- 1

- 1

" - . pointers .

- . long bones - . , long bone, flat bone, cubic bone, -3 : 2 , epiphysis. . diaphysis. -long bones shaft. (= ) (=..) . , long bones . , -cubic bones ( 8 -7 ); -flat/irregular bone . .

: ( ...) ( ), articular cartilage. . . , . ( ), . periosteum (os - , peri - ). . . , , . 1. , - fibrous tissue + . .2. - elastic fibers, . " . " , . , , .

: ( - vascularization). , . . . , . . , . (2 ), nutrient artery . , , .

, , . . , , '. ( 2-3 ). ( ). , , (). . , .

- innervation ( ). . , , . ( ). . , . . , . . ( ).

- . -3 : 1. - , . 2. . 3. - . . . ( '). , , ( ). . . , . . . . . . , . 2 : (tibia), , (fibula) . , . . . ? , . .

- .

: compact bone ( , ). . ( ) , " . , " ". , cortical bone (= ). spongy bone- . - , trabecula. .

: . . -spongy bone. : , . 10 . ( , ). " -shaft . , metapysis. , , . (endosteum).

(medullary cavity). , . [" "]. : osteomedulla , bone marrow ( ), - . . ( ) , . ? ' - . , ? ? . - long bones, short bones. cubic bones (= ). ' ( ). ( -flate bones) .

- ' ? . , ( ). ' , . ? - , . . 2 . . , ( ). ( , ). - / - articulation/joint. :1. - , , , , . 2. - (sternum - ) , . " . .3. - . (8 , ) -wrist, ( ), ( ) . . . " . .

. 2 - 2 . :

-2 . 6 , .

- .1. , , - ball and socket: . " . , , socket (acetabulum), . . , . " .

2. - gliding sliding ( ): (trochlea) - . 2 , - 2 . . , gliding -sliding.

.

! . : flexion (=), extension (=), '. sliding flexion -extension.

3. Facet: . . - . (ulna) facet:

4. { Pivot () - . , : -C2 ( -axis) C1 ( ), . }

gliding . 6 . , . . , . . : articular cartilage -epiphysis. : (, , ). articular cartilage hyaline cartilage - , . , . ( ). . , , . : . - . . . , , -ball and socket , -socket () .

, . intraarticular space. ( ). . .

. -articular capsule, , . , - , . , ( . ). . .

- , . , . , . extra capsular # (# - ), - intra capsular fracture, , . ( ), . . , . . - . , . . , . . , .

, . . . . - , , . . . osteoarthritis - . , -osteomyelitis ( ). .

. . , , . - . . , ( - ). . , . . ligament.

Ligament - . (tendon) . - . . . . . , . 3 . , . " , .

Capsular Ligaments - . . , 2 . . ( ). , ( ). . , -clavicle ( ) (scapula, ) , - . Accessory Ligaments. , - -capsular ligaments. , . . . .

, . . (sprain), , . , , - .

, , , " " . Avulsion Fracture - "" , - . . .

: , intra-articular space ( ). . . Synovial Membrane ( ). , . Synovia -intra articular space. : . . , , . . , . . . . - . " - , , .

( ) , . . . . : . . ? . . ? " . , . . , . . , -intra articular space ( "), . , -articular disc fibrocartilage . . . , -sternoclavicular joint , .

: . origin - insertion. , , . . , , , .

- 2

- " - Thorax - ( ) ' . . .

: - , : (pulmonary aa. / v.), Inferior & Superior Vena Cava ((IVC&SVC, . : () ( ). . ' - (thoracic spinal cord) T1-T12, ((DRG, thoracic symphathetic trunk, parasympathetic nerves (Vagus). ' - ( ). , . -T. T . - lymph nodes, thoracic duct ' . - (esophagus), . - .

- T1-T12. (sternum), 12 . 1-7 true ( ) , 7-10 false 11-12 floating . : " . , , ( - -), . - 1-10 , . (spinous) , .

(sternum) - . -3 : manubrium . -jugular notch. . (T2 -body) "", -xiphoid process. . 40 . , . 3-6 , 7 -xiphiloid.

-sternum angle -body , . : , .

" , . ( ) -sternal angle T2.

. Superior Thoracic Aperture - (, , , , ). (SVC, ) inlet . T1 .

Inferior Thoracic Aperture . 7-10 -costal margin, T12, -Xiphoid . . . " . : , , . .

? ; - -IVC, . . .

. : . .

:

Mid Sternal Line - , . Mid Clavicular Line - . Mid Axillary Line - .

, [ ' 91]:jugular notchSternal Angle - -thoracic duct ? - . 2-10. -spinous process - T1 & C7 , . . -T10-11 . . .

.

: . (recess) - spare capacity. , . . . () , ( ..). -recess 8-10 , ! "" -apex of lung . - ( 2-6) . - 6, : 8. : 10.

:

, . -mid sternal line " . apex ( ) -9-10 " -mid sternal line . ( 2 6 ) - . " . , . , . . 4 ( ). , . , . - : , . , . .

: - external intercostal muscles - " ". - internal intercostal muscles - -external . - innermost intercostal muscles - " -internal.

- . . -. (major/ minor pectoralis). , . . (oblique) .

. . 3 , : -external -internal, .

VAN - Vein, Artery, Nerve -groove. - -VAN . ( ). " " . - . -costal groove -VAN. -VAN -internal -innermost, . , -internal thoracic artery. -. , . . . . . . " - groove, .

: :1. Inferior and superior vena cava- .2. - , . :CNS - (T1-T12). ' . -PNS - -CNS. -Dorsal Root Ganglia . (= ) - . . . ' , , , , " . ' " . .

- ( ) - . = . ? 7 , - CNS, .

- . " - , 2 - . . . ' , - ( ), - . - 2 pre -post , -post - . .

" - ( )- :- serous membrane - . . : ( , '). parietal pleura- . visceral pleura. -interlobal fissures- . . . . ?1. - 760 " 750 " . .2. /- . . . ' . . (pleural effusion) , , ' .

, . :1. Costal pleura: . , . 2. Cervical pleura: -costal pleura -apex () . -neck . . superpleural membrane. -transverse process C7. " -scalenous muscle . ' . . scalenus minimus muscle -transverse process C7 . -cervical membrane. 3. Mediastinal pleura: -root of lung. -Pulmanory hilus ( ). - , Pulmonary aretery ( ), bronchus, pulmonary veins ( ). -suprior lobe -inferior lobe. . " -hilus. , . -Hilus lymph nodes, pulmonary nerve plexus ( - . , . . ). -mediastunum. -root of lung. -root of lung: : . . : -root of lung " -visceral pleura . : esophagous -visceral pleura pulmonary ligament. . -Hilus . . 4. Diaphragmatic pleura: . costophrenic angle( ). . -pleural cavity . .

Pleumothorax- . : - (, ) , , '. () . . . - . . -visceral pleura. - . . , . , . ( ). . . . collapse. " . 1. . . . . plleuromediastunum- . 2. . Pleural effusion () . (" ) . , 4-5 . . . , . . . .

? ( ). . -sternal angle ( -manubrium ). 2 . .

:-trachea - : -midline , -carina ( -bronchi), . - , . . elastic fibrous membrane : . . ( ) 2 : longitudinal fibers = - , fibers transverse . -elastic fibrous . -transverse fibers -longitudinal . -mucus membrane. 202 .

.

Carina - -right&Left Principal Bronchus (brunchi ). main bronchus. : endotrachial tube , . , -bronchus .

-right principal bronchus - ( 2 - 2.5 " 5 "), , ( ). , .

- ( ) . .

-right main bronchus 2.5 " , superior lobe bronchus -lobar bronchi . " -3 : -Segmental Bronchi. -apical segmental bronchus. (apex) = . . posterior segmental bronchus. , . " , posterior lateral -superior -inferior 4 ( posterior lateral inferior). -superior lobe Bronchus -anterior segmental bronchus . , anterior lateral.

-superior lobe bronchus. :-right bronchus ( main) -2 " lobe bronchus - -middle lobe bronchus. . -middle lobe bronchus , . segmental bronchi, medial lateral. : - middle lobe bronchu-right bronchus segmental bronchus epical basal (epical segmental bronchus of inferior lobe). -inferior lobe! -right bronchus -middle lobe , . medial segmental bronchus of inferior lobe/medial basal segmental bronchus. -right bronchus -3 : posterior basal , anterior basal -lateral basal . + . . .

-left principal bronchus 5 ". 5 ", ( ), superior lobar bronchus , , : superior division -inferior division. -superior division -superior lobe bronchus . -superior division anterior segmental bronchus , apicoposterior, -apicoposterior , -posterior segmental -apical segmental.

-inferior division? - lingular bronchus. Middle lobe bronchus. , . -middle lobe -medial -lateral, -lingular -superior lingular -inferior lingular. : -superior lobe bronchus . . , -superior division -lingular bronchus -middle lobe.

-superior lobe bronchus lingular ( - lingular pneumonia). -left bronchus . medial basal bronchus. , . -bronchi - . bronchioli , terminal bronchiolus ( 204 ) -alveoli (), . alveolar sac alveoli. -alveolar sacs , " . ' alveolar sacs lobulus. -lobulus , . lobules ( lobulus) broncho-pulmonary segment . ? . segmental bronchus . segmental bronchus broncho pulmonary segment. 10 -9 medial basal. !

. , . " lobe . , , ().

3 superior lobe, 2 middle lobe inferior lobe. superior -inferior -middle -lingular . inter lobar fissure. oblique -horizontal, oblique fissure. " ( , '...).

- -pulmonary Hilus = : pulmonary hilus ( ) pulmonary artery ; -principal bronchi ; -2 pulmonary veins . . ? -superior - middle (), -inferior lobe " . -hilus pulmonary nerve plexus, anterior posterior. -anterior -principal bronchus -posterior -principal bronchus. -posterior -anterior. -hilus lymph nodes - lymph nodes . , ' ( ), . ( ) . !

- 3

- " 182-184 . . , , . . . , . (explorative laparotomy) .

, " . (, , MRI). , " , .

, . : Glandular tissue - . Areolar Tissue- . Fibrous Tissue. Fatty Tissue - . . , .

: -superficial fascia . , , .

: 2, 6. - . , ! , . , 1%-1.5% , - .

. -mid axillary line, . - Axillary Tail -) axilla ), ( ) -deep fascia -pectoral lymph nodes.

-deep fascia 3 : -pectoralis major, -serratus anterior, -external oblique aponeurosis - . () . -. , .

-deep fascia loose areolar tissue ( ) Rertomammary Space submammary space. Mamma . ? -retromammary space . , , . . , , .

, , -retromammary space, -deep fascia -pectoralis major. -pectoralis major . -pectoralis major . - -axillary tail -pectoralis major.

-Nipple (), 15-20 lactiferous ducts - . , sinus of lactiferous duct. . " ". -nipple , , -2 : circular fibers -longitudinal fibers. () , erection -nipple. -3 : , ( "") , ( ).

-longitudinal fibers retraction -nipple, , . -nipple retracted . 2 : , retracted ! . , erection retraction .

-nipple Areola - . -areola , . -areola . -areola areolar glands. , -areola. -nipple, -areola . . -areolar glands ( ?) I.V. , . -areolar glands sebaceous glands ( . , . - " : ! , - ) -areolar glands sweat glands ( ). -areolar glands sweat glands -sebaceous glands. subcutaneous fat, , . .

- -deep fascia -pectoralis major, suspensory ligaments " Cooper, . 182 . -nipple -areola. , . , -suspensory ligaments . . , , contractures " fibrous tissue -suspensory ligaments , . " ". , . . : , , . . . , . , .

: . " .

-glandular tissue. . -subareolar space -deep . : . -alveoli. . alveolus . -alveoli , alveoli lobulus (lobules ). -lobules " . lobules " areolar tissue, lobe . -lobe areolar tissue, . lobulus . lobe . " 15 -20 lobes . 15-20 lactiferous ducts, . -lactiferous ducts -lobe. .

-lactiferous ducts: , lactiferous ducts. . . ( ).

- -retromammary space -pectoralis major. . . - . .

: lobe -lobules -alveoli. :1. -lactiferous duct areolar tissue.2. elastic fibers: longitudinal transverse. 3. basement membrane .4. , myoepithelial cells. . 5. columnar epithelium . -columnar epithelium 2 ( ), -nipple, -sinus, -stratified squamous epithelium. . . . columnar epithelium stratified squamous epithelium .

, -alveoli ? . , -hypothalamus . -hypothalamus oxytocin . , -myoepithelial cells .

: . , . . Oesterogens . progesterone -corpus luteum ( ) . ! ( ) . . alveoli -lactiferous ducts ( -glandular ). pseudo-alveoli. alveoli !

: , . -corpus luteum -placenta (). 2 , prolactin ( , ) Growth Hormone. , -growth hormone . 3 -adenohypophysis . , , .

( 9 . ), -alveoli ( hibernate ). . , -menopause ( ), , , . . . , . . , , . alveoly . .

: - ; . . :1. . . 2. . . - , , . " " Witches' Milk. . .

: - .1. -axillary artery , 3 - superior thoracic, lateral thoracic - thoraco-acromial. .2. -anterior intercostal arteries - .3. internal/mammary thoracic artery - , -anterior thoracic arteries.

: venous circle -areola. -axillary vein -internal thoracic vein.

: -T4-6, , . .

- . 184 . lymph nodes -superficial lymph nodes -axillary lymph nodes. ( deep lymph nodes ). - axillary lymph nodes :1. Axial/Apical - ( ).2. -lateral.3. -lateral central. 4. sub-scapular. posterior .5. -pectoral lymph nodes -axillary tail . anterior . -lymph nodes lymphatic ducts . .

, :1. Ductal Carcinoma In Situ (DCIS) - - . , -ducts. in situ = . -myoepithelial cells. -myoepithelial cells, . . -myoepithelial cells, DCIS. .2. Infiltrate/Invasive Ductal Carcinoma - / -myoepithelial cells. . . , .

.

40 . "" . . ( ) MRI. / . . . - . - . , . , . , ( ) .

.Mastectomy - , -Pectoralis Major.Lumpectomy - . 20% .

? ( ). . -axilla -lymph nodes, -lymph nodes . : , . , -lymphatic ducts .

-sentinal node: -lymph node . -lymph node . , , , . lymph node, .

: . 5 " - .

- 4

" - , . ( , ). . , . . .

aortagutCoelomic cavityCoelomic wallHeart tubevertebraVisceral pericardiumparietal pericardiumgutaortaPleuraVisceral pericardiumParietal pericardiumPleuraDorsal mesocardium1.2.3.4. ( ). . . . coelomic cavity- . "", . . .

' . . transverse sinus. : aorta, pulmonary trunk. :pulmonary vein (4), superior & inferior vena cava. apex-, . oblique sinus. - transverse sinus. . - - . - fibrous pericardium. .

. . , . . . - . . - . , . - left auricle . . , - coronary sinus, . crista terminalis. SA node ( ). : , .

LA

RA

V (fossa ovalis). . (). . (). . - , . , . . - . . . -10% . - interventricular septum)) (1 "), . . -aorta - pulmonary trunk . . ( - membranous intraventricular septum). : . . blue babies. , . , , - pulmonary trunk, . - , .

1944 " , . . " . - left subclavian artery- . - left pulmonary artery, . - CO2 . , ' .Ligamentum arteriosum- - pulmonary trunk. , . 212,221 .

3 cusps . - cusps, . -Right & left coronary sinus. Right coronary artery- - right auricle. , , . . Left coronary artery- - left auricle. - left anterior descending . - . . - circumflex branch- . -AV node -circumflex branch of left coronary artery.

Coronary sinus- . (, -anterior cardiac veins) .

-coronary artery . . : , , , , , , . : . . . . ( )- , . 20% . .

" - -2:1. () - - . , , -4 .2. () - . - .

-4 : , . , - .

-

, . . ( 2/3) . . .

. Trans-Esophageal Echo. "" , .

-

( ), . -2: 1. - Parietal Pericardium - -parietal pleura . - -SVC, -pulmonary trunk . ( -Fibrous Pericardium + ).2. - Visceral Pericardium (-epicardial).

-phrenic C3, C4, C5 , .

-parietal pericardium:

- 4 : 1. Myocardium - . . , .2. 4 Valves - - . . ( ) . 3. Conduction System - "" , ( ). , . . (ion flux) .4. Blood Supply - (Coronary A&V) . , . .

, - ( ):

-2 - . -Sinus Venosus ( Sinus Venarum ), , -right auricle - . -Crista Terminallis. - 5 : SVC . IVC - . Coronary Venous Sinus - . -right atrio-ventricular canal . Fossa Ovale - -Foramen Ovale . - tricuspid ( ). .

-Foramen Ovale - . . . ( ), . -Septum Primum -Septum Secundum .

- (Chordae Tendineae) -papillary muscles. 3 ( ). Trabeculae Carnae Sinus Arteriosus. .

- ( ) (Trabeculae Carnae) , (Aortic Vestibule). . . , . . - 4 . left auricle.

-

2 . -Pulmonary Trunk . (Pulmonaric Valve) . 3 cusps, .-Aortic Valve . 3 - . -cusp . -right&left coronary arteries, . (), 2 , . - .2 -tricuspid -mitral . 2 - . 3 , , . (septum), .

-

. , -SA Node, . -SVC. . - ( ). . . . . -AV Node. -coronary venous sinus. -AV Node, Common Bundle Of Hiss -crux ( ) : Right Bundle -Left Bundle . , -bundles Purkinje Fibers . , .

- :

2 - LCA -RCA ( ). -cusp -LCA. -LCA -LAD -interventricular groove -Left Curcumflex CA -coronary groove -Left Marginal Artery ( ). -RCA -cusp , ,coronary groove , right marginal branch. -circumflex, -posterior descending -interventricular groove -LAD -apex.

: () -LAD -right posterior descending -left circumflex -RCA . .

- ( ) , . ( ) .

:1. .2. .3. .4. - .

- VITAMINC: Vascular, Infectious, Traumatic, Autoimmune, Metabolic, Idiopathic, Neoplastic, Congenital

- , , ( ), . . : Hypertrophic Cardiomyopathy - . ! . . . 1 . . " ( ). " . , (mitral regurgitation) - . . " . Dilated Cardiomyopathy - - . , . . Sterling . Sterling . : , , (). , (Congestive Heart Failure) . .

( VITAMINC). - Endocarditis - . . Aortic & Mitral Stenosis + Regurgitation - Rheumatic Heart Disease. A. , . , . . - . . - - . . . , . - . . - . .

- . : , , , , . Arrhythmia - '.

- Coronary Artery disease - 1 (90% ). 3 , (40% -41% ). .

: -3 : 1. Tunica Intima - -elastic lamina.2. Tunica Media - .3. Tunica Adventitia - , , , .

: , , , , , .

:1. , , .2. .3. -tunica media -intima . :

75-80% . , . 80%, (Angina Pectoris). , -95%, . ? - .

, , - collaterals. ! . -lumen . , . . , - . .

Plaque Rupture. , . / . (thrombus) " . , .

( ). - .

(Acute Thrombotic Occlusion)? Streptokinase Tissue Plasminogen Activator. (slow atheriosclerotic occlusion) - (Balloon Angioplasty) , . ( ), ( - ). ... - . " -30-40% . - . -20-30% , . , 10-20% .

- - - . - -internal thoracic . . -internal thoracic . . .

- . .

- 5

' - - : 30, " 3 . . . . . .. . . . LAD - . -LAD . - . " .

- :1. X- Ray- . X- Ray , , . - , - . , , , , , .2. CT- , . . , , . - 15 , , . - 5 . .3. - , , . , .4. MRI- , - . .: . - 50% . . . . .: . , - , . - , . . - , - .

. - . . . .

. - - . 2 , -chordae tendinae , . - . . , . ( - aortic stenosis). " " - . . , .

- . -SA node, . -AV node -left & right bundle branches. , . -AV Node - . - 30 . , .

-AV Node . (Sick sinus syndrome). -AV. . - - . : -IVC, . . . . .

- . . , . . . . . , , .

. .

2 :1. Atherothrombosis - . . (, ) . ( ) . - Plaque rupture. , - . . . . (CVA) . - . . . . . - ; . (VF). . - " " . , . . . ( - ) - . - . . - . Werner Forssmann - 1929 ( ). , ", . " - . . . ". . . ( ). . . - , . 2. Aortic Stenosis - , , , . . . , . . . , . . . .

Cleft mitral valve- , ( ).

- . , , . .

- " - 4 . 16 condacting air ways, 16-24 respiratory ways. .

- .

3 , - . - " (). . . " . .

Stridor - . .Congenital Stridor- : , . . laryngomalacia. . .

: , , . . - " ( ") . . Vocal Cord Paralysis ( ) .

( ) - . - . Subglotic Mangioma - . 3 , . - . -50% .

- . . - . - . - Tracheomalacia. , . . brachiocephalic trunk = inominate artery . . double aortic arch - . . - .

: apnea, ( CO2), , , .

- . - . - - Tracheo-esophageal fistula. " - . . 5 . -90% (atresia) . ' ' . . .

- , , .

Congenital Lung Cyst - . Congenital Cystic Adenomatoid Malformation - . 7-10 . : , , . .

Pulmonary Sequestration - - " ( ). - , - . .

- 20 , . . , , (grunting), - . , . . . , . ( ) - . .

- 90% bochdalek.

- . , , . . - Right Lung Agenesis. - , '. -50% .

- 6

" - . ( - ' ). , . ( ) . inguinal hernia - . , ? ? ?

. . . , . (- 70% ).

, . , . , - ventral hernia . .

-Superficial Fascia: . 2 -superficial fascia. -superficial fascia -trunk. -2 :1. Superficial Layer of Superficial Fascia - Fatty Areolar -inguinal ligament . , -scrotum ( ), Dartos Muscle. , -fatty areolar layer -superficial layer of superficial facia of perineum. 2. Deep Layer of Superficial Fascia - . (Fascia Latea). , . . , -deep layer (fundiform ligament of penis). -membranous/ deep layer of superficial fascia of perineum. 2 .

, , -superficial layer . -deep layer ( ) . . " - " ( ). , . , .

-2 : . -superficial fascia. . "", -Rectus Abdominis. Rectus=. Rectus .

:1. External Oblique - -origin -9 (4-12). -serratus anterior. -illiac crest, . aponeurosis. Aponeurosis (tendon) , . External Oblique Aponeurosis . -midline, . -Linea Alba - . .

, + -symphysis pubis. . -illiac crest -sympysis pubis - ! -Anterior Superior Illiac Spine (ASIS) -Pubic Tubercle -symphysis pubis -inguinal ligament.

-Inguinal Ligament , -Inguinal Ligament . , - . , . -external illiac artery -femoral artery .

-external oblique subcotanuos/Superficial Inguinal Ring. Inguinal Canal.

2. Internal Oblique - . . -external. , -origin -illiac crest, -inguinal ligament! , ! -inguinal ligament. ' ! . - ( ). -internal oblique aponeurosis. , : -rectus abdominis -arcuate line -2 : Anterior Layer -Posterior Layer. -rectus abdominis -external oblique aponeurosis. -internal oblique -external oblique aponeurosis. -internal oblique -rectus abdominis -linea alba . , -internal oblique aponeurosis -rectus abdominis. .3. Transversus Abdominis - . transversus . -origin ( -internal, -illiac crest -inguinal ligament. -thoraco lumbar facia , . ( ) -aponeurosis. -rectus abdominis, - superior layer -inferior layer: -Superior Layer -transversus abdominis - rectus abdominis -posterior layer of internal oblique aponeurosis. ? -tranversus abdominis. -inferior layer -rectus abdominis -anterior layer -internal oblique aponeurosis -linea alba. -external oblique aponeurosis. -rectus abdominis " .

.

- rectus abdominisRectus Sheath. -rectus abdominis . aponeurosis - . " aponeurosis. :1. anterior rectus sheath : external oblique aponeurosis, anterior layer of internal oblique aponeurosis -inferior layer of transversus abdominis aponeurosis. 2. posterior rectus sheath : posterior layer of internal oblique -superior layer of transversus abdominis.

, , , rectus sheath -transversalis fascia.

-rectus sheath Arcuate Line Semicircular Line. - rectus sheath Semilunar Line.

A -rectus sheath: -internal oblique aponeurosis -aponeurosis -external oblique -anterior rectus sheath, -rectus abdominis -transversus abdominis -rectus sheath. . .

B -arcuate line, - -internal oblique -inferior layer -transversus abdominis. .

-transversalis fascia . : . , -thoraco-lumbar fascia. -iliac crest -Inguinal ligament. -iliac fascia -iliacus. -pecten pubis.

:1. -Rectus Abdominis . -origin -xiphoid process 5-7. -rectus abdominis . . Intersection Tendons . ( -intersection tendons -linea alba ). . -rectus abdominis -semilunar line. , -semilunar line . 2. - .pyramidalis -.Rectus Abdominis -Rectus Abdominis. -pubic symphisis -rectus abdonomis muscle, . 20% .

: 1. . -rectus abdominis flexion () - 45 ! -45 Psoas Major , -inguinal ligament . . . -psoas . 2. , . , .3. . , . , , -rectus abdonomis , , '. , ( ) . .

Inguinal Canal. , -4 ". ( ) . -superficial inguinal ring -external oblique . -deep inguinal ring -internal oblique. , , -spermatic cord. ", -spermatic cord -Vas Deference = Deferent duct ( ). - -spermatic cord. -round ligament of uterus . . .

- -5 , , . ( ). , . , , - . -umbilical hernia - umbilicus(). . . -deep inguinal ring . -deep inguinal ring:

, , . . , . ? , , . .

. " :1. Reflected Part of Inguinal Ligament - -inguinal ligament, -linea alba. 2. Lacunar Ligament - -inguinal ligament -pecten pubis . 3. Pectineal Ligament ( " ) - -lacunar ligament -pecten pubis, . . . , - lacunar ligament , . , . 4. Conjoint Tendon - , ( ) . -reflected part of inguinal ligament. . -internal oblique -inguinal ligament tendinae -transversus abdominis aponeurosis -conjoint tendon. -pecten pubis -anterior layer -rectus sheath " interfoveolar ligament ( ) -transversus abdominis aponeurosis -superior ramus . , -superficial inguinal ring.

:1. Intercrural Fibers -external oblique aponeurosis . -deep -external oblique . . -superficial inguinal ring . .2. " -internal oblique muscle.

-spermatic cord -Vas Deferens. -spermatic cord : - vas cord " internal spermatic fascia, (Cremaster) external spermatic fascia. .

-external spermatic fascia -external oblique aponeurosis. -cremaster -internal oblique. -internal spermatic fascia -transversus abdominis. -Vas dferens - . -cremaster - , , . . cremasteric reflex - .

" ((hesselbach - Inguinal Triangle. -inguinal canal . - inguinal ligamrnt, - semilunar line -rectus abdominis, - inferior epigastric vein & artery -rectus abdominis. -conjoint tendon.

Inguinal Hernia - . -inguinal hernia -2 :1. Direct inguinal hernia - . -inguinal triangle . -Inguinal Triangle , -superficial inguinal ring. 2. Indirect Inguinal Hernia - -deep inguinal ring . . direct -Indirect.

: " . -superficial inguinal ring. . , , . , -scrotum, . . -inguinal canal .

. , . - . , . .

2 - :1. - . " MESH, . ilioinguinal nerve. , .2. - " 3 - ( 2 ") -2 - MESH , (?). -recurrence . -Inferior ilioinguinal nerve.

75% . fermoral hernia. -lacunar ligament. , .

- 7

" - . , , " . . - (Peritonitis)- . . , , (, , ), (perforation) - . . , . " , . . .

: , . . parietal peritoneum. . , " . , . , (, , , ...) , . parietal peritoneum visceral peritoneum. "" Mesentery - , . parietal, visceral -mesentery , . . -sacs . -greater sac -lesser sac.

2 : 1. -linea alba -pubis symphysis, 2. . . , , , " extra-peritoneal tissue. . . . . .

-mide line. -caudate lobe (-). . - neck , -3 , , . . . :Greater sac - Lesser sac. omental bursa. epiploic foramen, . , .

. - . , . fibrous cord Ligamentum Teres ( - teres ). .round ligament -obliterated umbilical vein - . . parietal peritoneum falciform ligament. -falciform ligament 2 .

: . - . - , ".

, -falciform ligament . :

. / -coronary ligament. . ( -right lobe) -visceral peritoneum. , , , , , -coronary ligament. . / -coronary ligament . -right lobe -right triangular ligament . , . . 2 -coronary ligament (bare area) . . - . . , .

. : -left triangular ligament. -falciform -left triangular ligament. -left lobe, , -left triangular ligament. -caudate lobe -left lobe fissure for ligamentum venosum - . -left lobe visceral peritoneum -fissure .

. , ( ). visceral peritoneum -fissure for ligamentum venosum. -fissure -fissure " -lesser omentum . - fundus, lesser curvature . visceral peritoneum - major curve, , - most anterior -greater omentum. -greater omentum , , - -most posterior -greater omentum.

-greater omentum , . ? -. -greater omentum -midline, . , -most posterior -transverse colon ( " ) . -pancreas . -transverse colon -transverse mesocolon (= mesentry of transverse colon) . , 2 -transverse mesocolon. , visceral peritoneum , . .

, , , visceral peritoneum / . , -parietal peritoneum . , , ( ). , , , , , . . -greater sac.

lesser sac, : -lesser sac -omental bursa. greater sac. , -lesser sac: , . -caudate lobe -caudate lobe. ( , ) -fissure for ligamentum venosum. -fissure -lesser omentum. , -greater omentum, . -minor curve, fundus ' -visceral peritoneum. -2 : hepato-gastric ligament - hepato-duodenal ligamnet. , .

, - 2 -anterior -greater omentum. -greater omentum, 3 posterior -greater omentum. (2 -3) . 3 -transverse colon -transverse mesocolon - . -greater -lesser sacs -lesser omentum. epiploic foramen. . -greater -lesser? ? . -lesser omentum -left&right gastric arteries .

2 : - , . ? ". - . ? .

: ( ) . , -parietal peritoneum . hepato-renal ligament . peritoneal recess - . . " , . (renal impression). -recess -3 : Hepato-renal Pouch, Sub-hepatic Pouch, Morison's Pouch. . . ( visceral -parietal ), Ascites - , , . . 2 -Morison's Pouch: . -morison's pouch . , B -C - morison's pouch . . . :

- -sigmoid colon, . , -visceral peritoneum. -sigmoid mesocolon. ( ) seminal vesicle ( , ) . " , Recto-Vesicle Pouch " Douglas. recto uterine pouch . . , para-rectal fossa - ( fossa ).

- -trunk , , , ascites. , , . - , , , ( , '). . .

-neck Sacro-Genital Fold. -folds -rectovesicle pouch -pararectal fossa . . -sacro genital fold -sacro genital ligament -fold, - , . , para-vesicle fossa " ( ) -vas deferens - . para-vesicle fossa, -round ligament. : . fold= . ligament= (, '). .

-para-rectal fossae . ( ), - . -pararectal fossa .

: , folds: 1. urachus median umbilical fold/ligament ( - ). . 2. 2 medial umbilical folds -obliterated umbilical arteries ( ) .3. lateral umbilical folds -inferior epigastric arteries.

fold :1. -median umbilical fold -medial .Supra Vesical Fossae2. -medial -lateral Medial Inguinal Fossae.3. -lateral Lateral Inguinal Fossae - -lateral inguinal fossa vaginal process , . , -lateral inguinal fossa." -fossae inguinal -folds umbilical. - Lateral Inguinal Fossae -femoral fossae ( ).

- -transverse colon: -linea alba -parietal peritoneum . , -ascending colon, -cecum . " - mesentery!

, -IVC . -mesentery . ( -superior mesentery) -mesentery . . , . , , . -mesentery -visceral peritoneum -IVC -mesentery. -parietal peritoneum -descending colon, ( ) -ascending colon -sigmoid colon .

- -transverse colon: . -IVC, , -linea alba -falciform ligament .

-lesser sac? -lesser omentum, -greater omentum. (posterior) -greater omentum, -parietal peritoneum . - -caudate lobe . - 2 -3 -Greater Omentum. -omental bursa () -right free border ( ) -great omentum. -greater omentum, " -head -neck . - -left free border -greater omentum. -root -transverse mesocolon ( ), .

-line alba, -spleno-renal ligament . . gastro-splenic ligament - (?) . , -lesser omentum, - fissure of ligamentum venosum , -gastro splenic ligament -splenorenal ligament -short gastric arteries. ', , -sub hepatic pouch -linea alba. splenic recess -gastro splenic -reno splenar. : right & left gastropancreatic ligament. - hepatic artery, left gastric artery. .

-epipoic foramen: , (gastro splenic ligament -reno splenar) gastro phrenic ligament . , 3 , . -epipoic foramen . , .

-greater omentum -3 , . ? -greater omentum " ": , -greater omentum , . -perforation ( ), ( ) . . - . -transverse colon -greater omentum - . , "" . -

, recesses . -mesoappendix recess -cecum recess (retro-cecal recess) -recess .

. , 1,2 , . . " - - ( ).

- 8

- " . -esophgous: . . . 4 . , . , '. ' . - , .

: fibrous coat - . , . . . , . -fibrous coat - : 50 , . . - ( , , ). , , . . (thoracotomy) " . , laparotomy ( ). . , . , . , , . -fibrous coat - , . -fibrous coat - . .

: . . " , . , . , . CT . 10 . : !!

, 20-25 ( ). . , , . , . . - . . ( ) . . . . . -mucous membrane . . , .

. , reflux . - -mucous membrane. . . - , ( ) , . . -right crus ( -left crus) - inspiration . . ? , . . . . .

- diaphragmatic hernia hiatal hernia -esophageal hiatus. reflux - , .

, . , .

anatomic sphincter, ( ). -2 : , " , , - .

stamic: " : left & right vagus . 2 , : . -3 Gastric Nerves - Superior, Middle -Inferior. 3 -3 () . -celiac plexus. . vagotomy - . , - . - , . selectinve vagotomy -gastric nerves . , . . -hepatic nerve plexus.

- short gastric, left&right gastric, left&right gastro omental . -rugae, " , . -rugae , , .-pylorus spincter " " .

- . . . . . - , .

: - . ? . 4 , . intra peritoneal - -visceral peritoneum, , , , , -jejunum, -ileum, , -transverse colon . , , sub/retroperitoneal. - -splenorenal ligament (?).

-jejunum , -ileum , . -mesentery, mesentery -jejunum, -ileum. . : : circular folds, -rugae . -rugae (transverse folds) . , -circular folds , . circular folds -terminal ileum circular folds. .

: -mucous membrane -intestinal villi, / . ( ), , , muscularis mucosa -mucous membrane. -villi . -villi . , , . - ( - Crohns Disease) . . , , -villi intestinal, . ( - ). -intestinal villi, -thoracic duct , . . , . - lymph follicles - . , , lymph node. 2 lymph follicles:1. Solitary Lymph Follicles - , .2. Aggregated Lymph Follicles - , . Peyer Patches ( )., . (aggergate+solitary) germination centers - , " . . - node , -lymph follicle " .

: - appendices epiploica appendices omenalis - -caecum, appendix, Rectum. .

reccesses (= ) " -omentum -caecum -ileum :1. Superior ileocaecal recess.2. Inferior ileocaecal recess.3. Retrocaecal recess.

: , , . . ' . , , . , - , . , . . - . -caecum .

- : 2 : . -longitudial fibers -circular fibers, longitudonal fibers - Taenia Coli. 3 :1. Taenia Libera - -transverse colon .2. Taenia Mesocolica - , -transverse colon .3. Taenia Omentalis - -transverse colon . taenia coli . Haustrations -taenia coli. -taenia coli . -longitudonal fibers -taenia -circular fibers. -circular fibers . , "" -taenia . , haustrations .

lymph follicles solitary . -mucus membrane .

: -mocus membrane : longitudinal folds . , . transverse permanent folds . , -transverse folds , ( , ). , 2 transverse folds: longitudinal fibers , longitudinal fibers .

: 4 ". 6 -10 vertical folds anal columns - . anal column superior rectal artery superior rectal vein. , -anal columns " anal valve , . 2 anal valve anal sinus .

rectal venous plexus - . 2 - -folds. hemorrhoids. 2 : Internal hemorhorids- -superior rectal vein " . External hemoroids- -external venous plexus, .

-anal sinus pectinate line . " spinal cord, . , . : internal hemorrhoids ( ). . -external hemerroids . . , . .

. ( ). - , " . , .

: . : , . , , , .

" -portal vein. L2, -SMV -splenic vein. -8 " -IVC. , -portal vein . , , -gastroduodenal artery, -bile duct. , -lesser omentum -bile duct -hepatic artery, -bile duct , -hepatic artery proper ( ) -portal vein , 2. -portal triad -hepato-duodenal ligament -lesser omentum. -70% , -30% , .

" lymph nodes, lymph ducts " -hepatic nerve plexus. , , , -lesser omentum " perivascular fibrous capsule. gilson's capsule " . 4 , 2 , - perivascular fibrous capsul . , ( ) , , -portal vein - portal hypertension.

-splenic vein ' : short gastric veins- , -gastrosplenic ligament. . 3-5 . - , .

, -porta hepatis, -& left portal veins right, -left -IVC " ductus venosus. ductus venosus -ligamentum venosum -fissure .

-portal vein? - superior mesenteric vein -mesentery. -SMA . -vein 2 pancreaticoduodenal veins, ( -SMA - -splenic artery). , -pancreticoduodenal, -SMV 2 - . , , : jejunal veins -illeal veins. ileocolic vein -terminal ileum, -cecum -appendix. right colic veins -ascending colon - middle colic veins -transverse colon. -SMV. - right gastro epiploic (omental) vein -SMV. -superior mesenteric vein.

-portal vein - -splenic vein? -splenic artery . " . -splenic vein , -short gastric veins , -left gastro omental vein, , , -pancreatic veins -splenic veins ( ). - -splenic -inferior mesenteric vein! -IMA . -IMV -splenic vein, - superior rectal vein, sigmoid branches, Left colic vein. -IMA -IMV , -IMV -splenic vein -duodenojejunal flexure. -duodenojejunal flexure " " . -right crus .

: . -left & right gastric veins? -portal vein. " , -cystic vein, -portal vein. - paraumbilical veins - -portal vein -ligamentum teres , -portal vein .

, . - portal hypertension - . , -portal veins, - cirrhosis. , ( ). , , . , , -4 : . " -esophageal veins , " -left gastric veins. " - coronary veins / vasa brevis ( ) -inferior epigastric . .

esophageal varices - , - . . , . " . .

- : -superior rectal vein ' , -middle -inferior . - ( ) .

-superficial epigastric veins -paraumbilical veins. -superficial epigastric ' caput medusa ( ) - . - .

, " . , , . shunt ' . .

, splenorenal shunt: -splenic vein -renal vein. -splenic -renal. . , . . - 9

" - : , " : 4 - ; ; caudate lobe () " -caudate process -right lobe; -quadrate lobe . . , -4 , Riedel's Lobe. . -right lobe - "" . . . . . . , . . . , .

: impressions . gastric impression . -renal impression ( -hepato renal ligament -morison's pouch). , . -colic impression -right colic flexure . supra-renal impression , - bare area . duodenal impression. " .

. , " . .

H. . -Inferior Vena Cava. , , . -IVC . , , . , . -IVC , . gall blader. -ligamentum teres. -ligamentum venosum -fissure for ligamentum venosum .

-porta hepatis - . : portal vein , bile duct -hepatic artery proper . -lesser omentum . lymph nodes, lymph ducts -hepatic nerve plexus. . -lesser omentum -perivascular fibrous capsule . . , . - perivascular fibrous capsule .

: , : , , '. 2 : -portal vein -hepatic artery . -portal vein . , , , , . 70% . -hepatic artery , . -hepatic artery -venous capillaries. -venous capillaries -central veins -hepatic veins -bare area -IVC. .

, : . -lobules, lobulus hepatic lamina - central vein . central veins . . -hepatic lamina () , " 6 . . .

- . bile canalicula - bile canaliculi . . -canaliculi. -hepatic lamina, -bile canliculi . -lobules.

-lobules portal vein, hepatic artery -lymph ducts. , Bile Ductule ( ). canaliculi, lobules. -bile ductule 2 , : -right -left hepatic ducts. , 4 , -caudate -quadrate. 2 -common hepatic duct -porta hepatis. -porta hepatis, .

: ( ), 2 , -mucous membrane. -. - -fundus, -body -neck. -neck cystic duct -common hepatic duct -bile duct ( , common bile duct). , . -hepatic ducts right&left -porta hepatis, -common hepatic duct -bile duct -porta hepatis. -bile duct -extra hepatic. , : . , - . , , . . , , ( ). -cystic duct -bile duct . -bile duct ? ? . , , -bile duct -cystic duct . -cystic duct . -hepatic nerve plexus - -common hepatic duct . " -hepatic nerve plexus . , .

( ). 3 : - ; -antrum pylorus ; (?).

: -portal hepatis vein -& left portal veins right, - ( venous capillaries), . : -lobulus, . (lobulus) hepatic lamina - / . -hepatic lamina . -hepatic lamina . ( ) -portal vein -lobules . lobules -portal vein ( bile ducts, ') . lobules. , -lobulus central vein. lobules central vein, -lobules - -sublobular veins.

-sublobular veins , -hepatic veis: anterior, middle, posterior, -porta hepatis , -bare area . " -IVC, -IVC . -middle -IVC. . . -portal vein 70% , -hepatic artery 30% , .

- -. , -hepatic veins -IVC. (IVC) . -"" " ". -IVC.

-hepatic arteries hepatic capillaries . . , , -hepatic arteries .

- - , . - bile ducts 2 ! hepatic ducts , common hepatic ducts bile ducts. .

. . . , . . . . . . " .

: -. . -splenic flexure , ( " ) -.

fibro-elastic capsule. . . . -hilum - trabecula. -trabecula -sub-divisions of trabecula. -splenic artery -hilum . -trabecula . -sub divisions -trabecula.

-trabecula . -adventitia ( ) -trabecules " -lymphatic tissue. white pulp. . . . " lymph folicles -white pulp . -lymph folicles . lymph follicles . . -lymph follicles. .

-arterioli red pulp. penicillin. . -pennicili . -lumen . -lumen ellipsoids. -arterial capillaries. .

vinous capillaries -arterial capillaries. -sinusoids. veinous capillaries . . . , . . -red pulp " . .

:1. . ght and left ducts . . , . . . lymph nodes , .2. 120-125 . .3. - . . stress , . . .

: - . . :1. -: . . . . . . , . 2. -: . , . . , . , FAST, -horison's pouch, -douglas . splectomy . 15 ( ). . splectomy. , . caloscopy 3-4 , . .

- . :1. head of pancreas .2. uncinate process . . , .3. neck of pancreas .4. body of pancreas .5. tail of pancreas - -splenic artery -splenorenal ligament . , -.

-pancreatic duct. () . -pancreatic duct -pancreas , -head of pancreas -bile duct -hepato pancreatic ampulla. -major duodenal papilla. - Sphincter Oddi. -3 :1. -bile duct.2. -pancreatic duct.3. -hepato pancreatic ampulla. 3 !

accessory pancreatic duct, , ( ) -uncinate process, -head -neck ( " -accessory duct " -duct ). -major duodenal papilla -minor duodenal papilla.

ERCP - Endoscopic Retrograde CholangeoPancreatography - . -major duodenal papilla, " -circular folds, , . - -bile duct . . , , -. -bile duct, . . . , : -bile duct .

: . : . -T12 L3, . "" ( ). . "" . , , , ''. , -quadratus lumbarum -iliac crest 12.

- perirenal fat. . - perirenal fat -renal sinus, -hilus. -morison's pouch.

: 1. . - , " " -bare area. - , , , ... ? . -perirenal fat. , . , -perirenal fat perirenal fat Ptotic/Floating Kidney. , . . -ureter. ! . . - hydronephrosis, . . . 2. -perirenal fat , , . - hematuria, ( ) ( ). - . , . . perirenal fat. , . perirenal fat , . 3. - perirenal fat 37 . .

-perirenal fat renal fascia. fibro-areolar tissue ( ' ). , -fascia transversalis - , :

visceral peritoneum, . , , , , ' , , , -transverse , . , , ( ), -.

-ascending -descending ? - . , -visceral peritoneum - -visceral peritoneum. . - -. . () . . " visceral . .

" - bare area, , . , -ascending -descending colon extra peritoneal - - .

-mesentery - , . , 11% Mobile Ascending Colon, , - Volvulus - . , . - -renal fascia -transversalis fascia -,perirenal fat . , -IVC . .

, -psoas major , -quandratus lumbarum. -body -intervertebral disc.

. , . 2 . - . , , . , , .

, , . morison's pouch.

, . -extraperitoneal tissue- , -illiac fascia ( ). , .

-perirenal fat , . -pararenal body ( fat pad) .

: () -2:1. Renal Pyramids - 2. Renal Columns - . - -renal columns . - -renal columns ( ). - , -. -ducts of bellini . 20 papillary duct .

-renal column ( ), ( henley's loop tubules ). .

- 10

- " . . . : pelvic bones sacrum. Coccyx - . , . . -Illium , -Pubis -Ischium . - . , . , .

-pelvic bone: -illium -body. , -body - -anterior inferior illiac spine. -ASIS (anterior superior) . -anterior inferior illiac spine . -ASIS -illiac crest , -posterior superior illiac spine, , -posterior inferior illiac spine. - -greater schiatic notch . , -illiac fossa . , -illium ala of illium (ala = , ). facet , -auricular surface for sacrum . articular surface auricular surface . , -Ischium, -greater schiatic notch. , ischial spine -notch -PIIS ( -ischial spine). -ischial spine -ischium -pubis, -body , , -body -ilium. -ischial spine -lesser schiatic notch. . -notches . -lesser schiatic notch , -superior ramus -inferior ramus.

-superior ramus of ischium , tuberosity. . . . , . .

-pubis - -of pubis superior ramus -pecten pubis -pubic tubercle -inguinal ligament , -ASIS. -pubis -body -pubis -bodies -pelvic. -symphysis pubis, 2 , -pelvic. . -ASIS . -symphysis pubis -inferior ramus -pubis (?)

-acetabulum -femur. -ilium, -pubis -ischium. . -pelvic -obturator foramen - . obturator membrane. -obturator canal -obturator vessles and nerves.

:

-auricular surface - -sacro-illiac joint . auricular surface . , , " -anterior sacro-illiac ligament . , " 2 : Short posterior sacro-illiac -long posterior sacro-illiac ligaments. . .

, , . -10 , . ( ), - , . -sacro-illiac joint .

- 1. - sacro-spinous ligament . -spine .2. Sacro-tuberous ligament - , , -tuberosity . . (= ) " .

. -greater & lesser schiatic notch/foramen. . . -4-5 . , . -ischial spine .

. :1. - . . . .2. - . , . -ascending colon -sacro-iliac joint -descending colon -sigmoid -sacro-iliac joint . : -illiac fossa " -illiacus, -psoas major ( ). : , . , : . .

:

: -illium -illiacus, -obturator internus, -levator ani . periphormis. . -greater sciatic notch . . -hip joint. -coccygeus.

: - Pelvic Fascia - -obturator internus obturator fascia. -pelvic fascia 2 , . , -illiac fascia ( , -inguinal ligament -illium). -obturator canal , -pubis. - -tendineous arch ( ) -ischio-rectal/anal fossa. . -ischio-rectal fossa . " sheath lunate fascia pudendal canal. -inferior urogenital diaphragmatic membrane . -levator ani -perinoeum.

- Fascia of Pelvic Diaphragm - -levator ani , . -obturator fascia. anal fascia, -ischiorectal fossa -lunate fascia. (2 -2 ): medial&lateral Pubo-prostatic Ligament , -medial&lateral pubo-vesical ligaments .

, -ischial spine, -tendineous arch. , tendineous . ' . --pelvic fascia -fascia of pelvic diaphragm -ischiorectal fossa. .

-levator ani coccygeous -coccyx, .

-levator ani , . -levator ani , -levator ani . origin : -levator ani , -tendineous arch, . -insertion : raph perineal body . -origion 8 .

, , -3 : 1. Illio-Coccygeus - . , . , , -midline raph. 2. Pubo-Coccygeus - , . , fibro-muscular layer raph- -illio-coccygeus. 3. Pubo-Rectalis - , -most medial part -pubo coccygeus. -ano-rectal junction . ( - ) - . , , .

- . . . , . . 2 : . , . , . , . .

. -levator ani . - -30' ! . , . - -ischio-rectal fossa -levator ani. - . . . mesh " mesh -mesh . , -mesh . .

-levator ani:1. .2. .3. , . , . . " " .4. , levator prostate levator vagina. -prostate .

: 264, 341, 402 . -abodminal aorta . -median sacral artery. -internal illiac artery -common iliac a. -abdominal aorta, -illio-lumbar, sup&inf lateral sacral. -internal pudendal -internal illiac , -greater schiatic notch ( - ) , -lesser schiatic notch . , ? (-levator ani ) ( , ) . -levator ani " - . -internal pudendal , - levator ani . , , . -greater schiatic notch -lesser schiatic notch . - -inferior rectal artery (402 ) -internal pudendal. -internal pudendal -perineal artery -artery of penis. -pernieal -transverse perineal -post. scrotal, -artery to penis - . (403 ).

-superior gluteal artery L4 -L5 -inferior gluetal artery L2 -L3. . -inferior vesical artery (403 ) -vaginal artery. -uterine artery .

-external illiac 2 : deep circumflex , ascending -transverse -illiolumbar artery.

-internal iliac artery , , , , . -internal illiac artery . , . , . , -internal illiac , . 9 -internal & external illiac . , -illio lumbar -deep circumflex. - -medial sacral -inferior lateral sacral. -internal illiac. .

: -sacral plexus. -lumbar plexus. , -L5 S1-3, S4-5 -coccygeal plexus -pudendal nerve. -schiatic nerve -sacral, , , -rotators -pudendal plexus. -lumbaro sacral trunk , L4 -L5, -sacral plexus S1-3. " . , -superior gluteal -lumbo sacral -S1, S1-S2 inferior gluteal - S2 -pudendal.

" . -abdominal aorta -superior hypogastric plexus , -hypogastric nerves . -internal illiac -sacral plexus .

: .

: . : -apex, -superior surface, -base, , 2 inferolateral surface . , . . , " . , -. . . (IV " ). , .

, 200-250 cc . -ureters . . ? " :1. true ligaments- . , fibro areolar tissue ' , 2 - medial&lateral pubo-prostetic/pubo-vesical ligaments . -urachus, ( - urachus ). -urachus . ... .-urachus -median umbilical ligament ., fibroareolar tissue -tendineous arch -lateral true ligaments of bladder, , , ( ) " prostatico-vesical venous plexus, vesical venous plexus. -fibroareolar -venous plexus -internal illiac veins -posterior true ligaments of bladder.

2. False Ligaments - folds -false ligaments of bladder: median, medial and lateral umbilical folds. - . , -lateral false ligaments of bladder, sacro-genital folds -posterior false ligaments of bladder.

.

. . . . , . :1. Sphincter vesicae: . " . . -rectus abdonomis . " . : external longitudal fibers, circular fibers -internal longitudal fibers. -uretha. ( ) -circular fibers -sphicter vesicae. . .2. " sphincter urethra. . uretha. : . -neck ( ) . . circular fibers. -longitudal fibers -oblique fibers. -urethra :1. -urethra : prostatic urethra, -sponge urethra ( ). " mucous membrane. , . -longitudal and oblique fibers -urethra. sphincter vesicae. . 2. sphincter urethra , . . -sphicter urethra . , -sphicter urethra , -pubococcygeous -levator ani -sphincter urethra , . , . -sphincter urethra -urethra . . , . . ( , ). -levator ani . -pubococcygeus , . . " .

: , "-" ".

(prostate): . , -symphysis pubis. , . -prostate : base, apex , inferolateral surface, anterior surface - posterior surface. -neck -anterior, -uretra () . depression -posterior surface -ejaculatory ducts , -prostate. -depression -posterior surface : , , -median lobe -prostate -ejaculatory ducts . -right -left lobes , -urethra, -uretra -right&left lobes " fibromuscular band Isthmus.

, , . .

- 11

" - -internal iliac. . , , " baseline. ' - ' : -uterine artery - . . -vaginal artery -inferior vesical - '. - .

: (). 2 - 2 " . 2 - ' , ' . Y/X? " . , , , . . . . . . -3 , . , 2 . ". 1:100,000. " . 2 -puberty. . -2 : . . -2 , 6 : , , -4 . ' ' . " .

: . . , .

: -testis () . , . -ovarian fossa. . -ovarian fossa " -obliterated umbilical artery " -internal iliac artery -urether ( ). , -ureter -internal iliac artery . broad ligament. . .

. , . , . . . 2. 3 ", " 1 ". . , . .

: tubal extremity - -uterine tube (). -external iliac vein 2 :1. -suspensory ligament - . 2 -suspensory ligament -psoas major . descending colon- . 2. ovarian fimbriae. -uterine extremity -tubal extremity. " " " -ovarian ligament 2 -broad ligament , 2 . -ovarian ligament .

- -lateral surface -parietal peritoneum -ovarian fossa -extraperitoneal tissue .

- medial surface " -peritoneal recess -medial surface -mesosalpinx ovarian bursa. Salpix , . , .: -uterine tube -broad ligament - mesovarium -uterine tube = mesosalpinx. -medial surface -ovary , recess ovarian bursa, .

-ovarian bursa -ovarian cyst ( , ). , . . ( ): -medial surface . -medial surface , . -testis (3X1X1.5 " "). 2 3, -suspensory ligament . - torsion . , . . . periovarian cyst, . DD , . , . .

-urethra . -urethra . tunica albuginea .

: 10 " , . -broad ligament. , . ( " ). . abdominal opening. . . , . , . " .

-fimbriae " mucous membrane. logitudinal folds -longitudal folds -mucous membrane -infindibulum. ovarian fimbria. , . - " . . " . , '. . , . . -ampulla . - . -2 :1. . " 7-10 . , .2. ( ) . ! . .

: :1. Infundibulum- . infundibilum . . 2. Ampulla: . -ampulla ". . 7-10 . 3. Isthmus: . -isthmus . -isthmus " . 4. Uterine part of tube: " . , - longitudial fibers circular fibers. . ???

: . : Longitudal fibers circular fibers. mucoes membrane -sub mucousal membrane. columnar ciliated epithelium. . . 7-10 , . . mesothelium. -3 "!

, ( , ). - " . . . . .

3 " , ( ). . ( ) -IVF. - mucous membrane . " . .

: -7.5 ", 2.5 "- . fundus , body -cervix . 2-2.5 " . . . . internal os -body, -external os . . . " " . . . , " . -body utero-vesical fold pouch, , vesico-uterine pouch.

-body (supra vaginal part ) . -supra vaginal part " cellular tissue parametrium 2 -broad ligament. , -supravaginal part , -rectouterine puch douglas. - . -douglas, . . , stage 4, .

. anterflexion. -internal os acute anterflexion ". , . anteverted. . . . , . .

-uterine pouch " . recto-uterine folds utero-sacral ligaments -sacrogenital . -douglas - recto-vaginal ligament.

, longitudal ridge palmate folds. (-longitudal ridge). arbor vita utery " ". . , . myometrium. . :1. longitudal fibers.2. longitudal fibers, oblique fibers transverse fibers. .3. circular fibers. . ? . . , , ( , ). . . . . . . . , . . . . . . , .

. . . . hysterectomy .

-mucous membrane . endometrium. mucous membrane . -mucous membrane . -mucous membrane: . .

. " . . . , . . . . . .

-mucous membrane -body columnar epithelium ( ). -mucous membrane uterine glands. . -2/3 cynderial epithelium stratified squameous epithelium. ( ) .

" follicles () -2/3 . ovula nabothi cystes. -follicles . - . . -follicles ( ) ( ). . . . 14 . - .

-. -douglas. -ureters 2 " , -internal iliac artery. -Historectomy :1. .2. .3. Gistorectomy . vaginal hysterectomy, . . .-rectouterine folds - practogenital folds . -uterine artery -ligamentum transversalis coli/cardinal ligament. - -uterine artery -internal iliac artery -urether. , -urether - . , : 2 -urethers, , . urether , . , . .

-historectomy :1. Broad ligaments.2. Round ligament of uterus- -broad ligament. -inguinal canal. .

: . -Testis - . : . -5 ", -3 ". -2: - , - Epididimis- -Testis. Sinus of Epididimis -Tunica Vaginalis.

Tunica Vaginalis. . - . , Vaginal Process. , - . -lateral inguinal fossa , . 2 : -vaginal process , . . 2 tunica vaginalis. ? . -testis tunica vaginalis -testicular artery . . ( ).

Appendix of Testis:

. , " , Appendices of Epididymis. . - . ( ), , . . ( ) - . . 2 - . -appendix of testis -appendices of epididymis .

-tunica albuginea - - ( ) . 2 : . , (convoluted) . . vertical septum mediastinum testis.

. septula testis -lobules. -tunica albuginea -lobules . 300 lobules. lobulus 1 -3 seminiferous tubules convoluted tubules. 70 -80 ". 400-600 seminiferous tubules . . -seminiferous tubules interstitial cells - . -seminiferous tubules .

-apex -lobules (-base ), straight tubules. -20-30 straight tubules -convoluted. -mediastinum testis, , Rete testis. , 20-30 straight tubules effernt ductules (efferent = , ductule = -tubule). - 12-20 efferent ductules. . Convoluted Ducts ( convoluted tubules ). convoluted duct -20 ". -head of epididymis - . -ductules - duct of epididimys -body of epididimys -tail of epididimys - -duct 6 . -vas deferens deferent duct. -2 , . -spermatic cord, . .

-inguinal hernia -vas deferens .

-vas deferens, -ampulla of vas deferens - seminal vesicle . -vas deferens -ejaculatory duct. -urethra + . depression -ejaculatory duct . -seminal vesicle :1. . , " . 2. -seminal vesicle .3. . , -seminal vesicle .

-prostate - , -fibro muscular band -left&right lobe :1. . 2. -ejaculation " . .

2 - -pudendal plexus -prostate. , . - . " , " . , - bulbous spongiosus (?) -ejaculation. -urthera . .

- bulbo-urethral gland. -urethra. . , -seminal vesicle " -bulbo-urethral gland.

: ( ). , - . . . - ( ). , . US . . -2 : -sphincter vesica . , . . . , , . , '. .

- 12

" - : , -levator ani. -symphisys pubis , . . . .

-2 " -ischial tuberosities:1. - anal region anus- -sphincter anal externus subcutaeous, superficial deep. -levator ani. . .2. - urogenital region - . . -symphisys pubis. -symphisys pubis -coccyx. . , .

, perineal body - . -perineal body - -fibro muscular tissue. . . Levator ani, , -ampulla rectic -perineal body. . . , 8 ( origin insertion):1. Bulbo spongiosus.2. Levator ani.3. Sphincter ani externus.4. Superficial transverse perineal muscle, deep transverse perineal muscle. -perineal body. -Perineal body .

. .

, :1. - Fatty Areolar Layer -superficial fascia , . -posterior scrotal artery + nerve , posterior labial artery and nerve. . . ( -inferior rectal artery). 2. 2- superficial fascia of Membranous Layer. - - deep layer of superficial fascia . 3. -3 :1. Transversus Perinei Superficialis - , ' , -ischial tuberosity -perineal body. 2. -Bulbospongiosus Muscle . -mid line. ' -bulb -penis ( -corpus spongiosum) - bulb . - -urethra . . - -corpus spongiosum, (). -ejaculation () -urethra. ( ) " . . , -bulbosponiosus , -ejaculation. 3. - -Ischiocavernosus -ischial tuberosity -symphisys pubis. -crus penis, -corpus cavernosum. -bulb -crus . -bulb -crus (ischial tuberosity) . . -corpus cavernosum . 4. , - Inferior Urogenital Diaphragmatic Fascia. Perineal Membrane. .5. -perineal membrane, 2 :1. Bulbourethral Gland . ' .2. Artery to Penis -artery to Bulb -bulbourethral nulb. -dorsalis penis artery .6. 2 :1. Sphincter Urethra - , . . 5 .2. Transversus Perinei Profundus - deep transverse perineal muscle -perineal body ( ). .7. Superior Urogenital Diaphragmatic Fascia - . . -Urethra. , -levator ani.

1-4 superficial perineal pouch. 4-7 deep perineal pouch. 4 , . .

. -urethra -mucous membrane urethral crest -ejaculatory ducts frena of urethral crest, -crest. -urethra terminal fossa valve. -urethra . .

, , . . : . -vestibule, -urethra, -clitoris. -bulbous spongiosus muscle . . -superficial perineal pouch 2 :1. -bulb of vestibule -bulb of penis . bulb , 2 (=) 3 ", . , 2 " comissura bulborum. 2. -greater vestibular gland. - bartholin gland. . -bulbourethral gland . - -deep perineal pouch -sphincter urethra, -superficial perineal pouch -perneal membrane. -vestibule. -penis , . . -bulb of vestibule. 2 : , bartholin cyst. , , , , . . ( ). . . clitoris-, . corpus cavernosum. crus of clitoris, body -glans . .

, , -perineal body. , -episiotomy. . -perineal body , -levator ani -prolapsed- , .

. -shphincter urethra -urethro-perineal profundus. -bolbus spongiosus muscle. -transversus perinea profundus . .

-labia majora : . . " -anterior commisure. . . . -posterior commisure. -labia minora . : . -clitoris. -frenulum of clitoris. " frenulum of labia manor. .

- 13

" - - . - , , . - , . -superior lobe bronchus , apical posterior anterior anterior apico-posterior -apical -posterior.

- lingular bronchus -superior segmental& inferior segmental -middle lobe bronchus . -superior lobe bronchus: -superior division -superior lobe bronchus. -basal bronchi medial basal medial basal 10 -9 .

- . . - , . elastic fibrous membrane . 2 - . 2 , . -elastic fibrous membrane - longitudinal -transverse fibers . -transverse fibers . inspiration - .

[ - ].

- -alveolar sacs " . . -sacs lobules. Lobules lobes. - apex, base, .

" -medial basal segment . - -cardiac notch . lobar pneumonia -superior lobe . . -fissures. oblique fissure - . oblique & horizontal . -oblique fissure -superior lobe -inferior lobe. -middle lob -inferior lobe. -horizontal fissure -superior -middle -superior -inferior. " . groove for azygos vein, -grooves , -pulmonary hilus, , , . -cardiac impression -cardiac notch. -principal bronchus -pulmonary artery -superior & middle lobar veins superior right pulmonary vein .

: . ! , . -superficial fascia - superficial fatty & deep membranous. -superficial layer fatty alveolar, , -superficial fascia .

-deep layer -superficial fascia , latta . -fundiform ligament of penis " -membranous layer of superficial fascia of perineum.

origin & insertions .

-origin & insertion, . ' -internal oblique -illiac crest -inguinal ligament -. -aponeurosis -linea alba. -external oblique -illiac crest -linea alba, -pubic crest -ASIS -pubic tubercle -inguinal ligament. -vas deferens -spermatic cord. -spermatic cord , , .-internal oblique -semilunar line . . -external oblique -transversus abdominis.

-transversus abdominis -semilunar line of rectus abdominis, -aponeurosis . ( ) -internal oblique. -internal oblique ( internal oblique), -external oblique. -transversalis fascia.

-transversalis fascia extraperitoneal fat .

-inguinal canal. , . 1. Inguinal ligament - . reflected part , .2. -lacunar ligament . 3. pectineal ligament , . mesh , -pectineal .4. -conjoint tendon - -internal oblique -inguinal ligament , -transversus abdominis. -anterior layer of rectus sheath -interfoveolar ligament -transversus abdominis aponeurosis -superior ramus . -conjoint tendon -inguinal anal, -reflected part of inguinal ligament. .

- -intercrural fibers -external oblique fascia, -deep fascia -linea alba. -superficial inguinal ring. . , " -internal oblique . , -deep inguinal ring.

-inguinal triangle -inguinal ligamnet , -semilunar line -inferior epigastric artery. direct inguinal hernia - , . -indirect inguinal hernia -deep inguinal ring . .

:1. - , . -ilioinguinal nerve . 2. - . -genitofemoral nerve . mesh , .

-spermatic cord . : External spermatic fascia = external oblique aponeurosisCremaster = internal obliqueInternal spermatic fascia = transversalis fascia

75% . Direct hernia , -conjoint tendon . -indirect inguinal hernia -deep inguinal ring.

, - cremasteric, testicular .

inguinal hernia femoral hernia -femoral canal. . -femoral canal cul de sac -inguinal ligament, -pectineal ligament -lacunar ligament .

, .

3 -folds : Media