of the cells to the kidneys, the excretory organs. According to the character of the circulating fluid, the vascular system is classified into two systems: 1. The blood vascular system, made up of tubes (the heart, arteries and veins), through which the blood circulates; and 2. The lymphatic system, made up of tubes along which lymph, a colourless fluid, flows. The blood vascular system The blood vascular system (the cardiovascular system) consists of the heart as a central organ, and blood vessels, tubes of various calibres connected to it as peripheral organs. The blood vessels passing from the heart to the organs and carrying blood are called arteries (Gk arteria windpipe). Histologicaly the wall of the artery consists of three coats. The inner coat (tunica intima) is lined with endothelium and an inner elastic membrane. The middle coat (tunica media) is made up of two layers of smooth muscle fibres (an external longitudinal and an internal circular layer), which alternate with elastic fibres. The outer coat (tunica externa or adventitia) contains connective tissue fibres. The elastic elements of the arterial wall form a single elastic frame, resilient as a spring, which lends elasticity to the arteries. Some arteries supply whole organs or parts of organs with blood. Arteries can be classified as extraorganic arteries, which pass outside the organ before entering it, and their continuations, intraorganic arteries, which branch out inside the organ. Lateral branches of a single trunk or branches of different trunks can join one another. Such a junction of vessels before their division into capillaries is called an anastomosis (Gk anastomoein to provide with a mouth). Most arteries form anastomoses. The final branches of the arteries are very fine and delicate and are, therefore, classified separately as arterioles. They are directly continuous with the capillaries. Capillaries are hair-like vessels concerned with metabolism. The capillary wall consists of a single layer of flat endothelial cells permeable to substances and gases solved in liquids. The pre-capillaries, capillaries, postcapillaries, and venules primarily perform a trophic (metabolic) function The capillaries anastomose widely among themselves and form networks continuous with the veins. The veins carry blood from the organs to the heart, i.e., in a direction opposite to the flow of blood in the arteries. The walls of veins are formed in the same way as those of the arteries, except that they are much thinner and contain less elastic and muscular tissue. As a result, empty veins drop flat while the lumen of an artery in cross section gapes. The initial segments of the venous bed are the venules, which form directly from the capillary network and make up the roots of the veins. The venules are continuous with the veins which merge to form large venous trunks passing to the heart. The veins anastomose widely among themselves and form venous plexuses. Blood flows through the veins because of the suction action of the heart and the thoracic cavity. Suction is created by negative pressure produced during inhalation as the result of the difference of pressure in the cavities, the contraction of striated and smooth muscles of the organs, and other factors. Venous blood is prevented from flowing backward by special semilunar valves in the venous walls. These valves are shaped from the folds of the endothelium with a thin layer of connective tissue inside. As an individual grows older, the diameter of his veins and the capacity of the venous bed increase relative to the diameter of the arteries and the volume of the arterial bed. There are also the direct connections between the tiniest arteries and veins in many organs, called arterio- venous anastomoses, formed in such a way that the artery divides into two branches, the larger of which branches out further into arterioles and capillaries, while the smaller merges with the veins, losing the characteristics of an arterial vessel and becoming closer in structure to a vein. As a consequence, an excess of arterial blood flowing at any moment to the tissues may be diverted to the venous bed, bypassing the capillary network. This functional adaptation saves the energy of the heart muscle and, in some cases, becomes significantly important to the function of the organ. The arteries and attended by two veins and the large-calibre arteries by one. The exceptions to this rule, besides certain deep veins, are mainly superficial veins passing through the subcutaneous tissue that are rarely accompanied by arteries.