SAMENVATTING ANATOMIE HUMANE PATHOLOGIE:

VESSELS:
p.37-46:
The heart consists of 2 pumps that act in series. The circulation is divided
into the pulmonary and the systemic circulation.
- Pulmonary circulation: pulmonary arteries go from the right atrium
to the lungs and returns with oxygen richt blood via the pulmonary
veins.
- Systemic circulation: The aorta brings oxygen rich blood to the rest
of the body, which returns with the vana cava inferior and superior.
Arteries:
Blood vessels have three coats (tunicas): tunica intima (=endothelium and
connective tissue, capillaries only have this tunic), tunica media (=smooth
muscle and most variable, for example elastic fibers) and tunica
adventitia.
Arteries are variable: elastic arteries (receive direct cardiac output),
medium muscular arteries (can regulate their diameter) and small
arteries/arterioles. Anastomoses connect the arteries to ensure bloodflow
if an artery would close. However it requires time to enlarge so cannot
cope with sudden occlusion.
Veins:
Lower blood pressures and thinner walls than the corresponding arteries,
their expanding capacity is larger: 80% of the blood lies in the veins.
Venules are the smallest veins. Veins contain valves that ensure blood
return.
Often the veins lie within a vascular sheet within the artery they
acompany so that blood flowing through the artery can cause blood flow in
the veins (arteriovenous pump). In the legs the muscle contraction also
allows blood to flow back (musculovenous pump).
Blood capillaries:
Allow the exchange of materials, capillary beds are the networks that
connects the arterioles to the venules.
Anastomoses between arteries and venes also exist and have an
important role in preserving body heat as venous blood tends to be cooler.
When two capillary beds are linked by a vene this vene is called a portal
vene.
Lymphoid system:
3L per day fails to be reabsorped by the blood capillaries and therefore
needs to be reabsorbed by the lymphatic system to avoid edema.
- Lymphatic plexuses
- Lymphatic vessels
- Lymph (similar composition as blood plasma)
- Lymphocytes
- Lymphoid organs (thymus, red bone marrow, spleen, tonsils and
lymphoid nodules)
The right lympathic duct drains the right upper quadrant whereas the
thoracic duct drains lymph from the remainder of the body.

p.93-96:
Vasculature of Thoracic Wall: it runs in the intercostal spaces, parallel to
the ribs.
ARTERIES:
Thoracic aorta posterior intercostal and subcostal arteries (3rd to 11th).
Subclavian artery internal (anterior) thoracic and the supreme
intercostal arteries (1st and 2nd intercostal spaves)
Axillary artery superior and lateral thoracic arteries.
VEINS:
Intercostal veins accompany the intercostal arteries. There are 11
posterior ntercostal veins and a subcostal vene on each side. There are
also anterior intercostal veins. (see p.96)
p.116-118:
VASCULATURE OF LUNGS AND PLEURAE:
Pulmonary arteries supply oxygen poor blood to the lungs and originate in
the pulmonary trunk. They enter the lungs and divide into lobar arteries
and further divide into segmental arteries.
The two pulmonary veins carry the oxygen rich blood to the left atrium of
the heart.
Bronchial arteries supply blood for nutrition of the structures making up
the root of the lungs. They arise from the thoracic aorta. The bronchial
veins and pulmonary veins both drain the blood of the bronchial arteries.
The right bronchial vein drains into the azygos vein and the left bronchial
vein drains into the hemiazygos vein.
The pulmonary lympathic plexuses:
Superficial plexuses bronchopulmonary lymph nodes
Deep plexuses pulmonary lymph nodes
From them the lymph goes to the superior and inferior tracheobronchial
lymph nodes. right and left bronchomediastinal lymph trunks right
lymphatic duct and the thoracic duct.
p.161-163:
THYMUS:
Anterior part of the superior mediastinum. After puberty it is largely
replaced by fat. The veins of the thymus end in the left brachiocepahlic,
internal thoracic and inferior thyroid veins. Arteries are the anterior
mediastinal branches of the internal thoracic arteries. The lymphatic
drainage is done by the parasternal, brachiocephalic and tracheobronchial
lymph nodes.
GREAT VESSELS:
The internal jugular vein and the subcalvian veins unite to form the
brachiocephalic vein of which the left is longest. These unite to form the
superior vena cava, which returns blood from the above structures except
the lungs and the heart.
The ascending aorta forms an arch at the level of the sternal angle. The
arch descends posterios to the left root of the lung beside the T4 vertebra.
The brachiocephalic trunk is the first large branc containing the right
common carotid artery and the right subclavian artery. The left common
carotid artery follows and the left subclavian artery is last.

p.167-170:
THORACIC AORTA:
Begins on T4 and descends. It displaces the esophagus to the right. It
terminates at the aortic hiatus in the diafragma at T12 level. The paired
parietal branches of the thoracic aorta are the nine posterior intercostal
branches.
ESOPHAGUS:
Posterior to and to the right of the aorta. It crosses the diafragma at the
esophagal hiatus at the level T10. It is compressed at 3 locations:
- the arch of the aorta
- left main bronchus
- the diaphragm.
THORACIC DUCT AND LYMPHATIC TRUNKS:
Thoracic duct is the largest lymphatic vessel in the body. It originates from
the chyle cistern and ascencs through the aortic hiatus. At the level of T4,
T5 and T6 it crosses over to the left. It receives the jugular, subclavian,
and bronchomediastinal lymphatic trunks.
VESSELS AND LYMPH NODES OF POSTERIOR MEDIASTINUM:
Azygos vein = collateral pathway betewen SVC and IVC.
Hemiazygos vein on the left side joins the azygos vein (see pictures in the
book).
p. 195-196:
VESSELS OF ANTEROLATERAL ABDOMINAL WALL:
Cutaneous veins, parumbilical veins and obliterated umbilical vein.
The primary blood vessels are:
- Superior epigastric vessels (continuation of the internal thoracic
artery)
- Inferior epigastric (external iliac artery) and deep circumflex iliac
vessels
- Superficial circumflec iliac and superficial epigastric vessels
- Posterior intercostal vessels and subcostal vessles.
Superfical lymphatic vessels accompany the veins and the deep lymphatic
vessels drain into the external iliac, common iliac and right and left lumbar
(caval and aortic) lymph nodes. (see p.196)
p.228: plaatje bekijken!
p.236-237:
plaatjes en tabellen bekijken!
245-246:
plaatjes!
The superior mesenteric artery arises from the abdominal aorta at the
level of L1 1 cm inferior to the celiac trunk. 15-18 branches, called arterial
arcades and vasa recta, go to the jejunum and the ileum. The superior
mesenteric veins drains the jejunum and the ileum.

Within the mesentery the lymph passes sequentially through 3 groups of

lymph nodes: juxta-intestinal lymph nodes, mesenteric lymph nodes and
the superior central nodes.
250: plaatje en tabel bekijken!
266: plaatje: laat zien dat de celiac artery in verschillende takken splitst
waaronder the gastroduodenal artery, the splenic artery
280: plaatje over de hepatic veins
295-296:
VESSELS AND NERVES OF THE KIDNEYS, URETERS AND SUPRARENAL
GLANDS:
Renal arteries arise at the level of the IV disc between L1-L2. The longer
right renal artery passes posterior to the IVC.
Renal arteries separate into segmental arteries: superior, anterosuperior,
antero-inferior, inferior and posterior segmental arteries.
Arterial supply and venous drainage of ureters:
Arterial braches to the abdominal portion of the ureter arise consistently
from the renal arteries. Less arise from the testicular/ovarian arteries, the
abdominal aorta and the common iliac arteries.
Veins draining the abdomnal part of the ureters drain into the renal and
gonadal veins.
Suprarenal arteries and veins:
- Superior from the inferior phrenic arteries
- Middle from the adbominal aorta
- Inferior From the renal arteries.
The venous drainage of the suprarenal glands occurs via the suprarenal
veins (right drains into the IVC and the left into the left renal vein.
Lymphatics:
Renal lymphatic vessels drain into the right and left lumbar lymph nodes.
The middle part of the ureter usually drains into the common iliac lymph
nodes. The inferior part drains into the common, external or internal iliac
lymph nodes.
313-316:
ABDOMINAL AORTA:
Most arteries supplying the posterior abdominal wall arise from the
abdominal aorta. The latter is +/- 13 cm long and begins at the aortic
hiatus in the diaphragm at T12 and ends at L4 where it divides to give the
common iliac arteries.
VEINS:
Veins of the posterior abdominal wall are tributaires of the IVC, except the
left testicular/ovarian vein.
The inferior vena cava begins anterior to L5 where the iliac veins join. It
ascends through the caval opening in the diafragm at T8.
LYMPHATIC VESSELS AND LYMPH NODES OF POSTERIOR ABDOMINAL
WALL:

Lymphatic vessels and lymph nodes le along the aorta, IVC and iliac
vessels. Convergence of the main lymphatic ducts of the abdomen
happens at the cisterna chyli.

LUNGS:
p.72-97:
The thorax can be divided in 3 spaces: the mediastinum and the left and
right pleural cavities. The function of the rib cage is to protect, resist the
negative internal pressures, provide attachment of the upper limbs and
many muscles.
RIBS:
12 in total of which 1st to 7th are true, 8th till 10th are false and the 11th and
12th which are floating. To see parts see page 74.
The cartilages contribute to the elasticity of the thoracic wall. The
intercostal spaces are named according to the rib composing the superior
border of the space.
STERNUM:
Flat, elongated bone that forms the middle of the thoracic cage. It is
composed of the manubrium, a body and a xiphoid process. (see p.78).
Dit deel is niet heel interessant en valt na te lezen in het boek.
MUSCLES:
Pectoralis major/minor and the serratus anterior. Scalene muscles that
descend from the neck. The true muscles of the thoracic wall are:
- Serratus posterior (proprioreceptor)
- Levatores costarum (proprioreceptor)
- Intercostal external used for elevation (inspiration), internal
(expiration) and innermost separated from the rest by intercostal
nerves and vessels.
- Subcostal (blend with the internal intercostal muscle)
- Transversus thoracis (forced inspiration).
The diaphragm is however the primary muscle of inspiration.
The fascia overlying the anterior thoracic wall is called the pectoral fascia.
Nerves:
Subcostal nerve.
Intercostal nerves originating from vertebraes. (see p.92)
p.106-127:
lungs are surrounded by the pleura (visceral and parietal between which a
thin film of fluid lies). For more details on the pleura see p.108-109.
LUNGS:
Light, soft and spongy. Have an apex and a base. The rigth lung has 3
lobes and the left lung has 2. These are separated by connective tissue
fissures. The left lungs superior lobe is larger. The lungs are attached to

the mediastinum by the roots of the lungs: bronchi, superior and inferior
pulmonary veins, pulmonary plexuses of nerves, lymphatic vessels.
TRACHEOBRONCHAL TREE:
Hyalin cartilage rings to keep the trachea from collapsing. It seperates in
the main bronchus branches of which the right is larger. This bronchus
seperates into lobar and segmental bronchi and become conducting
bronchioles (no more cartilage). After this the bronchioles become terminal
bronchioles, conducting bronchioles and respiratory bronchioles, which is
surrounded by alveoli.
For the rest of the notes see previous notes.
KIDNEYS:
p.290-301:
kidneys produce urine which is conveyed by the ureters to the urinary
bladder. On each kidney lies the suprarenal gland, which is separated from
the kidney by a small fascia.
The kidneys are retroperitoneal viscera. They are surrounded by
perinephric fatwhich is enclosed by a membranous layer of renal fascia
which extends to form the periuretic fascia. Arround this lies the
paranephric fat. The renal fascia sends collagen bundles through the
paranephric fat. Normal renal mobility is approximitaly 3cm.
The right kidney is lower (T12-L3/4) than the left (T11-L2). The primary
attachement of the suprarenal glands is the diaphragm.
KIDNEYS:
Renal hilum = the entry space within the kidney: renal sinus.
Kidneys are approximately 10cm in length, 5 cm in width and 2.5 cm in
thickness.
At the hilum, the renal vein is anterior to the renal artery, which is anterior
to the renal pelvis (beginning of ureter). Kidneys are obliquely placed
because of the protrusion of the lumbar vertebral column. The renal pelvis
becomes major calices and two or three minor calices in which the
pyramids end.
Abdominal aorta Renal arteries segmental arteries interlobar
arteries arcuate arteries interlobular arteries afferent arterioles.
URETERS:
Ureters are muscular ducts (25-30 cm in length). They are retroperitoneal
through their whole course. They demonstrate 3 places of constriction
(gives problems with uretic stones:
- Junction of ureters and renal pelves
- Crossing of the pelvic inlet
- Passage through the urinary bladder wall.
SUPRARENAL GLANDS:
Major attachment of the glands is the diaphragmatic crura. Right gland is
more apical and contacts the IVC, whereas the left gland is related to the
spleen, stomach and pancreas. Each gland had a hilum, where the veins
and lymphatic vessels exit.
The suprarenal cortex secretescorticosteroids and androgens whereas the
suprarenal medulla secretes catecholamines.
For the blood and venal systems see previous notes.

HEART p.127-180
The mediastinum is covered by the mediastinal pleura and contains all the
visceral thoracic structures except the lungs. It is divided into superior and
inferior parts for description. The superior mediastinum goes from the
thoracic aperture (sternal angle) to the T4-T5 vertebrae. The inferior goes
to the diafragm.
PERICARDIUM:
= A fibroserous membrane with a parietal and a visceral layer between
which a thin layer of fluid allows the heart to beat. It protects the heart
against sudden overfilling.
It is:
- Continuous superiorly with the tunica adventitia of the great vessels.
- Continuous inferiorly with the central tendon of the diaphragm.
(=pericardiophrenic ligament)
Arterial supply: slender branch of thoracic artery =the pericardiacophrenic
artery.
Venous drainage: pericardiacophrenic veins (internal thoracic veins) and
tributaries of the azygos venous system.
Nerve supply: phrenic nerves.
For details on the heart and the several chambers see p.135-144.
VASCULATURE OF THE HEART:
Coronary arteries are vessels that arise from the aorta and supply the
outside of the heart (myocardium and epicardium). The inside of the heart
is supplied by the blood in the heart itself (diffusion). From the right aortic
sinus arises the right coronary artery (RCA). From the left coronary sinus
arises the left coronary artery (LCA). These two give branches that are
considered to be functional end arteries: sinus coranarius (right and left).
The one that goes around the whole heart is the sinus circumflex. When it
is the right one the heart is rightly dominant. This circumflex supplies the
SA and AV nodes.
Venous drainage: veins that empty in the coronary sinus: great cardiac
vein.
CONDUCTING SYSTEM OF THE HEART:
Nodal tissue and conducting fibers:
SA node AV node AV bundle right and left bundles Purkinje
fibers.
Innervation of the heart: sympathetic supply from the cell columns and the
parasympathetic supply from the vagus nerve.
SUPERIOR MEDIASTINUM:
THYMUS:
Anterios part of the superior mediastinum, it is after puberty replaced by
fat. The arterial supply is from the intercostal arteries, whereas the venal
drainage happens via the left brachiocephalic vein, the internal thoracic
vein and the inferior thyroid veins.
GREAT VESSELS

Right and left brachiocephalic veins

Superior vena cava
Ascending aorta + arch (descends posterior to the left lung at the
level of T4)
- Brachiocephalic trunk
- Left common carotid artery
- Left subclavian artery
NERVES:
Right vagus nerve enters the thorax anterior to the right subclavian artery,
where it gives rise to the right recurrent laryngeal nerve. Lower it divides
into the right pulmonary plexus.
The LVN forms the left pulmonary and the esophagal plexus.
Phrenic nerves give the diaphragm motor sensory fibers and also the
pericardium and mediastinal pleura.
TRACHEA:
Descends anterior to the esophagus. Terminates superior to the level of
the heart and is not a component of the posterior mediastinum.
p.167-173
p.217-290 PERITONEUM AND PERITONEAL CAVITY:
lines the abdominopelvic cavity and invests the viscera.
The gut knows growth and needs to curl to fit into the abdominal cavity
and several parts of the gut come to lie against the posterior wall (colon
ascendens and descendens and the duodenum which is retroperitoneal).
Layers of peritoneum that fuse are called the fusion fascia: a mesentery is
a double layer of peritoneum and provides neurovascular communication
between organ and body wall.
The omentum is a double layered extension or fold of peritoneum: greater
and lesser omentum.
A peritoneal ligament connects an organ to another organ. (see p.219).
SUBDIVISIONS:
Posterior to the stomach lies the bursa omentales permitting free
movement of the stomach. It communicates with the greater sac through
the omantal foramen. (see p.222) The tranverse mesocolon divides the
abdominal space into a supracolic compartment (liver, stomach, spleen)
and a infracolic compartment (intestines).
ABDOMINAL VISCERA:
Liver, stomach and spleen are all in the dome of the diafragm and
protected by the thoracic cage. The falciform ligament divides the liver
into two lobes. The gallbladder projects inferior to the sharp border of the
liver. Digestion mostly occurs in the stomach and duodenum. Peristalsis
begins in the middle of the stomach and moves the content to the pylorus.
Absorption of the compounds occurs in the small intestine.
Arterial supply from the abdominal aorta three major branches: celiac
trunk, superior and inferior mesenteric arteries.
ESOPHAGUS:
Three constriction points:
- Cervical constriction
- Thoracic

- Diaphragmatic
It is encircled by the esophagal (nerve) plexus.
Esophagogastric junction lies to the left of the T11 vertebra. The
diafragmatic musculature functions as a esophagal sphincter
preventing reflux from the stomach.
STOMACH:
Chief function is enzymatic digestion. Four parts:
- Cardia
- Fundus
- Body
- Pyloric part (see p.231/233).
It has two curvatures and a mucous layer that protects the inner surface
from gastric acid which the stomachs glands secrete.
The right and left gastric arteries from the celiac trunk provide the
stomach with blood. Rigth and lef gastric veins
And the anterior vagal trunk.
SMALL INTESTINE:
DUODENUM:
Begins at the pylorus and ends at the duodenojejunal flexure at the L2
vertebra. At the first 2cm of the superior part is an ampulla.
Arteries: gastroduodenal artery and its branch pancreaticoduodenal artery.
Veins: hepatic portal veins
Nerves: nerves of the duodenum
JEJUNUM AND ILEUM:
Mesentery is a fan-shaped fold of peritoneum that attaches the jejunum
and ileum to the posterior abdominal wall. Between the 2 layers of the
mesentery are the superior mesenteric vessels. Superior mesenteric artery
jejunum and ileum via the jejunal and the ileal arteries. It arises from
the abdominal aorta at the level of L! vertebra.The branches to the
intestines are calles the arterial arcades later called vasa recta. The
superior mesenteric vein drains the jejunum and the ileum. Sympathetic
fibers originate in T8-T10 and give rise to the superior mesenteric nerve
plexus. Intestine doesnt feel cutting or burning but is sensitive to stretch
and tension.
LARGE INTESTINE: resorption of water to produce feces.
CECUM AND APPENDIX:
2.5 cm of the inguinal ligament can be lifted freely as it has no mesentery.
The arterial supply is from the ileocolic artery, the terminal branch of the
SMA. The appendicular artery is a branch of the ileocolic artery and
provides blood to the appendix.
COLON:
4 parts: ascending, tranverse, descending and sigmoid. The arterial supply
is given by the SMA colic arteries until the tranverse, than it is the middle
colic artery from the SMA and the sigmoid with the sigmoid arteries.
The sympathetic nerve supply is from the sympathetic trunk whereas the
parasympathetic nerve supply is from the pelvic splanchnic nerves.
RECTUM AND ANAL CANAL:
Rectum = fixed and lies at S3 vertebra
SPLEEN:

Largest of the lymphatic organs, it participates in the bodys defense

system as a site of lymphocyte proliferatin and of immune surveillance. It
is however not a vital organ. The visceral peritoneum surround the spleen
except at the splenic hilum. It normally contains a large quantity of blood
that is expelled periodically into the circulation by the action of the smooth
muscle in its capsule and trabeculae. It is connected to the greater
curvature of the stomach with the gastrosplenal ligament and to the left
kidney with the splenorenal ligament. The arterial supply happens from
the splenic artery that arises from the celiac trunk. Venous drainage
happens via splenic veins which unite with the SMV posterior to the neck
of the pancreas.
The nerves from the spleen dervie from the celiac plexus.
PANCREAS:
Accessory digestive gland that lies retroperitoneally transversly crossing
L1 and L2 vertebrae. It lies posterior to the stomach between the
duodenum on the right and spleen on the left. It had an exocrine function:
pancreatic juice and an endocrine function (insulin and glucagon).
It has a:
- Head: C-shaped curve of the duodenum to the right to the right of
the superior mesenteric vessels just inferior to the transpyloric
plane. Posteriorly on the IVC.
- Neck
- Body
- Tail: anterior to the left kidney where it is closely related to the
splenic hilum.
The main pancreatic duct begins in the tail of the pancreas and runs
through the parenchyma of the gland to the pancreatic head.
Hepatopancreatic ampulla (of Vater) in the descending part of the
duodenum.
Several sphincters function in this duct (see p.267)
The accessory pancreatic duct opens in the minor duodenal papilla.
The arterial supply of the pancreas is derived mainly from the branches of
the splenic artery. Venous drainage happens through the pancreatic veins.
Tributaries of the SMV and parts of te hepatic portal vein.
LIVER:
Liver stores glycogen and secretes bile (to aid the emulsion of fat). Bile
goes from the liver via the biliary ducts to the common hepatic duct and
finaly form the cystic duct. This bile accumulates I the galbladder.
It lies deep to the ribs 7-11 on the right side and crosses the midline
toward the left nipple. It is separated into a right and left lobe by the
falciform ligament which caudaly is the ligamentum teres hepatica.
The liver lies in direct contact with the diaphragm via the coronary
ligament. The anterior part of the coronary ligament meet to form the left
triangular ligament. Furthermore there are fissures on the liver from the
surrounding structures (see p.270).
The lesser omentum encloses the portal triad (bile duct, hepatic artery,
and the hepatic portal vein).
ANATOMICAL LOBES OF THE LIVER:

2 with the right lobe much smaller than the left lobe. Functionally these
left and right lobes are much more equal in size. Each part receives its
own primary branch from the hepatic artery and hepatic portal vein. In
total there are 8 lobes.
BLOOD VESSELS OF THE LIVER:
Hepatic portal vein brings 75-80% of blood to the liver. Hepatic artery
arises from the gastroduodenal artery.
The liver is a major lymph producing organ. Most lymph is drained in the
perisinusoidal spaces (of Disse) and is drained into the hepatic lymph
nodes celiac lymph nodes cisterna chyli (sac at the inferior end of the
thoracic duct).
The nerves of the liver are derived from the hepatic plexus, other than
vasoconstriction their function is unclear.
BILIARY DUCTS AND GALLBLADDER:
Convey the bile from the liver to the duodenum. The bile is produced in
the liver and stored and concentrated in the gallbladder. Hepatocytes
secrete bile into the bile canaliculi interlobular biliary ducts collecting
bile ducts common hepatic duct.
GALLBLADDER:
Lies at the junction of the right and left (parts of the liver). Parts = fundus,
body, neck. The cystic duct connects the neck of the gallbladder to the
common hepatic duct, it has a spiral fold which keeps the duct open and
prevents sudden dumping of bile.
The arterial supply of the gallbladder and cystic duct is from the cystic
artery (arises from the right hepatic artery). Venous drainage is via the
cystic veins, which drain into the hepatic veins. The veins from the fundus
and the body drain into the hepatic sinusoids. Lymphatic drainage is to the
hepatic lymph nodes.
Nerves = celiac plexus (see p.280)
Hepatic portal vein L1 vertebra. As it approaches the prta hepatica it
divides into right and left branches.
Portal system anastomoses:
- Submucosa of the inferior esophagus
- Submucosa of the anal canal
- Paraumbilical region.