I. Ya. Horbachevskyy Ternopil State Medical University

 

Human Anatomy Department

 

 

 

 

 

 

 

 

 

 

 

Methodical Instructions

for  student of the medical faculty

to practical classes on human anatomy

(Vessels and nerves of trunk and extremities)

according to the credit-module system

 

 

Module 5

Vessels and nerves

of trunk and extremities

 

 

 

 

 

 

 

 

Ternopil 2009

 

 

 

Methodical instructions have been prepared by: Assoc. Prof. Reminetskyy B.Y.

 

    Practical lesson 35

Theme. Lymphatic vessels and nodes of abdomen and pelvis. Lumbar part of sympathetic trunk and abdominal division of vagus. Autonomic plexus of abdomen. Pelvic part of sympathetic trunk.

Pelvic division of the parasympathetic nervous system. Autonomic plexus of pelvis.

Practical skills ‘anatomy of vessels and nerves of trunk’

Purpose: To learn the structures of the lymphatics of abdominal  region and pelvis. To learn lumbar part of sympathetic trunk and abdominal division of vagus, innervation of organs. To learn peripheral structures of AUTONOMIC NERVOUS SYSTEM, what responsible at innervation of pelvic viscera.

Professional orientation of students. Knowledge the structure of pelvic sympathetic and parasympathetic divisions of the autonomic nervous system is the base for understanding of neurophysiology and neuropathology of various prlvic organs. Anatomical peculiarities of the location of central and peripheral parts is necessary for therapeutical and surgical treatment of pelvic viscera  and walls.

Knowledge the structure of lumbar sympathetic division of the autonomic nervous system is the base for understanding of neurophysiology and neuropathology. Anatomical peculiarities of the location of central and peripheral parts is necessary for therapeutical and surgical treatment of abdominal viscera (oesophagus, lungs and heart) and walls.

The knowledge of regional abdominal and pelvic lymphatic nodes is important for two reasons: first is the possibility of forecasting the probability of spreading from certain lymphatic nodes in case when a tumour or infectious center are known. And on the contrary, the knowledge of regional lymphatic nodes allows to find out a unknown place of localization in case when pathologically changed lymphatic node or group of nodes have been detected.

Base level of knowledges and abilities.

Latin terminology.

2.        Common data about lymphatic of system.

3.        Location and structure of abdominal and pelvic organs.

I.                   Practical studies – 9:00-11:15 am (3 hours)

Program of self-preparation.

I. Learn the ‘Lymphatics of abdomen and pelvis” in references and find the plates in ‘Atlas of Human Anatomy’.

²². Create the graphic charts.

²²². Answer the questions.

Illustrative material.

Demonstration corpse with dissected retroperitoneal space.

2.          Educational corpse.

Method of implementation of practical work.

Work 1. Finding and demonstration of lymphatic nodes of the separate groups on the demonstrative and studying corpses.

Work 2. Dissection of abdominal cavity by method of  “ apron".

The lateral cut on anterior axillary lines,continue to anterior spina of left and right. Maximum pulling anteriorly chest wall, cut off sternal and costal parts of diaphragm and round ligament of liver from it, where up on anterior paries of trunk turn away forward and down, widely open thoracic and abdominal cavities. 

Work 3. Dissection of retroperitoneal space.

Drawing off a liver upwards and stomach a little down and to the left, dissect a lesser omentum, dissect a left gastric artery in gastropancreatic ligament. Find  a common hepatic artery in the hepaticduodenal ligament and dissect its branches. Dissect gastrocolic ligament. A stomach draw for greate curvature upwards and dissect splenic artery and vein on the superior edge of pancreas. 

Work 4. Dissection of celiac plexus.

Drawing off a liver upwards and stomach a little down and to the left, dissect a lesser omentum, dissect a left gastric artery in gastropancreatic ligament. Find  a celiac trunk and celiac plexus in the hepatogastric ligament.

Work 5. Dissection of superior and inferior mesenteric plexuses.

Heave up greater omentum and turn away by its free edge upwards, opening a middle storey of the peritoneal cavity. Exfoliating and ablating parietal peritoneum, open abdominal part of aorta and initial parts of  the superior and inferior mesenteric arteries and same name nervous plexus.

 

II. Seminar discussion of practical work 11:45 am – 13:15 pm (2 hours)

List of questions:

1.     Where and how is thoracic duct formed, peculiarities of its topography?

2.     What lymphatic trunks fall into thoracic duct?

3.     From what sites of a body does thoracic duct collect lymph?

4.     What parietal lymphatic nodes are located in abdomen?

5.     What visceral lymphatic nodes are located in abdomen?

6.     What group of lymphatic nodes is biggest?

7.     Describe location of mesenteric lymphatic nodes?

8.     What parietal lymphatic nodes are located in pelvis?

9.     What visceral lymphatic nodes are located in pelvis?

10. What vessels and nodes drain the stomach?

11. What vessels and nodes drain the esophagus?

12. What vessels and nodes drain the pancreas?

13. What vessels and nodes drain the jejunum and ileum?

14. What vessels and nodes drain the kidneys?

15. What vessels and nodes drain the liver?

16. What vessels and nodes drain the uterus?

17. What vessels and nodes drain the rectum?

18. Describe lumbar sympathetic ganglia and their branches.

19. Describe plexuses of abdominal cavity.

20. Where is located and how is formed celiac plexus?

21. What does celiac plexus innervate?

22. What does plexus of abdominal aorta innervate?

23. What do white communicating rami connect?

24. What do grey communicating rami connect?

25. What does pelvic plexuses innervate?

26. Describe plexuses of pelvic cavity.

27. Describe autonomic innervation of abdominal organs.

28. Describe autonomic innervation of pelvic organs.

29. What divisions does vagus nerve have?

30. Describe topography of left and right vagus trunks.

31. What do the branches of vagus form in an abdominal region?

32. What do the branches of vagus innervate in an abdominal region?

33. What physiological effect of vagus innervating?

34. Describe pelvic sympathetic ganglia and their branches.

35. What do grey communicating rami connect?

36. Describe plexuses of abdominal cavity.

37. Where is located and how is formed celiac plexus?

38. What does celiac plexus innervate?

39. What does superior mesenteric plexus innervate?

40. What does abdominal aortal plexus innervate?

41. What does inferior mesenteric plexus innervate?

42. What do pelvic splanchnic nerves innervate?

43. Describe plexuses of pelvic cavity.

44. What does inferior hypogastric plexus innervate?

45. Describe autonomic innervation of pelvic organs.

46. Describe autonomic innervation of stomach.

47. Describe autonomic innervation of small intestine.

48. Describe autonomic innervation of large intestine.

49. Describe autonomic innervation of large intestine.

²²². Òest control – 14:15 – 15:00 pm (1 hour)

 

References: 1. Gray`s Anatomy. Lawrence H.Bannister, MartinM.Berry, Patricia Collins and others. Churchhill Livingstone, - 1999. 2092 p. 2. W. Kahle, H. Leonhardt, W. Platzer. Colour atlas and Textbook of Human Anatomy. – Stuttgart, New York, 1986. 3. R.D. Lockhart, G.F. Hamilton, F.W. Fyfe. Anatomy of the human body.Philadelphia,  19651. 4. F.H. Netter. Atlas of Human Anatomy. – Ciba Pharmaceuticals Division, 1994. – 514 p. 5. Synelnikov R.D. The atlas of anatomy of the man. In the 4-th volumes. - Medicina, 1991.6. Lecture. 7. Colin H. Wheatley, B.Kolz. Human anatomy and physiology. 1995.