Peritoneum is a thin serous membrane with a smooth, blinking one-sided surface, covered with scabbards, cavitas abdominis, and a part of the small pelvis, grown in all empty organs. The top of the quill should become close to 20400 cm 2 and as large as the dorsal area of ​​the shkiri. The peritoneum is set up by the vasna plate, lamina propria, serous membrane and single-globular flat epithelium, which is curved, - mesothelium, mesothelium.

, scho whistles of the abdomen, are called a parietal quill, peritoneum parietale; a nutlet, which is covered with an organ, is a visceral necklace, peritoneum viscerale. Transfer from one organ to another, from one organ to another, from one organ to another, from one organ to another, the stems of the ligaments, ligamenta, folds, plicae, breeches, mesenterii.

Because of the fact that the stalk is visceral, and that the other organ is curled, go to the stalk, more organs appear fixed to the stink of the empty. The visceral gullet is curved in a different way: from the sides (intraperitoneally), from the three sides (mesoperitoneally) or from one side (retro- or extraperitoneally). Up to the organs, covered by a chain of three sides, rostasovanim mesoperitoneally, to be carried, partly from the top and from the bottom to the middle, the middle part.

Prior to the growth of extraperitoneal organs, they are introduced (except for the cob її ї ї ідділа), pidshlunkovy zloza, nadnirkovі zalozi,.

Organize, roztashovanі intraperitoneally, lighten the breeze, scho tinkling with the parietal.

Brijaє with a plate, which can be stored from two single leaves of a duplikatury queue. One - the wilderness - is the edge of the breech that hunts the organ (intestine), as it is bi pidvishyuchi yogo, and the other edge goes down to the black wall, and the leaves spread out into the small sides of the viglyadi of the parietal queue. Call the breeze leaves (or sounds) to the organ to receive blood, lymphatic judgment and nerves. A bit of a cob of a breech on a black stint is called the root of a breech, radix mesenterii; passed to the organ (for example, to the intestine), the sheets spread out from both sides, overlapping the vuzka bіlya mіstsya attachment - the earliest field, area nuda.

The gray coat, for example, the serous membrane, tunica serosa, does not lie down without the middle to the organ or the cranial wall, but from them with a ball of the semi-tissue tissue basis, tela subserosa, which is in the middle of the rose. So, the base of the serous membrane of the liver, diaphragms, the upper side of the anterior wall of the abdomen, navpaki is weakly rooted, the base of the serous membrane of the liver, the diaphragms, of the upper side of the anterior wall of the abdomen, navpaki, is significantly reduced to the side of the back wall; for example, in the area of ​​nirok and so on, de ocherevina is even more ruhomo z'єdnana with organs, which can be used, or with parts.

The peritoneum of the empty, or the empty of the queue, cavitas peritonealis, is closed in the choloviks, and in the females through the uterine tubes, the uterus, and emerge from the callous middle. Porozhnina line - chain line space folding form, Stored in a small amount of serous age, liquor peritonei, erythematous surface of organs.

Parietal backyard of the empty stomach in the middle of the backwall of the empty space, spatium retroperitoneale, in which it covers the back of the body, organa retroperitonealia. In the urethral space, behind the urethral urethra, the urethral fascia, fascia retroperitonealis, grows.

Pose-gut space, spatium extraperitoneale, є also pubic space, spatium retropubicum.

Cherevny nakryvnyfolds. The anterior parietal cleft, peritoneum parietale anterius, on the anterior stance of the abdomen has a number of folds. In the middle line, there is the middle umbilical fold, plica umbilicalis mediana, stretching from the umbilical ring to the top; a semi-tissue strand is laid in the central warehouse, which is an obliterated sech duct, urachus. From the umbilical ring to the lateral walls of the cuticle, go through the medial umbilical folds, plicae umbilicales mediales, in which heavy anterior umbilical arteries are laid, which have been launched. The names of these folds are located lateral umbilical folds, plicae umbilicales laterales. The stench is drawn from the middle of the groin ring obliquely to the middle, to the back. In cich folds, the lower epicranial arteries are laid, aa. epigastricae inferiores, as they live the straight mucous membrane of the abdomen.

At the base of the folds, pits are established. Along the sides of the middle umbilical fold, between it and the medial umbilical fold, above the upper edge of the cuticle, є supravesicales, fossae supravesicales. Between the medial and lateral umbilical folds there are medial groin fossa, fossae inguinales mediates; the names of the lateral umbilical folds fill the lateral groin pits, fossae inguinales laterales; tsі pits roztashovuyutsya against glyboky odonnykh dumplings.

Tricut dilenca of the groin, roztasovana over the medial groin pit and bordered from the medial side by the edge of the straight abdomen, from the lateral - lateral umbilical fold, and below - the inner trigum of the groin of the groin, to wear.

Parietal ocherevina, which curls the front verstat of the abdomen with the umbilical ring and diaphragm, passing to the diaphragmatic surface of the liver, setting the sickle-like sound of the liver, which pidvishu, lig. falciforme hepatis, which can be stored in two leaves of a queue (duplikatura), rosted in the sagittal area. At the bottom of the lower edge of the sickle-shaped ring, pass the strand of the round ring of the liver, lig, teres hepatis. The leaves of the sickle ligament go backwards at the anterior leaf of the vintsevo ligament of the liver, lig. coronarium hepatis. Vaughn є the transition of the visceral line of the diaphragmatic surface of the liver into the parietal line of the diaphragms. The posterior leaf of the central link passes to the diaphragm from the visceral surface of the liver. The offense of the leaves of the vintsevoy ligament converge with lateral knots and establish the right and left of the triangular ring, lig. triangulare dextrum ta lig. triangulare sinistrum.

Visceral orevina, peritoneum visceralis, the liver is curled from the lower side of the gum michur.

From the visceral line of the liver, there is a straight line to the small curvature of the slunk and the upper part of the twelve-fingered intestine. Vona є with a duplication of a cauliflower leaf, which can be repaired from the edges of the vort (transverse furrow) and from the edges of the line of the venous ligament, and it is removed from the frontal area. The liva part of the ligament (from the ligament of the venous ligament) before the small curvature of the slunk is the chain of the pechin-slunk ligament, lig, hepatogastricum. Vona can see a thin pavutin-like plate. Between the leaves of the chinko-slunk connection, the small curvature of the slunk, pass the arteries and veins of the slunk, a. et v. gastricae, nerves; there are roztasvanі regional lіmphatic universities. The right part of the ligament, shilnisha, where from the gate of the stove to the upper edge of the collar and the twelve-fingered intestine, the whole viddil is called the pechinko-duodenal ligament, lig. hepatoduodenale, and to avenge the gallbladder duct, the gallbladder artery and the gillet, the vortic vein, lymphatic judges, the nerves. Right-handed pechinkovo-duodenal connection fixes the anterior edge of the omentum opening, foramen epiploicum (omentale). Pidіyshovshi up to the edge of the slunk and twelve-fingered intestines, the leaves of the ligament disperse and cover the front and back walls of the cich organs.

Offense of the connection: pechinkovo-shlunkova and pechinkovo-duodenal storage malium omentum, omentum minus. Inexperienced advancements of the small oil seal є pechinkovo-rim link, lig. hepatocolicum. Sickle-shaped ligament і malium omentum є ontogenetically with the anterior, ventral, breech of the shlunk.

From the other part of the bath with diaphragms, enter the parietal eyelet, then move to the cardial shaft and right half of the crypt of the slunk, making a small slurry-diaphragmatic ring, lig. gastrophrenicum.

Between the lower edge of the right part of the stove and let us put the upper end of the right part of the stove here, and then we will make the transition between the fold and the pechinka-nirka ring, lig. hepatorenale.

The leaves of the visceral queue of the anterior and posterior surfaces of the shlunk, along the great curvature of it, continue downward at the viglyad of the great omentum. The great omentum, omentum majus, in the form of a wide plate ("apron") goes down the level of the upper aperture of the small pelvis. There are two leaves, which make it come true, they turn and turn, straight ahead burn down behind the lower two leaves. Tsі zorotnі leaves zroshchenі with front leaves. On the flats of the transverse colon intestine, all of the leaves of the great omentum grow to the omentum line, rosted on the anterior surface of the intestine. Then the rear (turning) leaves of the omentum go out from the front, go through the breech of the transverse colon intestine, mesocolon transversum, and go dorsally to the line of the bridle along the rear end of the front

In such a rank, between the anterior and posterior leaves of the omentum on the level of the transverse colon, the intestine is established. Going up to the front edge of the bottom of the omentum, two posterior leaves of the omentum diverge: the upper leaf goes over to the posterior wall of the omentum bursa (on the surface of the bottom of the omentum) at the view of the lower leaf of the omentum of the transition

The dilyanka of the great omentum between the great curvature of the shlunk and the transverse intestine of the rim is called the shlunk-rim ring, lig. gastrocolicum; tsya zyvyazy fiksuє transverse to the rim of the intestine to the great curvature of the slunk. Between the leaves of the shlunkovy-rim connection of the great curvature, pass the rights of the shlunkovy-glandular arteries and veins, cover the regional lymph nodes.

The great omentum is attached to the front of the small intestine. Between the omentum and the anterior cephalic wall, the vuzka shchilina becomes the epiploic space. The great omentum є by the extended dorsal breech of the shlunka. Її to the continued ones to serve the shlunkov-selesinkovo ​​link, lig. gastrolienale, і diaphragmatic-splenic sound, lig. frenikolієnale, as one goes to іnshu.

Three two leaves of the line of the shlunkov-splenic ligament of the anterior pass to the spleen, removing from the sides, turn back to the organ at the vyglyadi leaf of the diaphragmatic-splenic ligament. The posterior leaf of the cranial-splenic ligament, which extends to the gate of the spleen, is turned right to the posterior cranial wall at the viglyad of another leaf of the diaphragmatic-splenic ligament. As a result, the spleen yak bi is included from the side at the link, but the lower curvature of the slunk with the diaphragm is large.

Breeze of the colon intestine, mesocolon, in the children of the intestine there are not the same size, but in the case of the day. So, the intestine, which has the shape of a bear, is covered with a necklace from the sides, ale the breeze at her every day. With a whole wormlike appendage, which comes out of the intestine, discharge also from the sides of the worm (intraperitoneal position), we get the breeze of the wormlike appendage, mesoappendix, which is beyond the reach. At the point of transition of the lumbar intestine to the upper rim intestine, the breeze of the upper rim intestine, mesocolon ascendens, is insignificant.

In such a rank, the upper rim of the intestine, the serous sheath is curved from three sides, overlapping the back wall (mesoperitoneally).

The bridle of the transverse rim intestine should be repaired on the back cage point on the equal lower part of the twelve-fingered intestine, the head and the trunk of the middle gut, the lymph nirka; pidіyshshi up to the intestine at the breech line, two leaves of the breech spread out and hunt the intestine near (intraperitoneally). On the whole length of the breech from the root to the place of attachment to the intestine, the width becomes 10-15 cm and changes to vigin, de von go over to the parietal leaf.

The rim intestine is skid, so it is viscid, it is covered with a serous membrane of three sides (mesoperitoneally); It is not important to cover the lichen lesion in the back wall of the middle third of the lower rump intestine.

The breech of the sigmoid colon, mesocolon sigmoideum, is 12-14 cm wide, the yak with a bowel extension is significant. The root of the brizhi has rewound the bottom of the club hole obliquely і from top to bottom і right-hander, club and transverse connections, as well as roztasvani along the borderline line of the outside club of the judge and livy sechovod; Having passed the line along the line, the breeze straddled the area of ​​the left kryzho-club slope and moved to the front surface of the upper kryzhovy ridges. On the edge of the III crustal ridge of the breech of the sigmoid colon, it ends at the ear of a narrower breech of the rectum. Dovzhina root of the brizhi is strongly varied; from it to lie the steepness and the size of the loop of the sigmoid colon.

The expansion of the rectum to the urethra of the small pelvis in the first half of the year changes. The basin of the basin is covered with a serous shell with this world. The gulf of the part is filled with a gall-mound. The naybilsha upper (nadampopular) part, which is to be repaired on the level of the III kryzhov ridge, is sharpened by a serous curvature and a short and high breeze.

Livy vigin of the rim of the intestine with the diaphragm of the horizontally expanded diaphragmatic diaphragmatic-rim fold (in one case it means the diaphragmatic-rim ring, lig. Phrenicocolicum).

A number of topographic and anatomical values ​​are needed for the individual development of the topography of the queue and the organs of the emptying of the abdomen.

Cherevny folds, links, breeches and organizers at the empty quill are apparently isolated from one lost quill, tract, bursae and sinuses.

When empty, the empty queue can be poured onto the top on top and on the bottom on top.

The upper on top of the inclinations from the lower horizontally expanded breech of the transverse colon (at the level of the II transverse ridge). The breech є with the lower boundary of the upper one on top, the diaphragm - with the upper one, and the small walls of the empty stomach are flanked from the sides.

Lower on top of the empty quill of the abdomen at the top with the transverse rim intestine and breech, from the sides - with the thighs of the empty stomach, at the bottom - with the quill, which wraps around the basin.

At the upper surface of the empty queue, there are piddiaphragmatic sagging, recessus subphrenici, podpechinki sagging, recessus subhepatici, omental pouch, bursa omentalis.

Piddiaphragmatic breakdown by sickle-shaped rings is broken down to the right and left of the part. The rights of the part of the piddiaphragmatic death are the price of the earthen emptying between the diaphragmatic surface of the right part of the liver and the diaphragm. Behind it is surrounded by the right part of the knot ring and the right knotted knot of the stove, the hand - by the crescent-shaped ring of the stove. The whole process of death is caused by the rostashovy lower right pedunculate space, the right colo-intestinal boron, far from the club hole and through it through the small pelvis. The space under the dome of the diaphragms between the part of the stove (diaphragmatic surface) and the diaphragm - for the purpose of losing the diaphragm.

The right-hander is outnumbered with a sickle-shaped ring, at the back - with a single part of the vintsevoy and tricot ring. The process of death is caused by the growth of lower levels of death.

The space under the visceral surface of the stove can be cleverly divided into two parts - right and left, between which you can use the sickle-like round ring of the stove. The right of the pidpechenka to grow out of the way of the visceral surface of the right part of the liver and the transverse rim intestine and the breech. Behind the death of a parietal necklace (pechinkovo-nirkova sound, lig.hepatorenale). Laterally, the right to death is seen from the right side of the intestinal groove, from the gland through the omental opening - from the omentum bag. Vіddіl pіdpechіnkovogo space, ripples near the back edge of the stove, right-handed from the ridge stop, we call the pechіnkovo-nirkovy zagliblennyam, recessus hepatorenalis.

In case of death, there is a price for the length between a malim oil seal and a slurry from one side and the visceral surface of the left part of the stove - from the other. A part of the wide open space, roztasovna called і kіlka back to the great curvature of the shlunka, reaching the lower edge of the spleen.

With such a rank, the right to the child's heart, and the right to perish, to feel the right part of the stove that zhovchny mikhur (here the surface of the twelve-fingered intestine is brutalized). At the topographic anatomy, the stench is called "pechinka bag". In the left part of the stove, the malium omentum, the front surface of the shlunk, the part of the stove, the malium gland, the front surface of the shlunk grow out. In topographic anatomy, they call it a pre-shlunkovy bag. Salnikov's bag, bursa omentalis, stitched behind the slag. The right-hander will expand to the gland opening, left to the gland opening. The front wall of the omentum bag is a maliy omentum, the rear wall of the omentum, the slug-rim of the sack, and only the upper part of the great omentum, as the lower and the hanging leaves of the omentum of the woman's bag do not go through

The back wall of the omentum bag is used as a parietal gland, which is used to curl the lower back wall of the empty abdomen: the lower empty vein, cranial aorta, livy nadnirnik, upper bone, saline nirkovy

The upper wall of the omental bursa serves as the tail of the part of the liver, the lower - the transverse rim intestine and the breeze. Liva stinka - the whole of the shlunkov-splenic and diaphragmatic-splenic dysfunctions. The entrance to the bag is an omental opening, foramen epiploicum (omentale), straps at the right part of the bag behind the pechinkovo-duodenal ligament. Tsei otvir skips 1-2 fingers. The anterior wall of the yogic є pechinkovo-duodenal ligament with rostasovanny in nіy sudins and the zagalny zhivka duct. The back wall is a pechinko-nirk ring, behind which the opening of the lower empty Vienna and the upper end of the right nirka. The lower part of the tail is set up to pass from the bowel to the twelve-fingered intestine, the upper part of the tail is the part of the liver. The closest to the opening of the large bag is called before the day of the omentum bag, vestibulum bursae omentalis; in the encirclement of the caudate part of the liver from above and the upper part of the twelve-fingered intestine from below.

Behind the caudate part of the pechinka, between it and the covered parietal spine with the medial lower diaphragms, є the intestine is the upper omental gagging, recessus superior omentalis, which is at the bottom of the appendix near the beak. To the bottom there is a ditch, between the rear wall of the slurry and the slurry-rim ring in front and the covered parietal groove of the slurry and the breech of the transverse rim of the intestine behind the lower recess is located Even before the day, the empty omental bursa is sounded by the gastropancreatic fold of the omentum, plica gastropancreatica, from the upper edge of the omental tubercle of the omental tubercle of the omentum burrow, and only to the small curvature of the omentum. For the continuation of the lower death it is left to serve the sinus, it is roasted between the shlunkov-splenic ligament (in front) and the diaphragmatic-splenic ligament (behind), which are called splenic recessional ligaments.

At the lower side of the vertebral emptying, at the rear end, there are two great brijov sinuses and two colo-intestinal furrows. Here, the lower leaf of the breech of the transverse rim intestine, from the bottom of the root, goes to the parietal leaf of the root, which whistles the back wall of the sinuses of the breech.

The cherevina, which curls the back wall of the abdomen in the lower surface, passes over to the small intestine, draining from the sides (except two-fingered ones) and setting up the breeze of the small intestine, mesenterium. The breech of the small intestine is a subordinate leaf of the queue. The root of the brizhi, radix mesenterii, is seen obliquely from top to bottom from the level of the II transverse ridge of evil to the kryzho-club member of the right-handed person (where the club intestine falls into the slit). The root should be 16-18 cm, the width of the breech is 15-17 cm, the protest in the most distant from the back of the abdomen will grow in the small intestine. Along its course, the roots of the brizhi peretinate in the mountains of the upper part of the twelve-fingered intestine, distant the cranial aorta on the level of the IV transverse ridge, the lower empty vein and the right secovid. The bridle of the root of the brigi go, straight from the top of evil down and right-handed, the upper brigade of the judgment; The breeches of the bowel are extended between the leaves of the breeze of the intestine to the wall of the intestine. In addition, among the leaves of the breeze, pass the lymph judges, the nerves of the regional lymph nodes. All with a valuable world, they zoom out, but the duplex plate of the small intestine has become stiff and frail.

Brizhkoyu of the small intestine is capped at the bottom of the emptying on top of the split into two plates: right and livy brijovy sinuses.

The right brijovy sinus of the encirclement from above is the breech of the transverse rim intestine, the right-handed person is the vischid rim intestine, the evil and from the bottom is the brizhkoy of the small intestine. In such a rank, the right brijovy sine has the shape of a tricycle, and closures from the sides. Through the parietal gut, which whistled yogo, contour and educate in the mountain under the breeze of the rim intestine, the lower end of the right nirka (right); to it, the lower part of the twelve-fingered intestine is reduced, and the lower part of the head of the subcutaneous cavity is cut off by it. Below, in the right sinus, you can see the right cutoff, which goes down, and the air-rim artery with the vein.

Below, at the muscle of the club intestine into the slit, there is an ileocecal fold, plica ileocecalis. It has been removed between the medial wall of the intestine, the anterior wall of the club intestine and the parietal cervix, as well as the medial wall of the mucous intestine from the lower wall of the globular base of the gut. In front of the ileocecal cut, the fold of the squamum grows - the swelling fold, plica cecalis vascularis, in which the anterior artery passes. The fold extends from the anterior surface of the small intestine and to the anterior surface of the small intestine. Between the upper edge of the worm-like appendage, the ductal gut and the wall of the medial section of the bottom of the intestine, there is a breech of the worm-like appendix (appendix), mesoappendix. At the brizhi pass judgment, how to live, a. et v. appendiculares, and pledges of regional lymphatic universities and nerves. Between the lateral edges of the bottom of the intestinal tract and the parietal fossa there are slit folds, plicae cecales.

From the ileocecal fold, fill the rosette above and below the intestinal intestine: upper and lower ileocecal lagging, recessus ileocecalis superior, recessus ileocecalis inferior. On the occasion of the bottom of the intestine є behind the buckthorns, recessus retrocecalis.

The right-handed person from the viscid colon is known to be right-handed. Vona is surrounded by a parietal gut of the abdominal wall, an evil - by a viscid gut of the rim; from the bottom to see the club hole and the ratchet emptying of the small pelvis. In the mountains, borne will be seen with the right pediatric and phrenic gagging. In the course of the furrow, the parietal gullet creates transverse folds, so that the upper right viginus of the rim intestine is closed from the side of the abdomen and the right diaphragmatic-rim ring with the right diaphragmatic-rim ring, evokes, slightly rotated.

Livy brijovy sinus is surrounded from the top - by the breech of the transverse rim intestine, zlivy - by the lower rim intestine, the right-handed person - by the bryzhkoy of the small intestine. To the bottom of the lіviy sinus brijoviy go to the gutted emptying of the small pelvis. The sinus is irregularly shaped and downwardly inclined. Through the parietal neck of the left breech sinus, the lower half of the left nirka is seen and contoured in the mountains, the cranial aorta is lower and medially across the ridge, and to the right is the lower empty vein and the cobs of the lateral tuberosity of the court. On the side of the ridge, one can see the liva artery of the yachka (yachnik), the livy sechovod and the gilki of the lower bryzhovo artery and veni. At the upper medial kutku, near the ear of the small intestine, the parietal spine will open a fold, and the oblyamov intestine above and below, - the upper duodenal fold (duodenal-jejunal fold), plica duodenalis superior (plica duodenalis superior) (plica duodenalis superior) The paraduodenal fold, plica paraduodenalis, which is like a fold of the queue, is folded on the opposite side of the twelve-fingered intestine and curved around the rim of the artery. This fold is intertwined in front of the non-perishable paraduodenal loss, recessus paraduodenalis, the back wall of which becomes a parietal neck, and the lower duodenal fold (duodenal-duodenal fold), plerica duodenal

The evil comes from the root of the brisket of the small intestine, behind the upper part of the twelve-fingered intestine, there is a fossa of the fossa - retroduodenal gagging, recessus retroduodenalis, glibina as much as possible. Malice from the lower colon is located; the won is surrounded by an evil (lateral) parietal cervix, which whistles the back wall of the abdomen. From the bottom it is boring to pass at the ductal fossa and dal - into the empty basin of the small pelvis. Burn down, on the ryvnі lіvіy vigina of the rim intestine, the furrow of the retinaculum and the diaphragmatic-rim fold of the ovary is well-rotated.

Below, between the vigines of the breech of the sigmoid colon intestine;

You will be happy read:

The skin of a lyudin starts very early and starts thinking about the ones that have the appendix in that bots. Knowing more accurately the rosetting of organs in the black empty, you can make more sense with the doctor, especially if you are connected to the telephone mode, and you can ask the person to help the sick backdoor before arriving.

How is it that it’s empty?

The medical term depends on the space, where it is located in the diaphragm, in the same way inside the interior. The walls of the urethral space are covered with a serous membrane, the yak expands to all fillings. The lower region of the queue smoothly overturns on the malium pelvis.

Natural physiology and anatomy of organs in the black empty and sternum great people vashtovani in such a rank, so that their surfaces are not rubbed one by one. The price is overwhelmed by the presence of a serous line and an epithelial ball. Organize the chest and chest empty ones, the diaphragm between them.

Rooting of organs of empty waste

Physicians can see three options for growing the inside of the root of the root of the root:

• Extraperitoneal. And here the stalk curled up the anterior part of the internal organ. The best butt of such a roasting is є nirka.
• Mesoperitoneal. Also, the rosetting of organs in a black empty space is based on respect for the manifestation of one side of the insides, not in a serous shell. With the best butt, you can use the stove.
• Intraperitoneal, for which it is characteristic of everybody to oblyagannya to the body with a string. We can use the butt of such a shake-up to press into the small intestine.

Yak organi outbid the black empties?

Malice, before the diaphragm, the disassembly of the shlunks, and the small-like extensions of the herbal tract. Obliged to the body to lay down as a matter of fact. It is here that the accumulation and the first over-etching of the їzhі are seen.

Behind, trochas lower than the shlunka, there is a pidshlunkov zloza, which is introduced to the herbal system. Wonderful over the function of the secretary. In the process of її robots, we see pancreatic sic, to take revenge on the powerless herbal enzymes. In addition, the function of the internal secretary, the function of the internal secrets, is taken into account in the form of carbohydrates, fatty and fatty acids.

Right-handed, before the diaphragm, there is a stove, as a result of cleansing the body. Vaughn will be stored in two parts. The growth of the right part of the area is overwhelming the size of the left. The stove belongs to the category of vital organs. Before the її functions to enter into the organism of allergens, toxins and other unnecessary words. In addition, the liver will take care of the etching processes that will prevent human body with glucose.

The anatomy of a black empty man is built in such a way that in the lower part of the stove a young woman grows up. Here itself the viscous green ridina, called zhovchu, concentrates.

At the upper left part, behind the slurry, there is a spleen, which has the form of a flattened and podvzhenoi pivsphere. The whole organ of the vison is immune and hematopoietic function. The spleen is a filter of foreign particles and takes over the fate of the synthesis of lymphocytes.

The small intestine is located just below the slunk, and the tube is completely tangled. The whole organ is gradually transformed into the intestine. In addition, as the intestines function correctly, our health will be maintained.

De є parni organi people?

Those who have seen the school lessons of anatomy, melodiously, guess about the so-called young organs. One of them is nirki. The rooting of the organs of the wormwood is vastored so that the stench is found behind the leaves of the stem. This is a young organ, which is responsible for the filtration and secretion of the section, the sewing from the sides of the transverse side. Nirki lie down to vital organs, the stench itself controls chemical homeostasis.

Ugory, in the area of ​​nirok, there are nadnirkovy zalozi, which regulate the exchange processes. They synthesize cortisol, cortisone, corticosteroids and adrenaline.

The most widespread pathology of the organs of the queue

One of the most widespread ailments of the organs, which can grow in the entire anatomical zone, invading appendicitis. As a rule, it develops as a result of bacterial information. Likuєt tse zhvoryuvannya viklyuchno operative way.

It is not often that such problems are encountered, such as the state of intestinal imperfection and spike ailment. With the appearance of a blockage in the development of a child's safety, the adhesion is increased by the operative connection. The adhesions that provoked the development of the gastrointestinal form of intestinal imperfections are seen throughout life. At the same time, there is a need for intelligence, that the operation in large numbers should be carried out until it is re-educated. When symptoms of partial failure appear, physicians recommend that a slag-free activity is taken.

The symptomatology is typical for the lowering of the organs of the black emptying; The treatment of the given pathology of the field in the nose of a special bandage;

Methods for cutting through emptying

For the detection of pathological organs in the black empty, vicoristovuyut ultrasound diagnostics. This method allows you to look over the topography of the queue. It is safe and not very long-lasting to be carried out frequently, ultrasound fragments are not infused into the structure of the clitin. The event of organs in the black emptying is diagnosed by percussion, auscultation and palpation. About those, how correctly rosetting of the same organ, can be judged not only by the results of ultrasound, but by the data of magnetic resonance and computer tomography.

Schemes for the development of internal organs of people in writing by zones.

The knowledge of an attachment is the key to the intelligence of processes and malfunctions in robots, to be found in a new one.

The set of obov'yazkovyh knowledge of the people is gradually expanding. However, without a clear rationalization of the function of the body, it will need to interconnect the organs of the solution to the direction of science and progress of the market.

Lecture at the details of the anatomy of vivchayut students of medical universities. For the average statistical age of people, there is enough mother to know about the development of organs from their own on the basis of school programs.

Proponymous to revive knowledge of tsiy galuzi.

Roztashuvannya organіv lyudynya: photo with writing

Internal organizations of people are compactly dispersed in tulips behind the wash-down areas:

• chest
• cherevna
• great and small pelvis

The first zone is traversed by other diaphragms. Another that third zone does not have such a clear cordon.

The breast area at its own store is stored in:

• 2 spacious legs
• heart zone

The empty cottage is also divided into 2 warehouses:

• bezposeredno cherevnu
• zaurevinnu

The functions of the team are fundamentally transformed between themselves and water-tightly knitted.

So, the organization of the breast tissue is considered for:

• dikhannya
• registration of sourness and relief from the prepared drink
• pumping blood

Organize empty empty ones:

• equal processes
• mastery of the cinnamon speeches
• mіtsnіst to immunity
• filtration of toxins, remove
• the fate of the blood-forming body, and in the female variant - the fetus
• acid preparation for over-etching
• hormonal regulation of correct robots of all organs in the cranial cavity

The great and the little tazi have their own zeal:

• seeing the promulgated speeches
• breeding
• hormonal control of the robotic organs of the opened zone

For Budova that the newest vigle internal organizations are available for:

• pipe parts, or empty - for example, butt
• tsіlісні, do not miss the empty - for example, stove

• m'yazi drink the fast organ,
• mucous membranes - waste and chafing of words,
• a slimy callous ball - the visibility of rubbing between organs.

Have a part of the organs of a guy, for example, lungs, a part without a bet, for example, a heart.

Marvel at the inner budov tila people in the photo below.

Yak organi roztasovani at the breast clit: scheme with letters

The breast cell is the center of the dislocation of the organs of the environment, the spring is light.

• The stench practically occupies the entire space, especially at the moment of inhalation. At the bottom of the legends vpirayutsya at the diaphragm. Near them there is a burst of ribs.
• The bronchial tree grows in the middle of the leg and from the trachea.
• At the same time, it’s tonesha і dovsha, nіzh right.

The heart is the motor of your body, like a rocking roof I cut the sudin. Vono roztashovane mіzh the legend over the diaphragm, I easily nagged back. 2/3 of the heart are located at the left part towards the center of the breasts, and 1/3 at the right.

Vilochkova zalosa is the local organ of the breast. Roztashovana at the upper part of the rest over the bronchial rims in the leg. Take the fate of the robotic immune system and people.

On the diagram of the organs of the breast tissue, look at the structure.

Yak organi roztashovani in black empty: scheme with letters

The empty chaise is filled with a large number of organs, lower in front. Clearly їх distribution for 3 parameters:

• centered
• right handed
• evil

• The small intestine looks like a thin twisted tube. Vіn establish itself on the stage of the sound of the shlunk and at the end of the building up to 6 m. Smoothly expand into the intestine at the bottom right. It’s staying true for a year’s shooting across the whole expanse of black emptying and ending with an anal opening.

The intestine is the most important organ of the immune system. The staff of yogh zdatnost_ to a pulsating pressure on the body vivoditsya otrut, toxins, shkidlivi speech.

Shlunok - expanded to stravohok, scho nagaduє mishok. To be recognized just by the diaphragm.

• The world has built up its vitality and its own growth. People from the addiction to the chasing of the great kilkosty and the slunks have been improved.
• Wine is a reservoir for accumulating and over-etching, passing through the first stage of conquering the brown words.

The shlunok is a chain organ from the kilkoma with balls of mucus. The fast-growing food will collapse by the organ and far into the intestines.

Pidshlunkovy zolose roztastova trocha lower pid slunk. Won:

• take the fate of the process of over-etching,
• viroblya sіk for її splitting,
• I will save the exchange processes in the body, and the very high-carbohydrate and fatty.

The spleen will provide blood for the growth of humans and the fetus in women. To be found out for the slag. At the viglyad - nastateva schilna napivsphere.

Selezinka:

• testimonials for lymphocyte viroblast
• accumulate platelets
• I will catch high-quality speeches and bacterias, filter
• a participant in the exchange of processes in the body
• shvidka help for erythrocytes and thrombocytes with thin membranes

The pechinka is the vital organ of the people. It will be stored in 2 parts, with the rights of a smaller size, lower liv.

At the heart of the stove lies the establishment of neutralization of odor and toxic spores from the more recent processes of the body. And also:

• customizing the balance
• assimilation of cholesterol and glucose
• vivdennya overworldly number of vitamins and messages of internal exchange

Zhovchny mikhur is a small pear-shaped bear, which is located under the right part of the liver.

Yogo zavdannya - accumulate zhovch, how to come from the liver, and guide it into the intestines. Vaughn will help you to digest the food at all stages of the process, fixing the shlunk.

On both sides there are nirkas and nirkivs.

Nirkas are similar in shape to kvasolini.

• Roztashovani behind the organs of the transverse emptying closer to the transverse zone.
• Rights of nirka mensha for liv. The size of a single bottle is 100-190 g, and the size is close to 10 cm.
• The significance of nirok is the filtration and secretion of the slaughter, the regulation of chemical processes.

Nadnirkovy zalozi - guys zalozi, representatives of the endocrine system. Consider the regulation of hormone levels:

• adrenaline
• statevich - androgen
• corticosteroids
• cortisone and cortisol
• norepinephrine

Overhaul will help people adapt to new minds to live and cope with stressful situations.

Visually memorizing the rosetting of organs in a black empty space, a diagram is also available.

Budova organs in the small pelvis: a diagram with letters

Oskil people go to two groups for familiar statuses, then the set of organs in the small pelvis is not the same for us.

In a small bowl of roztashovani:

• sečovy mіkhur і rectum - zagalny
• uterus and ovaries - in females
• beforemіkhurova zalosa and yaachka - at the cholovikіv

On the first two, there are more details.

Sečovy mіkhur piled on the pubic area. In an empty mill, the wine grows flat, but it looks like an oval shape.

Yogo zavdannya - akumulyuvati rіdinu from nirok і through the vivodіvody vivoditi to organіzm.

Rectum є advances in the colon. Root vertically downward along the distal stage of the small pelvis.

Її zabdannya - the collection and implementation of the material used for the etching process.

Between the two weights and the rectum to be found:

• uterus in women
• in front of michurova zalosa at cholovikiv

The diagram of the growth of organs in the small pelvis is presented below.

Since then, we have looked at the anatomical development of the internal organs of the people, we have learned about the main workers and abilities.

Svidomo svidomo budova. Listen to the rumors and consume that life in harmony with him!

Video: Anatomy of a Human. De i scho?

Cherevna empty - space, spreading below the diaphragms, and at the bottom of the encirclement with a clearing line, scho to pass through the adjacent basin line. Іnshi boundaries: in front - aponeurosis of the external and internal oblique, as well as the transverse abdominal mucosa, straight mucosa; back-ridge stovp (transverse viddil), inwardly-across the mucus, from the side-whiskers of the abdominal mucosa.

Description of a black whale

The empty chambers of the people є in the place of organs, anatomical devices: the shlunka, the gum michur, the spleen, the intestines (thin, club, transverse rim, sla and sigmoid), the aorta. The growth of cich organs is intraperitoneal, so cover it with a quill, or, more precisely, with a visceral leaf, I will increase it in chastkovo.

Extraperitoneally (tobto in the umbilical space) there are organisms of black emptying: nirkas, nirkovy zalozi, pidshlunkov zaloz, sechovody, the main part of the twelve-fingered intestine.

A partly visceral leaf of the mucous membrane obtіkaє two interstices of the rim intestine (viscid and low), so that organically the vascular emptying grows mesoperitoneally.

Among the organs, which can be brought up to the mesoperitoneal intrata, it is possible to see the liver. Vona may appear as a serous membrane.

Budova

Cleverly cherevnaya empty razdіlen fakhіvtsyami on the surface:

• Budov top on top of a gland hole. Ma "pidrozdili": pechinka bag, omentum, pereshlunkov shchilina. Pechinkova will love the right part of the pechinka, and in the її glybinі it is possible to make a nirku right-handed and nadnirnikova zalozu. The peredshlunkov schilina includes a part of the organs: spleen and slunk, livu pechinka part. Porozhnina, which is called an omental bag, can be seen from the empty queue through the vuzky opening. At the top, it is surrounded by a pechinka (tail part), on the front side, by the edge of a pechinka-two-fingered ring, at the bottom to serve as a cordon duodenum, behind-a serosa. The posterior stinka, represented by a parietal leaf, is covered with a cherevny aorta, pidshlunkov zalosa, nirka zlyva, nadnirnik, lower empty vein. Budova of the great omentum is offensive. The great omentum is nagadu apron, which hangs from the transverse part of the rim intestine. On a small stretch of wine, the loops of the small intestine are crooked. For the sake of the chotiri leaves of serosi, which have grown in the viglyadi platyvok. Between plates є empty. You will see from the top with the vastness of the omentum bag, and among the grown-ups you will grow mustache leaves of growth, so that the empty is obliterated. At the omentum itself, the lymph nodes are rosted, so that they can not see the lymphs from the transverse rim intestine and the great omentum.
• Middle over. It is possible to look at it if the intestine is transversely roasted and the great omentum is removed. Tsey over the top to extend with a viscid, low part of the rim intestine, a bridle of the small intestine on a chotiri part. Tse bichni channels right-handed і lіvoruch, two sinuses brigovykh. A fold-cut with two leaves of serosi, the yak will secure the attachment of the small intestine to the back of the abdomen. That її part, which can be cured to the back wall of the abdomen, is called the root of the brijah. Yoogo dinner is not more than 17 cm. The opposite edge, which appears to be strong, I am looking for bad that club gut, you will see the total amount of time in the intestine. The breech itself is fastened obliquely, repaired along another transverse ridge to the club fossa right-handed. The breeze, the yak is filled with cells, to avenge the blood-bearing vessels, lymph nodes and nerves of the fibers. The posterior leaf of the queue is pristinkovy, there is a large number of fossae. Oh, the meaning is great, the smack of the stench can be a weak person, de-established retroperitoneal grizzly.
• anatomy of the lower top. They carry the organizers and structures that are roasted in the empty basin. The peritoneum descends down to that curved organ, the walls of the pelvis. Bringing the organs to the queue to lay in the stati. Intraperitoneal growth in such organs: the cob rectum and the sigmoid colon. Tsi organi also work on the breeze. The peritoneum curls the middle part of the rectum only from the sides and anteriorly (mesoperitoneally). The lower part of the rectum is located extraperitoneally. In cholovikov serosa, pass from the rectum (front surface) to the section mikhur (back surface). Go to death for the sečovy mіkhur (retrovesical). And the upper-rear part of the empty slash michura will create a fold, it will be very special when it is done. Іnsha anatomy at the leaf of the queue of the women of the mother of the roztasovany mattsi mіzh sečovym mihurom and the rectum. The uterus is wedged with a string. There are many reasons for females at empty basins to form two anatomical "intestines": between the rectum and the uterus, between the uterus and the uterus. In women and in choloviks, there is more space before the throat, the statements of the head of the transverse fascias and the chaff with the whale.

Which includes the empty belly?

Anatomy of the liver and the nobility of the people. Pechinka roztashovuєtsya on the first, upper surface of the black empty. Great її part to take revenge on the right side of the side, less in the upper part of the side of the side. The sides of the stove, beyond the back, cover with a leaf of the visceral queue. The back side is lying down to the lower empty vein and diaphragms. The pechinka extends in crescent-shaped rings to the right of a large and a small part. Blood-bearing judges, nerves, pechinki ducts, lymphatic paths become the gates of the oven. Vaughn is fixed by the choir with links, pechinkovy veins, which flow into the lower empty vein, to the diaphragm, and also behind the additional internal vise.

Anatomy of a ruminant michur. Wines at the same yamts. Tse empty organ, like a nagaduє mіshok or a pear behind the shape. Yogo budova is awkward: tilo, shyka that bottom. Obsyag reach from 40 to 70 cm cubic, up to 8 to 14 cm, width from 3 to 4 cm. On the surface of the chewing mikhur pass a part of the line from the stove. To that, the growth of the yogo boom grows: from the meso-to the intraperitoneal. Zhovchny mikhur at the people of dressing with pechinka cells, vessels with that necklace. Due to the peculiarities of the budovi, the bottom of the mikhura stands out from the chinky edge, lying down to the anterior wall of the abdomen. As soon as the growth is low, it appears to be lying on the loops of the small intestine, so be it a pathology of the cych organs can lead to the development of adhesions and fistulas. On the front cherevnu wall, the mikhur is designed at the point, which is on the right side of the costal arch, on the right side of the straight abdomen. Due to the position of the mihur, people do not depend on the appearance of the action, more often they see three names, more often on the inner side. From the zhovchny mikhura, from the yogo shyki, enter the duct, up to 7 cm.

Anatomy of the human spleen. At the upper surface of the black empty spleen, it is intraperitoneal. There is one of the head organs of the hematopoietic and lymphatic systems of humans. Roztashovana lіvoruch at the pіdrebernіy regionі. On the surface, which is called visceral, the gates of the spleen are shattered, until the nerve fibers enter. Fiksovana won three tinkles. Blood posture is seen for the spleen artery, yak є with a pelvis of the cranial trunk. In the middle of her blood-bearing judges, they are rounded up on the court of the pulmonary caliber, which zoom in on the segmental Bud's spleen. Such organization will provide more easy resection by sectors.

The intestines were two-fingered. It’s possible to repair the small intestine in humans. Duodenum has the head of the pancreatic zolozi at the viglyad loops, literi U, C, V and the mahogany parts: upper, lower, lower and horizontal. To the structures of the urethral expanse out of the duodenum, there are links, which will prevent them from fixing. Krym, fixing the roots of the rim gut, ocherevina. Significant infusion of intestinal ligaments from the slurry zone. Budova: the cob of the trocha intestine is enlarged, which is called the ampoule, cibulin. The folds of the mucous membrane are rotated later, in other parts circularly. On the inner wall of the lower part, there is a large late fold, it ends with the Vater papilla. On the surface there is a sphinkter of Odd, through which two ducts can be seen: gum and pancreatic. Trochi vische is located in the malium papilla, where it can grow into another duct in the middle, which is anatomically variable.

Anatomy of a creeper. Roztashovana in person. It is cleverly divided into three parts: hvist, tilo, head. The head grows up at the sprout near the viglyad, the whip, the wines are hungry, the rots on the dorsal surface of the wiggles, and the lower, empty veins. In most options, the head of the її is rosette in front of the other - the third transverse ridges. Dovzhina zalozi from 17 to 21 cm, sometimes reaching 27 cm. The shape is most often trigran, ale buvay and kuto-like, flat. From the tail to the head, from the pancreatic duct, it emerges into the empty space of the twelve-fingered intestine, in the lowest part. The projection is placed on the front wall of the people: umbilical, epigastric and live pidreber'ya.

Budova shlunka. Lay up empty organs. To fix the letter to the stravohode, then go to the duodenum. Yogo volume (empty) up to 0.5 liters, when in the middle up to 1 liter. In some cases, it can stretch up to 4 liters. The middle dough is from 24 to 26 cm.,. From the front to the new bed, the lava of the pechinka part, the backward pancreatic zloza, the loops of the small intestine from below, and the spleen to the top of the evil. A slunk is designed at the epicheral dilyantsi, covered with serosa from the sides. When empty, there is a slurry sack, and it contains enzymes: lipase, pepsin, chemosin, and other components, for example, hydrochloric acid. In the slunker behind the rakhunok, the peristalsis is mixed up with the chemus, which penetrates through the collar into the intestines. It should be pushed into the slurry for the winter hour: a row of 20 khvili, roughly with fibers - up to 6 years.

15.1. CORDONI, AREAS OF TA VIDDILI ZHIVOTA

Above, it lives with costal arches, below it - with club crests, groin ridge, and the upper edge of the pubic growth. Bichna between the abdomen pass by vertical lines, so that the end of the XI ribs with the anterosuperior spines is drawn (Fig. 15.1).

Two horizontal lines live to extend into three sections: the epigastric (epigastric), the cherevce (mesogastric) and the cephalic (hypogastric). The name of the region is straight from the abdominal muscles to go from the bottom to the top and to distribute the skin in three areas.

Slide mother on uvaz, but between empty stomachs do not appear between the anterior cervical wall. The emptying of the abdomen is a space, the covering with the inner urinary fascia, the top is surrounded by a diaphragm, from the bottom - a near-line line, as the empty stomach is lifted out from the empty small basin.

Small. 15.1.Abdominal growth in each area:

1 - projection of baths with diaphragms;

2 - linea costarum; 3 - line spmarum; a - overcranial; b - belly; c - p_dcherev'ya; I - vasne epigastric region; II і III - the rights of the same region; V - umbilical region; IV and VI - the rights of the country; VIII - suprapubic region; VII and IX - clubs and groin areas

15.2. PEREDNEBICHNA CHEREVNA STINKA

Anterior cherevna stinka is a complex of soft fabrics that are spread at the abdomen's edges and screw up the cage empty.

15.2.1. Projection of organs onto the anterior columnar wall

At the right side of the edge of the region, there is a pechinka (right part), a part of a zhovchny mikhura, a pechinkovy vigin of the rim intestine, a right nadnirnik, a part of a right nirka (Fig. 15.2).

Near the vlastnu above-cranial region, the left part of the stove, the part of the zhovchny michur, the part of the tila and the piloric viddil of the shlunka, the upper half of the twelve-fingered intestine, two-twelve-fingered pechin, the part of the tavern, part of the tavern lower empty Vienna.

At the left side of the edge of the region, the bottom is being designed, the cardia and the part of the slunk, the spleen, the tail of the slurry, the part of the left nirka and the part of the left part of the stove.

By right, the abdominal area is designed with a viscous rim intestine, a part of the club intestine, a part of the right nirka and a right sechovod.

At the umbilical area, a part of the shlunk (great curvature), a transverse rim intestine, loops of the bad and club intestine, a part of the right nirka, aorta, and lower empty vein are projected.

At the left side of the stomach, the lower rim intestine, the loops of the thin intestine, the livy sechovod are designed.

At the right, the spineless region is designed with a small intestine with a wormlike growth and a small intestine.

In the suprapubic area, the loops of the bad and club intestines are designed, the section of the small intestine, the part of the sigmoid intestine (transition to the straight line).

The sigmoid intestine and the loops of the bad and club intestine are designed in the livu zduhvinno-pakhvinnu region.

The uterus in the norm does not protrude beyond the upper edge of the pubic symphysis, but with vaginosis in the presence of the term, it can be projected into the suprapubic, umbilical or epigastric dilyanka.

Small. 15.2.Projection of organs onto the anterior columnar wall (c: Zolotko Yu.L., 1967):

1 - anterior pleural interface; 2 - sternum; 3 - stravohid; 4 - heart; 5 - liva part of the stove; 6 - cardial cut of the shlunks; 7 - bottom of the shlunka; 8 - mid-ribbed area; 9 - XII rib; 10 - the backbone of the duct; 11 - spleen; 12 - tilo slunk; 13 - livy vigin of the colon; 14 - costal arch; 15 - twelve-fingered schoochkovy vigin; 16 - thin gut; 17 - lower rim intestine; 18 - sigmoid colon; 19 - krilo club gut; 20 - anterior upper spine of the club gut; 21 - V transverse ridge; 22 - fallopian tube; 23 - ampulla of the rectum; 24 - pіkhvu; 25 - uterus; 26 - rectum; 27 - worm-like outgrowth; 28 - intestinal duct; 29 - intestinal slips; 30 - throat of the air-spouting flap; 31 - viscid rim intestine; 32 - two-fingered intestine;

33 - right vigin of the colon; 34 - pyloric shape of the shlunks; 35 - zhovchny mikhur; 36 - Mikhura ducts; 37 - postal pechinka duct; 38 - share of pechinki ducts; 39 - oven; 40 - diaphragm; 41 - lighter

15.2.2. Topography of spheres and weak muscles of the anterior cranial wall

ShkiraThe area is jumbled, elastic, so it allows you to be victorious in plastic purposes in case of plasticity defects of the disclosure (method of the stem of fillets). Hairy curl of apology to do good.

Pidshkirna fatty cells it is divided by the surface fascia into two balls, the development steps can be good for children. In the area of ​​the navel of the klitkovina, practically every day, the bridging of the lineage is weak.

Superficial fascia be stored in two leaves - superficial and large (Thompson's fascia). A thin leaf that is microbial and strong for the surface and adheres to the inguinal ligament.

Vlasna fasciya curling the belly і grows with an odorous smell.

Naybilsh over the top zovnishniy-oblique m'yaz of the abdomen. It will be stored in two parts: meat, roasted more laterally, and aponeurotic, lying forward towards the straight meat of the abdomen and taking care of the fate of the shaped meat of the straight meat. The lower edge of the aponeurosis is turned downwards and in the middle and in the form of an odorless sound.

Biggly roste internal oblique mucus of the abdomen. Vaughn is also composed of the meat and aponeurotic parts, the proteaponeurotic part of my folds. Aponeurosis can be late in the line, roztashovanu on the іvnі close to 2 cm below the navel (Douglas line, or arched). The food of the line of aponeurosis is stored in two leaves, one of which grows forward towards the straight abdomen, and the other - backwards. At the bottom of Douglas's line, offended leaves get angry one by one and spread forward towards the straight meat (Fig. 15.4).

Straight belly to grow in the middle part of the abdomen. Fibers її straightened from top to bottom. The mouth is broken by 3-6 tendon loops and lie on its own, formed by the opening of the aponeuroses of the inner and lateral joints of the abdomen. The anterior stinka of pichvi is represented by an aponeurosis

zovnishny oblique that part of the inner oblique of the abdomen. Vona pukhko is lifted out of the straight meat, but grows with it in the range of tendon loops. The posterior wall is formed for the opening of the aponeurosis of the inner oblique (chastkovo), transverse abdominal mucosa and the inner urinary fascia, and nowhere with the mucus it does not grow, molds

Small. 15.3.Balls of the anterior chernaya stinka (from: Voilenko V.M. and in.,

1965):

1 - straight m'yaz of the abdomen; 2 - zvnіshnіy oblique m'yaz of the abdomen; 3 - jumper between straight meat segments; 4 - aponeurosis of the lateral oblique meat of the abdomen; 5 - pyramidal mu'az; 6 - insect cord; 7 - supine-inguinal nerve; 8 - anterior and lateral cranial nerves of the respiratory-podcranial nerve; 9, 12 - anterior cranks of intercostal nerves; 10 - lateral cranial nerves of the intercostal nerves; 11 - front side of the straight abdomen

the space, in which the upper and lower supracranial walls pass. With a large number of veins in the dialect of the navel, one by one should be joined and form a large venous border. In a row of vipads, the straight mucus of the abdomen below the bottom is covered with a paramedal mucosa (Fig. 15.3).

Small. 15.4.Gliboki blood-bearing judgments of the anterior cranial wall (from: Voilenko V.M. et al., 1965):

I - upper epicranial artery and vein; 2, 13 - back wall of the straight abdominal meat; 3 - mіzhrebernі arterії, veni that nerves; 4 - transverse abdomen; 5 - hypochondriacal nerve; 6 - dagopodibna line; 7 - lower epicranial artery and vein; 8 - straight belly; 9 - the supine-inguinal nerve; 10 - internal oblique muzzle of the abdomen;

II - aponeurosis of the internal oblique meat of the abdomen; 12 - front side of the straight abdomen

Transverse abdomen lie all over the place. Vaughn is also stored in the meat and aponeurotic parts. The fibers grow transversely, with a whole aponeurotic part of the nagato shirsha behind the meat, as a result of which there is little space in the middle of the transition. The transition of the myazovaya part into the tendon cannon looks like a round line, which is called a spigel line.

According to the line of Douglas, the aponeurosis of the transverse abdominal muscle can also develop: the pathway of the line of wines passes through the direct abdominal muscle and takes part in the formed posterior wall of the direct muscle, and the lower part of the bone in front of the

From the transverse ointment, the inner urinary fascia grows, I will call it transverse in the area (according to the ointment, to lie on) (Fig. 15.4).

It is imperative that the aponeurosis of both right and right oblique and transverse joints of the abdomen along the middle line grow one by one, forming the line of the abdomen. There is a strong feeling of being in vessels, there is a sound between the balls and the abundance of food, the very line of the abdomen is the most convenient surgical access when handled on the inside of the abdomen.

On the inner surface of the cranial wall, you can see a number of folds and gagging (pits).

The middle umbilical fold grows vertically along the middle line, the yak є overgrowth of the fruit duct, overgrown with the year. At the oblique right from the umbilicus to the lateral surfaces of the cuticle, go to the inner or medial, right and left umbilical folds. The stench є surpluses of obliterated umbilical arteries, covered with a string. Nareshti, from the navel to the middle of the inguinal ligament, to stretch laterally, or the lasting umbilical folds, fixed by a cervix, which curved the lower epigastric judgment.

Between the significant folds, the nadmichurov is folded, medial inguinal and lateral inguinal fossa.

For those who understand the "weak mind of the wickedness", they can see those little pictures that are weakly streaming the inner vise, and when they are moved they can be the first ones to enter the grids.

Until such a moment, there is a must-have for the fossa, the inguinal canal, the line of the abdomen, the sixth-century and arc-like lines.

Small. 15.5.Topography of the inner surface of the anterior-bicheskoy cranial wall:

1 - straight m'yaz of the abdomen; 2 - transverse fascia; 3 - middle fold; 4 - inner umbilical fold; 5 - the name of the umbilical fold; 6 - lateral inguinal fossa; 7 - medial inguinal fossa; 8 - nadmіchurova fossa; 9 - stegnova fossa; 10 - lacunarna link; 11 - gliboke stegnova ring; 12 - the name of the club Vienna; 13 - the name of the club artery; 14 - nasinnєviy cord, 15 - gliboke groin of the groin canal; 16 - lower supercranial judges; 17 - umbilical artery; 18 - parietal nut

15.2.3. Topography of the inguinal canal

The groin canal (canalis inguinalis) is folded over the groin and thickened space between it and the wide abdomen. At the inguinal canal, there are 4 stems: anterior, upper, lower and posterior and 2 openings: internal and external (Fig. 15.6).

Anterior wall of the inguinal canal є the aponeurosis of the lateral oblique meat of the abdomen, which at its lower part is puffed up and added to the dose, forming an odorous sound. Stay є the lower wall of the inguinal canal. At the end of the region, the edge of the inner oblique and transverse ligaments of the groin of the groin of the inguinal ligament, and in this order the upper wall of the inguinal canal is formed. Rear wall represented by a transverse fascia.

Zovnishnu openings, Above the surface of the pahvinne ring (annulus inguinalis superficialis), it was approved for the rakhunok two times the aponeurosis of the lateral oblique abdominal meat, which diverge to the sides and adhere to the pubic symphysis and the pubic hump. At the same time, from the outer side, the little one shrinks with the so-called middle ring, and from the inner side - with the bent ring.

Internal openings, For a glimpse of the groin (annulus inguinalis profundus), є a defect in the transverse fascia, rosetting on the rivní lateral groin fossa.

In the place of the inguinal canal, in the choloviks the ductal inguinal nerve, the statute of the staginous nerve and the sinewy cord. Ostanniy є sukupnistyu anatomical statements, tied with fluffy cells and covered with a vaginal shell and ointment, which is enough for me. At the nasіnnєvuyu canal from the back, it’s going to work with the same duct from a. сremasterica and veins, before they lie down the artery and venous gossip.

In the place of the inguinal canal in females there is an inspiratory inguinal nerve, a staple of the stiticular nerve, a vaginal outgrowth of the cervix and a round uterine ulcer.

A slid of memory, a groin canal є there are two types of grids: straight and oblique. At the time, when the groin canal, there is a growth of the inguinal canal, tobto. the arm of the gryzogo mouse grows into the lateral pit, the gryzha is called a scythe. As the gryzha is located in the area of ​​the medial fossa, it is called straight. You can also shape the groin in the groin of the groin canal.

Small. 15.6. Inguinal canal:

1 - anterior wall of the inguinal canal (aponeurosis of the lateral oblique abdominal meat); 2 - upper stinka of the inguinal canal (lower edges of the internal oblique and transverse muscles of the abdomen; 3 - posterior wall of the inguinal canal (transverse fascia); 4 - lower wall of the inguinal canal (inguinal ligament); 5 - aponeurotic oblique abdomen; 6 - inguinal 7 - internal oblique mucus of the abdomen; 8 - transverse abdominal mucosa; 9 - transverse fascia; 10 - inspiratory-inguinal nerve; 11 - state of the staggerous nerve; - duct, blame it, 15 - call of nasinya fasciya

15.2.4. Topography of blood vessels and nerves of the anterior cranial wall

The blood-bearing judges of the anterior cranial stem grow into a ball of balls. Most of the top in the pediatric fatty cells of the hypogastrium to pass through the throat of the stegovy artery: the first statues, the supercranial and the superficial artery, which fills the artery. Arteries supravodzhuyut one, two, one veni. At the pediatric adipose cells of the epigastrium, from the top to the bottom, pass the thoracoepigastric vein (v. Thoracoepigastrica), which stretches to the umbilical region, and gets angry with the superficial venous hedgehog. In such a rank, in the navel area an anastomosis is formed between the system of the lower empty veins (for the superficial supracranial veins) and the upper empty veins (for the chest and supracranial veins).

Between the transverse and the inner mowing of the abdomen, the arteries and veins are torn apart, which should lie between 7-12 mid-ribs.

The upper abdominal artery and the vein (below the navel) and the superior epicranial sudini (the belly button) should be located. The first and the most famous club arteries and veins, others - without the mediocre continuation of the internal breast arteries and veins. As a result of the reduction of veins in the umbilicus, another anastomosis is formed between the system of the lower empty veins (for the opening of the lower epicranial veins) and the upper empty veins (for the opening of the upper epicranial veins).

In the area of ​​the navel, from the middle to the anterior cranial wall, there is a round ringing of the stove, in the navel of the navel, the nasal veins grow, as if the ringing of the neural vein is dying. In the result of the umbilical region, the formation of portocaval anastomoses is formed between the perimeter veins and the lower and superior supracranial veins (glibular) and the superficial supracranial veins (superficial). More importantly, there is a superficial anastomosis: in case of portal hypertension of the pediatric vein, it grows rapidly in size, and the symptom is called "the head of a jellyfish."

The innervation of the anterior cranial nerves is working for the opening of the lower 6 intercostal nerves. Storms of nerves are folded out between the transverse and internal mowing, with a whole overcranium, 7, 8 and 9 mid-ribbed nerves, the worm - 10 and 11;

15.3. DIAFRAGMA

The diaphragm is a dome-shaped septum, which is used to distribute the chest empty and empty the abdomen. On the side of the thoracic emptying, there is an internal chest fascia and a parietal pleurov, on the side of the empty stomach - an internal urethral fascia and a partial pleura. Anatomical characteristics

Tendon and ovules are seen with diaphragms. In the muscular appearance, there are three parts, which are visible up to the point of attachment to the diaphragms: the sternum, the rib and the cross section.

Small. 15.7.Lower surface with diaphragms:

1 - tendon part; 2 - sternum part; 3 - rib part; 4 - cross section; 5 - sternocostal tricut; 6 - transverse rib tricut; 7 - opening of the lower empty vein; 8 - stravohidny hole; 9 - aortic opening; 10 - medial midnight schilina; 11 - lateral mid-section; 12 - aorta; 13 - stravohid; 14 - right bloody nerve; 15 - aorta; 16 - thoracic lymph duct; 17 - cute Stovbur; 18 - unpaired vein; 19 - black nerves

Topography of openings and trikutniks of diaphragms

In front, between the sternal and costal parts, the sternocostal tricytes are expanded, at the back - the transverse-costal tricytes. In tricyclic tricycles, the fibers and the leaves of the inner-chest and inner-thoracic fascia are stuck.

The cross section of the diaphragms is shaped like three pairs of legs: medial, middle and lateral. The medial nizzhki are crossed between themselves, the result is that two openings are formed between them - aortic (posterior) and stravohidne (in front). With a lot of fibers, you can feel the stravohoid opening, set up the sphinkter stravohodu. Instead of these openings, it is shown in Fig. 15.7.

15.4. THE TOPOGRAPHY IS LOOKING ABOVE ON TOP

CHEREVNO EMPTY

The upper on top of the black empty space grows out from the diaphragms to the root of the breech of the transverse colon gut, the projection of which big-mens goes through the biosteel line.

Internal organi

At the upper surface of the black empty, the stove, gum michur, shlunok, spleen and part of the twelve-fingered intestine grow. It is unimportant for those who can lie near the pectoral cells, through the topographic, classical and functional closeness to the overhauled organs, and can also be carried to the organs of the upper surface of the pelvis.

Peritoneal bags and ligaments

The upper peritoneum on top, curving the inner organisms, fixing three bags: Pechinkova, Peredshlunkova and Omental. At the same time, the fallow step is visible in the form of a cervix, intraperitoneally or internally (from the sides), mesoperitoneally (from three sides) and retroperitoneally (from one side), the organisms are rotated (Fig. 15.8).

The pechinka bag is lined with a medial crescent and round knobs of a stove that is stored in three pieces. Above-like viddil, abo the right piddiaphragmatic space, lie between the diaphragm and the stove, є

Small. 15.8.Diagram of the sagital cut of the abdomen:

1 - anterior cherevna stinka; 2 - piddiaphragmatic space; 3 - oven; 4 - pechinkovo-slunk connection; 5 - pedestrian space; 6 - shlung; 7 - shutter-rim link; 8 - stuffing box opening; 9 - pidshlunkova zloza; 10 - stuffing box bag; 11 - breech of the transverse rim intestine; 12 - transverse rim gut; 13 - great omentum; 14 - parietal nutlet; 15 - loops of the small intestine and breeze of the small intestine

empty. There is plenty of room to accumulate twists and turns with perforated internal organs. In front of you, go over to the frontal wall, and lie between the frontal side wall of the abdomen. The frontal slit from the bottom to pass at the pediatric space, the retouching between the visceral surface of the liver and the lower organs - part of the twelve-fingered intestine and the pectoral viginus of the colon intestine. Behind the lateral side, the pedicle space is placed behind the right bicon canal. At the rearmedial part of the pediatric space, there is a two-fingered pechink-two-fingered and pechink-nirk sound;

The stuffing box bag is in the rear left position. The back of the von is surrounded by a parietal gland, anteriorly and laterally - with a slurry with zykh zyvyazy, medially - with stings of the omentum opening. It’s a wide space, but it’s not easy, but it’s just a gland hole, there’s a connection with an empty tube. The whole fact will explain the possibility of a trivial, malosymptomatic overbearing of an abscess, which has been rocked in the omentum.

The front bag is in the front position. The back of the vaughn is surrounded by a slurry with zyty ties and a small spleen, in front - with an antero-lateral wall of the abdomen. The upper part of the anterior pouch is called livim piddiaphragmatic space. From the lateral side, the bursa is moved from the left lateral canal.

Bloodbathing judges

Bloodlettingorgans of the upper on top of the cartilage empty (Fig. 15.9) take care of the abdominal part of the lower aorta. On the lower edge of the XII chest ridge, from it to go through the stovbur, which can go at once on its own small heads: liva shlunkova, zagalnu pechinkova and splenic artery. Liva shlunkov artery straight up to the cardial part of the shlunka and then grow on the left half of the small curvature. Zagalnaya pechinkova artery from the bottom of the head: up to the twelve-fingered intestine - the shlunk-two-farther artery, to the shlunk - the right shlunk artery and allowed to pass from the vlast pechin artery, like the blood-suckers, the stoves Selezinka artery where it may be horizontally left up to the spleen, with a path through a short spout to the slurry.

The venous roof from the organs of the upper on top of the black emptying is seen at the vortnu vein (from the unpaired organs, beyond the liver), which is straight at the gate of the furnace, rostatyuchuyuyu at the furnace-two-fingered links. From the stove, the roof is brought into the lower empty vein.

Nerves and nerves gossip

Інnervatsіyathe top on top of the cranial emptying will get rid of the bloody nerves, the pretty stove and the cranial nerves. Throughout the course of the cranial aorta, gossip grows aortic through the aorta, formed for a rakhunok of pretty and parasympathetic gilk. At the point of view of the aorta of the cranial stovbur, gossip is formed through

Small. 15.9.Top on top of the black light (s: Voilenko V.M. ta in, 1965):

I - backward pechinka artery; 2 - spleen artery; 3 - cross stovbur; 4 - lіvі slunkovі artery and vein; 5 - spleen; 6 - shlung; 7 - lіvі slunk-rims artery and vein; 8 - great omentum; 9 - right slunk-rims artery and vein; 10 - two-fingered intestine;

II - right slunk artery and vein; 12 - gastroduodenal artery and vein; 13 - the backbone of the duct; 14 - lower empty vein; 15 - komіrna Vienna; 16 - vlasna pechinkova artery; 17 - oven; 18 - zhovchny mikhur

it will be widened at once with the crankshaft stovbur. As a result, by the close of the organs, organ nerves gossip (pechinkove, selezinkove, nirkove) are established, which will prevent the innervation of the organs. At the center of the Upper Brigade artery, gossip is rocked by the Upper Brigade, and take care of the fate in the energy of the slunk.

Groups of lymphatic universities

Lymphatic system the upper on top of the cartilage emptying is represented by lymphatic collectors, which fix the thoracic lymphatic duct, lymphatic vessels and universities. You can see the regional groups of lymphatic universities, so that you can pick up the lymph from the other organs (right and only slunk, pechin, selezin), that collector that will take in some of them They are referred to through the aortic and lymph nodes. From them, the lymph flows into the thoracic lymph duct, as it pretends to be the path of zlittya of two transverse lymph stubs.

15.5. KLINICHNA ANATOMIYA SLUNKU

Anatomical characteristics

The slunker is an empty meat organ, in which one sees the cardial part, the bottom, the bottom, the bottom part. The slurry wall is stored in 4 balls: a mucous membrane, a slime base, a meat ball and a quill. The balls are tied together in pairs, so that they are allowed to be pulled together in the case: mucus-mucous and serous-mucous (Fig. 15.10).

Topography of the slunk

Holotopia.The shlunok roztashovuyutsya at the livu pidreber'i, chastkovo in the epigastriya.

Skeletotopiathe shlunk in the edge is not stable and grows in a similar vorozhnenny mill. Enter the shlunks to project to the point of origin with the sternum of VI or VII costal cartilages. Bramnik projects 2 cm to the right towards the middle line at the level of the VIII rib.

Syntopy.The front wall of the slider lies down to the anterior wall of the crank. The curvature is great to stick to the transverse

colon intestine, small - with the left part of the liver. The back flap clings to the bottom of the slurry, and sometimes to the bottom - from the bottom and the top of the slab.

Sound apparatus. Distribute glib and surface links. The superficial ligaments are attached along the course of the great and small curvature, and they will spread out at the frontal area. Before them, the great curvature of the slunk-stravohid ring, the slunk-diaphragmatic ring, the slunk-spleen ring, the slunk-rim ring, are carried along the great curvature. Due to the small curvature, the pechinko-two-twelvefold and the pechinko-shlunkovy zyvyazyut, which at once from the shlunkovo-diaphragmatic sound is called a malim omentum. Glybokі ties fasten up to the back wall of the shlunka. The chain of the shlunkov-pidshlunkov sound and the gatekeeper-pidshlunkov sound.

Small. 15.10.The slunker that twelve-fingered intestine was seen. Shlunok: 1 - cardial part; 2 - bottom; 3 - tilo; 4 - antral part; 5 - gate;

6 - shlunkovo-twelve-fingered transition. Two-fingered intestine;

7 - upper horizontal part;

8 - low part; 9 - lower horizontal part; 10 - visible part

Blood circulation and venous vidtik

Bloodstending.Isnuє 5 dzherel slunk bloodlet. By great curvature, the rights of the shlunkovy-gland arteries are being rocked, by the smallest curvature - the rights of the shlunkovy arteries. In addition, a part of the cardiac and rear wall of the body can be harvested from the short cinder arteries (Fig. 15.11).

Venous bedThe shlunka extends to the internal organ that post-organ part. The internal organ of the venous hem is re-welded with balls up to the balls of the slunk wall. The position of the organ of the part is transformed into an arterial channel. Venous roof from the slunk

vidtіkє at the vortnu vein, protest memory, in the region of the cardia є anastomoses with veins to the travohode. In such a rank, a portocaval venous anastomosis is formed in the slunk cardia.

Інnervatsіya

Інnervatsіyathe shlunk zdіysnyuєtsya gilkami bloody nervіv (parasympathetic) and cranial gossip.

Small. 15.11.Arteries of the liver and shlunka (z: Great medical encyclopedia. - T. 10. - 1959):

1 - Mikhura ducts; 2 - postal pechinka duct; 3 - vlasna pechinkova artery; 4 - gastroduodenal artery; 5 - the back of the pechinka artery; 6 - lower diaphragmatic artery; 7 - black stem; 8 - posterior bloating nerve; 9 - liva shlunkov artery; 10 - anterior bloating nerve; 11 - aorta; 12, 24 - spleen artery; 13 - spleen; 14 - pidshlunkova zloza; 15, 16 - livi shlunkovo-omental artery and vein; 17 - lymph nodes of the shlunk-stuffing box connection; 18, 19 - right shlunkovo-omental vein and artery; 20 - great omentum; 21 - the rights of the shlunkov vein; 22 - oven; 23 - splenic vein; 25 - zhalynaya zhovchna duct; 26 - the rights of the shlunkov artery; 27 - gateway Vienna

Lіmfovіdtіkannya. Similarly to the venous bed, the lymphatic system also extends to the internal organ (along the balls of the stem) and the part of the organ, which guides the course of the veins of the slunk. Regional lymph nodes for shlunks є vuzli of small and great omentum, as well as vuzli, rostasovanі vіla vіt spleenki i vdovzh of the cranial trunk (Fig. 15.12).

Small. 15.12.Groups of lymphatic universities on the upper top of the black empty space: 1 - pechinkovs; 2 - cherevny vuzli; 3 - diaphragmatic universities; 4 - lіvі shlunkovі vuzli; 5 - universities; 6 - lіvі shlunkovo-glandular universities; 7 - right shlunkovo-stuffing box universities; 8 - right shlunkovy vuzli; 9 - gateway universities; 10 - pancreatoduodenal universities

15.6. KLINICHNA ANATOMIYA DRUKU I ZHOVCHNIKH SHLYAKHIV

Anatomical characteristics

Pechinkaє the great parenchymatous organ of the wedge-like abnormal-flattened form. There are two surfaces: upper, or diaphragmatic, and lower, or visceral. The pechintsi see the right, the lion, the square and the tail of the part.

Topography of the stove

Tolotopia.The stove grows in the right side, chastkovo in the epigastriya and chastkovo in the left side.

Skeletopia.The upper boundary of the projection of the stove onto the back wall shows the height of the dome with diaphragms on the right, the lower edge of the individual and can appear along the edge of the costal arch, either as though it were at the bottom.

Syntopy.The diaphragmatic surface of the liver is tightly up to the diaphragms, through the yak it sticks to the right legends and to the heart. The miscellaneous of the diaphragmatic surface of the liver from the visceral back is called the back edge. Wine of additions to the cauliflower, so let’s talk about the cavernous surface of the stove, or pars nuda. In the middle of the disease to the liver, the aorta, especially the lower empty vein, is tightly attached to the parenchyma organ. The visceral surface of the stove has a number of furrows and depressions, or even squeezing, crumbling into the edges of the individual, and forming further in embryogenesis, furrows are formed by magical and ductal crevices that pass through, and press down on the lower organs. Razr_znyayut right and left late furrows and transverse furrows. The rights of later life are borne to revenge the young woman and the lower empty vein, but later on - the round and venous ligaments of the liver, the transverse boron is called the gate of the liver and the little bit of penetration into the organ of the gate of the gate of the wind, the right it is possible to wipe the squeeze from the shlunk і to the strand, on the right - from the twelve-fingered intestine, the shlunk, the colon intestine, and the right nirka with the supra-nirkovy zalose.

Clinking apparatus representations by means of the transition of the queue from the stove to the organisation's anatomical approval. On the diaphragmatic surface, a pechinko-diaphragmatic sound is seen,

it is stacked with late (sickle-like connection) and transverse (wine-like connection with right and left tricent links) parts. Tsia zyazka є one of the main elements of the fixation of the stove. On the visceral surface, pechink-two-twelve-fingered and pechink-slunk links are formed, such as a duplex queue with rostatised all-middle vessels, nervous gossip and kletkovinoy. Two zv'yazkoy, order from the slunk-diaphragmatic sound, store the malium gland.

The shelter is consumed in the stove by two vessels - the gate of the vein and the powerful stove artery. The gate vein is shaped by a path of evil of the upper and lower brijovy veins from the spleen vein. As a result, the portal vein carries shelter from the unpaired organs of the black empty - the small intestine, the shlunk, the spleen. Vlasna pechinkova artery є one of the kintsev arms of the zagalnoy pechinkova artery (the perch of the cherevny trunk). The gate vein and the vlasna pechinkova artery roztashovuyutsya in the comrade pechinkovo-two-twelve-fingered ring, with which the vein is borrowed in the middle between the stovbur artery and the zalous chewing duct.

Not far from the stove is the meaning of the decision to go to the skin on two of its keys - the right and the right to penetrate the stove and go to other keys. Parallel to the parenchyma of the liver, the swelling of the ducts grows. The closeness and parallelism of the values ​​\ u200b \ u200bof the vessels and ducts made it possible to see the functional group, so called the Glisonic triad, which does not provide the function of a strictly singing, admirable The liver segment is a parenchymal liver, in which there is a segmental gate of the vortic vein, as well as a type of vascular liver artery and a segmental duct. In the given hour, the furnace was taken over by Couinaud, but there are 8 segments (Fig. 15.13).

Venous vidtikfrom the stove to look for the system of the hepatitis veins, overrunning some non-growing elements of the glisonic triad. The peculiarities of the liver veins are the visibility of the valves and the muscles of the tissue from the tissue stroma of the organ, although the chain does not subside when it is damaged. In the case of 2-5 cyclones, the veins are drawn into the lower empty vein, passing behind the liver.

Small. 15.13.Links of that segment of the liver: 1 - the right of the tricut link; 2 - the rights of the vintseva sound; 3 - liva vintseva ring; 4 - tricut link; 5 - sickle-like sound; 6 - round sound of the stove; 7 - stove gate; 8 - pechinkovo-twelve-point sound; 9 - venous connection. I-VIII - liver segments

Topography of the zhovchny mikhur

Zhovchny mikhurIt is an empty muscular organ, in which one sees the bottom, only a little, behind the addition of some kind of dressing through the ducts of the michur with the other components of the gums.

Tolotopia.Zhovchny mіkhur roztashovutsya at the right pіdrebernіy dіlyantsі.

Skeletopia.The projection of the bottom of the chewing mikhura is shown to the point of the overretching of the costal arch and the last edge of the straight abdomen.

Syntopy.The upper part of the russet michur is flattened down to the visceral surface of the furnace, at which a small hole is formed. Innocent female mikhur appears in the parenchyma. More often than not, the lower stink of the gut muffin sticks to the transverse intestine of the rim (one from the twelve-fingered intestine and the slurry).

Bloodlettingzhovchnogo mikhur zdіysnyut for a rakhunok mіkhurova artery, yak, as a rule, є gіlkoy right pechіnkovo ​​artery. Vrahoyuchi, who is even more variable, in the practice of revealing the michurian artery, is reproached by the tricycle Callot. Walls of a tricycle є

Small. 15.14.Pozapechnikov zhovchny paths: 1 - the rights of the pechinkov channel; 2 - liva of the Pechinka duct; 3 - postal pechinka duct; 4 - Mikhura ducts; 5 - the backbone of the duct; 6 - supraduodenal part of the posterior zhazhnoy duct; 7 - the posterior part of the posterior zhazhnoy duct; 8 - punk-reatic part of the zhazhnoy zhovnoy duct; 9 - the intramural part of the zhazhnoy zhazhnoy duct

michurova duct, zhaglna duct and mikhurova artery. The blood from the mikhur through the mikhurovs of the veins is from the right to the right of the gates of the veins.

Topography of the zhove ducts

Zhovchni ductsє empty tubular organs, which can be used to secure the passage of the gut from the liver into the intestine. At the gates of the pechinka, right and left of the pechinka ducts are laid out without delay, as they get angry, they set up the pechinka duct. If you get angry with the duct of the michura, I will leave the gut duct, the yak, which grows in your pechin-two-fingered ligaments, will appear in the enlightenment of the twelve-fingered intestine with the great papilla. Topographically, one can see such parts of the lateral duct (Fig. 15.14): supraduodenal (the duct is rosted in the two-fingered pectoral ring, occupying the extreme right position along the extension to the protruding stage of the artery) the duct is rosted behind the head of the papillary gland, and sometimes it is embedded in the parenchyma of the gorse) and intramural (the duct passes through the wall of the two-fingered intestine and enters the papilla). In the remaining part of the posterior gut duct, as a rule, it is closed from the posterior pancreatic duct.

15.7. KLINICHNA ANATOMIYA PIDshlunkovoi zalozi

Anatomical characteristics

Pidshlunkova zloza is a parenchymal organ of a stretched form, in which a head is seen, only and a tail.

(Fig. 15.15).

Tolotopia.Pidshlunkova zalosa is designed for the epigastric and partly livas of the region.

Skeletopia.Tilo zalozi zvvychay grow on the level of the II transverse ridge. The head should lie lower, and the tail is a ridge by 1 ridge.

Syntopy.Put the head up, down, and right-handed gently lie down to the viginus of the twelve-fingered intestine. At the back of the head, the aorta and the lower empty vein are expanded, and above along rear surface -

Pochatkova part of the gateway veni. In front of it, lay the shlunnu on top of her omental bag. The back flap of the slurry is prone to grow up to the bottom, and when it turns into a new twist or the pathological process, it is not easy to switch to the fennel (in cychids, it is said about the penetration of the fenestration). The tail of the spleen should go even closer to the gate of the spleen, and it can be squeezed when the spleen is visible.

Small. 15.15.Topography of pidshlunkovoy zalozi (z: Sinelnikov R.D., 1979): 1 - spleen; 2 - shlunkovo-spleenny zyvyaz; 3 - the tail of the slurry zone; 4 - thin gut; 5 - viscid form of the two-fingered intestine; 6 - the head of the slurry hole; 7 - liva head rim artery; 8 - liva rim vein; 9 - a horizontal part of the gut; 10 - lower vigin of the twelve-fingered intestine; 11 - root of brizhi; 12 - lower part of the twelve-fingered intestine; 13 - upper pancreatoduodenal artery; 14 - the upper part of the gut; 15 - komіrna Vienna; 16 - vlasna pechinkova artery; 17 - lower empty vein; 18 - aorta; 19 - black stem; 20 - selezinkova artery

Blood circulation and venous appearance. Three dzherels take the fate of a bloodstatic zalozi: a cherewny stovbur (behind the help of a twelve-fingered artery) that upper brijov's artery, in the main, will prevent the bloodletting of the head of that part of a zalozi; just a little bit to get shelter from the short pancreatic throats of the spleen artery. The venous roof is introduced into the spleen and upper bridgeway vein (Fig. 15.16).

Small. 15.16.Arteries of the pidshlunkovaya zalozi, twelve-fingered intestine and spleen (s: Sinelnikov R.D., 1979):

I - lower empty vein vein; 2 - the back of the pechinka artery; 3 - splenic artery; 4 - liva shlunkov artery; 5 - liva shlunkovo-stuffing box artery; 6 - short slurry arteries; 7 - aorta; 8 - spleen artery; 9 - splenic vein; 10 - upper pancreatoduodenal artery;

II - gastroduodenal artery; 12 - komіrna Vienna; 13 - the rights of the shlunkov artery; 14 - vlasna pechinkova artery; 15 - right shlunkovo-stuffing box artery

15.8. THE TOPOGRAPHY OF THE LOWER SURFACE OVER THE CROWN EMPTY IS VERY LOOK

Internal organi

The lower on top of the black emptying rots out from the root of the breech of the transverse colon to the near-cord line, tobto. the entrance to the empty pelvis. At the same time, there is a thin and small intestine, at which the neck is curved in a simple way, as it happens in times of transition of the visceral queue to the parietal, and when the queue moves from the organ to the organ, it starts to swell. Practically significant ciche dullness of the field at the possibility of widening (canals) is, navpaki, intermittent (sinus, swelling) of a pathological process, as well as the ability to form internal grids (swells) (Fig. 15.17).

The root of the small intestine is a duplication of the root of the root of the root of the small intestine with the growth of the middle cells, the nerves and the nerves. Root out the wines obliquely: from top to bottom, wicked to the right, start at the half of the second cross ridge and end at the right heart. On his own way, the vein peretinaє two-hundredths of the intestine (kintseviy viddil), the cranial aorta, the lower empty vein, the right sechovod. You must pass the upper Brigade artery with the upper Brigade vein.

Black sinuses and intestines

Right Brigovian sinus obmezheniya from the top of the breech of the transverse colon intestine, evil and below - the root of the breech of the small intestine, right-handed - the inner wall of the upper rim intestine.

Livy brijovy sinus between the top of the root of the small intestine, below - the thermal line, evil - the inner wall of the lower rim intestine.

Small. 15.17.Channels of the sinus of the lower on top of the cartilage empty: 1 - right bichny channel; 2 - livy bichny channel; 3 - right Brigovian sinus; 4 - liviy brijovy sinus

Praviy bichny channel to grow between the viscid rim intestine and the antero-lateral wall of the abdomen. This canal can be seen between the pechink bag and the right club hole, tobto. between the top and bottom on top of the black empty.

Liviy bichny channel lie between the antero-lateral wall of the abdomen and the lower rim intestine. At the upper part of the canal, a diaphragmatic-rim link is formed, which closes the canal from above in 25% of people. This canal is more common (if the sound is not flickering) between the club hole and the front bag.

Quiches of queues. In the area of ​​twelve-fingered viginus, the Treitz's cistern, or recessus duodenojejunalis, grows. Yogo klinichne meaning of the field at the opportunity to win here is a reference to the inner grids.

In the area of ​​the ileocecal junction, three colonies can appear: upper and lower ileocecal, rostasis as seen in the ileocecal junction, and retrocecal, which lies behind the intestine. This is the place where you will receive special respect for the surgeon during the visitation of the appendectomy.

Between the loops of the sigmoid intestine, the intestine (recessus intersigmoideus) grows. In the middle of a colony, it is also possible to determine internal grids.

Bloodbathing judges (Fig. 15.18). On the level of the I transverse ridge from the cranial aorta, the upper artery of the Bryzhov emerges. Vaughn enter at the roots of the small intestine

Small. 15.18.Gilki of the upper and lower brijovy arteries: 1 - the upper brijov artery; 2 - middle rim artery; 3 - the rights of the rim artery; 4 - zduhvinno-slipokishkov artery; 5 - artery of the wormlike appendage; 6 - lean arteries; 7 - bowel arteries clubs; 8 - lower Brigova artery; 9 - liva rim artery; 10 - sigma-like arteries; 11 - upper rectal artery

Small. 15.19.Vorotna vein and tributaries (z: Sinelnikov R.D., 1979).

I - stravohidnі veni; 2 - lіva gіlka vіtnoї veni; 3 - liva shlunkova vein; 4 - the rights of the shlunkov vein; 5 - short slurry veins; 6 - splenic vein; 7 - liva shlunkovo-omental vein; 8 - gland veins; 9 - liva nirkova vein; 10 - mice anastomosis of the middle and left rim veins;

II - liva rim vein; 12 - lower Brigov's vein; 13 - lean veins; 14, 23 - home clubs veni; 15 - sigmoid vein; 16 - upper rectal vein; 17 - internal club Vienna; 18 - the name of the club Vienna; 19 - middle rectal vein; 20 - lower rectal vein; 21 - rectal venous gossip; 22 - vein of the worm-like outgrowth; 24 - zehvinno-rim vein; 25 - rights of the rim vein; 26 - middle rim vein; 27 - upper Brigov's vein; 28 - pancreatoduodenal vein; 29 - right shlunkovo-stuffing box vein; 30 - umbilical veins; 31 - komіrna Vienna; 32 - the rights of the gate; 33 - venous capillaries of the liver; 34 - pechinkovy veins

kіntsevі gіlki. On the level of the lower edge of the trunk of the III transverse ridge, from the aorta, enter the lower Brigov's artery. Vona roztashovuutsya in the uterus and from the bottom to the lower rim, sigmoid and rectum.

The veins are venous from the organs of the lower on top of the veins at the upper and lower brijovs, which, angry from the spleen vein, fill the vortic vein (Fig. 15.19).

Nerves gossip

Nerves gossip the lower top is represented by parts of the aortic gossip: on the level of the upper bridal artery, the upper bridle of gossip is used, on the level of the lower bridal - the lower bridal of gossip. Above the entrance of the malia, the pelvis of the lower Brigade gossip is transformed into the upper hypogastric gossip. The purpose of gossip will provide the innervation of the small intestine.

Groups of lymphatic universities

Lymphatic system the small intestine is analogous to the arterial and is represented by a series of lymph nodes. The first row of ripples along the edge of the artery, the other - the order of the intermediate arcades. The third group of lymphatic universities is located along the upper breech artery and the back for the small part of the intestine. The lymphatic system of the intestinal tract can also be stored in several rows, the first to lie bridging the edge of the intestine. In a number of people, there are groups of lymphatic universities of the slit, upper, transverse rim, lower rim, and sigmoid colon. On the rivni arcades lie another row of lymph universities. Nareshti, along the course of the stovbur of the lower Brigade artery, there is the third row of lymphatic universities. On the level of the II transverse ridge, the formation of the thoracic lymphatic duct appears.

15.9. KLINICHNA ANATOMIYA TONKOYU

І thick intestine

Tovsta and the small intestine є empty mucilaginous tubular organs, which are stored in 4 balls: mucous membrane, mucous membrane, mucous membrane and serous membrane. Shari

Combine at the case in the same way until the bottom of the shlunka. The small intestine is divided into three parts: twelvefold, thinner and thinner. Tovsta gut is divided into 4 parts: slip, rim, sigmoid rectum.

In the course of operations on the organs of a void, it is often necessary to remove the small intestine from the body. See the basic and additional signs that allow you to see one intestine from the inside.

The main signs: at the point of the intestine, the late ball of oyster fibers grows unevenly, it is combined in three late lines; mіzh with lines the bowel stinks are called; mіzh vipinnya stinki є constrictions, which add to the inconsistency of the stinky gut. Additional signs: tovsta gut in normal small diameter is lower than thin; the stem of the intestine is siruvato-green coli, the stem of the small intestine is erysipelas; The arteries and veins of the intestine can be easily molded into the fringes of arcades, on the view of the arteries of the small intestine.

15.9.1 Two-fingered intestine

The two-hundredth intestine is an empty muscular organ, which has 4 sections: upper horizontal, lower, lower horizontal and upper.

Tolotopia.Twenty-five intestine growths are mainly in the epigastric and partly in the umbilical areas.

Skeletopia.The shape of the bowel can be small, the upper edge of the bowel grows on the level of the upper edge of the I transverse ridge, the lower one - on the level of the middle of the IV transverse ridge.

Syntopy.Through the middle of the lower part of the twelve-fingered intestine, horizontally pass the root of the breech of the transverse colon. The inner surface of the twelve-fingered intestine is tightly tied with the papillary zone, in the same place the mother of the nipple grows - the place where the gallbladder and pancreatic ducts fall into the intestine. Zovnishnoprava the intestine is prone to right nirka. The upper wall of the intestinal ampoule is shaped like a vise on the visceral surface of the liver.

Sound apparatus. A large part of the intestine is fixed to the back wall of the abdomen, the protrusion and the tip of the intestine appear, or lie down easily and tighten with ligaments. The ampoule is adapted to the pechink-two-twelve-fingered and twelve-fingered-nirkovo sound. Kintseviy

viddil, abo flexura duodenojejunal,fixing for the help of the call Treytsa, yak, on the view of all the calls, I have my own comrade m'yaz - m. suspensorius duodeni.

Bloodlettingtwelve-fingered intestines are provided with two arterial arches - anterior and posterior. At the same time, the upper part of the cich arcs is fixed by the shlunkov-two-twelve-fingered arteries, and the lower part - by the upper brizhova. Venous vessels grow in the same way before arteries.

Інnervatsіyatwelve-fingered intestines are mainly responsible for the bladder nerves and cranial gossip.

Lіmfovіdtіkannya.The main lymphatic judges grow out at once from the blood-bearing ones. Regional lymphatic universities є universities that lie at the gates of the liver and in the roots of the small intestine.

15.9.2. Huda i klubova gut

Tolotopia.Small intestine can be found in the mesogastric and hypogastric areas.

Skeletopia.The small intestine is not responsible for its position, fixed only ears and ears, the projection of some types of projection of the ear and the root of the small intestine.

Syntopy.At the lower surface of the black empty, the thinner intestine grows in the central part. Behind them lay the organ of the urethral space, in front - the great omentum. The right-handed person is located at the bottom of the rim intestine, the slice of the intestine and the worm-like outgrowth, at the top is the transverse rim intestine, the hand is at the bottom of the rim intestine, and the hand is at the bottom of the sigmoid.

Bloodlettingbad and club gut, try to get to the top of the upper brigade artery, as well as the lean and gut arteries (in numbers 11-16). The skin of the arteries goes by the type of bifurcation, moreover, the heads, which go, get angry one by one, forming a system of collaterals called arcades. The rest of the series of arcades roztastoyutsya order from the wall of the small intestine and is called parallel or extreme court. Go down to the intestinal wall to go through the rectum, the skin of the blood-flowing dilemma of the small intestine. Venous vessels grow in the same way as arterial ones. The venous roof is in the upper Brigovian vein.

Інnervatsіyaof the small intestine to gossip from the upper breeches.

Lіmfovіdtіkannyafrom the bad and club gut, from the brijov limphatic universities, far from the lymphatic universities, where to lie bridle of the aorta and lower empty veins. A part of lymphatic vasculature emerges without anteriorly into the thoracic lymphatic duct.

15.9.3. Slipa gut

The slime of the intestine grows in the right air hole. At the lower part of the intestine lie a worm-like outgrowth, or an appendix.

Tolotopia.Slip gut and worm-like appendage, as a rule, is designed on the right-sided-and-backward region, protea appendix can be placed either directly or directly from the suprapubic to the right biconline or to navigate the subcostal region. It takes an hour for the operation to move the wormlike outgrowth to pick up the throat lines of the intestinal tract - the throat of the appendix grows to move all three lines one by one.

Skeletotopiaintestine, as well as rim, individual. As a rule, the intestine grows loose in the right airway.

Syntopy.From the inner side to the lumbar intestine, the lining of the club intestine is attached. At the point of transition of the club intestine into the slit, the so-called ileocecal flap, or valve, is called. At the upper part of the slice, the intestine passes at the upper rim.

Bloodlettingof the intestine, like a wormlike appendage, go to the back of the back of the upper bridle artery - the spiritual-colonic artery, yak, go to his own, walk until the transition Venous vessels grow in the same way as arterial ones (Fig. 15.20).

Інnervatsіyathe intestines of the wormlike appendage stand for the breech gossip.

Lіmfovіdtіkannya.Regional lymphatic universities for the intestine and appendix є universities, rostasovani vdovzh Verkhnih Sudin Brizhovyh.

Small. 15.20.Parts of that blood-bearing judgment of the іleocecal cut: 1 - club gut; 2 - worm-like outgrowth; 3 - intestinal slips; 4 - viscid rim intestine; 5 - upper zduhvinno-slipokishkov kishena of the queue; 6 - lower zduhvinno-sl_pokishkov quill; 7 - breeze of the worm-like outgrowth; 8 - front line of the colon; 9 - upper stool of the ileocecal valve; 10 - lower chair; 11 - upper bridal artery and vein; 12 - artery and vein of the worm-like outgrowth

15.9.4. Obodova gut

Visible, transverse, lower, and sigmoid rim intestine. The transverse intestine is covered with a gut from the sides, the breeze is located on the border of the upper and lower surfaces. The hanging and lower rim intestine is covered with a collar mesoperitoneally and rigidly fixed in a black empty one. The sigmoid colon grows in the air in the middle of the hole, covered with a string from the sides and the breeze. Behind the brigade, there is a mishsigmopodibna of a roast.

Bloodlettingof the colon gut zd_ysnyuєu upper and lower brigade arteries.

Інnervatsіyaof the colon to get rid of the gibberish gossip.

Lіmfovіdtіkannyastay at the university, rostashovani along the course of the brigade's vessels, the aorta and the lower empty vein.

15.10. LOOKING OUT TOPOGRAPHY ZAGORUSHINNY

SPACE

Outside of the uterine space - the space of the cells with the organs that have grown in the new one, the vessels and nerves, to become the back of the empty abdomen, between the front of the parietal queue, behind - the inner side of the gland, downward From the sides of the uterine space, go to the anterior urethral space. In the outer space, there are middle views and two lateral ones. At the lateral part of the urethral space, there are supernatant zalozi, nirka, sechavodi. At the middle part, there is a cranial aorta, a lower empty vein, and nerves gossip.

Fascia and klіtinnі spaciousness

The extra-urethral fascia extends the extra-urethral space on the cell, the first of which is the extra-urea cell, which is surrounded by the intra-urethral fascia back and the extra-urethral fascial front (Fig. 15.21, 15.22). Tsei ball є to the continuation of the anterior chalice, up the hill to pass from the cell to the middia-phragmatic space, from the bottom to the cell of the small pelvis.

At the outer edge of the nirka, the zapadine fascias extend into two sheets, which are called the transversal and posterior fascias. Tsі sheets mіzh themselves flank the offensive ball of Klitkovini - near-nirkova Klіtkovina. Fat cells of the whole ball from their sides let the nirk go, stand up the hill, hunt supra-nirkovy, and from the bottom go into the peri-ureteric cell and go away from the cell of the small pelvis.

In the medial tension of the posterior fascia, it grows from the internal diabral fascia, as well as from the outskirts of the XI-XII ribs, in such a rank, the vernacular ball of the cellulose spherical і znikaє. It is important to pass the fasces behind

twelve-fingered intestines and pidshlunkovoy zolozi and close with such a fascia of the prototypal side. Between the important organs, the most important thing is to get wide open space, to avenge the fluff on the unformed fabric.

Behind the viscid and low forms of the colon gut є posteriorly the oddodcous fascia (Toldt's fascia), which surrounds the third ball of the clytkina in front of the clytkovina. Behind the navkoloobodovoy klitkovini surrounded by the fastia.

Expanding the wider processes in the middle of the day and by the way. Through knowledge in the vastness of cells of nerve gossip, the important role in the implementation of the mass blockades for the disease is important.

Small. 15.21.Diagram of the space behind the umbilicus on the horizontal perspective: 1 - skir; 2 - adipose blood cells; 3 - superficial fascia; 4 - hairy fascia; 5 - tendon of the supreme back muscle; 6 - the best m'yaz of the back; 7 - m'yaz, scho straightening the ridge; 8 - outer braid, inner braid and transverse muzzle of the abdomen; 9 - square m'yaz; 10 - great transverse m'yaz; 11 - internal fascia; 12 - urethral fascia; 13 - anterior urethral cell; 14 - liva nirka; 15 - navkolonirkova klitkovina; 16 - near-edged kishkov klitkovina; 17 - upper and lower rim intestine; 18 - aorta; 19 - lower empty Vienna; 20 - parietal nut

Small. 15.22.Diagram of the extra-urethral space on the sagittal vision: - Intra-urethral fascia; 2 - vlastny urevinniy keratin ball; 3 - posadinirkova fascia; 4 - navkolonirkovy klinny ball; 5 - the fascia is overridden; 6 - nirka; 7 - a cross-section conductor; 8 - navkolosechovidny keratin ball; 9 - near-rim cortical ball; 10 - viscid rim intestine; 11 - visceral neck

15.11. KLINICHNA ANATOMIYA NIROK

Anatomical characteristics

The name of Budova. Nirki roztashovany in the lateral part of the urethral space from the sides to the ridge stovp. The stench sees the front and back surfaces, the lasting opuces and the inner edges. On the inner edge there is the gate of the nirka, before which the nirkova nizhka enters. Before the warehouse of the nirkova nizhka, there are nirkova artery, nirkova vein, baliya, nirkova nerve gossip and lymphatic judges, which are digested at nirkova lymph nodes. The topography of the elements of the nirkova nizhka is offensive: the front position of the nirkova vein, behind it there is the nirkova artery, and behind the arteriyu side of the nirkova balya. The parenchyma of nirka is divided into segments.

Segmental Budova. The anatomical basis of the nirka on the segment is the distribution of the nirk artery. Naybils often develop options - rose into 5 segments: 1st - upper, 2nd - anterior-upper, 3rd - anterior-lower, 4th - lower and 5th - posterior. Between the first 4 segments and the 5th segment, pass the line of natural conformity of the nirka. Nirkas otochenі three shells. The first fibrous capsule of the nirka is prilly to parenchyma, from which it is tied with fluff, which allows you to see it with a dull path. Friend's capsule

Zhirova - molded on a columnar fat pad. The third capsule is fascial

To pretend to be leaflets in front of the posterior fascia. Take three capsules before the fixing device to carry the nirku nyzhka, the m'yaz bed and the inner vise.

Topography nirok

Skeletotopia(Fig. 15.23). Skeletopic nirkas are designed from the XI thoracic ridge to the I transverse ridge and from the XII thoracic ridge - II transverse ridge to the right. XII rib overflows to Lviv

Small. 15.23.Skeletotopia nirok (front view)

nirku in the middle, and to the right nirku - on the level of the upper and middle third. On the front cherevnaya wall of the nirka, it is designed near the vasna nadcranial region, along the edge of the bichni region. The gates of the nirka are designed in front of the middle edge of the straight edge of the abdomen from the line, from the end of the XI ribs. At the back of the gate, it is designed into a cuff between the back and the XII edge.

Syntopy.Syntopy of nirok is foldable, moreover, nirkas are stuck with the oozing organs of the vigils of their sheaths and the adjoining klitkovini. So, the rights of the nirk are from the top between the pechinka and we rule the supra-nirkovy zloza, the evil - from the lower end of the two-fingered intestine and the lower empty vein, in front - from the lower end of the rim and loops of the thin loops. Liva nirka sticks up from the top of the supra-nirkovy zalozya, in front - from the tail of the lumpy root, the lower end of the rim intestine, the right-handed person - from the cranial aorta. Behind the offense of the nirka lie at the box, fixed by the meat of the transverse area.

Holotopia.Later, the axis of the nyrok set up the kut, go down to the bottom, besides, the horizontal area of ​​the nirk set up the kut, go ahead. In such a rank, the gates are straight down and forward.

Blood circulation and venous vidtik

Nirkas are bloodstained with nirkovy arteries, such as spines of the cranial aorta. The rights of the nirkova artery are short for a lion, there is to pass behind the lower empty vein and the lower part of the twelve-fingered intestine. Liva nirkova artery to pass behind the tail of the pidshlunkovaya zalozi. Before entering the nirku from the arteries, enter the lower upper arteries. At the gates of the nirok artery go to the front and rear arms, the front, its own side, to extend into 4 segmental arms. In 20% of vipadkіv nirka otryuyut additional blood flow from additional blood vessels, which come either from the cranial aorta, or from the bloodstream. Additional arteries most often penetrate the parenchyma at the spheres of the poles. The venous outlet flows behind the nircovy veins into the inferior empty vein. The yachkov (yachnikov) vein falls on its own way to the left nirkovo vein.

Nirk's nerves get nervous with nerve gossip, like localized with a stretch of nirk's artery.

Lymphatic vessels of nirok fall at the lymphatic node of nirk vort, and distant at the university along the aorta and lower empty vein.

15.12. URINALS

Nowadays, you can fix it all the way and end up with the depressions of the sech. The stench is an empty meat organ with a typical Budova stinka. Dovzhin to make the seeding path 28-32 cm, diameter 0.4-1 cm. See two paths to the seeding path: a cross and a basin one, a cordon between them to serve as a line. In the course of the sechovod є there are three zvuzhennya. The first ringing is to be in the middle of the passage of the river into the sechovy, the other - on the level of the borderline and the third - at the point of falling into the sechovy mikhur.

The projection of the cuttings onto the anterior cranial wall leads to the last edge of the straight abdomen. Synthetic production of cuttings, as it is itself, is based on fat cells, which will drain them away. Medially from the right branch duct pass the lower empty vein, lateral-lateral viddil of the colon intestine. Throughout the middle of the duct pass through the cranial aorta, called the lower end of the colon intestine. In front, the injury of the sechovodi is re-melted with gonadal vessels. At the empty small basin from the back to the cuttings, the inner club artery. In addition, in women, the uterine appendages are rearranged from the back.

Blood postures occur in the upper viddili gilkami nirkovo artery, in the middle third - yachnikovy or yuchnikovu artery, in the lower third - sechopus arteries. Innervatsiya zdіysnyuєtsya from nirkovy, transverse and michuric gossip.

15.13. HANDMARKS

Nadnirkovy zalozi - guys zalozi internal secrets, which are located at the upper part of the urea space. Above-nirkovy zolozi can be found in the form of a droplet, O-shaped, oval-shaped. The right overhead grows between the peck and the transverse part of the diaphragm, with the same overhead and the upper pole of the right hand, up to 3 cm. nirkova nizhka. The blood circulation of the supra-nirkoval zalosis is derived from three main dzherels: the upper supra-nirkovo artery (the lower diaphragmatic artery), the middle

supra-nirkovo artery (gilka cherevnoy aorta) and lower supra-nirkovo artery (gilka nirkovo artery). The venous origin is located in the central vein of the supramundane and in the lower empty vein. Get nervous over the head with nervous gossip. Zalizi are stored from the brain and brain speech and vibrate a number of hormones. Glucocorticoids, minerocorticoids and androgens are produced by cortical speech, adrenaline and norepinephrine are synthesized in cerebral speech.

15.14. Laparotomy

Laparotomy - prompt access to the organs of the empty empty, so that you can go by the way of the ball distribution of the anterior ganglia and the opening of the empty empty.

Check out different types of laparotomy: late, transverse, braid, combined, thoracolaparotomy (Fig. 15.24). If you have access, you can use a vimogam until the development of a cranial scar, which is responsible for giving the projection to the organ, the organ is sufficiently exposed, but it is low-traumatic and it forms a small-scale operative scar.

Until late development, mid-growth (upper-middle, middle-middle and lower-middle laparotomy), transrectal, pararectal, late bichni are presented. Medium growth, which most often occurs in the classroom, is characterized by minimal traumatization of tissue, slight bleeding, and a wide variety of mucus.

Small. 15.24.See laparotomny designs:

1 - upper midline laparotomy;

2 - rose at the right edge behind Fedorov; 3 - pararectal growth; 4 - according to Volkovich-Dyakonov; 5 - lower midline laparotomy

access to the organs of the abdomen. Alle, in the low-class clinics, later in the middle, they have unsuccessful access to a secondary operative look-up. Todi are allowed to go up to the last, in the winter to more traumatic combined accesses. With the viscous pararectal, oblique, transverse and combined accesses of the surgical procedures, the ligament of the anterior cranial wall can be overturned, which can lead to the most frequent atrophy and acceleration of the operation

15.15. GRIZHYACHI

Gryzha is a defect of the myazo-aponeurotic spheres of the cranial stem through the defect of the myazo-aponeurotic spheres. Warehouse parts for grids є grids, grids and grids. From the gryzovy gates there is a natural or pathological opening at the myazo-aponeurotic ball of the chernaya stinka, through which to enter the gryzhovy vipinennya. Gryzhovy Mishok is a part of the parietal queue, which can be drawn through the gryzhovy gates. Organi, parts of organs and textiles, which are found in the empty grill bear, are called grilled vmist.

Small. 15.25.The stage of seeing a grilled mouse in case of oblique pachyvinny grizzly: a - exposure of the aponeurosis of the lateral oblique meat of the abdomen; b - visions of a gryzhovy bear; 1 - aponeurosis of the lateral oblique meat of the abdomen; 2 - insect cord; 3 - gray bear

In the classroom practice, the most common are pahwinny, stegnov, umbilical grids.

In case of odorous griffins, before the gryzogo vipinnya, there is a rupture of the groins of the inguinal canal, and a grizzly bear from instead of walking around the groin over the stinky sound. Gryzhovim vmestom, as a rule, є loops of the small intestine or the great omentum. I see a straight braid of groin. As soon as the back wall of the inguinal canal is pulled down, then there is a gray bear on a short path, and the gray gates are expanded into a medial nutty hole. Such a grill is called straight. With a slanting pakhvinny gry, the gates will grow into the lateral pakhvinny pit, the grizzly bear enter through the grizzly pakhvinne ring, pass through the entire channel and, having flown through the front wall, go through the surface of the girder. Due to the nature of the grizzly - a straight braid - see the development of methods of operative treatment. In case of straight pachyvinny grizzly, the back wall of the canal is completely changed, in case of mowing - the front wall of the pakhvinny canal.

When the stegovy gryzha gates are located under the smelling smell, and the gryzovy mishka goes out from the shkir through the myazovu or sudinnu lacuna.

Pupkova gryzha is characterized by vipinennya in the navel; as a rule, є on the back.

15.16. OPERATION ON THE SLUDE

Gastrotomy- Operation of the rosette to open the shlunks to the onset of the closing rosters.

Shown before the operation: difficulty in diagnostics and clarification of diagnoses, single polyp of the slunk, chuck at the gateway zone of the mucous membrane of the slunk, third-party til, bends, bleeding in weakened ailments.

Operation technology. Access is carried out by way of the upper middle laparotomy. On the middle and lower thirds, on the anterior stance, visually raise the stem of the slunk through the shank bar along the length of 5-6 cm parallel to the lateral axis of the organ. The edges of the wound should be raised with slacks, instead of the slurry, vidmoktuyut, look around the slime shell. In case of detected pathology (polyp, swelling, bleeding), check the necessary manipulation. Sewing a gastrotomy wound is sewn with a noble suture.

Gastrostomy- Operation of the stem of the lasting noritsi of the slunk with the mark of a piece year for the sick.

Shown before the operation: cicatricial, swollen stenosis to the travoductus, severe craniocerebral trauma, bulbar trauma, which require a tricky piece of food for a sick person.

Operation technology. When entering the empty house, carry out the path of the left-sided transrectal laparotomy. At the wound, insert the front wall of the shlunk, and in the middle of it, with the great and little curvature along the late axis of the shlunk, put a hum tube to the side of the shlunk, and the end of the line is straightened to the cardial part. Form folds near the tube from the side of the shlunka, such as fixing the kelkoma with serous-myase sutures. A purse-string suture is applied at the last suture, at the center of the rosette, and the tip of the probe is introduced at the slings. Tighten the purse-string seam, close the folds of the wall over the tube. The proximal end of the tube is inserted through the operative wound, and the wall of the shlunk is sewn to the partial end of the tube with high-knot syro-serous sutures. Sew the operative wound in a round manner.

Gastroenterostomy - operation from the application through the slurry and the small intestine.

Indicated before the operation: inoperable cancer of the antral cavity of the shlunk, cicatricial stenosis of the collar and twelve-fingered intestine.

Operation technology. The anastomotic anastomosis of the small intestine can be visonano in the small intestine: posteriorly, either in front of the colon, and also as a result of the fact that the anastomosis of the anterior or posterior is lined with the small intestine. Most often the front front and back rear options are vicious.

Anterior anterior gastroenterostomy (Welfler) to visit from the upper-middle laparotomy. When shooting a rosette of a black empty, there are twelve-fingered-papillary vigin and at a distance of 20-25 cm to take a loop of the small intestine, as a way to help the hand with a slag over the transverse rim of the intestine and the great omentum. The bowel loop is guilty of roztashovuvatis і isoperistaltically with the slag. Dal, between them, put an anastomosis on the crossbar at the side of the noble suture. To complete the passage through the loop of the small intestine, to bring and introduce, to impose another Brown anastomosis after the type of bik to bik. The operation is to end the grubbing of the empty worms tightly.

Posterior posterior gastroenterostomy. The access is similar. In case of rosette emptying, the great omentum and the transverse rim of the intestine are fed up into the mountains and in the bridle of the transverse rim of the intestine (mesocolon) on the diameter without vessels, the rosette is close to 10 cm. Having entered the twelve-fingered-like intestinal vigina, they see a loop of the small intestine and between it and a fold on the posterior end of the slunk, impose an anastomosis behind the type of bik with a noble suture. The growth of anastomosis can be transverse or later. Distant edges to the opening in the bridle of the transverse colon intestine with gray-serous sutures are sewn up to the back wall of the slunk, which will remove the lick and wring of the loops of the small intestine. Sewing the empty kernels loosely and tightly.

Shlunk resection - the operation of the visible part of the shlunk from the form of the shlunkovo-intestinal sputum.

Shown before the operation: chronic wounds, great wounds, good and bad new slunk.

It is far from the bottom of the slunk, when you can see it, it will open proximally (the view of the cardiac view, the bottom and the floor), the pyloroantral (the view of the tree view and part of the wall) and the part of the bottom For a large part, you can see it, you can see a resection of one third, two thirds, half a shlunk, subtotal (seeing all shlunks, behind a vignette of your card and crypt), total (abo gastrectomy).

Operation technology. There are no simple options for the resection of the slunk, which are most often used for stagnation of operations with Bilrot-I and Bilrot-II and other modifications (Fig. 15.26). Access to the slunk is by way of the upper middle laparotomy. The operative asker to be stored from a number of stages. With a lot of access to carry out the mobilization of the slunk. The next step is the resection of the preparation to the visible part of the shlunk, while suturing the proximal and distal cups, which have become overshadowed. There is a necessary and obligatory step-by-step є renewal without interruptions to the herbal tract, as there are two ways: Bilrot-I and Bilrot-II. The operation in both cases will end with the sanitation of the black emptying and the general sutures.

Gastroctomy- Outside the view of the shlunk with overlaid anastomosis between the stravohode that thin intestine. Shown and basic steps

Small. 15.26.Schemes of the resection of the slunk: a - between the resections: 1-2 - pyloroantral; 1-3 - subtotal; b - scheme of resection Bilrot-I; в - scheme of resection z Bilrot-II

operations analogous to such a resection of the slunk. For visualization of the shlunk, the absence of interruption of the shlunkovo-intestinal tract is introduced by the way of obtaining the pathway through the small intestine (the form of esophagojunoanastomosis).

Gastroplasty- autoplastic operation of replacing the slunk with a segment of the small intestine. To get into trouble with gastrectomy, as a sign of torturing the function of etching. Yak autograft vikoristovuyut dilyanka of the small intestine up to 15-20 cm, which is inserted through the stravohode and two-fingered intestine, transversely or lower rim of the intestine.

Piloroplasty according to Geynek-Mikulich - the operation of the late development of the collar sphinkter without rosette of the mucous membrane with the additional stitches of the wall at the cross-section. Stagnate with chronic and accelerated swollen ailments of the twelve-fingered intestine.

Vagotomy- Operation of overflowing nerves, or some of them. It’s not self-defeating, it’s stagnant, like a pre-termination during operations with the drive of a twisting ailment of a slunk and a twelve-fingered intestine.

Razrіznyayut stovburovu that selective vagotomy. With stovburov_vagotomy, retinue the storms of blistering nerves from the diaphragm to the numbness, with selective - slugs of the blistering nerve from the spared slugs to the stove and cranial plexus.

15.17. OPERATIONS ON A FRIEND AND ROCKING HOSTS

Resection of the liver- Operation to see a part of the stove.

The resections are divided into two groups: anatomical (types) and atypical resections. Prior to anatomical resections, the following are included: segmental resections; side-sided hepatectomy; right-sided hemihepatectomy; left-sided lateral lobectomy; right-sided lateral lobectomy. To atypical resections, wedge-like is carried out; edge and transverse resection.

Shown for resection є injuries, good and bad puffs and other pathological processes, which may be surrounded by wideness.

Access to the stove to grow deeply as a result of the pathological knowledge. Most often it is possible to get laparotomy of growth, but it can be combined access. The stage of anatomical resection is repaired from the vision at the gates of the liver of the segmental heart of the liver artery, of the segmental head of the portal vein and of the segmental duct. For ligation of the segmental head of the pechinkovo ​​artery of the parenchyma of the liver of the change of color. Along the way, there is a segment of the liver that is known to the pechinka vein, so that the venous roof is brought in from this dilenka, and it is ligated and overwhelmed. Dalі the wound surface of the stove is sewn from the stitches straight atraumatic heads and from the buried near the seam of the stove capsule.

In case of atypical resections with the first stage, the rostin parenchyma should be selected, and then the perevyazuyut perev'yut perezheni sudin and zhovchny ducts. With the remaining step, sew in the wound surface of the stove.

A special group of liver operations see operations for portal hypertension. Splenorenal anastomosis, which in this hour is recommended to be applied with microsurgical techniques.

Operations on the gallbladder can be distributed on the operation on the gallbladder, surgery on the backbone prototype, surgery on the duodenal papilla, reconstructive surgery on the gallbladder.

The main accesses to the post-pecunian zhovch's nobles є cut through the Fedorov, Kocher, upper-middle laparotomy, and earlier - іnshі vidi laparotomy. Sickness: anesthesia, a sick person's camp - lying on the back with a padded roller.

Operations on zhovchny mikhury

Cholecystotomy- the operation of the development of the stink of the mikhur for the visualization of the stonework from the empty space of the coming sutures of the stink of the mikhur.

Cholecystostomy - Operation of the invoice of the newest noritsi zhovchny mikhur. Victory in weakened ailments on the elimination of the manifestations of a mechanic zhovtyanitsa.

Cholecystectomy - The operation of seeing the chewing mikhur.

Technically, one can see two modifications: from the visions of the mihura from the bottom. Viconize at the hostile chi-chronically fired zhovchny mikhur. Everyday minds often use the technique of laparoscopic vision of the microscope.

Operations on the foreign female prototypes

Choledochotomy- operation of the rosette to educate the backbone duct by way of the path to the rosette of the first step from the onset of the sutures or drains. Fallingly from the rosette, they see the supraduodenal, retroduodenal, transduodenal choledochotomy. The name of the drainage of the zagalny zhovnoy ducts is called choledochostomies.

Operation on the great duodenal papilla

Stenosis of the great duodenal papilla that is wedged by a stone in the yogic arm is the main indication for the introduction of offensive operations.

Papilotomy- Rise of the wall of the great duodenal papilla.

Papiloplasty - Rise of the wall of the great duodenal papilla with the onset of suturing.

Papillosphincterotomy - Rise of the wall of the sphincter of the great duodenal papilla.

Papillosphincteroplasty - The development of the picture of the sphincter of the great duodenal papilla with the additional overlays of sutures on the development of the region.

Papillotomy and papillosphincterotomy can be seen endoscopically, tobto. without rostinu enlighten the twelve-fingered intestine. Papillosphincteroplasty is shown from the opening of the black empty and twelve-fingered intestine.

Before reconstructive operations, there should be biliodigestive anastomoses. Shown: stenosis of the post-pecunian zhovchny shlakhiv

of a growing genesis, iatrogenic ears, young people and children.

Cholecystoduodenostomy - the operation of applying an anastomosis between the gum michur and the twelve-fingered intestine.

Cholecystoyunostomy - operation of anastomosis imposition between the gum tissue and the thin intestine.

Choledochoduodenostomy - anastomosis between the zaghalny zhyvny duct and the two-fingered intestine.

Choledochyunostomy - the operation of the imposition of the back through the zagalny zhovchny duct and the loop of the small intestine.

Hepaticoduodenostomy - operation of imposing anastomosis between the postal pectoral duct and the thin intestine.

In the present hour, bіlіodigestive anastomoses are guilty of obsolescence of reflux and sphіnkternі power, which can be reached with victorious microsurgical technology.

15.18. OPERATION ON PID

Operations on the slurry hall should lie down to the folding operative ones. Access to the zalos can be made from behind the gut (up to the back surface of the gut), and through the gut, through the crankshaft-rim connections or the breech of the transverse rim gut.

Nekrectomy- the sparing operation of seeing necrotic dilankas of the slurry zone. Viconize with pancreatic necrosis, gnar pancreatitis on a heavy sick camp.

Cystoenterostomy - the operation of the application of the formation of the small intestine by the mucous membrane.

Shown before the operation: a bunch of sandwiches with well-formed walls.

Operation technology. By making a rosette of black emptyings To control the growth of the walls of the paint, її instead of evacuating, partitions in it to shape up a single empty space. Dale between the wall of the bone and the small intestine to impose an anastomosis. The operation is completed for the drainage and for the wide-ranging sutures of the operation wound.

Left-sided resection of the bottom hole - the visible tail of that part of the body of the felted burrow.

Shown before the operation: tail trauma, pancreatic necrosis of the dilyanka, puffy injury. Access to the description of the food.

The main reason for a successful operation: preserving the pancreatic secretion on the cephalic duct, which leads to the peritonisation of the pancreatic secretion. For the operation, it is necessary to monitor the patient's insulin level.

Pancreatoduodenal resection - operation of the visualization of the head of the pancreatic junction at the same time with a part of the twelve-fingered intestine with the onset of the gastrojejunostasis, choledochojejunostomy and pancreatojejunostomy for the renewal of the tracts of the slurry passage, the juices of the tavern. Operation - one of the most common operational involvement in the connection with significant traumatization of organs.

Shown before the operation: swelling, necrosis of the head of the pidshlunkovoy zalozi.

Operation technology. Access - laparotomy. A handful of ways to carry out the mobilization of the two-fingered intestine, the slurry, the slunk, the choledochus. Far from being significant organizers of retail ukrittam kuksi pidshlunkovoy zalozi, sob to uniqueness the food of pancreatic juice. Great care is taken to ensure that all stages of all operations are carried out by roasting vessels. Let's start є reconstructive stage, before the hour when we impose pancreatojejuno-, gastrojejunojunostomy and choledochojejunostomy. The operation is to end the business, the drainage and the emptying of the worms.

15.19. OPERATIONS ON TONKІY І TOLSTІY KISHTSІ

Intestine suture - a seam that can become stuck when all empty tubular organs are sewn together, the walls that can be worn in a case, tobto. It consists of 4 shells: mucous, mucous and serous (or adventitious), combined in two fluffy tied between them cases: mucous-mucous and serous.

The intestinal suture is to blame for the satisfaction of several vimogs: the blame is for being airtight for a leaky organ and mechanically minuscule, besides, when the suture is declared, it is guilty of an insecure hemostatic. Still one vimoyu є asepticity of the intestinal suture, tobto. The head is guilty of penetrating through the mucus membrane into the enlightened organ, the inner shell is guilty of becoming intact.

Enterostomy- the operation of the imposition of a callous noritsi on the worse (jejunostomy) or the duhvinny (ileostomy) intestine.

Indicated before surgery: for drainage of the posterior zhazhnoy duct, parenteral feeding, decompression of the intestinal tube, colon cancer.

Operation technology. Access - laparotomy. The loop of the small intestine is sewn with knotted sutures to the parietal neck. The intestine is opened all at once, or in 2-3 days. The edges of the intestinal wall are brought up to shkiri.

Colostomy- The operation of the overlay of the lasting noritsi on your intestine. Through the overlaid colostomy, one can see the loss of a portion of feces, it is decided to pass its own path.

Shown before colostomy: necrosis or perforation of the bowel of the intestine due to the discomfort of the second resection, swelling of the intestine. Regularly from the localization of the development of tsecostomy, sigmoideostomy and transverse endostomy. Most often, a tsecostomy is an operation of applying a callous noritsi to the slips of the intestine. Technique of tsekostomy is offensive. Razrіz vikonuyut at the right zduhvinnіy dіlyantsі through the point of McBurney. At the wound, the intestine is lined up and podshivayut to the parietal cervix. Do not open the intestine, put an aseptic bandage on the wound. For 1-2 days, the visceral stitch is welded along the entire stake of the seam from the parietal. It is possible to develop intestinal education. For a decade, a drainage tube can be inserted into the intestine. In the Danish hour, it will be specially sorted out kalopriymachi.

The technique of sigmoideostomy and transverse resistance is similar.

Prototype natural rear passage - Piece by piece the opening of the surgical operation of the healthy intestine, through which calovy instead of being seen, will be called.

Shown before surgery: swelling of the lower intestine, injury to the rectum, perforation of lesions and diverticulums.

Operation technology. The operation is to display only on vilnyh dylyankas of the intestine - transverse rim or sigmoid. Access - oblique rozrіz in lіvіy zduhvinnіy dіlyantsі. Up to the shkіri we make a parіetal wedge. At the wound, there are loops, which lead and lead, the sigmoid colon, and the edges of the sigmoid colon are sewn with gray-serous nodular sutures to make the "two-barreled". The visceral gut of the intestine is fed up to the parietal for isolation of the empty gullet from the zovnishny middle. Intestine wall

open through the chain of the days with a transverse opening, such a rank of openly opening and looping, how to bring, and introduce, how to transfer the stool masses into the distal loop. Behind the overlay of a piece back aisle is a necessary retelny look.

Small intestine resection - the operation of the visible part of the bad abdominal intestine with the form of an intestinal anastomosis on the chinstorm at the end or at the bottom.

Indicated before the operation: swelling of the small intestine, necrosis of the small intestine with thrombosis of brijovic vessels, intestinal imperfections, pinched grids.

Operation technology. Access - laparotomy. To open a black emptying of the intestine, to make a resection, to remove the wound and release it with gauze servet. It is far away for a long time to carry out dressing of all vessels of the breech, when they see them from the intestines. Dalі to vikonuyut resection of the intestine і to mold kuksi on the edges, scho zalishayutsya. The stumps are applied one to one isoperistaltically and the enteroenteroanastomosis is applied in order to renew the passage of the herbal tube. Deyakі surgeons determine the anastomosis at the end of the day at the end of the day, which is more physiological. Sew the laparotomny wound wide.

Resection of the transverse colon - operation of a visible part of the transverse colon with overlapping anastomosis between parts of the type end to end.

Shown before the operation: intestinal necrosis, pukhlini, infection.

The technique of the operation is similar to resection of the small intestine. When a part of the intestine is visible, the passage of an anastomosis of the end-to-end type is observed. Vrahoyuchi means bacterial obstruction of the intestine, when the anastomosis is applied, the three-row suture should be stashed, or the anastomosis should be applied in an incremental order.

Right-sided hemikolectomy - operation of the visualization of the intestine with the endocytic intestinal tract, the viscous rim and the right side of the transverse colon with the overlapping anastomosis between the duct and the transverse intestinal tract according to the type of the intestinal tract

Shown before the operation: necrosis, infection, puffiness.

Operation technology. Vykonuyut laparotomy. I saw the rosette of the empty intestine, bandage it.

Judge її Brizhі, for whom the brizhu is driving. To overflow the gut of the club for the required dilyants. The next step is to see the slit intestine and the hanging rim and bandage the judges, so that they can live. A part of the intestine is visible, and the kuksu is sewn in with a three-row seam. For renewal of intestinal permeability on to the final stage operations impose ileotransverse anastomosis. Blow and suture the wound.

Left-sided hemikolectomy - the operation of visualization of the left side of the transverse, lower rim and large part of the sigmoid colon with the overlapping anastomosis between the transverse rim and the coxae of the sigmoid or cob part of the rectum behind the end of the end of the rectum. Shown before the operation: a swollen process at the left half of the rim intestine.

15.20. APENDECTOMIA

Apendectomy is an operation to see the worm-like outgrowth. This operation is one of the most frequent victims in abdominal surgery.

Shown before the appendix to serve catarrhal, phlegmonous or rotten worm-like outgrowth.

Operation technology. On the right side of the wind, to carry out a change in the front row along the Volkovich-Dyakonov line, parallel to the pakhvinny ring through the McBurney point, which is located between the last and the middle third of the front line. ... With a scalpel, use a scalpel to restore the skin, the fatty fatty tissue, the superficial fascia and the aponeurosis of the lateral oblique abdominal meat. Then, along the fibers, use a blunt method to spread the inner braid and transversely to the abdominal mucosa (the muff cannot be repaired with a scalpel at the link with the more damaged blood in them). With a scalpel, spread the transverse fascia of the abdomen, the parietal neck and enter at the empty hole. At the wound, there is a dome of the slit intestine at once from a wormlike appendage. The visual familiarity of the intestinal tract from the club є the appearance of adipose adiposities, both the late and late vertebral stitches, at the same time it is necessary to remember that all three lines converge for the basis of the wormlike orbital Pomichnik fiksuє slipu gut, surgery near the end of the growth

Small. 15.27.Coordinate changes in apendectomy:

1 - zvnіshnіy oblique m'yaz of the abdomen; 2 - internal oblique muzzle of the abdomen; 3 - transverse abdomen; 4 - stalk

imposing on the yogh brizhu treadmill and pidnima yogo. Dalі on the breeze to impose a blood-backed rush, and out of sight. Pid the tussles to bandage the breech of the worm-like sprout. The visit and the dressing of the brigi will be able to make a return visit, so that you can eliminate the severe bleeding from the breeches.

The next step is the management of the adrenaline itself. Appropriate for the surplus of breeches in the area of ​​the bone, on the small intestine near the base of the outgrowth, apply a serous purse-string suture. When it is applied, it is necessary to stitch, the golka was able to see through the serous membrane for the whole hour, and it was necessary to uncover the pockets of the mucous membrane. Do not tighten the purse-string seam for an hour. Put on the basis of the worm-like outgrowth

zatiskach, p_d yakim a worm-like growth mintly bandage with a ligature. Then the sprout comes out, yake kuksu is drenched with iodine. Accept the kuksu with an anatomical pincer, surgical zanuryuє at the side of the intestine, immediately tightening the purse-string suture. Pislya yogo zav'yazuvannya kuksu can be brought up in nyogo zanurena. On top of the purse-string suture for a change, put a Z-podbny serous-myazovy suture.

Further drain the empty wood, control hemostasis. Drainages are installed for consumption. The operative wound is stitched in loosely with catgut: a sprinkle of the oleum, then the ointment of the ooze, the aponeurosis of the lateral oblique ooze of the abdomen, and the fatty tissue of the abdomen. The remaining row of seams is applied to the skirting from the sewing stitches.

15.21. OPERATIONS ON R&D

Operations on the organs of the secular system and the development of mental health and vision in the field of medicine - urology. With rice operation on the organs of the perineal space є the manifestation of special surgical instruments, the visibility of the perineral access, and the last hour is the visibility of high-tech methods of operation. Modern technologies allow the stasis in urology of mini-invasive approaches, microsurgical priyomy, endovideochirurgical and retroperitoneoscopic methods.

Nephrotomy- Development of nirka.

Shown before the operation are the side walls of the nirka, the slips of the early canals, the stone of the nirka, with ill-fortune being seen through the bali.

Operation technique (Fig. 15.28). With one access to denuce the nirku, to bring it into the wound. Dalі nirku fіxuyut and expand the fibrous capsule and parenchyma. To make a side effect on the nirku, impose a shvi in ​​such a rank, so that the stench didn’t go to the cup-pelvis system.

Nephrostomy- overlay of piece noritsi between education and the most important center.

Shown before the operation: mechanic transfer to a seeding path, as it is hard to see it in a good way.

Technique of the operation of the field near the naked nirka, carried out by the nephrotomy, the development of the ball. Place the drainage tube with a purse-string suture and name it.

Nirka resection- Vidalennya part of the nirka. Nirka resection is carried out before organ-saving operations, to that witnesses for her, there are processes that can sicken a part of the body, for example, tuberculosis, the cob stage of chickpea nirka, echinokok, wounded nirka and іnshe.

For the technique of resection, it is divided into anatomical (visual segment, two segments) and non-anatomical (clinopodic, edge and in.). Etapi vikonannya operatsii takі. When the naked nirka is fired, I drag the nirk's nizhku, and then the dilenka is scrapped in the middle of healthy tissues. Sew the wounds on the surface with a nozzle overlapping seams or plastics with a clap on the sudinniy nizhtsi. Nirk's bed is draining and stitching in the operative wound.

Small. 15.28.Right-sided nephrectomy: the stage of ligation and the overflow of the nirkova nyzhka.

Nephrectomy- Vidalennya nirka. Shown before nephrectomy є malignant pukhlina, brassiness of nirka, hydronephrosis and іn. Slid to brutalize with especial respect for the functional camp of another nirka; do not carry out the operation without a thorough operation.

Operation technique (Fig. 15.28). With one access to bare the nirku, wring it into the wound. Then we should carry out the key stage of the operation: the processing of the nirkovo nyzhka. A sprinkle of sechovod is sprinkled, bandaging between two houses with ligatures, and the kuksi are primed with an antiseptic solution. Then we proceed to the dressing of the nirkovo artery and nirkovo veni. Having crossed over at the hopes of the ligatures, the judge is rewinding and seeing the nirku. Blow and suture the wound.

Nephropexy- Fixation of nirka when omitted. Shown before nephropexy є the descent of the nirka, when you see the pendulum of the vertebral depression and the collapse of the blood. In a given hour, a simple way of fixing nirka is described. For example, to fix to the recumbent rib with ligatures, є methods of cutting the fascial and myasial valve, behind an additional organ to fix in the buttery box. It’s a pity, the mustache methods are too slow to lead to relapses.

15.22. TEST VVDANNA

15.1. The antero-lateral wall of the abdomen behind the addition of horizontal and vertical lines is added:

1. Into 8 regions.

2. Into 9 regions.

3. For 10 regions.

4. 11 regions.

5. For 12 regions.

15.2. We carry out the middle laparotomy in the epigastria, surgery after the development of the ball of the anterior cervical wall. Check the last of the distribution of balls:

1. Bila line of the abdomen.

2. Shkira with pediatric adipose tissue.

3. Parietal stem.

4. Superficial fascia.

5. Transverse fascia.

6. Precursor cellulite.

7. Vlasna fasciya.

15.3. The middle puffy-napkin fold, which pretends to be the result of the development of the fetus, is:

1. Obliterated umbilical artery.

2. Obliterated umbilical vein.

3. Obliterovana of the sech duct.

4. Sim'avividnu duct.

15.4. In the right piedraberniy region, you want to design 3 re-insured bodies or parts:

1. Part of the right part of the pechinka.

2. Spleen.

3. Part of the right nirka.

4. The tail of the slurry.

5. Right vigin of the colon.

6. Zhovchny mіkhur.

15.5. On the antero-lateral wall, the intestine was designed in the offensive areas:

1. In the right and left bichniy.

2. At the umbilical and epicheral vasne.

3. In the epicheral and the life of the child.

4. At the vlasne nadcherevn_y right bichn_y.

5. At the navel and right bichniy.

15.6. At the inguinal canal, you can see:

1.3 stinks and 3 open.

2. 4 plates and 4 open.

3.4 stinks and 2 open.

4. 2 plates and 4 open.

5. 4 plates and 3 open.

15.7. The lower stinka of the inguinal canal is approved:

1. The lower edges of the inner oblique and transverse joints.

2. A smell of smell.

3. Grebintsevoy fascia.

4. Parietal queue.

5. Aponeurosis of the lateral oblique meat of the abdomen.

15.8. With the plastic of the inguinal canal in a sick person with a scythe with an erythematous grill, the surgery is straightforward to change:

15.9. With the plastic of the inguinal canal in a sick person with a straight groin grill, the doctor is straightforward to change:

1. Upper wall of the inguinal canal.

2. Anterior wall of the inguinal canal.

3. The posterior wall of the inguinal canal.

4. The lower side of the inguinal canal.

15.10. In case of a mid-laparotomy:

1. The navel is to bypass the right-handed person.

2. Bypass navel lіvoruch.

3. The navel grows thin.

4. The navel is flattened against the front.

5. The vibe of the side is not significant.

15.11. One of the symptoms that can be diagnosed with a number of ailments, that there is a congestion in the system of the portal vein, and the expansion of the pediatric veins in the umbilical dilation of the anterior cervical stage. The price is clear here:

1. Arteriovenous shunts.

2. Kavo-caval anastomoses.

3. Lymphovenous anastomoses.

4. Portocuval anastomoses.

15.12. Upper and lower epicranial artery with one veins, supravlyuyutsya, rozstashivayutsya:

1. In pediatric fat cells.

2. In the middle of the stomach muzzles straight ahead of the muzzles.

3. Have a straight belly muzzle behind the muffs.

4. In the anterior urethral cells.

15.13. Upper and lower on top of the black empty lamp add:

1. Great omentum.

2. Shlunkovo-rim link.

3. Breech of the transverse colon.

4. Breeze of the small intestine.

15.14. Up to the organs of the upper on top of the black emptying, 4 s are introduced:

2. Slunker.

4. Pechinka iz zhovchny michurom.

5. Pidshlunkova zalosa.

6. Spleen.

8. Sigmoid intestine.

15.15. Up to the organs of the lower on top of the black empty space, 5 s are introduced:

1. Visible rim intestine.

2. Slunker.

3. Skhidna rim intestine.

4. Pechinka iz zhovchny michurom.

5. Pidshlunkova zalosa.

6. Spleen.

7. Slip intestine with wormlike outgrowth.

8. Sigmoid intestine.

9. Hud and zduchinnaya gut.

15.16. Install between the pechinkovo ​​bags.

1. Above.

2. Get ahead.

3. Backward.

4. Below.

5. Right-Handed.

6. Zlіva.

A. Bichna abdominal wall. B. Vintseva sound of the stove.

B. Anterior cephalic stinka.

D. Transverse rim intestine. D. Right dome with diaphragms. E. Rib arch. J. Serpodibna sound of the stove.

15.17. Insert between the front bag.

1. Above.

2. Below.

3. Get ahead.

4. Behind.

5. Right-Handed.

6. Zlіva.

A. Bichna abdominal wall. B. Livy dome with diaphragms.

B. Slinker.

G. Maliy oil seal. D. Front cherevna stinka. E. Transverse rim intestine. J. Serpodibna sound of the stove.

15.18. Before the storage of the small oil seal, there are 3 links from:

1. Diaphragmatic-slunk sound.

2. Shlunkovo-splenic connection.

3. Shlunkovo-rim link.

4. Pechinkovo-twelve-ringed sound.

5. Pechinkovo-slunk connection.

15.19. Install the liners of the stuffing box:

1. Top.

2. Lower.

3. Front.

4. Back.

A. Breech of the transverse colon. B. Shlunok.

B. Shlunkovo-rim link. G. Maliy oil seal.

D. Back leaf of the parietal queue. E. Transverse rim intestine. J. The tail is a part of the stove.

15.20. There are 4 wartholes of the lower on top of the empty cartwheels, it is possible to get around the wedge bags of the upper top:

1. Liva Brijov's sinus.

2. Livy bichny channel.

3. The rights of the Brigian's bosom.

4. Right bichny channel.

15.21. The shlunok is bloodsucked by arteries, which can enter:

1. Tilki from the cranial trunk.

2. View of the cranked stovbur and the upper bryzhovo artery.

3. Tilki from the Upper Brigade artery.

15.22. Gastrostomy - tse:

1. The introduction of the probe at the hole of the shlunk.

2. Overlay of piece-shaped noritsi on the slurry pipe.

3. Formation of the shlunkovo-intestinal anastomosis.

4. Razs_chennya stinka shlunnya for the use of a side body for the onset of stitching wounds.

5. Visible part of the slunk.

15.23. Gastropexy - tse:

1. Zshivannya dlyanoks of the shlunka wall near the tube during gastrostomy.

2. There is no such term.

3. This is the name of the rosette of the shlunka wall.

4. Fixation of the slurry to the partial slurry with seams for the isolation of the empty slurry from the slurry.

5. Development of meat pulp in the gatehouse.

15.24. Total vagotomy transmission:

1. Peretin of the stovbur of the bloody nerve above the diaphragm.

2. Peretin of the stems of the left and right bloating nerves immediately below the diaphragms.

3. Peretin of the stovbur of the bloody nerve immediately below the diaphragms.

4. Peretin of the stovbur of the bloody nerve in the lower part of the protrusion of the hepatitis nerve.

5. Peretin of the glock of the bloody nerve, which comes up to the bottom of the shlunk.

15.25. Selective transmission vagotomy:

1. Peretin of the stovbur of the bloody nerve in the lower part of the protrusion of the hepatitis.

2. Peretin of the glock of the bloody nerve, which comes up to the bottom of the shlunk.

3. Peretin the glock of the bloating nerve, so that it goes up to the bottom and the bottom of the shlunk.

4. Peretin of the stovbur of the bloody nerve in the vische of the vysokhozhennaya pechinkovoy gilka.

5. Joden of options.

15.26. The users see:

1.7 segments.

2. 8 segments.

3.9 segments.

4. 10 segments.

15.27. In case of cholecystectomy, michurov's artery is based on the Kalo tricycle, with two anatomical statements on the sides:

1. Zagalna zhovchna duct.

2. Zagalna pechinka duct.

3. Rights of the Pechinka duct.

4. Puhirna duct.

5. Vlasna pechinkova artery.

15.28. Look at the last part of the zhazhnoy zhovnoy duct:

1. Duodenal part.

2. The supraduodenal part.

3. The part is pancreatic.

4. Retroroduodenal part.

15.29. In addition, roztashuvannya in the pechinkovo-two-twelve-fingered zv'yaztsi zahalnoy zhazhnoy ducts, the power pechinkovo ​​artery and voritnoy veni onset:

1. Artery along the vilny edge of the ligament, duct livoruch, vein between them and behind.

2. The duct along the vilny edge of the link, the artery livoruch, the vein between them and back.

3. Vіden along the upper edge of the ligament, lіvoruch artery, duct between them and posteriorly.

4. The duct along the іlny edge of the link, the vein lіvoruch, the artery between them and backwards.

15.30. The cranial trunk grows into:

1. Liva shlunkovu artery.

2. Upper Brigade artery.

3. Lower Brigade artery.

4. Selezinkovu artery.

5. I will go to the Pechinka artery.

6. Zhovchno-Mikhurov's artery.

15.31. In the vortic vein of the secondary vein, the venous blood is in 5 organs from the reinsured:

1. Shlunka.

2. Nadnirkovy zalozi.

3. Rim gut.

4. Pechinka.

5. Pidshlunkova zalosa.

6. Nirki.

7. Spleen.

8. Small intestine.

15.32. At the lower empty vein, the venous vein is venous from 3 organs from the reinsured:

1. Shlunka.

2. Nadnirkovy zalozi.

3. Rim gut.

4. Pechinka.

5. Pidshlunkova zalosa.

6. Nirki.

7. Spleen.

8. Small intestine.

15.33. The 4 most important indications of the intestine are given by the same name:

1. Growth of late muscles of the intestine yak three lines.

2. The appearance of haustra and circular furrows in the intestine.

3. The appearance of fatty deposits in the intestine.

4. The siruvato-blakytny vidtinok of the intestine and the svitlo-rhizobia colir is thin.

15.34. Blood circulation of the intestinal tract is connected to the artery pool:

1. Upper Brigade.

2. Lower Brigovy.

3. Zovn_shn_y zuhvinny.

4. Internal club.

5. Zagalna Pechinkova.

15.35. The venous outlet from the intestinal tract enters the vein system:

1. Bottom emptying.

2. Top empty.

3. Lower and upper empty.

4. Vorotny.

5. Gate and lower empty.

15.36. Special features, which zoom in on the operations on the intestine from the operations on the small intestine, should be considered as follows:

1. Tovsta gut grows thin, not thin.

2. Tovsta gut grows thin, but not thin.

3. The small intestine can be inflicted vmist, nizh tovsta.

4. Tovsta gut is small.

5. Inconsistently rosters of muscle fibers in the intestinal tract.

15.37. In the extra-uterine space between the intra-uterine and intra-uterine fascial growths:

1. Zajrevinny klinny ball.

2. Blizkoobodova Klitkovina.

3. Navkolonirkova Klitkovina.

15.38. Blizkoobodova klitkovina roztashovuetsya mіzh:

1. Viscous or lower rim intestine and posterior fascia.

2. Posterior and lateral fascia.

3. Posadiobodovoy and internalocular fascia.

15.39. Navkolonirkova Klitkovina roztashovute around the nirka:

1. Fibrous capsule of nirka.

2. Between fibrous and fascial capsule.

3. On top of the nirka fascial capsule.

15.40. Nirkovy arteries come from the cranial aorta in the region:

15.41. Start the procedure for rosetting three capsules of nirka, repairing them with the help of the parenchymi:

1. Fat capsule.

2. Fascial capsule.

3. Fibrous capsule.

15.42. Along the way up to the Liva Nirka ridge, go to the Rivne:

15.43. On the way to the ridge, the right nirka roztashovuyutsya on the rivn:

15.44. In front of the livoy nirka, there are 4 organizers:

1. Pechinka.

2. Slunker.

3. Pidshlunkova zloza.

4. The intestine was two-fingered.

5. Loops of the small intestine.

7. Splenic vigin of the colon.

15.45. In front of the right nirka, there are 3 organizations:

1. Pechinka.

2. Slunker.

3. Pidshlunkova zloza.

4. The intestine was two-fingered.

5. Loops of the small intestine.

6. Visible rim gut.

15.46. The elements of the nirkovo nizhki will be rocked straight from the front to the back at the onset of the end:

1. Nirkova artery, nirkova Vienna, balia.

2. Nirkova vein, nirkova artery, balia.

3. Lohanka, nirkova vein, nirkova artery.

4. Lohanka, nirkova artery, nirkova vein.

15.47. The basis of the vision of the segments of the nirka is:

1. Razgaluchennya nirkovo artery.

2. Formation of nirkovo veni.

3. Roztashuvannya malikh and great nirk women.

4. Raztashuvannya nirkovykh piramids.

15.48. The chopper can do it on his own arm:

1. One ringing.

2. Two rings.

3. Three rings.

4. Chotiri is ringing.

15.49. Anterior and posterior boundaries of the umbilical space є:

1. Parietal stem.

2. Fascia endoabdominalis.