Snímek 1 - anatomie.lf3.cuni.cz

Snímek 1 - anatomie.lf3.cuni.cz

Tepenn soustava Systema arteriarum Truncus pulmonalis = plcnice sinus trunci pulmonalis (dx., sin., ant.) crista supravalvularis bifurcatio trunci pulmonalis

arteria pulmonalis dx. + sin. lig. arteriosum (Botalli) funkn obh plic tlak v zaklnn (PCW) plicn emblie ACS vtv z TP

Aorta ascendens; Pars ascendens aortae = Vzestupn srdenice sinus aortae Valsalvae (dx., sin., ant.) arteria coronaria dx. + sin. crista supravalvularis bulbus aortae = koen srdenice aneuryzma

Aneurysma aortae ascendentis operan een Arcus aortae levostrann (ptci pravostrann) truncus brachiocephalicus a. subclavia dx. a. carotis communis dx.

a. carotis communis sin. a. subclavia sin. isthmus aortae lig. arteriosum Botalli glomera aortica (chemoreceptory) topografie: horn mediastinum, ventrln ly, dorzln prdunice a jcen

Variace vtv arcus aortae a. thyroidea ima (2 %) a. vertebralis (3 %) a. lusoria (1,5 %) A. carotis communis

glomus caroticum (chemoreceptor) tuberculum caroticum (C6) Chassaignaci vagina carotica spatium parapharyngeum trigonum caroticum + omotracheale

bifurcatio carotidis C4 a. carotis interna a. carotis externa A. carotis externa

ventromediln 8 vtv obliej, jazyk, stn dutina, hltan, pleny A. carotis interna

dorzolaterln dn vtev na krku mozek, oko Arteria carotis externa vtve ventrln: a. thyroidea sup. a. lingualis

a. facialis dorzln: a. occipitalis a. auricularis posterior mediln: a. pharyngea ascendens koncov: a. temporalis superficialis a. maxillaris

Arteria carotis externa topografie trigonum caroticum spatium prestyloideum ventrolaterln: m. sternocleidomastoideus n. XII

uvnit glandula parotis ken s vtvemi n. VII mediln: pharynx a. carotis int. (nejprve dorzolaterln, pak dorzomediln) m. stylopharyngeus

A. thyroidea superior

r. infrahyoideus r. sternocleidomastoideus a. laryngea superior r. cricothyroideus r. glandularis anterior r. glandularis posterior r. glandularis lateralis b s n. laryngeus superior

me bt vtv z ACC nebo z bifurcatio ACC A. lingualis

r. suprahyoideus rr. dorsales linguae a. sublingualis a. profunda linguae angulus Bclardi trigonum a. lingualis Pirogovi podvaz tisk

canalis paralingualis podbh: n. XII v. post. m. digastrici m. stylohyoideus m. hyoglossus Trigonum a. lingualis Pirogovi

Angulus Bclardi A. facialis a. palatina ascendens r. tonsillaris a. submentalis rr. glandulares a. labialis inferior

a. labialis superior r. septi nasi r. lateralis nasi a. angularis A. facialis trigonum submandibulare

podbh: v. post. m. digastrici m. stylohyoideus glandula submandibularis tlakov bod: doln okraj mandibuly ped m. masseter vlnit prbh na oblieji

A. occipitalis

rr. sternocleidomastoidei r. mastoideus r. descendens r. auricularis rr. occipitales r. meningeus pebh: n. XII

vagina carotica sulcus AO ossis temporalis A. auricularis posterior

rr. parotidei r. auricularis r. occipitalis a. stylomastoidea rr. mastoidei a. tympanica post. r. stapedius

odstup nad m. digastricus A. pharyngea ascendens rr. pharyngei a. meningea post. a. tympanica inf. nejten vtev z ACE

stoup mezi ACI a hltanem Arteria temporalis superficialis koncov vtev

r. parotideus a. transversa faciei rr. auriculares anteriores a. zygomaticoorbitalis

a. temporalis media r. frontalis r. parietalis Arteria temporalis superficialis tlakov bod ped boltcem stopkov cva pro kon a svalovkon laloky

arteritis temporalis (Horton) zntliv revmatick onemocnn Arteria maxillaris spatium prestylodeium uvnit glandula parotidea

ventrln od lig. sphenomandibulare fossa infratemporalis ventrln/dorzln od m. pterygoideus lat. (1:1)

fissura pterygomaxillaris fossa pterygopalatina 3 sti 13 vtv maxilofaciln chirurgie

a. auricularis profunda a. tympanica anterior fissura petrotympanica a. alveolaris inferior canalis mandibulae r. mylohyoideus rr. dentales + peridentales r. mentalis

foramen mentale a. meningea media foramen spinosum r. accessorius r. frontalis r. orbitalis r. parietalis

r. petrosus canalis n. petrosi majoris a. tympanica superior canalis n. petrosi minoris Arteria maxillaris pars mandibularis Arteria

meningea media epidurln krvcen (raz) okovit tvar rychl intervence trepanance odst

a. pterygomeningea a. masseterica incisura mandibulae a. temporalis profunda anterior + posterior rr. pterygoidei a. buccalis Arteria maxillaris

pars pterygoidea aa. alveolares sup. post. foramina + canales alveolares rr. dentales + peridentales a. infraorbitalis sulcus + canalis infraorbitalis

a. alveolaris sup. media a. alveolaris sup. ant. a. canalis pterygoidei canalis pterygoideus r. pharyngeus canalis palatovaginalis

a. palatina descendens a. palatina major canalis + for. palatinum majus aa. palatinae minores cann. + forr. palatina minora a. sphenopalatina

foramen sphenopalatinum aa. nasales post. lat. rr. septales post. a. nasopalatina canalis + for. incisivum Arteria maxillaris pars pterygopalatina

Arteria maxillaris - klinika maxilofaciln chirurgie hluboko, obtn dosaiteln a. sphenopalatina krvcen v nose krvcen na septu z

locus Kiesselbachi hypertenze kauterizace embolizace Arteria carotis interna

mozek (80 % krve), oko anatomicky 4 sti klinicky 7 st siphon caroticum circulus arteriosus cerebri Willisi A. carotis interna pars cervicalis dn vtve na krku

laterln dorzln a. pharyngea dorzomediln od ascendens ACExt. vagina carotica sinus caroticus (baroreceptor)

trigonum caroticum + spatium parapharyngeum spatium retrostyloideum pstup k sonografickmu vyeten A. carotis interna pars petrosa aa. caroticotympanicae

A. carotis interna pars cavernosa r. meningeus r. sinus cavernosi

a. hypophysialis inferior rr. ganglionares trigeminales A. carotis interna pars cerebralis

a. ophthalmica a. hypophysialis superior a. communicans posterior a. choroidea anterior koncov vtve: a. cerebri anterior a. cerebri media circulus arteriosus cerebri Willisi

A. ophthalmica odstup pod pravm hlem canalis opticus vztah k n.II onice + on koule stnice postien vtv u hypertenze a DM

Arteria ophthalmica a. centralis retinae pars extraocularis + intraocularis

a. lacrimalis aa. musculares a. supraorbitalis a. ethmoidalis anterior r. meningeus anterior rr. septales anteriores rr. nasales anteriores laterales

a. ethmoidalis posterior a. supratrochlearis a. dorsalis nasi A. carotis interna pars cerebralis

a. ophthalmica a. hypophysialis superior a. communicans posterior a. choroidea anterior koncov vtve: a. cerebri anterior a. cerebri media

circulus arteriosus cerebri Willisi Klinick dlen ACI Bouthillierova klasifikace: C1 = cervical segment (the bulb is indicated by stippling, and the ascending segment by horizontal lines) C2 = petrous segment

C3 = lacerum segment C4 = cavernous segment C5 = clinoidal segment C6 = ophthalmic segment C7 = communicating segment Reprinted with permission from Osborn AG: Diagnostic Cerebral Angiography, ed 2, Lippincott Williams & Wilkins, Philadelphia, 1999.

Arteria subclavia pars intrascalenica a. vertebralis a. thoracica interna truncus thyrocervicalis pars interscalenica truncus costocervicalis

pars extrascalenica (a. transversa coli) Arteria vertebralis pars prevertebralis pars cervicalis s. transversaria forr. transversaria C6-C1 rr. spinales et musculares

pars atlantica sulcus a.v. (canalis a.v.) membrana atlantooccipitalis post. foramen magnum pars intracranialis rr. meningei a. inferior posterior cerebelli a. spinalis post.

a. spinalis ant. neprov ze provch bezejmennch zdrojnic Arteria basilaris 2 aa. vertebrales a. basilaris a. inferior anterior cerebelli

a. labyrinthi aa. pontis aa. mesencephalicae a. superior cerebelli aa. cerebri posteriores circulus arteriosus cerebri Willisi Klinick poznmky

vertebrobazilrn insuficience syndrom prohlen katedrl steal fenomn aneuryzmata Steal syndrom a. subclavia klinicky vznamn snen ptoku okyslien krve do mozkovho kmene a

mozeku zptn tok krve pes a. vertebralis do HK kvli uzvru/zen centrlnho seku AS i TBC pznaky: vertigo, synkopa, peruovan klaudikace postien HK Aneurysmata

Arteria subclavia sulcus arteriae subclaviae pulmonis apertura thoracis superior sulcus arteriae subclaviae costae primae fissura scalenorum syndrom horn hrudn apertury (thoracic outlet syndrome)

steal phenomen (a. vertebralis) Arteria subclavia Arteria subclavia pars intrascalenica a. vertebralis a. thoracica interna truncus thyrocervicalis

pars interscalenica truncus costocervicalis pars extrascalenica (a. transversa coli) nkter vtve variabiln

A. thoracica interna rr. mediastinales rr. thymici

a. pericardiacophrenica rr. sternales rr. perforantes rr. mammarii mediales (r. costalis lateralis) rr. intercostales anteriores koncov vtve: a. musculophrenica

a. epigastrica superior ped trigonum sternocostale A. thoracica interna horn mediastinum 1. vrstva doln pedn mediastinum dve a. mammaria int.

klinicky LIMA, RIMA elastick bypass na aa. coronariae A. thoracica interna Truncus thyrocervicalis

a. thyroidea inf. a. laryngea inf. rr. glandulares rr. oesophageales

rr. pharyngeales k n. laryngeus recurrens a. cervicalis ascendens asto vtev z a. thyroidea inf. b s n. phrenicus po m. scalenus ant. Truncus thyrocervicalis

a. suprascapularis (86 % z TTC) a. transversa colli (36 % vskyt) r. superficialis (jako a. cervicalis superficialis v 83 % z TTC) r. profundus (a. dorsalis scapulae v 36 % z TTC, jinak z pars extrascalenica arteriae subclaviae) velk variabilita bez klinickho dopadu

Truncus costocervicalis z pars interscalenica a. cervicalis profunda trigonum omotrapezium a. intercostalis suprema a. intercostalis posterior prima a. intercostalis posterior secunda

Klinick poznmky aterosklerza = kornatn ve vysplch sttech je pinou 50 % mrt kombinace zmn tunica intima tepen + ukldn lipid, polysacharid, destiek tvo se subintimln ztlutn = aterom pozdji fibrotizace a kalcifikace trombotizace uzvr hypoxie

Aterosklerza rizikov faktory: LDL hypertenze kouen DM obezita nedostatek pohybu

Aortln aterom (HE) Zdrav a. coronaria Aterom Lipidov plaky Trombza infarkt

Aterosklerza (AL) AT je klinicky nm a do vzniku kritick stenzy, trombzy, aneuryzmatu i emblie nedostaten zsoben perifern tkn intermitentn klaudikace, angina pectoris nhl uzvr: AIM, CMP diagnza: angiografie, sonografie

terapie: rizikovch faktor, LDL (statiny) CT a MR Aneurysma ACI sti mozkovch tepen a. cerebri ant.

pars precommunicalis; segmentum A1 pars postcommunicalis; segmentum A2 a. cerebri media pars sphenoidealis/horizontalis; segmentum M1

pars insularis; segmentum M2 a. cerebri post. pars precommunicalis; segmentum P1 pars postcommunicalis; segmentum P2

Aneurysma ACA

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