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On the left side erectile dysfunction pills from india , the nerve passes across the medial border of the scalenus anterior onto the front of the first part of the subclavian artery. On the right side, the nerve usually crosses the medial border of the scalenus anterior lower down so that the nerve does not come into direct contact with the first part of the subclavian artery, but is separated from the second part by the scalenus anterior. The relationship of the subclavian artery to the brachial plexus is as follows: Scheme to show the branches of the superficial temporal artery Relationship of the subclavian artery to the scalenus anterior Chapter 42 Blood Vessels of Head and Neck 849 6. The first part of the artery lies below the level of the plexus, but the second and third parts come into relationship with the trunks of the plexus. The upper and middle trunks lie above the second part of the artery, and above and lateral to its third part. The ansa subclavia is a nerve cord that descends from the middle cervical sympathetic ganglion to the front of the first part of the artery, and looping round it ascends behind it to reach the inferior cervical (cervicothoracic) sympathetic ganglion. The terminal part of the thoracic duct comes into relationship with the first part of the left subclavian artery. After ascending into the neck along the lateral side of the oesophagus the duct turns laterally forming a wide loop that is convex upwards. The terminal part of this loop descends in front of the artery (near the medial border of the scalenus anterior) to terminate by joining the junction of the left internal jugular and subclavian veins. The relationship of the subclavian artery to the internal jugular and subclavian veins has already been noted. The vertebral vein descends across the first part of the subclavian artery to end in the brachiocephalic vein. The external jugular vein descends across the third part of the subclavian artery to end in the subclavian vein. In front of the artery the external jugular vein is joined by the transverse cervical, suprascapular and anterior jugular veins. Relationship of the subclavian artery to the vagus the relations of the subclavian artery explained above nerve. Lower trunk of brachial plexus behind second and third parts 850 Part 5 Head and Neck the subclavian artery gives origin to several branches that are shown in 42. It runs upwards to enter the foramen transversarium of the sixth cervical vertebra. The internal thoracic artery arises from the first part and runs downwards into the thorax. The thyrocervical trunk is a short vessel arising just medial to the scalenus anterior muscle i. On the right side, it usually arises behind the scalenus anterior (then being a branch of the second part). It divides into the inferior thyroid, suprascapular and transverse cervical arteries. The internal thoracic artery has been dealt with in the thorax and is described on page 464.

In the fetus erectile dysfunction commercial bob , the ductus arteriosus connects the left pulmonary artery to the arch of the aorta just distal to the origin of the left subclavian artery. If the ductus remains patent after birth, blood from the aorta enters the pulmonary arteries. This term refers to a condition in which the aorta is abnormally narrow near the attachment of the ligamentum arteriosum. The narrowing is proximal to the attachment of the ductus arteriosus that usually remains patent and feeds blood to the part of the aorta distal to the coarctation. In the postductal variety, seen in adults, the ductus arteriosus is usually not patent. Blood reaches the distal part of the body through an elaborate collateral circulation. These arteries enlarge and produce characteristic notching on ribs that can be seen in a skiagram. When coarctation is present there is hypertension in the part of the body supplied by branches arising above the level of constriction, and hypotension in parts supplied by branches arising below the level of constriction. Hence, blood pressure recorded from the upper limbs is much higher than that recorded from the lower limbs. At present, coarctation can be surgically corrected by removing the narrow segment and anastomosing the two cut ends of the aorta. The dilatation may be fusiform or may take the form of a sac attached to the main vessel. In some cases an aneurysm splits the wall of the aorta into two layers (dissecting aneurysm). A physical sign called tracheal tug may sometimes be elicited when an aneurysm of the aorta is present (See Chapter19). Some of the branches are large and have a wide distribution, while others are small. The importance of a knowledge of their course and branches has increased considerably in recent years as these arteries are often visualised in the living (coronary angiography) for diagnosis of possible obstruction to them (21. Course of Right Coronary Artery the right coronary artery arises from the ascending aorta, from its anterior sinus (21. The second part runs downwards on the sternocostal surface of the heart between the right atrium and right ventricle. Reaching the inferior (or acute) margin of the heart the artery curves round it to become the third part, which lies in the posterior part of the atrioventricular groove (between the right atrium and ventricle). Just before its termination, it gives off the posterior interventricular branch that runs downwards, forwards and to the left in the posterior interventricular groove (21. The left coronary artery arises from the left posterior sinus of the ascending aorta (21. It passes to the left between the pulmonary trunk and the left atrium and appears on the sternocostal surface of the heart after passing deep to the auricle of the left atrium (21. Here, the artery divides into two main branches that are more orlessequalindiameter.

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Commonly impotence cures natural ,thestomachisJ-shapedhavingalongvertical part (above and to the left) and a shorter horizontal part (belowandtotheright)(27. Along the greater curvature (between the 2 layers of the greater omentum), there are the right and left gastroepiploicarteries. Lymph from all these nodes ultimately reaches the coeliac nodes (around coeliac trunk). S:Superiorpart;D:Descendingpart; H:Horizontalpart;A:Ascendingpart 542 want to know more Chapter 27 Oesophagus, Stomach and Intestines Ascending (Fourth) Part Anteriorly a. The mucous membrane of the jejunum is marked by the presence of numerous, large, transverse, folds. Thesearethecaecum,theascending colon,thetransverse colon,thedescending colon,thesigmoid (or pelvic)colon,therectum andtheanal canal. The veins from the colon drain through the superior and inferior mesenteric veins. The preganglionic neurons concerned are located in segments S2, S3 and S4 of the spinal cord. It is included amongst the accessory organs of the alimentary system because it produces a secretion, the bile, which is poured into the duodenum (through the bile duct) and assists in the digestive process. All the blood circulating through the capillary bed of the abdominal part of the alimentary canal (excepting the lower part of the anal canal) reaches the liver through the portal vein and its tributaries. In this way, all substances absorbed into the blood from the stomach and intestines are filtered through the liver, where some of them are stored and some toxic substances may be destroyed. Numerous other functions essential to the well being of the individual are performed in the liver that is, therefore, regarded as one of the vital organs. It lies mainly in the right hypochondrium and in the epigastrium, but part of it extends into the left hypochondrium and part of it into the right lateral region. To the right of the midline, the upper border follows the upward convexity of the right dome of the diaphragm reaching to a level just below the right nipple. To the left of the midline, the upper border follows the curve of the medial part of the left dome of the diaphragm, and ends a little below and medial to the left nipple. The right border runs vertically, with an outward convexity and ends at the level of the tip of the tenth costal cartilage. A liver extending below the level of the lateral part of the right costal margin is considered to be enlarged. Above it has a convex diaphragmatic surface, and below it has an inferior or visceral surface. These parts are sometimes referred to as anterior, superior and posterior surfaces but there are no features that demarcate them from one another. Before proceeding to study the features to be seen on individual surfaces of the liver, it is necessary to briefly consider the basic peritoneal relationships of the organ. At an early stage in development, the stomach has a ventral mesogastrium that passes from its ventral border (future lesser curvature) to the developing diaphragm and anterior abdominal wall (28. After the formation of the liver the peritoneum of the ventral mesogastrium passes from the stomach to the liver, covers the greater part of the liver, and is then reflected from the liver to the diaphragm and anterior abdominal wall (28.