Anatomy organs.

THE TRACHEA (TRACHEA)
- it is a membraneous pipe wich connects the larynx with the lungs, having its
posterior surface flattened and being situated in front of esophagus and
deviated slighty to its right side
- it starts at the level of C6 vertebra (liggamentum crico-trachealis) and it ends
at Th4 vertebra (bifurcatio tracheae) and thus presents a cervical part and a
thoracic one, having a supero-inferior direction and a slighty oblique antero-
posterior orientation
- at the level of Th4 it divides at approximately 80 degrees angle into the main
right and left bronchus (bronchus principalis dexter et sinister)
I. The COMPONENTS of the trachea are:
- cartilagines tracheales - the tracheal cartilages are incomplete arches
(in the posterior part of the trachea) in number of 18-20
- carina tracheae – it represents the last tracheal cartilage wich has
a “V” shape
- liggamenta trachealis (annularia) - the ligaments of the trachea wich
are situated in between the cartilages
- paries membranaceus - the membranous part of trachea is situated
posteriorly in between of the ends of the incomplete tracheal cartilages
- musculus trachealis - the tracheal (smooth) muscle wich is part of the
paries membranaceus
- the lumen of the trahea - the interior of the trachea is coated with
tunica mucosa wich incorporates glandulae tracheales
II. The TOPOGRAPHICAL RELATIONSHIPS of the trachea are:
- anterior - with arcus aortae, to the antero-right side with truncus
brachicephalicus and to the antero-left side with arteria carotis
communis sinistra and vena brachiocephalica sinistra
- posterior - with the oesopagus wich is situated slighty to the left side
of the trachea
- right - with vena cava superior, arcus venae azygos, nervus phrenicus
dexter and pleura medistinalis
- left - with arcus aortae, arteria carotis communis sinistra and nervus
laryngeus recurrens sinister

THE LUNGS (PULMOS)
- the lungs are pair organs situated in the pleural cavity
I. The lung presents:
- apex pulmonis - the tip of the lung wich exceeds the first rib with 2-3
cm
- basis pulmonis - the base of the lung wich is concave lying on the
diaphragm
II. The SURFACES OF THE LUNG are:
- facies costalis – the costal surface is the lateral one and presents the
imprints of the ribs (impressio costales)
- facies diaphragmatica – the diaphragmatic surface is the inferior one
- facies medialis – the medial surface it is split into:
- pars vertebralis - the posterior smaller part
- pars medistinalis - the anterior bigger part wich presents:
- hilus pulmonis - the hilum of the lung wich is situated in
its upper third
- it presents imprints given by other anatominal structures
situated in direct contact with this surface:
- impressio cardiaca – the imprint of the heart wich is
present on both lungs and it is more accentuated on the left
lung and they are situated antero-inferior to the hilum
- sulcus arteriae subclaviae – the groove of the subclavian
artery wich is present on both lungs and it is situated antero-
superior to the hilum
- impressio venae cava superioris – the imprint of the
superior caval vein wich is situated anterior to the right hilum
- impressio arcus venae azygos – the imprint of the arch of
the azygos vein (wich comes from posterior to anterior) wich
is situated above of the right hilum
- impressio oesophageus – the imprint of esophagus wich is
situated in the inferior part of facies mediastinalis of the right
lung

- impressio aorta descendens – the imprint of the
descending aorta wich is situated posterior to the left hilum
- impressio arcus aortae – the imprint of the arch of the
aorta (wich comes from anterior to posterior) wich is situated
above of the left hilum
- facies interlobaris – the surface situated in between the lobes
III. The MARGINS OF THE LUNG are:
- margo anterior – the anterior margin wich is situated in between the
costal and medial surfaces
- incisura cardiaca pulmonis sinistri - the cardiac notch of the left
lung is situated on the left anterior margin
- lingula pulmonis sinistri - the “lingula” of the left lung
represents the “process” of pulmonar tissue situated under the
lingula and oriented towards anteriorly
- margo inferior - the inferior margin wich is situated circumferentially
around the inferior surface
IV. The FISSURES OF THE LUNG are:
- fissura obliqua – the oblique fissure wich is present on both lungs and
it is situated on the costal surface; it starts posteriorly 6-7 cm under the
tip of the lung (at Th3 level) and goes towards antero-inferior part of the
lung along the costal surface, reaching the inferior margin near the
meeting point with the anterior margin; it will split each the lung into
lobus superior and lobus inferior
- fissura horizontalis pulmoni dextri – the horizontal fissure wich is
present only on the right lung and it is situated also on the costal surface;
it starts where the fissure oblique meets the 4th
rib (in the middle axillary
line) goes towards anterior margin along the 4th
rib; it will generate
(from the right superior lobe) the lobus medius pulmoni dextri
- each of the lung will contain 10 segments (the components of the lobes)
– each of them is considered a small lung, having a prismatic shape with
the tip oriented towards the hilum of the lung (and receving through this
tip a segmental bronchus and an artery) and the base of the segment being

oriented towards the surfaces of the lung (along the surfaces of the
segment are situated the segmental veins of it):
-the right lung presents 3 segments in the superior lobe
(segmentum apicale, anterius, posterius), 2 segments in the
medial lobe (segmentum mediale, laterale) and 5 segments
in the inferior lobe (segmentum superius, basale anterius,
basale posterius, basale mediale, basale laterale)
-the left lung presents 5 segments in the superior lobe
(segmentum apicale, anterius, posterius, lingulare
superius, lingulare inferius) and 5 segments in the inferior
lobe (segmentum superius, basale anterius, basale
posterius, basale mediale, basale laterale)
V. The HILUM OF THE LUNG:
- is situated in the upper third of the pars mediastinalis of the medial
surface and it is surrounded by the ligamentum pulmonare of
“Zenker” (the reflection of pleura medistinalis in pleura visceralis)
- anterior to the hilum lies the phrenic nerve
- posterior to the hilum lies the vagus nerve
- it represent the zone through the components of the pedicle of the lung
(radix pulmonis) enter/exit into/from the lung; the pedicle consists in:
- venae pulmonales - two pulmonary veins (superior et inferior)
for each lung, wich are going to be drained into the left atrium; they
contain the oxygenated blood coming from the peri-lobular
network, than from the segmental veins wich in the end are forming
the lobar veins and from here the pulmonal veins
- arteria pulmonalis dextra / sinistra (=vasa publica) - the main
right / left pulmonary artery wich are the two division branches of
the pulmonary trunk and they contain un-oxygenated blood wich
goes towards the lungs in order to be oxygenated
- bronchus principalis dexter / sinister - the main right / left
bronchus are the two division branches of trachea
- in the both hilums the order of these three components in
antero-posterior direction is V-A-B
- in the right hilum the order of these three components in
supero-inferior direction is B-A-V

- in the left hilum the order of these three components in
supero-inferior direction is A-B-V
- arteria bronchialis dextra / sinistra (=vasa privata) - the right /
left bronchial arteries wich are destined to vascularise the lung as
organ; they are situated on the posterior surface of the bronchus,
being branches of the thoracic aorta
- venae bronchiales dextrae / sinistrae - the right / left bronchial
veins wich are destined to drain the lung as organ – situated also on
the posterior surface of the bronchus and they are drained into the
azygos / hemiazygos system
- lymphatic vessels – they are draining the limpha from the two
networks of the lung: the superficial (under the pleura visceralis)
and the deep one (intrapulmonar)
- vegetative nervous networks – branches from the vagus nerve
(plexus anterior) and from the sympatic thoracic chain (plexus
posterior) wich are going into the lung along with the bronchial
three
a. The main bronchi:
- they are the result of the bifurcation of the trachea at approximately 80
degrees angle at the level of Th4
- the two main bronchus are united inferiorly under the bifurcation by the
“inter-bronchial ligament of Lushka”
- the main right bronchus (bronchus principalis dexter) it is shorter and
larger, being almost vertical in the axis of the trachea; it will be split into
the lung in three lobar bronchi corresponding to each lobe: bronchus
lobaris superior, medius et inferior dexter
- the main left bronchus (bronchus principalis sinister) it is longer and
thinner, being deviated to the left from the axis of the trachea; it will be
split into the lung in two lobar bronchi corresponding to each lobe:
bronchus lobaris superior et inferior sinister
- the lobar bronchi will split in 10 segmentar bronchi (bronchus
segmentalis) corresponding to each segment
- the segmentar bronchi will split in lobular bronchi (bronchus lobularis)
corresponding to each lobuli
- into the lobuli the lobular bronchi will split in bronchioli respiratorii,
wich will split at their turn in 2-3 ductuli alveolares wich will end with
sacculi alveolares wich are made from alveoli pulmonis (where the gas
exchange take place)

b. The main pulmonary arteries:
- they are the result of the bifurcation of the truncus pulmonalis
- the main right pulmonary artery (arteria pulmonalis dextra) it is longer
and larger, going almost transversally under the aortic arch towards the
right pulmonar hilum; it will split into the lung in two lobar arteries
(arteria lobaris superior et inferior dexter), the inferior one giving the
branch for lobus medius (arteria lobaris media)
- the main left pulmonary artery (arteria pulmonalis sinistra) it is shorter
and thinner, going above the right main bronchus towards the left
pulmonar hilum; in between the aortic arch and the initial portion of the
artery there is the “ligament arteriosum of Botallo”; it will split into the
lung in two lobar arteries (arteria lobaris superior et inferior)

The stomach
It’s the most dilatated segment of the digestive tract, situated in the left hypocondrum, about 1300 ml
capacity, between the oesophagus and duodenum. The two major parts, the horizontal one and the
vertical one give the J shape aspect.
Walls:
-paries anterior- is pointing to anterior and superior ;
-paries posterior- is pointing to posterior and inferior.
They are joint in two margins:
-curvatura ventriculi minor-the superior fusion of the two walls. On the inferior part a sudden
change of curve’s direction from vertically to horizontally is called incisura angularis
-curvatura ventriculi major-the inferior joint of the walls.
The entering in the stomach is bordered by the cardia – a sphincter muscle with one way valve
function.
The exit from the stomach is delimited by the pylor with the same function.
The constitutive parts of the stomach: a bisecting line through the incisura angularis split the stomach
in two parts:
-pars verticalis (pars dygestoria): above
-pars cardiaca – a small part situated around the cardia with mucous glands in submucosa;
-fundus ventriculi – the part situated above the horizontal line through the cardia, rich in
hydrochloric acid secretory glands. Usually this part is full of air. The angle between the curvatura
ventricului major and fundus ventricului is called Incisura cardiaca or His angle.
-corpus ventriculi – the largest vertical part under the horizontal line through the cardia, with
hydrochloric acid secretory glands and pepsinogen secretory glands.
-pars horisontalis (pars egestoria): under
-antrum pyloricum – the last dilatated part of the stomach , where the ingested aliments are
prepared and waiting to be evacuated ( antrum means waiting room) ;
-canalis pyloricus- it’s a 1 cm length channel at the end of the stomach which contains the
pyloric muscle-the circular muscle layer development.
The interior aspect of the stomach:
-the folds of mucosa are called plicae villosae and delimit between them ariae gastricae.
-on the small curve, two developed longitudinal folds goes downwards and parallel from cardia to
pylor and bound a groove for the liquids flow – Waldayer highway.
-a wide thin fold – Gubarov’s valve - situated on the cardial region has an one way valve function.
The stomach layers:
-mucosa-the glandular epithelium lies on the thin muscular layer-muscularis mucosa. Also here are
developed the secretory glands, producing hydrochloric acid, pepsinogen, mucous and gastrin.
-submucosa – contain collagen fibres, vessels and autonomic nerves (plexus Meissner).
-the muscular layer:

-the inner one- oblique fibres, surrounding the stomach
-the middle one – the circular muscle layer which is more developed at the sphincter regions.
-the outer one-the longitudinal muscle layer, more developed at the curves regions;
-serosa-the peritoneum which cover the stomach.
The topography of the stomach:
-the anterior wall is pointing to the abdominal wall.
-Labbe’s triangle – bordered by the inferior margin of the liver, the inferior left margin of the
thoracic wall and a horizontal line through the 9th
ribs.
-spatium semilunare Traube- a semilunar space on the left lateral thoracic wall with the top of
the arch at the 5th
rib.
-the posterior wall is pointing to bursa omentalis.
The arteries of the stomach are organised along the two curves as two anasomotic arches. They are
directly or indirectly branches of the truncus celiacus.
-a.gastrica sinistra – the most important branch, arises from truncus celiacus and is situated on the
superior part of the small curve;
-a.gastrica dextra – branches from a.gastroduodenalis (from a.hepatica communis) and lies on the
inferior part of the small curve;
-a.gastroepiploica sinistra – is situated on the superior part of the large curve. Is a small branch of
a.lienalis;
-a.gastroepiploica dextra – branches from a.gastroduodenalis and is situated on the inferior (right)
part of the large curve.
-aa.gastricae breves – a few branches from arteria lienalis to fundus ventriculi.
The veins of the stomach have the same disposition and drain in the portal system:
-v.gastrica sinistra and dextra drains in vena porta;
-v.gastroepiploica sinistra-drains in v.lienalis;
-v.gastroepiploica dextra – drains in v.mesenterica superior;
-vv.gastricae breves-drains in vena lienalis
A small branch of v.gastrica sinistra is connected with the caval system (v.azygos) in the lower part of
the oesophagus ( here is the site of the oesophageal varix in liver chirossis)
The lymph is drained in:
-nodi lymphatici gastrici dextri et sinistri;
-nodi lymphatici gastroepiploici dextri;
-nodi lymphatici pylorici;
-nodi lymphatici pancreaticolienalis;
-nodi lymphatici celiaci.
The autonomic nerves are:
-sympathetics: enter in the stomach layers around the arteries;

-parasympathetics: belong to the vagus nerves, with a very important role in hydrochloric acid
secretion.
The two autonomic systems are organised into the stomach layers in:
-plexus submucosus Meissner;
-plexus myentericus Auerbach.
1. The duodenum
It’s a horseshoe shape organ, about 25-30 cm length, situated in continuation of the stomach.
Duodenum division:
-pars superior-bulbus duodenalis-is between the duodenopyloric groove (where vena pylorica is
situated) and superior duodenum’s knee-flexura duodenalis superior;
-pars descendens-the second part, between flexura duodenalis superior and flexura duodenalis
inferior;
-pars horisontalis-intersect the spine at L4 level and cross in the left side;
-pars ascendens – the last part, until the duodenojejunal flexure
-flexura duodenojejunalis or the Treitz angle , the starting point of the jejunum.
The flexure is sustained by a small muscle-musculus Treitz, which arises from the left pillar of
diaphragm and aorta abdominalis.
The layers of duodenum:
-mucosa-the inner layer , made by glandular epithelium and under it, muscularis mucosae.
-submucosa-contains glands specific to duodenum-glandulae duodenales with mucous secretion. Also
here are the nerves of plexus submucosus Meissner;
-tunica muscularis: circular and longitudinal fibres. Also contain the plexus myentericus Auerbach.
-serosa (adventitia): only the first part of duodenum is situated inside the peritoneal cavity and is
covered by peritoneum. The rest of it is in retroperitoneum. A peritoneal fold, situated behind of the
Treitz’ angle, split the space between the last part of duodenum and the posterior peritoneum in two
parts: recessus retroduodenalis superior et inferior.
The internal aspect of duodenum;
Due to muscularis mucosae, the inner layer appear life circular folds, named Plicae circulare
Kerkring.
-on the posterior wall of pars descendens a vertical fold is the mark of the choledocus situated
posterior;
-also in pars descendens on the medial wall, there are two little perforated mucosal projections:
-papilla duodeni major-the opening of the choledocus and Wirsung channel in duodenum;
-papilla duodeni minor-the opening in duodenum of ductus Santorini (canalis pancreatis
accesor).
The blood supply will be presented at the pancreas.
The autonomic nerves arise from plexus celiacus (sympathetic part) and from vagus nerves
(parasympathetic part), forming the two inner layer plexus:

-plexus submucosus Meissner;
-plexus mientericus Auerbach.
2. The pancreas
It’s a double function gland: endocrine and exocrine situated profound, behind the stomach.
The parts of pancreas:
-Head – caput pancreatis - is situated in the duodenal frame and presents two surfaces:
-facies anterior-points to bursa omentalis and through it, to the posterior wall of the stomach. It is
split by the mesocolon insertion in a supramesocolic and inframesocolic parts. A small pancreatic
tissue called processus uncinatus, borders with the inferior part of the head the pancreatic notch
(incisura pancreatica). Inside of it lies artera and vena mesenterica superior.
-facies posterior-points to the retroperitoneum. Behind the pancreas and duodenum is stretching
the fascia retroduodenopancreatica Treitz. Through it, the pancreas borders with the following
retroperitoneal organs:
-vena cava inferior;
-the right kidney and the suprarenal gland
-choledocus;
-vena porta.
-Neck - Collum pancreatis– is a small narrowing part between the head and corpus
-Body - Corpus pancreatis– presents three margins:
-margo superior – is bordering by the splenic artery ;
-margo anterior-represents the insertion of the transverse mesocolonum;
-margo inferior (posterior)
-and three surfaces:
-facies anterior-points to bursa omentalis;
-facies posterior-points to retroperotoneum(aorta abdominalis, vena renalis sinistra, vena
lienalis);
-facies inferior-points to the inframesocolic region.
- Tail - Cauda pancreatis- is situated on the left in front of the kidney and suprarenal gland and is
continued by the pancreaticolienalis ligament which is the spleen’s vascular pedicle.
The endocrine function consists of insulin and glucagon secretion by the alpha and beta pancreatic
cells.
The exocrine function consists in enzymes secretion in two collecting channels:
-Wirsung duct-canalis pancreatis principalis – cross the entire gland and is opened with
choledocus in papilla duodeni major;
-Santorini duct-canalis pancreatis accesorius-crosses only the superior part of the pancreatic
head and is opened in papilla duodeni minor. The connection with the Wirsung duct is variable.
Arteries of the pancreas:
-Head – has the same vascularisation with the duodenum. The two anastomotic arches situated in front
and behind the head (arcada pancreatis anterior et posterior ), have the following sources:
-a.pancreaticoduodenalis superior-branches from a.gastroduodenalis;
-a.pancreaticoduodenalis inferior-branches from a.mesenterica superior.

-Body and tail: due to a large variability, is almost individual. The most frequent pattern contain three
arteries: a.pancreatica magna, a.pancreatica dorsalis and a.pancreatica inferior. All of these are
anastomosis between a.mesenterica superior and a.lienalis.
The veins of the pancreas have the same distribution and drain in vena porta.
The lymph is drained in:
-nodi lymphatici hepatici-the head;
-nodi lymphatici celiaci-the body;
-nodi lymphatici pancreaticolienalis-the tail.
The nerves arise from plexus celiacus (sympathetic part ) and vagus (parasympathetic part).
3. The spleen (Lien)
It’s an ovoid shape organ, situated in the left hypocondrum. The dimensions are 12/8/4 cm.
The ovoid has two extremities and two margins:
-extremitas anterior-points to anterior and inferior;
-extremitas posterior – points to posterior and superior;
-margo superior-easy to recognized due to irregular shape;
-margo inferior-smooth;
The surfaces of the spleen:
-facies diaphragmatica-convex, points to diaphragm;
-facies visceralis-points to the abdominal cavity and internal organs:
-facies gastrica – superior;
-facies colica – inferior and anterior;
-facies renalis-inferior and posterior;
-hillus lienis – is situated between the three surfaces contains artera and vena lienalis.
The spleen’s ligaments
-ligamentum gastrolienale-is the left lateral part of omentum majus. Arteriae et venae gastricae
breves cross the ligament and provides the blood supply for the fundus ventriculi.
-ligamentum phrenicolienalis-maintain the spleen stick to the diaphragm;
-ligamentum pancreaticolienalis-contain the spleen vessels
-ligamentum phrenicocolicum sinistrum- the spleen lies on this ligament –this is the reason why
it is called sustentaculum lienalis.
The blood supply is provided by the artera lienalis, a branch of truncus celiacus, it is situated first
on the superior margin of the pancreas body and enter in ligamentum pancreaticolienalis;
Vena splenica drains in vena porta;
The lymph is drained in nodi lymphatici pancreaticolienalis;
The nerves arise from plexus celiacus and vagus.

THE PERICARD (PERICARDIUM)
- it is a membranous sac wich contains in interior the heart and the main
vessels from the base of the heart
I. The COMPONENTS of the pericardium are:
- pericardium fibrosum – the fibrotic pericardium wich is the external
thicker layer
- pericardium serosum – the seros pericardium wich is the internal thinner
layer wich is made by two components:
-lamina parietalis – the parietal part wich is coating the internal
side of the fibrotic pericardium
-lamina visceralis (=epicardium) – the visceral part wich is
coating the external side of the muscle of the heart (=myocardium)
- so this layer is called epicardium
- cavum pericardii – the cavity of the pericardium (virtual) wich is situated
in between the two components of the pericardium serosum
- liquor pericardii – the liquid of the pericardium, in cuantity of
approximately 20g wich has the role of lubrifiyng the surfaces wich are
coming in contact durig the movements of the heart
II. The TOPOGRAPHICAL RELATIONSHIPS of the pericardium are:
- anterior - with the thymus (superiorly), the sternum (inferiorly) -here
presenting ligg. sterno-pericardica - and with the 4-6th
costal cartilage
- posterior - with the oesophagus
- right and left - with pleura mediastinalis on each side and through it
with the medistinal surface of each lung
III. The CONTENT of the pericardium is made by:
- cor – the heart wich is completely included into the cavity of the
pericardium
- aorta ascendens – the ascending aorta on wich pericardium extents until
the limit with the aortic arch (approximately 1,5 cm below the origin of
the brachio-cephalic truncus)
- truncus pulmonalis – the pulmonary trunk wich is completely included
- vena cava superior – the superior caval vein wich is almost completely
included (under the level of confluence of the azygos vein)

- vena cava inferior – the inferior caval vein wich has its entire supero-
diaphragmatic portion included
- venae pulmonales – the four pulmonal veins (two from right and two
from the left lung) wich have their distal portion included
- due to this inclusion/encircling of these vessels the pericardium presents
dorsally a reflection line (from lamina visceralis into lamina parietalis)
wich has a horizontalized “T” shape with its vertical part starting from
vena cava inferior, going up to the right pulmonary veins and from here to
vena cava superior, and the horizontal part starting from the right
pulmonary veins and going towards the left side to the left pulmonal veins
-in between the reflection line situated in between vena cava
inferior and the right pulmonal veins on one side, continued to the
left pulmonal veins on the other side, there will be a “closed” part
of the cavity of the pericardium called sinus obliquus of “Haller”
-in between the reflection line situated in between vena cava
superior and the right and left pulmonal veins on one side, and the
aorta acendens and truncus pulmonalis on the other side, there will
be a “open” part of the cavity of the pericardium called sinus
transversus of “Theile”
IV. The A-V-N package of the pericardium is made by:
- arteries – a. pericardio-phrenica (branch from a. mamaria interna)
- smaller branches from different sources: aorta descendens, a.
phrenicae superiores, a. eophageales, a. bronchiales
- veins – they are drained into the internal mammary veins and into the
superior phrennic veins
- nerves – branches from n. phrenicus, n. vagus and from the symphatic
thoracic chain
- lympha – is drained through a superficial and a deep networks
THE HEART (COR)

- the heart is an organ situated in the pericardial cavity cavity, having a
asymmetrical position related to the medio-sagital plane of the body with two
thirds situated to the left and one third situated on the right side of it
I. The EXTERNAL CONFIGURATION of the heart:
- atrium cordis - the atria of the heart, in numbers of two (right and left),
situated superiorly
- ventriculus cordis - the ventricle of the heart, in numbers of two (right
and left), situated inferiorly
- sulcus coronarius – the coronar groove is situated in between the atrias
and the ventricles
- sulcus interventricularis anterior - the anterior inter-ventricular
groove
- sulcus interventricularis posterior - the posterior inter-ventricular
groove
- incisura apicis cordis – the notch of the tip of the heart wich results
from the antero-inferior meeting of the two interventricular grooves
- apex cordis – the tip of the heart situated antero-inferiorly on the left
side of the incisura apicis cordis (belongs to the left ventricle)
- basis cordis - the base of the heart wich is situated supero-posteriorly
and it is made from the atrias and the proximal part of the big vessels
- auricula dextra – the right auricle represents an appendage of the right
atrium
- auricula sinistra – the left auricle represents an appendage of the left
atrium
II. The SURFACES OF THE HEART are:
- facies sterno-costalis – the sterno-costal surface is the anterior one
being made almost entirely from the right ventricle and right atrium
(3/4) and the left ventricle with the apex (1/4), the limit in between them
being sulcus interventricularis anterior
- on this surface we find the right auricle, truncus pulmonalis, aorta
ascendens, the distal portion of the left auricle
- facies diaphragmatica – the diaphragmatic surface is the inferior one
being made by the right ventricle and a small part of the right atrium
(2/5) and the left ventricle (3/5), the limit in between them being sulcus
interventricularis posterior

- facies pulmonalis (dextra et sinistra) – the lateral surfaces being made
on the right side by the right atrium and the right auricle, and on the left
side by the left ventricle, the left auricle and a small part of the left
atrium
III. The MARGINS OF THE HEART are:
- margo obtusa – the obtuse margin wich is rounded and situated in
between the sterno-costal surface and the left pulmonal surface
- margo acuta - the margin wich is situated sharper and situated in
between the sterno-costal surface and the right pulmonal surface
IV. The CHAMBERS OF THE HEART – are coated on their inner surface by
a thin layer of cells called endocardium:
- ATRIUM DEXTRUM – the right atrium has a cuboidal shape and
presents:
- sinus venarum cavarum – the posterior part wich receives the
blood from the two caval veins
- atrium primitivum – the anterior part
- crista terminalis – the terminal crest wich is situated endo-
atrially and represents the border in between these two parts
- sulcus terminalis – the terminal groove wich is situated exo-
atrially and represents the external correspondence of crista
terminalis
- auricula dextra – the right auricle wich is a anterior-oriented
appendage of the atrium primitivum, being larger and blunter than
the left auricle
- musculi pectinati – the “comb” muscles are oriented from crista
terminalis towards the right atrio-ventricular orifice and auricular
dextra
- ostium venae cavae superioris – the orifice of the superior caval
vein is situated superiorly
- ostium venae cavae inferioris – the orifice of the inferior caval
vein is situated inferiorly and presents a embrionar reminiscence:
valvula venae cavae inferioris of “Eustachio”
- tuberculum inter-venosum of “Lower” – the inter-venous
tubercle wich is situated posteriorly in between these two orifices

- ostium sinus coronarii - the orifice of the coronary sinus is
situated on the inferior wall and presents a embrionar reminiscence:
valvula sinus coronarii of “Thebesius”
- fossa ovalis – the oval fossa is situated on the medial wall (= the
common wall of the two atrias = inter-atrial septum) and presents a
border: limbus fossae ovalis
- foramina venarum minimarum – the orifices of the small veins
of “Thebesius” wich are situated near the inter-atrial septum
- ATRIUM SINISTRUM – the left atrium has a more rounded shape
and presents:
- ostia venarum pulmonalium – the orifices (4) of the pulmonar
veins wich are situated in two groups of two (superior and inferior)
on the right and on the left side of the atrium
- auricula sinistra – the left auricle wich is a anterior-oriented
appendage of the atrium primitivum, being thinner and sharper than
the right auricle
- valvula foraminis ovalis (= falx septi) – the valvula of the oval
fossa is situated on the medial wall (= the common wall of the two
atrias = inter-atrial septum) in the corresponding area of fossa ovalis
- VENTRICULUS DEXTER – the right ventricle has thin wall being
situated like a pocket attached to the left ventricle and presents:
- “the filling chamber” – represents the main part of the right
ventricle being situated inferiorly and towards the right side under
the right atrio-ventricular orifice; presents on the interior surface
muscular trabeculas (trabeculae carnae) of myocardium
-the “evacuation chamber” (= conus arteriosus = infundibulum)
– the infundibulum is situated superiorly and towards the left side
and presents on the interior surface muscular trabeculas less
accentuated than those from the filling chamber
- crista supraventricularis – the supraventricular crest is a bigger
muscular trabecula and represents the border in between these two
parts of the right ventricle
- trabecula septo-marginalis – the septo-marginal crest is an other
muscular trabecula situated into the filling chamber in between the

muscular part of the interventricular septum and the free wall of the
right ventricle
- ostium atrio-ventricularis dextrum – the right atrio-ventricular
orifice wich is situated in between the right atrium and ventricle
- valva atrio-ventricularis dextra (= valva tricuspidalis) – the
right atrio-ventricular valve wich is situated into the corresponding
orifice, being made from three parts (= cuspsis anterior, posterior
et septalis); each of these cusps will be connected by tendineous
chords (chordae tendineae) to the corresponding papillar muscles
(m. papillaris anterior, posterior et septalis) of the right ventricle
- ostium trunci pulmonalis – the orifice of truncus pulmonalis
wich is situated at the end (superior) of the infundibulum
- valva trunci pulmonalis – the valve of truncus pulmonalis wich
is situated into the corresponding orifice, being made from three
“pocket-like” parts with a semilunar shape (valvula semilunaris
anterior, dextra et sinistra); each of these valvula presents a free
margin called lunula (lunulae valvulae semilunaris) wich has in the
middle point a fibrotic nodule (nodulus valvulae semilunaris of
“Arantius”)
- VENTRICULUS SINISTER – the left ventricle has thick wall having
a conic shape and presents:
- “the filling chamber” – represents the part of the left ventricle
wich is situated inferiorly and to the left side under the left atrio-
ventricular orifice and presenting on the interior surface muscular
trabeculas wich are smoother than those of the right ventricle the
higher pressure
-the “evacuation chamber” – represents the part of the left
ventricle wich is situated superiorly and to the right side and
presents the interior surface smoother compare with that one from
the filling chamber
- ostium atrio-ventricularis sinistrum – the left atrio-ventricular
orifice wich is situated in between the left atrium and ventricle
- valva atrio-ventricularis sinistra (= valva bicuspidalis = valva
mitralis) – the left atrio-ventricular valve wich is situated into the
corresponding orifice, being made from two parts (cuspsis anterior
et posterior); each of these cusps will be connected by tendineous

chords (chordae tendineae) to the corresponding papillar muscles
(m. papillaris anterior et posterior) of the left ventricle
- ostium aortae – the orifice of aorta wich is situated at the end
(superior) of the evacuation chamber
- valva aortae – the valve of aorta wich is situated into the
corresponding orifice, being made from three “pocket-like” parts
with a semilunar shape (valvula semilunaris dextra, sinistra et
posterior); each of these valvula presents a free margin called lunula
(lunulae valvulae semilunaris) wich has in the middle point a
fibrotic nodule (nodulus valvulae semilunaris of “Arantius”); in
between each of these valvulas and the aortic wall there is a space
called sinus of “Valsalva”
V. The ARTERIES OF THE HEART – named coronary arteries and they are
situated under the epycardium, having a sinuous course and giving branches that
will go profound into the myocardium:
- Arteria Coronaria Dextra – the right coronary artery
-originates from the right sinus of Valsalva of the aortic valve and
goes towards the right side into the coronary groove under the right
auricle, than around the base of the right ventricle reaching sulcus
interventricularis posterior where it gives its terminal branch:
- ramus interventricularis posterior – the posterior inter-
ventricular branch
- it vascularises the right atrium, the inferior 1/2 part of the inter-
atrial septum, Keith-Flack nodule (rami nodus sino-atrialis), the
right ventricle, the posterior 1/3 of inter-ventricular septum, the
para-septal area of the left ventricle, the posterior papillar muscle of
the mitral valve
- Arteria Coronaria Sinistra – the left (main) coronary artery
-originates from the left sinus of Valsalva of the aortic valve and
goes towards the left side into the coronary groove in between the
left auricle and truncus pulmonalis, and after a short (main)
segment it divides in two branches:
- ramus interventricularis anterior – the anterior inter-
ventricular branch wich goes in sulcus inter-ventricularis

anterior, than in incisura apicis cordis towards sulcus
interventricularis posterior
- ramus circumflexus – the circumflex branch wich goes
towards the left side into the coronary groove under the left
auricle, than around the base of the left ventricle giving
branches on the postero-lateral surface of it
- it vascularises the left atrium, the superior 1/2 part of the inter-
atrial septum, the left ventricle, the anterior 2/3 of inter-ventricular
septum, the para-septal area of the right ventricle, the anterior
papillar muscle of the mitral valve
VI. The VEINS OF THE HEART:
- approximately 60% of the blood of the heart is drained towards the
coronary sinus (sinus coronarius) wich is situated on the diaphragmatic
surface of the heart and has a “funnel” shape (starting at the meeting point
in between the big cardiac vein and the vena of “Marshall”); it is drained
at its turn into the right atrium
- vena cordis magna – the big cardiac vein comes from the apical
area being situated into the anterior inter-ventricular groove and
goes upwards into the coronary groove under left auricle around the
base of the left ventricle; it will be drain into the left extremity of
the coronary sinus
- vena cordis media – the middle cardiac vein comes from the
apical area being situated into the posterior inter-ventricular
groove; it will be drain into the coronary sinus
- vena cordis parva – the small cardiac vein comes from the righr
side being situated into the coronary groove and goes under right
auricle and around the base of the right ventricle; it will be drain
into the right extremity of the coronary sinus
- vena posterior ventriculi sinistri – the posterior vein of the left
ventricle comes from the postero-lateral area of the left ventricle; it
will be drain into the coronary sinus
- vena obliqua atrii sinistri of “Marshall” – the posterior vein of
the left atrium comes from the posterior area of the left atrium; it
will be drain into the the left extremity of the coronary sinus (at the
meeting point of this vein with the big cardiac vein it will starts the

coronary sinus wich presents here an embrionar reminiscence:
“valvula of Vieussens”
- the rest of 40% of the blood of the heart is drained directly into the
cardiac chambers through:
- venae cordis anteriores – the anterior cardiac veins wich are
situated on the anterior surface of the right ventricle and they are
going to be drained into the right atrium
- venae cordis minimaes – the minimal cardiac veins wich are
situated on the surface of the atriums and they are going to be
drained into the right (mainly) or left atrium
VII. The CONDUCTING SYSTEM OF THE HEART – is made by special
cells situated in groups (wich are connected in between them by specific
pathways); these cells can generate and conduct electrical impulses wich are
going to give the contraction stimulus to the heart:
- nodus sino-atrialis of “Keith-Flack” – the sino-atrial node situated
anteriorly at the confluence in between the vena cava superior and right
atrium
- nodus atrio-ventricularis of “Aschoff-Tawara” – the atrio-ventricular
node situated inferiorly near the orifice of the coronary sinus into the right
atrium
- fasciculus atrio-ventricularis of “His” – the atrio-ventricular bundle
goes inferiorly through the right fibrous triangle near the membraneous
part of the inter-ventricular septum, being split in:
- crus dextrum – the right part situated in the right side of the
inter-ventricular septum
- crus sinistrum – the left part situated in the left side of the inter-
ventricular septum
- rete of “Purkinje” – the network wich derives from the right and the
left parts and it will be distributed into the myocardium of the ventricles
VIII. The SEPTUMS OF THE HEART – are the walls that are separating the
chambers of the heart:
- septum atrio-ventricularis – the atrio-ventricular septum is the wall
situated in between the two atrias on one side and the two ventricles on

the other side; it contains the ostiums of the two atrio-ventricular valves
and it is placed in the transversal plane
- septum interatriale – the inter-atrial septum is the common wall (the
medial one) of the atrias, being placed in the sagital plane
- septum interventriculare – the inter-ventricular septum is the common
wall (the medial one) of the ventricles, being placed also in the sagital
plane and having two parts:
- pars membranacea – the membraneous part wich is the superior
one; due to the different levels of insertion of the atrio-ventricular
valves (the tricuspid valve being placed more distally), this
membraneous part will present two components:
- the atrio-ventricular component of the membraneous part
(wich is the superior component, being placed above the
level of insertion of the tricuspid valve) wich is situated in
between the right atrium and the left ventricle
- the inter-ventricular component of the membraneous part
(wich is the inferior component, being placed under the level
of insertion of the tricuspid valve) wich is situated in
between the right ventricle and the left ventricle
- pars muscularis – the muscular part wich is the inferior one and
being situated under pars membranacea, in between the right
ventricle and the left ventricle
IX. The FIBROUS SKELETON OF THE HEART – has the role of support
for different components of the heart structure:
- annuli fibrosi – the fibrotic annuluses wich have the role of “ring” for
the insertion for the cusps of the atrio-ventricular and semilunar valves
- trigonum fibrosum dextrum – the right fibrotic triangle wich is
situated posteriorly in between the mitral valve (anterior cusp), the
tricuspid valve (septal cusp) and the aortic valve (posterior semilunar
valvula); it is perforated by the “His” bundle and presents two expansions:
- tendo coni arteriosi – goes on the posterior surface of the
pulmonary trunk
- tendo of “Todaro” – goes towards the atriums and to the
membraneous part of the inter-ventricular septum

- trigonum fibrosum sinistrum – the left fibrotic triangle wich is situated
anteriorly in between the mitral valve (anterior cusp) and the aortic valve
(left semilunar valvula)
X. The LYMPHATIC DRAINAGE AND INERVATION OF THE HEART:
- lymphatic vessels – they are draining the limpha from the three
networks of the heart: the under-epicardic, myocardic and under-
endocardic; in the end small leyphatic vessels deriving from these
networks are going along the coronary vessels to the anterior medistinal
nodes
- vegetative nervous networks – branches from the vagus nerve and
from the sympatic thoracic chain wich are going into the lung along with
the coronary vessels (plexus coronarius)

The abdominal wall
It’s a complex structure composed by muscles, aponeurosis and bones situated around the abdominal
cavity.
The distribution of the walls:
-superior: the diaphragm;
-inferior: the pelvic diaphragm-m.levator ani;
-anterior and lateral:
-m.obliqus externus;
-m.obliqus internus;
-m.tranversus abdominis;
-m.rectus abdominis.
-posterior:
-m.iliopsoas;
-m.quadratus lumborus;
-the paravertebral muscles;
The posterior wall will be studied in “The back muscles”
The abdominal wall muscles
1. M obliqus externus-the outer muscle. Its fibres go downwards and forwards .The muscular part is
situated only laterally and is continued medially by the aponeurosis musculi obliqus externus.
O : the surface of the 5th
to 12th
ribs. The origin of obliqus internus intersects the fibres of m.serratus
anterior
I: crista iliaca;
ligamentum inguinale;
linea alba.
N: nn.intercostales 6-12 , n.iliohypogastricum , n.ilioinguinalis.
A: rotates the thorax to the opposite side;
lateroflexion of columna vertebrae.
2. M.obliqus internus – the middle one with the direction of the fibres upwards and forwards. Like
the previous one, the muscular part is situated only laterally and is continued medially by the
aponeurosis musculi obliqus internus. The inferior margin free of any insertions is called Arcus
tendineus muscului obliqus internus, part of tendo conjuctivus.
O : crista iliaca;
fascia thoracolumbalis;
ligamentum inguinale;
I : the surface of the 10th
to 12th
ribs;
linea alba;
N : nn.intercostales 10-12, n.iliohypogastricum, n.ilioinguinalis.

A : rotates the thorax to the same side;
lateroflexion of columna vertebrae.
respiration muscle (the exhale phase)
3. M.transversus abdominis- the inner muscle of the abdominal wall with horizontal direction of the
fibres. The limit between the muscular part (laterally) and the aponeurotic part (medially) is a vertical
line – linea semilunaris Spiegel. The inferior free margin is the other part of tendo conjuctivus – Arcus
tendineus musculi transversus abdominis.
O : the inner surface of the 7th
to 12th
ribs;
fascia thoracolumbalis;
crista iliaca;
ligamentum inguinale.
I : linea alba
N : nn.intercostales 6-12 , n.iliohypogastrum , n.ilioinguinalis.
A : respiration muscle (the most important in the exhale phase).
4. M.rectus abdominis – situated medially, with 4-5 intermediate tendons between the origin and
insertion – intersectiones tendinea. They are situated into a sheath – vagina musculi rectus abdominis.
O : the external surface of the 5th
to 7th
ribs and processus xiphoideus;
I : simphysa pubica
N : nn intercostales 6-12;
A : respiration muscle (the exhale phase)
increase the abdominal pressure.
5. M.Pyramidalis-a small inconstant triangle shape muscles situated in the lower part of the rectus
abdominis sheath.
O : simphysa pubica;
I : linea alba;
N: n.intercostales 12;
The abdominal wall conjunctive structures
1. Ligamentum inguinale – represents the inferior part and also insertion of m.obliqus externus
stretched between spina iliaca anterior superior and tuberculum pubis.
-The medial insertion on pubis is complex, composed of three pillars:
-crus mediale
-crus laterale - between this two pillars are connecting fibres -Fibres intercrurales
-crus posterior-ligamentum reflexum Colles – the fibres from the two sides are intersected on
the superior surface of symphisa pubica.
-The three pillars delimit the superficial ring of the inguinal channel.
- In the angle between ligamentum inguinale and ramus superior osis pubis the arched fibres are called
Ligamentum lacunare Gimbernat.

-The pectineal muscle’s fascia which lies on the pecten osis pubis with ligamentum Gimbernat and
Thomson’s ligament fuse in ligamentum pectineale Cooper.
2. Linea alba-an aponeurotic raphe between processus xiphoideus and symphisa pubica and
represents the fusion of all aponeuroses on the median line. The inferior insertion is wide –
adminiculum lineae albae. In the middle is perforated by the anulus umbilicalis. Up to it, linea alba is
thinner than under it.
3. Vagina musculi rectus abdominis-is an aponeurotic sheath of rectus abdominis muscles with two
laminas (anterior et posterior).
In the upper part of the abdomen (2/3 superior) the disposition of the aponeurosis is:
-lamina anterior-aponeurosis musculi obliqus externus;
-the anterior splitting of obliqus internus aponeurosis;
-lamina posterior-the posterior splitting of obliqus internus aponeurosis;
-aponeurosis musculi transversus abdominis;
-fascia transversalis.
Lower (1/3 inferior) the disposition is changed:
-lamina anterior: - aponeurosis musculi obliqus externus;
- aponeurosis musculi obliqus internus;
- aponeurosis musculi transversus abdominis;
-lamina posterior : -fascia transversalis.
The two types of disposition are separated by an arcuate line-Linea arcuata Douglas.
On the lamina anterior are inserted the Intersectiones tendinea of m.rectus abdominis.
The arteries of the abdominal wall
There are two systems of arteries for the abdominal wall blood supply:
-transversal(horizontal);
-longitudinal(verical);
The transversal system-the arteries arise from laterally and goes to linea alba.
-aa.intercostales posterior 10-11;
-a.subcostalis;
-aa.lumbales 1-5;
The longitudinal system
-a.epigastrica superior: branch of a.thoracica interna, perforates the diaphragm through the Larrey’s
hiatus, then enters into the rectus abdominis sheath and lies on the lamina posterior;

-a.epigastrica inferior: branch of a.iliaca externa, is situated first in the preperitoneal space –
ligamentum ombilicale laterale and then perforates the lamina posterior of rectus abdominis sheath.
Inside of it conect the ending part of a.epigastrica superior, resulting the epigastric anastomosis.
Branches of a.epigastrica inferior:
-ramus pubica;
-ramus obturatoria-with the homonim branche from a.obturatoria (a.iliaca interna) form an
important anastomosis under the ramus superior osis pubis called corona mortis (the death’s arch) due
to severe bleedings in the past during the surgical interventions for femoral hernia repair;
-a.cremasterica – enter into the spermatic cord;
-a.circumflexa iliaca profunda – upwards and laterally.
The veins of the abdominal wall
The veins of the abdominal wall represent a wide anastomotic system between the major venous
systems: vena cava superior, vena cava inferior and vena porta.
The superior caval system tributary veins:
-vv intercostales 10-11 – drains in vena azygos and hemiazygos;
-v.subcostales - drains in vena azygos and hemiazygos;
-vv.lumbales 1-2 : - drains in vena azygos and hemiazygos;
-v.epigastrica superior – drains in vena subclavia.
The inferior caval system tributary veins:
-vv.lumbales 3-5 – drains directly in vena cava inferior;
-v.epigastrica inferior-drains in vena iliaca externa;
The portal system tributary veins:
-vv.periombilicales-are spiraling around the ligamentum teres hepatis.
Between the three systems result anastomosis which are very important in some conditions:
-the cavo-caval anastomosis;
-the porto-caval anastomosis (the jellyfish head sign).
The lymphatic drainage of the abdominal wall
-The superior part of the wall drains in the axillary and mediastinal lymph nodes;
-The inferior part of the wall drains in the inguinal lymph nodes and iliacus externus.
The nerves of the abdominal wall

-provide the motor innervation for the abdomen muscles and the sensitive innervation for the skin and
peritoneum.
-Nn.intercostales 6-8: for the superior part of the abdominal wall, goes medially, forwards and
upwards, resulting three curves with a superior concavity.
-N.intercostalis 9: for the medial part of the abdominal wall, goes forwards keeping its horizontal
trajectory.
-Nn.intercostales 10-12: for the inferior part of the abdominal wall, goes forwards and downwards,
resulting in three curves with inferior concavity.
-N.iliohypogastricus-branch of plexus lumbalis, lies on the m.obliqus internus. Gives motor branches
for the abdominal muscles and sensitive branches for the inferior part, the hypogastric region, after it
perforates the aponeurosis of m.obliqus externus.
-N.ilioinguinalis – arises from the same plexus, is situated between m.obliqus internus and
m.transversus abdominis. In canalis inguinalis, it is attached to the spermatic cord .Gives motor and
sensitive branches: Nn scrotales anteriores or Nn labiales anteriores
-N.genitofemuralis:the genital branch is attached to the spinal cord and gives sensitive branches for the
genital organs.
The topography of the abdominal wall
Using three imaginary lines the abdominal wall is divided in nine different regions.
The lines
-linia bisubcostalis-a horizontal line tangent to the inferior arch of the 10th
rib.
-linia supracristalis-a horizontal line tangent to the highest points of the crista iliaca;
-linia pararectalis-a vertical line tangent to the lateral margin of m.rectus abdominis.
The regions:
-the horizontal lines divide the abdominal wall in three compartments (superior, median, inferior) and
the two vertical lines split every compartment in three regions.
The superior compartment:
1. Regio hypocondrica dextra;
2. Regio epigastrica;
3. Regio hypocondrica sinistra;
The median compartment:
4. Regio lateralis dextra;
5. Regio umbilicalis;
6. Regio lateralis sinistra;
The inferior compartment:
7. Regio inguinalis dextra;
8. Regio hypogastrica;
9. Regio inguinalis sinistra.

The interior aspect of the abdominal wall
-covered by the peritoneum, the inside view of the abdominal wall presents folds and ligaments, most
of them embryonic rests. The center of all the folds is anulus umbilicalis.
The downwards folds:
-Plica umbilicalis mediana – a fold which contains ligamentum umbilicalis medius – the fibrotic
transformation of urachus.
-Plica umbilicalis medialis – laterally, contains ligamentum umbilicalis medialis – the fibrotic
transformation of the aa.umbilicales.
-Plica umbilicalis lateralis – more laterally, contains the inferior epigastric vessels, covered by the
peritoneum.
The upward fold:
-Ligamentum teres hepatis-betweeen the anulus umbilicalis and incisura hepatica, represents the
fibrotic transformation of the vena umbilicalis.
Canalis inguinalis
-situated on each sides above the ligamentum inguinalis is a 4-5 cm length channel.
The direction is parallel with the inguinal ligament.
The channel has two rings, four walls and the content.
The rings:
-Anulus inguinalis profundus-is situated at 2 cm above to the middle point of ligamentum inguinalis ,
bordered medially by the inferior epigastric vessels and ligamentum Hasselbach.
-Anulus inguinalis superficialis-situated at 2 cm above and laterally to the tuberculum pubicum is
bordered by the pillars of ligamentum inguinalis : crus mediale , crus laterale , fibres intercrurales and
posterior – ligamentum reflexum Colles.
The walls:
Anterior- Aponeurosis musculi obliqus externus.
Inferior- Ligamentum inguinalis;
Superior- the two inferiors margins of the m.obliqus internus and transversus abdominis-arcus
tendineus musculi obliqus internus, arcus tendineus musculi transversus abdominis. Sometimes these
margins are fused into a tendon called tendo conjunctivus or falx inguinalis.
Posterior-fascia transversalis enforced by three ligaments:
-ligamentum interfoveolare Hasselbach-the insertion on the ligamentum inguinalis of
linia arcuata Douglas, is situated on the lateral border of anulus inguinalis profundus.
-ligamentum Henle-the tangent part of fascia transversalis to the tendo conjuctivus. Some
authors include ligamentum Henle in tendo conjuctivus or falx inguinalis;

-ligamentum Thomson-the fusion of the fascia transversalis with fascia iliopsoica , is
situated behind to ligamentum inguinalis and parallel to it.
Trigonum Hasselbach – a triangle on fascia transversalis, bordered by ligamentum Hasselbach,
ligamentum Henle and ligamentun inguinalis. It is considered the weakest part of the posterior wall,
the place of inguinals hernias.
The content of canalis inguinalis is different in men and women:
-the spermatic cord-funiculus spermaticus-contains the arteries, veins, nerves for the testes, ductus
deferens and the cremaster muscle.
-ligamentum teres uteri-a ligament that keeps the uterus in a normal position.

Mediastinum posterior
-is situated behind the vertical plane traced through the posterior wall of the trachea and pericardium;
Walls:
-anterior: trachea and pericardium;
-posterior: columna vertebralis and the joints between the ribs and the vertebral bodies;
-lateral: the left and right pleura mediastinalis;
-inferior: diaphragma;
-superior: wide communication with the regions of the neck.
Contents:
1. Oesophagus
2. Aorta thoracica
3. Ductus thoracicus
4. Vena azygos et hemiazygos
5. Truncus sympathicus
Oesophagus
A muscular tube by 25 cm length, part of the digestive tract, between the pharynx and the stomach.
Divisions:
-the cervical part: 5 cm length, from the pharynx (C4) to apertura thoracica superior (Th1) with a
slight disposition to the left.
-the thoracic part: 17 cm length, from apertura thoracica superior to the hiatus oesophageus of
diaphragma (Th9).The aortic arch and the left bronchus subdivide it in a retrotracheal part
(suprabronchus part) and a retropericardium part (infrabronchus part).The last one is fixed by two
muscles : m.bronchooesophageus and m.pleurooesophageus);
-the abdominal part:3 cm length , from the hiatus oesophageus to the cardia (the junction between with
the stomach).
Constrictions:-represent the mark of some structures situated nearby the oesophagus.
-cricoidian constriction-behind the cricoid cartilage of the larynx;
-bronchoaortic constriction-due to aortic arch and left bronchus;
-diaphragmatic constriction- the mark of the diaphragma piercing.
Curves:

-in the frontal plane the oesophagus is situated first, on the cervical region, to the left, then in the
thorax it is pushed to the right by the aortic arch and finally, the last part, return on the left side, so
results three curves.
-in the sagittal plane the aspect is from posterior to anterior with one single curve anteriorly concave.
Structure:
-like all the digestive tract, the oesophagus has four layers:
-Mucosa-the inner layer is composed of stratified squamous epithelium which lies on the muscularis
mucosae;
-Submucosa-contains small blood vessels, collagen and elastin fibres, mucous glands and the
autonomic nerve;
-Tunica muscularis-a longitudinal outer part and a circular inner part. The last one, at the end of the
oesophagus, participates to the cardiac sphincter muscle.
-Adventitia: the outer layer, by the collagen and elastin fibres connects the oesophagus to the
surrounding tissues.
Blood suplie:
-a.thyroidiana inferior;
-rami oesophagei from:
-directly from aorta;
-aa.bronchiales;
-a.phrenica superior;
-aa.intercostales posterior;
-a.gastrica sinistra (a small branch which penetrates the hiatus oesophageus.
-the veins, organised in plexus perioesophageus, drains in v.thyroidiana inferior, vv.bronchiales ,
v.azygos , v.hemiazygos and v.gastrica sinistra. The last one is a part of the portal system and the rest
of the veins belong to the caval system. Therefore, the inferior veins of the oesophagus connect the
two major venous systems- portocaval anastomosis (shunt).This is the site of oesophageal varix in
liver cirrhosis.
-lymph is drained in nodi lymfatici cervicales profundae, tracheales, mediastinales and
juxtaoesophageles.
Nerves:
-the sympathetic innervation -postganglionary fibres from truncus sympaticus.
-the parasympathetic innervations-nervus vagus.
Aorta thoracica

-situated posteriorly to the oesophagus and also to the left side, from Th4 in continuation of aortic
arch, to the hiatus aorticus (Th10).
Rami viscerales:
-Rr bronchiales-for nutritive vascularisation of the lungs;
-Rr oesophagei;
-Rr pericardici;
-Rr mediastinales-for the mediastinal soft tissue.
Rami parietales:
-Aa. Intercostales posterior (3-11)-situated in the homolog intercostal spaces. The first two intercostal
arteries arise from truncus costocervicalis (from a.subclavia).
-each one gives the following branches:
-Rr dorsales-for the back muscles;
-Rr spinalis-for the transverse vascularisation of the spinal cord;
-Rr cutaneus lateralis et medialis-for the thoracic superficial layers;
-R.comunicans-with aa.intercostales anterior (from a.thoracica interna)
-A.subcostalis-for the inferior part of the thorax and the upper abdominal part.
-Aa phrenicae superiores-situated superior and posterior on the diaphragm (unlike the
a.pericardophrenica which is situated superior and anterior).
Ductus thoracicus
-a 30-35 cm length and 4 mm diameter vein-like tube;
-the lumbalis lymphatic trunks convey the lymph in an elongated lymph sac-Cisterna Chyli (Pecquet)
at L2 level.
-ductus thoracicus arises from cisterna chyli, at L2 level, goes upwards on the median line, perforates
the diaphragm through the hiatus aorticus and enters in the posterior mediastinum. Here, it first lies
between the aorta and azygos vein, then up the aortic arch, changes its direction to the left, behind the
oesophagus and finally enters into the left junction between the internal jugular vein and subclavian
vein (The Pirogov angle).
-collects the lymph from the inferior limbs, pelvis, abdomen, the left side of the thorax, the left
superior limb and head and neck.
-the right hemithorax and superior limb drains the lymph in the right lymph duct which enters in the
venous system in the same way as ductus thoracicus, but on the right side.
Venae azygos et hemiazygos

The azygos vein arises in the retroperitoneum, from the lumbalis veins, goes upwards piercing the
crus mediale of diaphragma, ascends on the right side of the aorta and enters in the superior vena cava
up to the right pulmonary pedicle (Th4).
-the azygos vein collects the intercostalis posterior veins 4-11, vena subcostalis, vena intercostalis
superior dextra(the common vein for the first three intercostales posteriores) , venae bronchiales and
venae oesophageales.
The hemiazygos has the same trajectory like the azygos on the left side of the aorta, until the Th6-Th8
level where the hemiazygos vein crosses the median line and enters in vena azygos.
-the hemiazygos vein collects the intercostalis veins from 6-8 to 11 and the left subcostalis vein. The
intercostales posteriores 4-6 are collected by the hemiazygos accesoria. The first three intercostales
veins drain in vena intercostalis superior sinistra with two possibilities to convey: in vena hemiazygos
accesoria or in vena brachiocephalica sinistra.
Truncus sympathicus
-the trunk consists of 11-12 ganglia joined by longitudinal preganglionary and postganglionary fibres.
It lies on the posterior wall of the thorax, on each side.
-the last cervical ganglion and the first thoracic one are frequently fused to form the cervicothoracic
(stellate) ganglion.
-the ganglions are connected with the spinal nerves (in our case the intercostal nerves) by white or
grey rami. The white rami (preganglionary fibres-covered by the myelin sheath) connects the
intercostal nerve with the trunk (the ganglion neurons) and by the grey rami (postganglionary fibers-
without myelin sheath) the fibres may return to the intercostal nerve following its trajectory.
Sometimes the postganglionary fibers remain individual forming autonomic nerves or plexus.
-from the first five ganglions, the postganglionary fibers provide the sympathetic innervation of the
oesophagus and lungs.
-from 6-9 ganglions arise nervus splanchnicus major wich contains postganglionary fibers for plexus
celiacus (the nervous system of the supramesocolic organs).
-from 10-11 ganglions arise nervus splanchnicus minor with postganglionary fibres for plexus
mesentericus superior et inferior (the nervous system of the small and large bowell)
-from the last ganglion result nervus splanchnicus minimus for the aorticorenalis plexus (the
retroperitoneal organs)

The mouth
(Cavum oris)
The first part of the digestive tract.
It is divided by the teeth and gums in two parts:
- vestibulum- the outer part
- cavum oris propria- the inner part
Vestibulum
Walls - is a slit- like space, bounded externally by the lips and cheeks; internally by the gums and
teeth.
Communications:
It communicates with - the surface of the body by the rima or orifice of the mouth.
- cavum oris propria- through the space between the teeth of the open mouth;
- cavum oris propria- through the retromolar space .
Divisions:
The groove between the two lips (sulcus interlabialis) divides the vestibulum in
- pars maxilaris(superior)
- pars mandibularis(inferior)
A vertical line traced on the angle of the lips delimits:
- regio gingivolabialis(medial)
- regio gingivobucalis(lateral)
Description:
- sulcus vestibularis superior- a groove between the superior external wall and processus alveolaris
maxillae;
- sulcus vestibularis inferior- a groove between the inferior external wall and processus alveolaris
mandibulae;
- frenulum labii superioris - a mucosal crest on the median line of the superior groove;
- frenulum labii inferioris - a mucosal crest on the median line of the inferior groove;
- papilla ductus parotidei- the opening of the parotid gland duct near the second superior molar;
- foramen infraorbitale- situated in the superior vestibular groove on a vertical line traced between
the two premolars;
- foramen mentale- situated in the inferior vestibular groove , on the same vertical line;
Arteries
- for the superior part (maxillaris)
- a. infraorbitalis;
- a. labialis superior(from a. Facialis);

- for the inferior part (mandibularis)
- a. mentalis
- a. submentalis
- a. labialis inferior
- for the lateral region
- a. bucalis
The veins drain in vena facialis and plexus pterygoideus
Nerves
- rami labiales superiores - from n. infraorbitalis
- rr. gingivales superiores - from plexus dentalis superior
- ramus labiales inferiores - from n. mentalis
- rr gingivales inferiores - from plexus dentalis inferior
- n. bucalis- for the cheek
Cavum oris propria
Walls:
- anterior and lateral: processus alveolaris (maxillaris and mandibularis) and the teeth
- superior: the hard palate (palatum durum);
- inferior: the floor of the oral cavity (M. mylohyoideus)
Comunications:
- vestibulum
- pharynx - isthmus facium
Divisions:
- Regio palatina;
- Regio sublingualis;
- Regio retromolaris
- Regio tonsillaris
Regio palatina
- the superior wall with two parts:
- hard palate (palatum durum);
- processus palatinus os maxillae
- lamina horisontalis os palatinum
- soft palate (palatum molle) ;

Description:
- Torus palatinus - a bony crest situated on the median line
- Raphe palati - the median joint of the mucosa and periosteum with poor vascularisation
- Papilla incisiva - 1 cm posterior to the incisive teeth, covers the opening of the canalis incisivum
- Plicae palatinae transversae - 2- 6 anterior transversal lines of the mucosa
- Hamulus processus pterygoidei - on the lateral part of the soft palate
- Foramen palatinum majus - in the posterior and lateral angle of the hard palate
- “A” line – the limit between the hard and the soft palate
- Isthmus facium - delimited by uvula palatina, radix linguae and the pillars of the soft palate
Arteries
- A. palatina major - for the posterior part of hard palate
- Aa. palatinae minores – for the soft palate
- A. nasopalatina - for the anterior part of hard palate
- A. palatina ascendens - for the soft palate
The veins drain in
- V. lingualis
- V. Facialis
- Plexus pterygoideus
Nerves
- N. nasopalatinus - the sensitive innervations of the anterior part of the hard palate
- N. palatinus major - for the posterior part
- Nn. palatini minors - for the soft palate, uvula and the tonsils
- N. glossopharyngeus and N. vagus give branches for the posterior part of the region
Regio sublingualis
The inferior wall of the mouth.
There are two symmetric triangular shape regions
Limits:
- anterior and lateral: processus alveolaris mandibulae;
- posterior :the root of the tongue;
- medial: frenulum linguae;
Description:
- pelvis salivalis - the deeper part of the triangle always full with saliva;
- frenulum linguae - a mucosal insertion of the top of the tongue;

- caruncula sublingualis - a little projection (tuberculum) situated on the anterior margin of the
frenulum lingualis and is perforated by the openings of the ductus submandibularis and ductus
sublingualis major.
- eminentia salivaris - the external shape of glandula sublingualis with a mucosal crest in the middle
– plica sublingualis- perforated by little channels- ductus sublinguales minores.
The arteries are from a. sublingualis, the veins drain in vena sublingualis and the sensitive
innervations is from nervus sublingualis.
Under the mucosa of the region and the inferior wall muscles we find a space called spatium
sublingualis.
Walls:
Superior: The mucosa of the regio sublingualis;
Inferior: musculus mylohyoideus;
Medial: musculus genioglossus and musculus hyoglossus
Lateral: fovea sublingualis (on the mandibula)
The contents of the space: the vessels and nerves penetrate into the region through the lateral groove
of the tongue.
- glandula sublingualis;
- ductus submandibularis (Wharton) - oblique trajectory from the lateral groove of the tongue to the
caruncula lingualis;
- nervus lingualis - spins around the Wharton duct;
- nervus hypoglossus - for the tongue muscles, is situated medial to the sublingual gland;
- artera sublingualis - from a. lingualis;
- vena sublingualis - drains in vena lingualis.
Regio retromolaris
The postero-lateral wall of the mouth situated between the last molars (superior and inferior) and arcus
palatoglossus.
Description:
- Fossa retromolaris superior(inferior): a little space behind the last superior (inferior) molar ,
covered by a little projection of the gum – papilla retromolaris superior (inferior);
- plica pterigomandibularis- a fold between hamulus processus pterygoidei and fossa
retromolaris inferior.
The mucosa of the region covers the pterygomandibular space- the anterior part of regio
infratemporalis.
The contents of the pterygomandibular space:
- ramus mandibulae- with its elements- foramen mandibulae , lingula , antilingula and sulcus
mylohyoideus.
- N. alveolaris inferior;
- N. buccalis;
- N. mylohyoideus;

- N. lingualis;
- A. alveolaris inferior.
Regio tonsillaris
Situated on the limit between mouth and pharynx (isthmus faucium)
Walls:
- anterior: arcus palatoglossus;
- posterior: arcus palatopharyngeus;
- inferior: plica triangularis
- lateral: pharyngeal wall.
Contents:
- Tonsilla palatina covered by capsula tonsillaris;
- The tonsillar vascular pedicle from a. pharyngealis ascendens and a. facialis;
- Fossa supratonsillaris - a space situated superior between the tonsil, the lateral wall and the two
arches.

THE LARYNX (LARYNX)
- the larynx represents the segment of the respiratory tract placed in between
farynx and trachea and being situated at the cervical level in the antero-
median part of the neck, corresponding to the 3-6 cervical vertebras
- it is the principal organ of fonation, but it has also respiratory and
sphincterian functions
I. The CARTILAGES of the larynx are in number of 9 (3 pair and 3 odd) and
they are making the cartilaginous skeleton of the larynx:
a. CARTILAGO THYROIDEA – the thyroid cartilage is an odd one and
presents:
- lamina dextra et sinistra - the right and left lamella, wich are united
anteriorly, in between them finding an angle openeds towards posterior
- proeminentia laryngea - the laryngeal proeminency represents the
angle situated anteriorly and given by the anterior unification of the
anterior margin of the two lamellas
- incisura thyroidea superior – the superior thyroid notch is situated on
the superior end of the angle
- incisura thyroidea inferior – the superior thyroid notch is situated on
the inferior end of the angle
- linea obliqua - the oblique line wich is situated on the external surface
of each lamella
- tuberculum thyroideum superius – the superior thyroid tubercle is
situated on the superior end of the oblique line
- tuberculum thyroideum inferius – the inferior thyroid tubercle is
situated on the inferior end of the oblique line
- cornu superius - the superior horn is situated in the postero-superior
angle of each lamella, being oriented superiorly
- cornu inferius - the inferior horn wich is shorter and it is situated in the
postero-inferior angle of each lamella, being oriented inferiorly
b. CARTILAGO CRICOIDEA – the cricoids cartilage is an odd one,
situated under the thyroid cartilage and presents:
- arcus cartilaginis cricoidea - the arch of the cricoid cartilage is situated
antero-laterally

- lamina cartilaginis cricoidea - the lamella of the cricoid cartilage is
situated posteriorly and presents:
- facies articularis thyroidea – the thyroid articular surface (pair)
is situated infero-laterally on each side of the lamella and it is
destined for the articulation with the inferior horn of the thyroid
cartilage
- facies articularis arytenoidea – the arytenoid articular surface
(pair) is situated supero-laterally on each side of the lamella and it
is destined for the articulation with the the arytenoid cartilage
c. CARTILAGO EPIGLOTTICA – the epiglottic cartilage is an odd one,
situated above the thyroid cartilage having an oval shape; the space situated
in between the thyroid and the epiglottic cartilages is filled by corpus
adiposum pre-epiglotticum; it presents:
- epiglottis - the epiglotta has as skeleton the epiglottic cartilage
- petiolus epiglottidis - the petiol of the epiglottic cartilage is situated
inferiorly being united with the superior thyroid notch by the
liggamentum thyro-epiglotticum
d. CARTILAGO ARYTENOIDEA – the cricoids cartilage is an pair one,
situated on the superior margin of the lamella of the cricoid cartilage and
presents:
- basis cartilaginis arytenoidea - the base of the arytenoid cartilage wich
presents:
- facies articularis – the articular surface for the articulation with
the cricoid cartilage
- facies antero-lateralis - the antero-lateral surface with a triangular
shape, presents:
- crista arcuata – the arched crest is situated obliqually on this
surface and presents on each end a small tubercle (colliculus)
- fovea triangularis – the triangular fovea is situated above the
arched crest
- fovea oblonga – the oblonga fovea is situated under the arched
crest
- processus vocalis – the vocal projection is situated in the antero-
inferior angle of this surface and serving for the insertion of the
vocal ligament

- facies medialis - the medial surface is orientd towards the other
arytenoid cartilage
- facies posterior - the posterior surface presents:
- apex cartilaginis arytenoidea – the tip of the arytenoids cartilage
is situated in the superior angle of this surface and it will be
articulated with the corniculate cartilage
- processus muscularis – the muscular projection is situated in the
postero-inferior angle of this surface and serving for the insertion of
crico-arytenoid muscle
e. CARTILAGO CORNICULATA “Santorini” – the corniculate cartilage
is small and pair, being situated on the superior tip of the arytenoid cartilage
and presents:
- tuberculum corniculatum - the corniculate tubercle wich lifts up the
mucosa of the laryngeal opening
e. CARTILAGO CUNEIFORME “Wrisberg” – the cuneiform cartilage is
small and pair, being situated supero-latyerally to the corniculate cartilage
and presents:
- tuberculum cuneiforme - the cuneiform tubercle wich lifts up the
mucosa of the laryngeal opening
f. CARTILAGO TRITICEA – the triticeal cartilage is small, pair and
inconstant, being situated on the posterior margin of the thyro-hyoidian
ligament
g. CARTILAGO SESAMOIDEA – the sesamoid cartilage is small, pair and
inconstant, being situated into the vocal muscle
II. The ARTICULATIONS of the LARYNX are:
a. articulatio crico-thyroidea – the crico-thyroid articulation is situated in
between the inferior articular surfaces of the lamella of the cricoid cartilage
and the inferior horns of the thyroid cartilage, and presents:
- capsula articularis crico-thyroidea - the crico-thyroid articular capsule
presents interiorly a synovial membrane and a ligament:
- liggamentum crico-thyroideum medianum – the median crico-
thyroid liggament is situated in between the inferior margin of the

lamellas of the thyroid cartilage and the superior margin of the
cricoids cartilage
b. articulatio crico-arytenoidea – the crico-arytenoid articulation is situated
in between the superior articular surfaces of the lamella of the cricoids
cartilage and the articular surfaces of the basis of the arytenoid cartilage, and
presents:
- capsula articularis crico-arytenoidea - the crico-arytenoid articular
capsule presents interiorly a synovial membrane and a ligament:
- liggamentum crico-arytenoideum – the crico-thyroid liggament
is strengthening the capsule
III. The LIGGAMENTS of the LARYNX are:
a. membrana thyro-hyoidea – the thyro-hyoid membrane is fibro-elastic
and situated in between the inferior margin of the hyoid bone and the
superior margin of the thyroid cartilage; it is strengthened by:
- liggamentum thyro-hyoideum medianum – the median thyro-
hyoid liggament is situated on the median line of the membrane
- liggamentum thyro-hyoideum laterale – the lateral thyro-hyoid
liggament is situated posteriorly in between the big horns of the
hyoid bone and the superior horns of the thyroid cartilage
- foramen thyro-hyoideum – the thyro-hyoid orifice is situated on
the lateral part of the membrane being destined for the superior
laryngeal vasculo-nervous package
b. liggamentum thyro-epiglotticum – the thyro-epiglottic liggament is
situated anteriorly in between the petiolus of the epiglottic cartilage and the
superior part of the inner angle of the thyroid cartilage
c. liggamentum hyo-epiglotticum – the hyo-epiglottic liggament is
situated anteriorly in between the epiglottic cartilage and the inferior part of
the hyoid bone
d. liggamentum crico-thyroideum – the crico-thyroid liggament is
situated anteriorly in between the inferior margin of the thyroid cartilage and
the superior margin of the cricoid cartilage

e. liggamentum crico-tracheale – the crico-tracheal liggament is situated
inferiorly in between the inferior margin of the cricoid cartilage and the
superior margin of the first cartilage of the trachea
f. liggamentum crico-pharyngeum – the crico-pharyngeal liggament is
situated in between the posterior surfaceof the lamella of the cricoid
cartilage and the mucosa of the pharynx that covers this lamella
g. membrana fibro-elastica laryngis – the fibro-elastic membrane of the
larynx is coated interiorly by the mucosa of the larynx; it covers the spaces
situated in between the components of the cartilaginous skeleton of the
larynx and it is made by:
- membrana quadrangularis – the quadrangular membrane
represents the superior part of membrane fibro-elastica and it
borders laterally the superior (vestibular) part of the larynx (being
situated in between the inferio-lateral margin of the epiglotta, the
almost entire inner part of the angle of the thyroid cartilage and the
anterior margin of the arytenoid cartilage); it presents:
- liggamentum vestibulare – the vestibular ligament wich is
the inferior free margin of the quadrangular membrane, being
situated in between the the inferior part of the angle of the
thyroid cartilage and the fovea triangularis of the arytenoid
cartilage
- conus elasticus – the elastic conus represents the inferior part of
membrane fibro-elastica and it borders laterally the inferior (infra-
glottic) part of the larynx (being situated in between the inferior
part of the inner part of the angle of the thyroid cartilage, the vocal
process of the arytenoid cartilage and the superior margin of the
cricoid cartilage); it presents:
- liggamentum vocale – the vocal ligament wich is the
superior free margin of the elastic cone, being situated under
the vestibular ligament, in between the inferior part of the
angle of the thyroid cartilage and the processus vocalis of the
arytenoid cartilage
IV. The MUSCLES of the LARYNX are:

a. musculus crico-thyroideus – the crico-thyroid muscle is situated on the
external antero-lateral surface of the larynx and presents two parts:
- pars recta – the straight part situated medially and presenting
almost vertical fibers
- pars obliqua – the oblique part situated laterally and presenting
almost horizontal fibers
b. musculus crico-arytenoideus posterior – the posterior crico-arytenoid
muscle is the only abductor of the vocal chords and it is situated on the
external posterior surface of the larynx and presents oblique fibers
oriented in supero-anterior direction
c. musculus crico-arytenoideus lateralis – the lateral crico-arytenoid
muscle is situated on the external lateral surface of the larynx and presents
oblique fibers oriented in supero-posterior direction
d. musculus arytenoideus obliquus – the oblique arytenoid muscle is
situated on the external posterior surface of the larynx and presents
oblique fibers crossed in between them
- pars ary-epiglottica – the ary-epiglottic part continues antero-
superiorly along the lateral margins of the epiglottic cartilage
e. musculus arytenoideus transversus – the transvers arytenoid muscle is
situated on the external posterior surface of the larynx, under the oblique
arytenoid muscle, and presents horizontal fibers
f. musculus thyro-arytenoideus – the thyro-arytenoid muscle is situated on
the internal surface of the larynx, with the fibers oriented antero-
posteriorly in between the inner part of the angle of thyroid cartilage and
the anterior part of the arytenoids cartilages; it presents:
- pars thyro-epiglottica – the thyro-epiglottic part wich is the
lateral one and continues towards the lateral margins of the
epiglottic cartilage
- musculus vocalis – the vocal muscle wich is the medial part
being situated in between the inner part of the angle of the thyroid
cartilage and the fovea oblonga of the arytenoid cartilage (along the
vocal ligament)
V. The CAVITY of the LARYNX is covered by mucosa (wich is coated on the
components of the fibro-elastic membrane of the larynx) and contains laryngeal
glands and lymphatic follicles; it presents three parts (with a “sand-watch”
shape) and an opening:

a. aditus laryngis – the opening of the larynx is situated superiorly into a
oblique plane oriented postero-inferiorly; the borders of the opening are
made in antero-posterior direction by:
- epiglottis – the epiglottic cartilage (wich closes / opens the aditus)
with its superior margin; it is connected with the base of the tongue
by plica glosso-epiglottica mediana and lateralis
- plica ary-epiglottica – the ary-epiglottic plica is situated on the
lateral side of the aditus and it is given by the mucosa over the
musculus ary-epiglotticus
- tuberculum cuneiforme – the mucosa over the cuneiform
cartilage’s relief, being situated in the posterior part of plica ary-
epiglottica
- tuberculum corniculata – the mucosa over the corniculate
cartilage’s relief , being situated in even more posterior part of plica
ary-epiglottica
- incisura inter-arytenoidea – the inter-arytenoid notch is situated
posteriorly in between the arytenoids cartilages
b. cavum supra-glotticum (vestibulum laryngis) – the vestibule of the
larynx is the superior part (being larger superiorly and narrower inferiorly
and placed in between the aditus of the larynx and the vestibular plica)
corresponding to the space situated under the aditus in between the two
membrana quadrangularis; it presents:
- plica vestibularis – the vestibular plica represents the inferior
border of the vestibulum, being placed horizontally and having a
antero-posterior direction; it is given by the mucosa over the
vestibular liggament (the vestibular plica + the vestibular liggament
are making togheter “the false” vocal chords)
- rima vestibularis – the vestibular slot represents the space
situated in between the two vestibular plicas
c. cavum intermedium (glotta laryngis) – the glotta of the larynx is the
narrow middle part being situated in between the superior and inferior
parts of the larynx - more accurate in between the plica vestibularis
(superior) and plica vocalis (inferior); it presents:
- plica vocalis – the vocal plica represents the inferior border of the
intermediate cavity, being placed horizontally under the vestibular
plica and having also a antero-posterior direction; it is given by the
mucosa over the vocal ligament; the vocal plica + the vocal
liggament + the vocal muscle are making togheter the (“true”)
vocal chords
- rima glottidis – the glottic slot represents the space situated in
between the two vocal plicas and presents:

- pars intermembranacea – the inter-membranous (anterior)
part wich is situated in between the two vocal plicas
- pars intercartilaginea – the inter-cartilagenous (posterior)
part wich is situated in between the medial surfaces of the
arytenoids cartilages
- ventriculus laryngis “Morgagni” – the laryngeal ventricles are
two diverticles of the glotta oriented laterally and presenting:
- sacculus laryngis – the laryngeal sacc represents the
superior extension of the laryngeal ventricle
d. cavum infra-glotticum – the infra-glottic part of the larynx is the large
inferior part (being narrower superiorly and larger inferiorly and placed in
between the vocal plica and the superior margin of the first cartilage of
the trachea), corresponding to the space situated in between the two conus
elasticus and the inner space of the cricoid cartilage until the first cartilage
of the traches
VI. The VASCULO-NERVOUS PACKAGES of the LARYNX are:
a. arteries – are given by two sources:
- arteria laryngea superior – it vascularises the external antero-
lateral muscles and by perforating the thyro-hyoid membrane
(through foramen thyro-hyoideum) is giving branches for the
interior of the larynx (supra-glottic and glottic parts)
- arteria laryngea inferior – it vascularises the external posterior
muscles and by perforating the crico-thyoid membrane is given
branches for the interior of the larynx (infra-glottic part)
b. veins – are drained in two directions:
- vena laryngea superior – it collects almost the entire venous
drainage of the larynx (going through foramen thyro-hyoideum)
- vena laryngea inferior
c. nerves – are given by one main source (nervus vagus):
- nervus laryngeus superior wich presents:
- an external motor branch (for the crico-thyroideus muscle)
- an internal branch (going through foramen thyro-hyoideum)
destined for sensitive and vegetative innervation of the supra-
glottic and the glottic part of the larynx
- nervus laryngeus inferior (from nervus laryngeus reccurens)
wich presents:

- an external motor branch (for all the other muscles of the
larynx)
- an internal branch destined for sensitive and vegetative
innervation of the infra-glottic part of the larynx
d. lymphatics – are drained in corresponding regional nodules:
- cavum supra-glotticum – the limpha from this part is drained
towards nodi lymphatici jugulares interni
- glotta – the limpha from this part is drained towards nodi
lymphatici cervicales anteriores profundi pre-laryngeales and then
to nodi lymphatici jugulares interni
- cavum infra-glotticum – the limpha from this part is drained
towards nodi lymphatici cervicales anteriores profundi pre- and
para-tracheales and then to nodi lymphatici jugulares interni or
mediastinales

The liver (Hepar)
It is the greatest gland attached to the digestive tract , situated in the upper floor of the
abdominal cavity : right hipocondrum , epigastrium and partially in left hypocondrum.
The weight is about 1,5 Kg at the cadaver and 2.0 Kg at living human , due to the inner blood.
External configuration:
The liver has an ovoidal shape with two faces and two margins:
-margo anterior-the sharp one , is divited in two parts by incisura hepatica;
-margo posterior-more rounded ;
-facies superior-facies diaphragmatica-is situated under the right and left diaphragmatic
domes.Between the two structures there is a virtual space – spatium interhepatophrenicum.
-facies inferior-facies visceralis-point to the intraperitoneal organs.
Facies diaphragmatica.
-through the diaphragmatic dome the superioe face is related with :
-the right anterior and lateral arch of the 7th
to 10th
ribbs-impressio costalis;
-the heart apex-impressio cardiaca;
-the posterior part of this face is partially uncoverred by the peritoneum-aria nuda-where the
liver is attached to the posterior abdominal wall and vena cava inferior.
-the inferior limit of facies superior ussualy follow a line that joint the tip of the 10th
rib from the right
with the tip of 8th
rib from the left.
-on the superior face the liver presents two external lobes:lobus dexter et lobus sinister separeted by
the ligamentum falciforme.This lobes are not the correspondents of the portobilliary division of the
liver , as we will see.
Facies visceralis:
Is divided in four lobes by a H shape grooves:
-sulcus longitudinalis sinister:
-pars anterior-is represented by the Fissura(Incisura) ligamenti teretis , where is the entrance
of ligamentum teres hepatis (the fibrotic transformation of vena umbilicalis)
-pars posterior-Fissura ligamenti venosi , where is situated the Ligamentum venosus Arantzius-
embriologycal rest of the umbilicalo-caval shunt;
-sulcus longitudinalis dexter:
-pars anterior-Fossa vesicae fellae-the site of the gallbladder;
-pars posterior-sulcus venae cave inferior-in the upper part of it is the confluence between the
suprahepatic veins and vena cava inferior.
-sulcus transversalis-joint the middle points of the two longitudinal lines and is occupied by the
hepatic pedicle (hillus hepaticus)
The visceralis face external lobes:
Lobus dexter:the greater lobe , situated in the right hypocondrum , on the right side of the falciform
ligament and the right side of sulcus longitudinalis dexter.
The organs related with this inferior lobe face are:

-impressio colica-situated anterior;
-impresio duodenalis-posteriorlly to the first one;
-impressio renalis and suprarenalis-more posteriorlly and inferiorlly to the others.
Lobus sinister
Medium size situated partially in epigastrium and left hypocondrium , on the left side of ligamentum
teres hepatis and sulcus longitudinalis sinister , presents a projection near to the hepatic pedicle-tuber
omentale.I.s releated with the abdominal oesophagus-impressio oesophagei
Lobus quadratus-situated anteriorlly to the hepatic pedicle presents the following limits:
-sulcus longitudinalis dexter-pars anterior-on the right side;
-sulcus longitudinalis sinister-pars anterior-on the left side;
-sulcus transversalis(hillus hepaticus)-inferiorlly;
-margo anterior
It’s releated with the pylor.
Lobus caudatus (The Spiegel’s lobe) -situated posteriorlly to the hepatic pedicle is bordered by:
-sulcus longitudinalis dexter–pars posterior;
-sulcus longitudinalis sinister-pars posterior;
-sulcus transversalis;
-margo posterior.
Presents two projections that points to bursa omentalis:
-processus papillaris-border inferiorlly the hepatic pedicle;
-processus mamillaris-border latterally on the left side vena cava inferior.
The ligaments of the liver
The entire organ , excepting the hepatic pedicle and aria nuda , is covered by the peritoneum with two
layers (tunica subserosa-the inner one and tunica fibrosa – Glisson)
-Ligamentum falciforme: two paralelly and adherent peritoneal folds between the diaphragm dome
and facies superior.The anterior part is continuated by the ligamentum teres hepatis.
-Ligamentum coronarium:is the posterior continuation of the falciforme ligament wich is splited in
two folds bordering superiorlly aria nuda.
-Ligamentum triangulare-two ligaments on the each side wich are joint with the coronar ligament
and border the lateral limit of aria nuda.
-Omentus minus :
-Ligamentum hepatoduodenale-between the first part of the duodenum and hillus hepaticus.
-Ligamentum hepatogastricum-between the inferior face of the liver and the lesser curvature.
The hepatic pedicle (porta hepatis):
-is situated on sulcus transversalis
The elements of the hepatic pedicle:
-ductus hepaticus comunis-is situated anteriorlly and to the right , represents the fusion of the canalis
hepaticus dexter et sinister.Transport the bile through it and then choledocus into the duodenum.
-artera hepatica propria-arise from artera hepatica communis , branch of truncus celiacus , is
situated anteriorlly and to the left.Represnts the nutritive blood suplie , transporting the oxygen and the
nutritive substances to the cells (hepathocites).After a short way into the hepatoduodenal ligament
divides in the right branche and in the left branche.The right one gives two segmentary arteries:
A.segmenti anterior and A.segmenti posterior.The left branche gives another two segmentary

arteries:A.segmenti medialis and A.segmenti lateralis.The caudat lobe receive blood suplie from the
booth branches
-vena porta-represents the joint of vena lienalis and vena mesenterica superior-is the functional blood
suplie of the liver by providing the absorbed nutriens from the small bowell to the hepatic cells.Is the
most posterior element of the hepatic pedicle.The intrahepatic divisions are the same like the arterie
system.
-lymph nodes:nodi lymphatici hepatici;
-nervs:symphatetic fibers:from plexus hepaticus;
parasymphatetic fibers:from n.vagus.
-capsula fibrosa perivascularis-the continuation of the Glison membrane , on the hepatoduodenal
ligament.
-Venae porte accesoria-small veins wich belongs to the portal system
The suprahepatic pedicle:
Drains the liver blood in vena cava inferior:
-Vena hepatica intermedia-principalis-the most important one;
-Vena hepatica dextra;
-Vena hepatica sinistra;
The three veins can drain into the inferior caval vein one by one , ore they are first joint into a single
big trunk.
The segments of the liver:
The anatomic segments-are the consequence of the vasculobiliary divisions inside the hepatic
tissue.The real limit between the right lobe and the left one from vascularisation point of view is an
imaginary line – scizura hepatica principalis – Rex Cantle line and is situated between the
gallbladder(anterior) and the left border of the inferior caval vein (posterior).Guiding by the arteria
hepatica division(or vena porta) results the following anatomical segments:
-Segmentum anterius of the right lobe;
-Segmentum posterius of the right lobe;
-Segmentum mediale of the left lobe;
-Segmentum laterale of the left lobe.
The surgical segments:is different to the anatomical division and has clinical and surgical importance
in hepatic resections.Through each suprahepatic veins thrre imaginary lines will split the liver in four
parts (four primary segments) , two situated on the left and two on the right.Then an horisontal plane
through the midle of the liver will divide each primary segment in two , resulting eight segments.An
easier way to evaluate the surgical segments is counting them on clockwise sense.
1. Segmentum paramedianum sinister superior-lobus caudatus;
2. Segmentum lateral superior sinister;
3. Segmentum lateral inferior sinister;
4. Segmentum paramedianus inferior sinister-lobus quadratus;
5. Segmentum paramedianus inferior dexter;
6. Segmentum lateral inferior dexter;
7. Segmentum lateral superior dexter;
8. Segmentum paramedianus superior dexter

The extrahepatic billiary system
1. Ductus hepaticus communis – arise from the confluence of canalis hepaticus dexter et
sinister.It’s about 3-4 cm lenght , situated on the right side of the hepatic pedicle crossing
anteriorlly the right branches of arteria and vena porta.The distal part will collect the cystic
duct.
2. Ductus choledocus-results from the confluence of ductus hepaticus and ductus
cysticus.Presents three parts:retroduodenal , retropancreatic and intraparietalis. Transports the
bile from the liver to the duodenum.Before the opening in ampulla duodeni major will fuse
with the Wirsung duct.
Quenu quadratum-is bordered by the first three duodenal parts and vena mesenterica superior.The
diagonal of this quadrilateral , from superior to inferior and from the left to the right is ductus
choledocus
3. The gall bladder(Vesica fellea) -a piriform storage chamber for the bile between the meals.It
has three parts:
-Fundus vesicae fellae-point to the abdominal wall;
-Corpus vesicae fellae-is attached to the liver and lies on the duodenum and transversal
colon;
-Collum vesicae fellae-ampular shape , presents a mucosal fold-plica spiralis or Heister
valve.
-Ductus cysticus:between the gallbladder and ductus hepaticus comunis.The Budde triangle
is bordered by the cystic duct , hepatic duct and the inferior face of the liver and is cossed by
arteria cystica-branche of a.hepatica dextra.
The sphincters muscles of the extrahepatic billiary system:
-Mirrizi sphincter muscle-on the ductus hepaticus communis;
-Lutkens sphincter muscle-on the cystic duct;
-The sphincter of the Wirsung duct;
-Oddi sphincter muscle-the common sphincter muscle for ductus choledocus and Wirsung duct.
The vessels, nervs and lymphatic system of the gallbladder
-arteria cystica arise from artera hepatica dextra;
-the veins drains into the portal system;
The lymph is drained in hepatic pedicle lymph nodes.Near to ductus cysticus is situated the
Mascagni lymph node considered particular for the gallbladder.
The nervs arise from plexus celiacus and the vagus nervs.

ORGANA GENITALIA MASCULINA
These consist of the testicles, genital ducts, accessory glands and copulating organ.
The testicle - Testis
The testis is responsible for producing the spermatozoa and male sex hormones. It has an oval shape,
slightly flattened from lateral, with a weight of 10-14 g, a greater length of 4-5 cm, a width of 2.5 cm
and an antero-posterior thickness of 3 cm.
External configuration
Extermitas superior et inferior - the former oriented antero-laterally, while the latter towards
postero-medial. Thus, the testicle suspended in the scrotum by the spermatic cord, has an oblique
position.
Facies medialis et lateralis
Margo anterior - anterior, convex margin
Margo posterior - posterior, more straight margin
The extremities, surfaces and anterior margin are free, smooth, covered by the visceral layer of the
tunica vaginalis. The posterior margin has attached to it the spermatic cord and epididymis.
Internal structure
Tunica albuginea - a thick, fibrous, whitish surface layer
Tunica vasculosa - a thin layer of loose connective tissue, with a fine vascular network
Mediastinum testis - the thickening of the tunica albuginea (called the “Body of Heighmore”), where
the vessels penetrate the testis
Septula testis - incomplete septa of connective tissue, positioned in a radial manner, dividing the
parenchyma of the testis in
Lobuli testis - 250-400 lobules of conical shape, with their bases toward the exterior and their apexes
toward the Heighmore body
Parenchyma testis - the proper tissue of the testis
Tubuli seminiferi contorti - 1-3 coiled seminiferous tubules, beginning blindly, with several
anastomoses between them and the tubules of the neighboring lobules
Tubuli seminferi recti - these are formed by the union of the previous tubules, and penetrate the
Heighmore body
Rete testis - the multiple anastomoses between the straight tubules form the “network of Haller”,
located in the Heighmore body
One testicle contains approximately 840 such seminiferous tubules, of 60-70 cm length, and 0.3 mm
diameter each
Interstitium testis - the spaces between seminiferous tubules, containing vessels and interstitial cell
islets (“Leydig cells”), which secrete androgens
Epididymis
It is the beginning of the genital tract.
Caput epididymidis - a club like upper part, turning anteriorly and attached to the superior pole of the
testicle
Corpus epidydimis - its intermediary part, following the posterior margin of the testicle
Cauda epidydimis - the thinner inferior segment, attached to the inferior pole of the testis
Ductuli efferentes testis - the head is made up of 12-15 efferent tubules, coming from the network of
Haller
Lobuli seu Coni epididymidis - after a short straight path, they coil up, and form a cone-shaped
lobule, making up together the head of epidydimis
Ductus epididymidis - the efferent tubules open into a single, coiled tube, having 6 meters in length,
and 0.5 mm diameter. The tightly packed convolutions of this tube are held together by loose
connective tissue, and it makes up the body and tail of the epidydimis
There are a series of vestigial structures contacting the head of the epidydimis:
Ductuli aberrantes - they represent the caudal portion of the persisting mesonephric tubules
(“aberrant vessel of Haller”)
Appendix epididymis - remnant of the Wolff duct

Anatomy organs.

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