Anatomia Veziculei Biliare

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<div class="outer_page only_ie6_border " id="outer_page_3" style="width: 347.6 48px; height: 450px;"> <div class="newpage" id="page3" style="width: 902px; height: 1167px; -moztransform: scale(0.385419); -moz-transform-origin: left top; display: block;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff2" style="font-size:117px"> <span class="a" style="left:2009px;top:743px">CUPRINS:</span><span class="a" sty le="left:663px;top:1218px">INTRODUCERE</span><span class="a" style="left:663px;t op:1455px;word-spacing:-2px">Cap. I. NOIUNI DE ANATOMIE I FIZIOLOGIE.</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:929px;top:1573px;word-spacing:-10px;letter-spacing:4 px">1.<span class="l9">1<span class="w" style="width:77px"></span>An<span class= "l9">at<span class="l9">om<span class="l9">ia f<span class="l7">ic<span class="l 8">at<span class="l9">ul<span class="l9">ui<span class="l8">.</span></span></spa n></span></span></span></span></span></span></span><span class="a" style="left:9 29px;top:1692px;word-spacing:-8px;letter-spacing:3px">1.<span class="l7">2<span class="w" style="width:78px"></span>An<span class="l7">at<span class="l7">om<spa n class="l7">ia ve<span class="l8">zi<span class="l7">cu<span class="l6">le<span class="l7">i bil<span class="l8">ia<span class="l7">re<span class="l6">.</span> </span></span></span></span></span></span></span></span></span></span></span><sp an class="a" style="left:929px;top:1810px;word-spacing:4px;letter-spacing:2px">1 .3<span class="w" style="width:74px"></span>Fiz<span class="l7">iol<span class=" l7">ogi<span class="l7">a <span class="l9">vez<span class="l7">icu<span class="l 7">lei <span class="l12">bil<span class="l7">iar<span class="l7">e.</span></span ></span></span></span></span></span></span></span></span><span class="a" style=" left:1194px;top:1929px;word-spacing:-3px">1.3.1. Bila. Proprietile i compoziia bilei .</span><span class="a" style="left:1194px;top:2048px;word-spacing:-3px">1.3.2. Rolul srurilor biliare n digestie.</span><span class="a" style="left:1194px;top:21 66px;word-spacing:-3px">1.3.3. Mecanismul secreie biliare. Eliminarea bilei.</spa n><span class="a" style="left:1194px;top:2285px;word-spacing:-3px">1.3.4. Reglar ea secreiei i excreiei <span class="w6"></span>biliare.</span><span class="a" style ="left:1194px;top:2404px;word-spacing:-4px">1.3.5. Funciile veziculei biliare.</s pan><span class="a" style="left:1194px;top:2522px;word-spacing:-3px">1.3.6. Funci ile cii biliare principale.</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:2760px;word-spacing:-2px">Cap. II. PATOLOG IA LITIAZEI BILIARE.</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:929px;top:2878px;word-spacing:21px">2.1 Definiie.</sp an><span class="a" style="left:929px;top:2997px;word-spacing:2px">2.2 <span clas s="w" style="width:22px"></span>Inciden. F<span class="l6">actori etiolog<span cla
ss="l6">ici i f<span class="l6">avorizani.</span></span></span></span><span class= "a" style="left:929px;top:3115px;word-spacing:21px">2.3 Etiopatogenie.</span><sp an class="a" style="left:929px;top:3234px;word-spacing:3px">2.4 <span class="w" style="width:21px"></span>Simptomatologie <span class="l8">i exam<span class="l6" >en obiectiv.</span></span></span><span class="a" style="left:929px;top:3353px;w ord-spacing:5px">2.5 <span class="w" style="width:19px"></span>Investigaii <span class="l8">de <span class="l6">laborator.</span></span></span><span class="a" st yle="left:929px;top:3471px;word-spacing:9px">2.6 Diagnosticul pozitiv.</span><sp an class="a" style="left:929px;top:3590px;word-spacing:8px">2.7 Diagnosticul dif erenial.</span><span class="a" style="left:929px;top:3709px;word-spacing:21px">2. 8 Complicaii.</span><span class="a" style="left:929px;top:3827px;word-spacing:21p x">2.9 Tratament.</span><span class="a" style="left:929px;top:3946px;word-spacin g:-4px">2.10 Evoluie. Pronostic.</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:4184px;word-spacing:-3px">Cap. III. METODE DE <span class="w7"></span>INVESTIGARE</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:929px;top:4302px;letter-spacing:3px">3.<span class=" l7">1<span class="w" style="width:51px"></span>Co<span class="l7">le<span class= "l7">ci<span class="l6">st<span class="l7">og<span class="l7">ra<span class="l6" >fi<span class="l7">a.</span></span></span></span></span></span></span></span></ span><span class="a" style="left:929px;top:4421px;letter-spacing:3px">3.<span cl ass="l7">2<span class="w" style="width:51px"></span>Co<span class="l7">la<span c lass="l7">ng<span class="l7">io<span class="l6">gr<span class="l7">af<span class ="l7">ia<span class="l7">.</span></span></span></span></span></span></span></spa n></span><span class="a" style="left:929px;top:4539px;word-spacing:-10px;letterspacing:3px">3.<span class="l7">3<span class="w" style="width:51px"></span>Tu<sp an class="l7">ba<span class="l7">ju<span class="l7">l duo<span class="l6">de<spa n class="l7">na<span class="l7">l.</span></span></span></span></span></span></sp an></span><span class="a" style="left:929px;top:4658px;word-spacing:-5px;letterspacing:2px">3.4<span class="w" style="width:47px"></span>Tub<span class="l8">aj u<span class="l7">l duo<span class="l6">den<span class="l7">al mi<span class="l7 ">nut<span class="l7">at.</span></span></span></span></span></span></span><span class="a" style="left:929px;top:4776px;letter-spacing:4px">3.<span class="l9">5< span class="w" style="width:50px"></span>Ec<span class="l9">og<span class="l9">r a<span class="l9">fi<span class="l8">a.</span></span></span></span></span></span ><span class="a" style="left:929px;top:4895px;word-spacing:-5px;letter-spacing:2 px">3.6<span class="w" style="width:47px"></span>Alt<span class="l8">e met<span class="l6">ode d<span class="l7">e inv<span class="l6">est<span class="l7">iga<s pan class="l7">re.</span></span></span></span></span></span></span></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2233px;top:5473px">3</span></div> </div> </div> </div> <div <div <div <div <div <div <div <div class="b_tl"></div> class="b_tr"></div> class="b_br"></div> class="b_bl"></div> class="b_t"></div> class="b_r"></div> class="b_b"></div> class="b_l"></div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_4" styl e="width: 347.648px; height: 450px;"><div class="newpage" id="page4" style="widt h: 902px; height: 1167px; display: none; -moz-transform: scale(0.385419); -moz-t ransform-origin: left top;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff2" style="font-size:117px"> <span class="a" style="left:1207px;top:540px;word-spacing:-2px">CAP. I. NOIUNI DE ANATOMIE I FIZIOLOGIE</span><span class="a" style="left:1703px;top:718px;word-sp acing:-4px">1.1. ANATOMIA FICATULUI</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:1251px;word-spacing:4px">Ficatul este cea mai mare gland anex a tubului digestiv abdominal i din corpul</span><span class="a" style="left:398px;top:1429px;word-spacing:-2px">uman, att n perioada de dezvoltar e embrional i fetal ct i la <span class="w6"></span>adult.</span><span class="a" styl e="left:663px;top:1607px;word-spacing:-4px">Are multiple funcii:</span></div> <div class="ff3" style="font-size:38px"> <span class="a" style="left:995px;top:1833px"></span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1179px;top:1795px;word-spacing:-2px">funcia de produc ere a bilei;</span></div>
<div class="ff3" style="font-size:38px"> <span class="a" style="left:995px;top:2026px"></span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1179px;top:1987px;word-spacing:-4px">funcii metabolic e multiple</span></div> <div class="ff5" style="font-size:47px"> <span class="a" style="left:663px;top:2217px">o</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1433px;top:2170px;word-spacing:-4px"> prelucrar ea substanelor absorbite prin mucoasa <span class="w6"></span>intestinal;</span></ div> <div class="ff3" style="font-size:38px"> <span class="a" style="left:371px;top:2409px"></span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:2370px;word-spacing:-6px">funcia hemodinami c</span></div> <div class="ff5" style="font-size:41px"> <span class="a" style="left:1459px;top:2606px">o</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1679px;top:2553px;word-spacing:15px;letter-spacing:2 px">int<span class="l7">erv<span class="l8">ine <span class="w" style="width:13p x"></span>n <span class="w" style="width:15px"></span>dis<span class="l7">tri<spa n class="l6">bu<span class="l7">ia <span class="w" style="width:15px"></span>mas< span class="l7">ei <span class="w" style="width:15px"></span>cir<span class="l6" >cul<span class="l7">ato<span class="l8">rii <span class="w" style="width:13px"> </span>san<span class="l7">gvi<span class="l7">ne <span class="w" style="width:1 6px"></span>din</span></span></span></span></span></span></span></span></span></ span></span></span><span class="a" style="left:1459px;top:2736px;word-spacing:7p x;letter-spacing:1px">organism, repartiznd i depozitnd snge dup necesiti, de</span>< n class="a" style="left:1459px;top:2914px;word-spacing:-1px">aici rezult c greutat ea sa este variabil la omul viu, ea fiind de</span><span class="a" style="left:14 59px;top:3092px;word-spacing:-3px">1/50 din greutatea corpului la <span class="w 6"></span>adult.</span><span class="a" style="left:663px;top:3269px;word-spacing :5px">Ficatul este o gland de constituie elastic, iar dimensiunile sale sunt variab ile n</span><span class="a" style="left:398px;top:3448px;word-spacing:8px;letterspacing:2px">raport cu vrsta i cu tipul constituional 22-25 cm diametrul transversa l, 15-22 cm</span><span class="a" style="left:398px;top:3625px;word-spacing:-4px ">diametrul antero-posterior, 5-10 cm diametrul vertical (nlime).</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:3982px;word-spacing:-8px">Situaie topogrifi c</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:4160px;word-spacing:-2px">Ficatul este sit uat n <span class="w6"></span>etajul abdominal supramezocolic sub bolta diafragma tic unde</span><span class="a" style="left:398px;top:4337px;word-spacing:14px;let ter-spacing:3px">oc<span class="l7">up<span class="l6"> <span class="w" style="wi dth:21px"></span>lo<span class="l7">ja <span class="w" style="width:19px"></span >he<span class="l7">pa<span class="l7">ti<span class="l6">c <span class="w" style ="width:18px"></span>de<span class="l7">li<span class="l6">mi<span class="l8">ta <span class="l6">t <span class="w" style="width:18px"></span>su<span class="l7">p e<span class="l6">ri<span class="l7">or<span class="l7">, <span class="w" style= "width:21px"></span>po<span class="l7">st<span class="l6">er<span class="l7">io< span class="l6">r, <span class="w" style="width:18px"></span>la<span class="l6"> te<span class="l8">ra<span class="l6">l <span class="w" style="width:21px"></spa n>i <span class="w" style="width:19px"></span>an<span class="l7">te<span class="l 7">ri<span class="l6">or <span class="w" style="width:17px"></span>de <span clas s="w" style="width:18px"></span>mu<span class="l8">c<span class="l6">hi<span clas s="l7">ul</span></span></span></span></span></span></span></span></span></span>< /span></span></span></span></span></span></span></span></span></span></span></sp an></span></span></span></span></span></span><span class="a" style="left:398px;t
op:4516px;word-spacing:-3px">diafragm, iar inferior de colonul i <span class="w6" ></span>mezocolonul transvers.</span><span class="a" style="left:745px;top:4693p x;word-spacing:22px;letter-spacing:4px">Fi<span class="l9">ca<span class="l9">tu <span class="l8">l <span class="w" style="width:24px"></span>se <span class="w" style="width:22px"></span>p<span class="l6">ro<span class="l8">ie<span class="l9 ">ct<span class="l8">ea<span class="l9">z <span class="w" style="width:21px"></sp an>pe <span class="w" style="width:20px"></span>pe<span class="l8">re<span class ="l9">te<span class="l8">le <span class="w" style="width:21px"></span>an<span cl ass="l9">te<span class="l9">ri<span class="l9">or <span class="w" style="width:2 1px"></span>al <span class="w" style="width:20px"></span>ab<span class="l9">do<s pan class="l8">me<span class="l9">nu<span class="l9">lu<span class="l9">i <span class="w" style="width:25px"></span>n <span class="w" style="width:20px"></span>r e<span class="l8">gi<span class="l9">un<span class="l9">ea</span></span></span>< /span></span></span></span></span></span></span></span></span></span></span></sp an></span></span></span></span></span></span></span></span><span class="a" style ="left:398px;top:4872px;word-spacing:7px">hipocondrului drept, n partea superioar a epigastrului i partea stng a hipocondrului</span><span class="a" style="left:398p x;top:5049px;word-spacing:-2px">stng. Loja hepatic comunic larg cu loja gastric.</sp an></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2233px;top:5473px">4</span></div> </div> </div> <div class="image_layer" style="z-index: 3"> <div class="ie_fix"> <img src="ANATOMIA-VEZICULEI-BILIARE_files/4-ffe7a4b14f.png" class="absimg" styl e="left: 239px; top: 125px; width: 475px; height: 39px; clip: rect(1px, 474px, 3 8px, 1px); display: block;"> </div> </div> </div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_5" style ="width: 347.648px; height: 450px;"><div class="newpage" id="page5" style="width : 902px; height: 1167px; display: none; -moz-transform: scale(0.385419); -moz-tr ansform-origin: left top;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:336px;word-spacing:6px;letter-spacing:2px" >Ficatul este delimitat superior de o linie care trece prin coasta a v-a de part ea</span><span class="a" style="left:398px;top:514px;word-spacing:-1px">dreapt i c oboar oblic spre stnga i inferior de o <span class="w6"></span>linie ce unete rebord ul costal drept la</span><span class="a" style="left:398px;top:692px;word-spacin g:2px;letter-spacing:1px">nivelul coastei a XI-a cu cel stng la nivelul coastei a VIII-a trecnd pe sub apendicele</span><span class="a" style="left:398px;top:870p x">xifoid.</span><span class="a" style="left:663px;top:1048px;word-spacing:-3px" >Posterior se proiecteaz pe ultimele trei <span class="w7"></span>vertebre lombar e.</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:1404px;word-spacing:-7px">Configuraia exter n</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:1582px;word-spacing:9px">Ficatul este un a <span class="l6">void <span class="w" style="width:33px"></span>secionat oblic, < span class="l6">cu extremitatea m<span class="l6">are orientat la <span class="l6 ">dreapta i</span></span></span></span></span><span class="a" style="left:398px;t op:1760px;word-spacing:-3px">fa convex superior.</span><span class="a" style="left: 663px;top:1938px;word-spacing:-2px">Are dou fee:</span><span class="a" style="left :929px;top:2115px;word-spacing:2px">- superioar<span class="l6"> <span class="w" style="width:24px"></span>(convex) <span class="l6">sau faa <span class="l6">diafr agmatic;</span></span></span></span><span class="a" style="left:929px;top:2294px; word-spacing:-3px">- inferioar (plan sau faa <span class="w6"></span>visceral)</span ><span class="a" style="left:663px;top:2471px;word-spacing:-3px">Are dou margini: </span><span class="a" style="left:929px;top:2650px;word-spacing:-3px">- inferio ar, ascuit care nu <span class="w6"></span>depete rebordul costal drept;</span><span lass="a" style="left:929px;top:2827px;word-spacing:-3px">- posterioar, rotunjit n r aport cu <span class="w6"></span>diafragmul.</span><span class="a" style="left:6 63px;top:3006px;word-spacing:-3px">Pe faa diafragmatic a ficatului, peritoneul tre ce de <span class="w7"></span>pe ficat pe <span class="w6"></span>diafragm, formn d</span><span class="a" style="left:398px;top:3183px;word-spacing:-3px">o plic sa gital numit <span class="w6"></span>ligamentul falciform sau suspensor care conine n <span class="w6"></span>el ligamentul</span><span class="a" style="left:398px;t op:3362px;word-spacing:-3px">falciform sau suspensor care conine n <span class="w7 "></span>el ligamentul rotund al ficatului care marcheaz</span><span class="a" st yle="left:398px;top:3539px;word-spacing:-3px">limita anatomic dintre lobul drept i
<span class="w6"></span>stng.</span><span class="a" style="left:663px;top:3718px ;word-spacing:-2px">Faa visceral are 2 anuri, anul anul sagital drept i <span clas </span>sagital stng mprite</span><span class="a" style="left:398px;top:3895px;word-s pacing:-3px">fiecare n dou jumti printr-un an transversal.</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:4252px">Raporturi</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:4429px;word-spacing:-3px">Faa diafragmatic v ine n raport prin <span class="w6"></span>diafragm cu baza plmnului drept, inim i</sp an><span class="a" style="left:372px;top:4607px;word-spacing:-3px"> pemcard care la nivelul lobului stng <span class="w7"></span>formeaz impresiunea cardiac a ficatului.</span><span class="a" style="left:663px;top:4785px;word-spacing:-3px ">Faa visceral vine n <span class="w7"></span>raport cu rinichiul drept, glanda sup rarenal dreapt, duoden,</span><span class="a" style="left:398px;top:4963px;word-sp acing:-3px">flexura dreapt a colonului, faa anterioar a <span class="w6"></span>sto macului i esofagului abdominal. Toate</span><span class="a" style="left:398px;top :5141px;word-spacing:-2px">acestea las pe faa visceral impresiuni cu acelai nume.</s pan></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2233px;top:5473px">5</span></div> </div> </div> </div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_6" style=" width: 347.648px; height: 450px;"><div class="newpage" id="page6" style="width: 902px; height: 1167px; display: none; -moz-transform: scale(0.752772); -moz-tran sform-origin: left top;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:515px;word-spacing:-9px">Segmentaia ficatul ui</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:692px;word-spacing:-2px">Limita real ntre lo bul stng i lobul drept este linia ce <span class="w7"></span>trece pe faa visceral p rin</span><span class="a" style="left:398px;top:870px;word-spacing:-2px">fosa ve ziculei biliare i anul venei cave inferioare, iar pe faa diafragmatic limita se</span ><span class="a" style="left:372px;top:1048px;word-spacing:-3px"> proiectea z la dou laturi de <span class="w7"></span>deget la dreapta ligamentului falciform .</span><span class="a" style="left:663px;top:1226px;word-spacing:-2px">Lobul stn g are un segment lateral i altul medial ce <span class="w6"></span>se ntinde ntre c ele dou</span><span class="a" style="left:398px;top:1404px;word-spacing:-3px">anuri sagitale cuprinznd lobul ptrat i <span class="w6"></span>caudat.</span><span class ="a" style="left:663px;top:1582px;word-spacing:-3px">Lobul drept este alctuit <sp an class="w6"></span>dintr-un segment anterior i unul posterior, limita dintre</s pan><span class="a" style="left:398px;top:1760px;word-spacing:-3px">ele fiind fi sura segmentului drept.</span><span class="a" style="left:663px;top:1938px;wordspacing:-3px">Fiecare din cele patru segmente <span class="w6"></span>are cte un <span class="w6"></span>pedicul segmentar, format din ramura</span><span class=" a" style="left:398px;top:2115px;word-spacing:-3px">segmentar, un canal biliar seg mentar, o <span class="w6"></span>ramur segmentar a venei porte, n <span class="w7" ></span>fisura</span><span class="a" style="left:398px;top:2294px;word-spacing:2px">segmentului drept se gsete vena hepatic dreapt, iar n cea stng, vena hepatic</ <span class="a" style="left:398px;top:2471px">stng.</span><span class="a" style="l eft:663px;top:2650px;word-spacing:-3px">Structura microscopica a ficatului. Fica tul este un <span class="w6"></span>organ intraperitoneal acoperit cu</span><spa n class="a" style="left:372px;top:2827px;word-spacing:-3px"> peritoneul vis ceral hepatic i este <span class="w7"></span>alctuit dintr-o strom conjunctiv i din c elule</span><span class="a" style="left:398px;top:3006px;word-spacing:-3px">hepa tice. Stroma conjunctiv cuprinde o membran de nveli (Capsula <span class="w6"></span >Gilsson) din care</span><span class="a" style="left:372px;top:3183px;word-spaci ng:-3px"> pleac septuri conjunctive n interiorul parenchimului hepatic care d elimiteaz nuiti mai</span><span class="a" style="left:398px;top:3362px;word-spacing :-3px">mici numite lobuli hepatici.</span><span class="a" style="left:663px;top: 3539px;word-spacing:-3px">Unitatea structural i funcional a ficatului este <span cla ss="w7"></span>lobului hepatic format din celule</span><span class="a" style="le ft:398px;top:3718px;word-spacing:-3px">hepatice numite hepatocite, capilare sinu soide care provin din <span class="w6"></span>ramificaiile cenei parte i</span><sp an class="a" style="left:398px;top:3895px;word-spacing:-3px">converg ctre vena co ntralobular sau central i <span class="w7"></span>din canalicule biliare.</span><sp an class="a" style="left:663px;top:4073px;word-spacing:-2px">Hepatocitele sunt d ispuse sub form de plci celulare anastomozate ntre ele, ce</span><span class="a" st yle="left:398px;top:4251px;word-spacing:-3px">formeaz o reea tridimensional, cu dis
poziie radical ctre <span class="w6"></span>vena central.</span><span class="a" styl e="left:663px;top:4429px;word-spacing:-2px">n ochiurile acestei reele se afl capila rele sinusoide. ntre feele celulare care vin</span><span class="a" style="left:398 px;top:4607px;word-spacing:-2px">n contact se afl canaliculele biliare intrahepati ce care nu au perei proprii i n care</span><span class="a" style="left:398px;top:47 85px;word-spacing:-3px">hepatocitele i vars produii de <span class="w7"></span>secrei e (bila). Ctre periferie i formeaz peretele</span><span class="a" style="left:372px; top:4963px;word-spacing:-3px"> propriu numit colangiol. Aceste canalicule bi liare se continu cu <span class="w8"></span>canalele intralobulare</span><span cl ass="a" style="left:398px;top:5141px;word-spacing:-2px">care se vars n mai multe c anale <span class="w6"></span>interlobare.</span></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2233px;top:5473px">6</span></div> </div> </div> </div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_7" style="w idth: 347.648px; height: 450px;"><div class="newpage" id="page7" style="width: 9 02px; height: 1167px; -moz-transform: scale(0.752772); -moz-transform-origin: le ft top; display: none;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:336px;word-spacing:-3px">Pereii capilarelor sinusoide sunt formai din celule litorale <span class="w6"></span>sau Kupfter ce aparin</span><span class="a" style="left:398px;top:514px;word-spacing:-3px">sist emului reticuloendotelial (macrofa<span class="l6">ge) cu funcie fagocitar i <span class="w7"></span>cu rol metabolic pentru</span></span><span class="a" style="le ft:398px;top:692px;word-spacing:-2px">c ele ncep transformarea metabolic a substanel or luate care este continuat de</span><span class="a" style="left:398px;top:870px ">hepatocite.</span><span class="a" style="left:663px;top:1048px;word-spacing:-2 px">La periferie spaiul dintre doi sau trei lobuli nvecinai se cheam spaiul portal</s pan><span class="a" style="left:398px;top:1226px;word-spacing:-2px">interlobular , de unde pleac o ramur interlobular a venei porte, una a arterei hepatice i</span>< span class="a" style="left:398px;top:1404px;word-spacing:-3px">un canal biliar i nterlobular, limfatice i nervi.</span><span class="a" style="left:663px;top:1582p x;word-spacing:12px;letter-spacing:1px">Ramurile-interlobulare ale venei porte s e ramific i se deschid ntr-un capilar </span><span class="a" style="left:398px ;top:1760px;word-spacing:7px;letter-spacing:1px">sinusoid periportal n care se de schide vena centrolobular, care reprezint captul de</span><span class="a" style="le ft:398px;top:1938px;word-spacing:-1px">origine al venelor hepatice care transpor t sngele din <span class="w6"></span>ficat n vena cav <span class="w7"></span>inferi oar. Toate</span><span class="a" style="left:398px;top:2115px;word-spacing:-2px"> vasele, arteriale, venoase din lobul <span class="w6"></span>au sfinctere la niv elul <span class="w6"></span>fiecrei ramificaii care regleaz</span><span class="a" style="left:398px;top:2294px;word-spacing:-3px">fluxul sanguin n ficat.</span></d iv> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:2650px;word-spacing:-4px">Vascularizaia i in ervaia ficatului</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:2827px;word-spacing:2px;letter-spacing:1px ">Vascularizaia nutritiv este dat de artera hepatic, ramur a arterei celiace care</sp an><span class="a" style="left:398px;top:3006px;word-spacing:8px;letter-spacing: 2px">aduce la ficat sngele oxigenat i la nivelul nilului se ramific ntr-o ramur lobar /span><span class="a" style="left:398px;top:3183px;word-spacing:1px">dreapt i alta stng iar aceasta n ramuri segmentare, ultimele ramificaii fiind ramurile</span><spa n class="a" style="left:398px;top:3362px;word-spacing:-3px">din spaiile portale.< /span><span class="a" style="left:663px;top:3539px;word-spacing:2px;letter-spaci ng:1px">Vascularizaia funcional este asigurat de vena port care adun sngele venos</s ><span class="a" style="left:398px;top:3718px;word-spacing:3px">din tot tubul di gestiv sub diafragmatici care la nivelul hilului hepatic d o ramur lobar</span><spa n class="a" style="left:398px;top:3895px;word-spacing:15px;letter-spacing:2px">d re<span class="l7">apt<span class="l7"> <span class="w" style="width:14px"></span >i <span class="w12"></span>alt<span class="l7">a <span class="w" style="width:14 px"></span>st<span class="l7">ng<span class="l7">, <span class="w" style="width:15 px"></span>din <span class="w8"></span>car<span class="l7">e <span class="w" sty le="width:14px"></span>ple<span class="l7">ac <span class="w9"></span>ram<span cl ass="l7">ur<span class="l6">ile <span class="w10"></span>seg<span class="l7">men <span class="l8">tar<span class="l6">e, <span class="w12"></span>ult<span class= "l7">ime<span class="l7">le <span class="w11"></span>ei <span class="w12"></span >ram<span class="l8">ifi<span class="l7">ca<span class="l7">ii</span></span></spa n></span></span></span></span></span></span></span></span></span></span></span>< /span></span></span></span><span class="a" style="left:398px;top:4073px;word-spa cing:1px">capilarizndu-se n <span class="l7">lobul <span class="w" style="width:22
px"></span>dnd natere ca<span class="l6">pilarelor sisnuso<span class="l6">ide.</s pan></span></span></span><span class="a" style="left:663px;top:4251px;word-spaci ng:3px">Sngele venos al ficatului este drenat n vena cav inferioar prin venele hepat ice:</span><span class="a" style="left:398px;top:4429px;word-spacing:1px">dreapt, medie i stng; originea lor fiind n venele centrale la nivelul lobulului hepatic,</s pan><span class="a" style="left:398px;top:4607px;word-spacing:-2px">unde se vars capilarele sinusoide, cele 3 vene hepatice.</span><span class="a" style="left:66 3px;top:4785px;word-spacing:9px">Limfaticele ficatului dreneaz limfa spre ganglio nii hepatici i celiaci pentru faa</span><span class="a" style="left:398px;top:4963 px;word-spacing:18px;letter-spacing:2px">inf<span class="l7">eri<span class="l7" >oar<span class="l7"> <span class="w" style="width:15px"></span>i <span class="w" style="width:13px"></span>n <span class="w" style="width:13px"></span>cei <span c lass="w11"></span>ste<span class="l7">rna<span class="l7">li, <span class="w11"> </span>med<span class="l7">ias<span class="l7">tin<span class="l7">ali <span cla ss="w11"></span>ant<span class="l7">eri<span class="l7">ori <span class="w10"></ span>i <span class="w" style="width:13px"></span>pan<span class="l7">cre<span cla ss="l7">oti<span class="l7">col<span class="l7">ien<span class="l7">ali <span cl ass="w11"></span>pen<span class="l7">tru <span class="w10"></span>fa<span class=" l6">a</span></span></span></span></span></span></span></span></span></span></spa n></span></span></span></span></span></span></span><span class="a" style="left:3 98px;top:5141px">diafragmatic.</span></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2233px;top:5473px">7</span></div> </div> </div> </div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_8" style=" width: 347.648px; height: 450px;"> <div class="newpage" id="page8" style="width: 902px; height: 1167px; -moztransform: scale(0.752772); -moz-transform-origin: left top; display: none;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:336px;word-spacing:6px;letter-spacing:1px" >Inervaia este asigurat de fibre care mpreun cu artera hepatic vin din plexul</span>< span class="a" style="left:398px;top:514px;word-spacing:-2px">celiac i din fibre parasimpatice din nervul vag.</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:871px;word-spacing:-4px">Cile biliare intra hepatice i <span class="w7"></span>extrahepati<span class="l6">ce</span></span></ div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:1048px;word-spacing:14px;letter-spacing:2p x">Ci<span class="l7">le <span class="w9"></span>bil<span class="l7">ia<span clas s="l6">re <span class="w8"></span>int<span class="l7">rah<span class="l7">epa<sp an class="l7">tic<span class="l7">e <span class="w" style="width:64px"></span>nc< span class="l7">ep <span class="w7"></span>din canal<span class="l7">icu<span cl ass="l6">lel<span class="l7">e <span class="w9"></span>bil<span class="l6">iar<s pan class="l7">e <span class="w9"></span>int<span class="l7">ral<span class="l6" >obu<span class="l8">lar<span class="l7">e <span class="w9"></span>car<span clas s="l7">e <span class="w11"></span>se</span></span></span></span></span></span></ span></span></span></span></span></span></span></span></span></span></span></spa n></span><span class="a" style="left:398px;top:1226px;word-spacing:4px">continu c u canalele din spaiul port i apropierea hilului din confluena lor se formeaz</span>< span class="a" style="left:398px;top:1404px;word-spacing:1px;letter-spacing:1px" >un canal drept i unul stng , iar prin unirea acestor dou canale rezult canalul hepa tic</span><span class="a" style="left:398px;top:1582px">comun.</span><span class ="a" style="left:663px;top:1760px;word-spacing:10px;letter-spacing:1px">De aici, ncep cile biliare extrahepatice care sunt reprezentate de calea biliar</span><span class="a" style="left:372px;top:1938px;word-spacing:10px;letter-spacing:1px">&n bsp;principal care rezult din unirea canalului hepatic comun cu canalul coledoc i c are</span><span class="a" style="left:398px;top:2115px;word-spacing:5px">transpo rt bila n duoden i de vezicula biliar care este de fapt un rezervor de bil care</span ><span class="a" style="left:372px;top:2294px;word-spacing:7px;letter-spacing:2p x"> pr<span class="l7">in canal<span class="l7">ul cisti<span class="l7">c <span class="w6"></span>se vars n <span class="w6"></span>col<span class="l7">edo< span class="l7">c <span class="w6"></span>i prin care vezi<span class="l6">cul<sp an class="l7">a <span class="w7"></span>bi<span class="l6">lia<span class="l6">r se <span class="w8"></span>lea<span class="l7">g <span class="w" style="width:48p x"></span>de calea</span></span></span></span></span></span></span></span></span ></span></span><span class="a" style="left:372px;top:2471px;word-spacing:-6px">& nbsp;biliar principal.</span></div> <div class="ff1" style="font-size:99px">
<span class="a" style="left:2233px;top:5473px">8</span></div> </div> </div> </div> <div <div <div <div <div <div <div <div class="b_tl"></div> class="b_tr"></div> class="b_br"></div> class="b_bl"></div> class="b_t"></div> class="b_r"></div> class="b_b"></div> class="b_l"></div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_9" style=" width: 347.648px; height: 450px;"> <div class="newpage" id="page9" style="width: 902px; height: 1167px; -moztransform: scale(0.752772); -moz-transform-origin: left top; display: none;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff2" style="font-size:117px"> <span class="a" style="left:1485px;top:515px;word-spacing:-3px">1.2 ANATOMIA VEZ ICULEI BILIARE</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:870px;word-spacing:-1px">Vezicula biliar (f esica fellea sau colecistul) este un diverticul biliar care constituie</span><sp an class="a" style="left:398px;top:1048px;word-spacing:1px;letter-spacing:1px">u
n organ de depozit i concentrare a bilei. Secreia biliar a ficatului este continu ns< span><span class="a" style="left:398px;top:1226px;word-spacing:4px">evacuarea ei n intestin este ritmat de perioade digestive, n perioada interdigestiv bila</span>< span class="a" style="left:398px;top:1404px;word-spacing:4px">este depozitat n vez icula biliar unde se concentreaz de aproape dou zeci de ori prin</span><span class= "a" style="left:398px;top:1582px;word-spacing:6px;letter-spacing:1px">absoria ape i i a srurilor anorganice, volumul de bil secretat pe o perioad de timp</span><span class="a" style="left:398px;top:1760px;word-spacing:-3px">adaptndu-se capacitii red use a veziculei biliare.</span><span class="a" style="left:663px;top:1938px;word -spacing:2px">Vezicula biliar este situat n fosa veziculei biliare de pe faa viscera l a ficatului</span><span class="a" style="left:398px;top:2115px;word-spacing:-3p x">n segmentul anterior al anului <span class="w6"></span>sagital drept.</span><spa n class="a" style="left:663px;top:2294px;word-spacing:1px">Este un organ cavitar avoid, n form de par sau piriform cu o lungime medie de</span><span class="a" style ="left:398px;top:2471px;word-spacing:-2px">8-10 cm i o grosime de 3-4 cm <span cl ass="w6"></span>i are trei poriuni:</span></div> <div class="ff0" style="font-size:31px"> <span class="a" style="left:663px;top:2699px"> </span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1194px;top:2659px;word-spacing:10px;letter-spacing:1 px">fundul veziculei biliare este poriunea mai dilatat i este orientat</span><span c lass="a" style="left:663px;top:2837px;word-spacing:8px;letter-spacing:2px">spre marginea inferioar a ficatului care prezint la acest nivel o incizur. Se</span><spa n class="a" style="left:637px;top:3015px;word-spacing:6px;letter-spacing:1px">&n bsp;priecteaz pe peretele anterior al abdomenului la locul unde ntlnete cartilajul</ span><span class="a" style="left:663px;top:3193px;word-spacing:-2px">coastei a X I-a, cnd volumul ei crete n cazuri patologice;</span></div> <div class="ff0" style="font-size:31px"> <span class="a" style="left:663px;top:3420px"> </span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1194px;top:3381px;word-spacing:9px;letter-spacing:1p x">corpul veziculei biliare continu fundul veziculei biliare n direcie</span><span class="a" style="left:663px;top:3558px;word-spacing:9px;letter-spacing:2px">asce ndent i spre hil. Faa care privete spre ficat ader de aceasta printr-un</span><span c lass="a" style="left:663px;top:3737px;word-spacing:5px;letter-spacing:1px">mezou numit mezocit. Faa opus sau liber a veziculei biliare vine n raport cu</span><span class="a" style="left:663px;top:3914px;word-spacing:-3px">colonul transversal i c u <span class="w6"></span>partea superioar i descendent a <span class="w6"></span>d uodenului;</span></div> <div class="ff0" style="font-size:31px"> <span class="a" style="left:663px;top:4142px"> </span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:1194px;top:4102px;word-spacing:2px">colul veziculei biliare este o dilataie conic ce se continu cu canalul</span><span class="a" style= "left:663px;top:4280px;word-spacing:-1px">cistic. n unghiul dintre corp i col cu d eschidere spre stnga, se gsete deseori, un</span><span class="a" style="left:663px; top:4458px;word-spacing:-4px">ganglion Mascagni limfatic.</span></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:4992px;word-spacing:-5px">Structura vezicu lei biliare</span></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2233px;top:5473px">9</span></div> </div> </div> <div class="image_layer" style="z-index: 1"> <div class="ie_fix"> <img src="ANATOMIA-VEZICULEI-BILIARE_files/9-daf5f95d17.jpg" class="absimg" styl e="left: 295px; top: 120px; width: 364px; height: 3px; clip: rect(1px, 363px, 2p x, 1px); display: block;"> </div>
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<div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:336px;word-spacing:2px">Peretele este form at din 4 straturi: La exterior se gsete tunica seroas, iar pe fa</span><span class="a " style="left:398px;top:514px;word-spacing:3px;letter-spacing:1px">lipit de perit oneu, esut conjunctiv. Sub peritoneu se afl stratul subseros care este un</span><s pan class="a" style="left:398px;top:692px;word-spacing:-2px">spaiu de clivaj cu v ase i <span class="w6"></span>nervi, pe care l folosesc chirurgii n colecistectomii .</span><span class="a" style="left:663px;top:870px;word-spacing:-1px">Malformaii le biliare congenitale pot fi severe, incompatibile cu <span class="w6"></span>v iaa. Cele minore</span><span class="a" style="left:398px;top:1048px;word-spacing: -3px">rmn asimptomatice, dar destul de frecvent evolueaz <span class="w6"></span>cu simptome dispeptice biliare.</span><span class="a" style="left:663px;top:1226px ;word-spacing:9px">Anomaliile ctigate sunt consecine ale altor afeciuni biliare (inf lamaii, litiaz,</span><span class="a" style="left:398px;top:1404px">etc.).</span>< /div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:1760px;word-spacing:-5px">Anomaliile vezic ulei biliare</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:1938px;word-spacing:1px">Anomaliile de for m sunt diagnosticate colecistografic: vezicul bilobat, vezicul</span><span class="a" style="left:398px;top:2115px;word-spacing:8px;letter-spacing:1px">n ceas de nisi p, n bonet frigian, vezicul septat, etc. Staza i inflamia datorit</span><span cla yle="left:398px;top:2294px;word-spacing:-3px">dificultilor de evacuare pot favoriz a apariia calculilor.</span><span class="a" style="left:663px;top:2471px;word-spa cing:18px;letter-spacing:1px">Diver<span class="l6">ticu<span class="l6">lii <sp an class="w8"></span>vezic<span class="l7">ulei <span class="w7"></span>bilia<sp an class="l7">re-si<span class="l7">mptom<span class="l7">atici <span class="w6" ></span>cnd <span class="w6"></span>se <span class="w9"></span>comp<span class="l 6">lic <span class="w7"></span>cu <span class="w9"></span>infl<span class="l6">am ai<span class="l6">e <span class="w10"></span>sau</span></span></span></span></sp an></span></span></span></span></span><span class="a" style="left:398px;top:2650 px">litiaz.</span><span class="a" style="left:663px;top:2827px;word-spacing:16px; letter-spacing:2px">Ano<span class="l7">mal<span class="l7">iil<span class="l7"> e <span class="w" style="width:15px"></span>de <span class="w12"></span>poz<span class="l7">ii<span class="l6">e. <span class="w" style="width:13px"></span>Ace<s pan class="l7">ste<span class="l7">a <span class="w" style="width:15px"></span>p un <span class="w10"></span>pro<span class="l7">ble<span class="l8">me <span cla ss="w" style="width:13px"></span>deo<span class="l7">seb<span class="l7">ite <sp an class="w11"></span>n <span class="w12"></span>caz<span class="l7">ul <span cla ss="w" style="width:13px"></span>int<span class="l7">erv<span class="l7">en<span class="l7">iei</span></span></span></span></span></span></span></span></span></s pan></span></span></span></span></span></span><span class="a" style="left:398px; top:3006px;word-spacing:-4px">chirurgicale pentru litiaz complicat, frecvent ntlnit.< /span><span class="a" style="left:663px;top:3183px;word-spacing:6px">Vezicula bi liar poate fi situat intrahepatic, transvers, sub lobul hepatic stng, n</span><span class="a" style="left:398px;top:3362px;word-spacing:-4px">ligamentul falciform, suprahepatic, subcutanat etc.</span><span class="a" style="left:663px;top:3539px ;word-spacing:11px;letter-spacing:2px">Ano<span class="l7">mal<span class="l7">i il<span class="l7">e <span class="w" style="width:19px"></span>inf<span class="l 7">und<span class="l8">ibu<span class="l7">loc<span class="l7">ist<span class="l 6">ice <span class="w" style="width:14px"></span>sun<span class="l7">t <span cla ss="w" style="width:19px"></span>mai <span class="w" style="width:13px"></span>d es <span class="w" style="width:14px"></span>con<span class="l7">gen<span class= "l7">ita<span class="l7">le <span class="w" style="width:17px"></span>(cu<span c lass="l7">du<span class="l6">ri <span class="w" style="width:16px"></span>ale <s pan class="w" style="width:14px"></span>cis<span class="l7">tic<span class="l6"> ulu<span class="l7">i,</span></span></span></span></span></span></span></span></
span></span></span></span></span></span></span></span></span></span><span class= "a" style="left:398px;top:3718px;word-spacing:7px">lumen ngust etc.), mai rar sec undare unor aderente inflamatorii sau stenozei i fibrozei</span><span class="a" s tyle="left:398px;top:3895px">cisticului.</span><span class="a" style="left:663px ;top:4073px;word-spacing:-3px">Evolueaz cu simptome datorate diskineziei.</span>< span class="a" style="left:663px;top:4251px;word-spacing:5px">Anomaliile de numr. Colecistul dublu poate avea un singur canal cistic sau dou</span><span class="a" style="left:398px;top:4429px;word-spacing:17px;letter-spacing:2px">can<span cla ss="l7">ale <span class="w" style="width:15px"></span>sep<span class="l6">ara<sp an class="l7">te. <span class="w" style="width:16px"></span>Si<span class="l6">m to<span class="l7">mat<span class="l7">olo<span class="l7">gia <span class="w" s tyle="width:15px"></span>se <span class="w" style="width:17px"></span>dat<span c lass="l6">or<span class="l6">eaz<span class="l7"> <span class="w" style="width:21 px"></span>com<span class="l8">pli<span class="l7">ca<span class="l6">iil<span cl ass="l7">or <span class="w" style="width:17px"></span>(i<span class="l6">nfl<spa n class="l7">ama<span class="l7">ie<span class="l7">, <span class="w" style="widt h:20px"></span>lit<span class="l7">iaz<span class="l7">) <span class="w" style="w idth:18px"></span>i</span></span></span></span></span></span></span></span></span ></span></span></span></span></span></span></span></span></span></span></span></ span><span class="a" style="left:398px;top:4607px;word-spacing:-5px">diskineziei asociate.</span><span class="a" style="left:663px;top:4785px;word-spacing:4px;l etter-spacing:1px">Colecistul triplu este o raritate. Agenezia veziculei biliare nu produce perturbri</span><span class="a" style="left:398px;top:4963px;word-spa cing:-2px">digestive i poate fi nsoit de dilataia compensatorie a cilor biliare.</spa ></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2211px;top:5473px">10</span></div> </div> </div> <div class="image_layer" style="z-index: 3"> <div class="ie_fix"> <img src="ANATOMIA-VEZICULEI-BILIARE_files/10-c3f9dda740.png" class="absimg" sty le="left: 130px; top: 583px; width: 196px; height: 6px; clip: rect(1px, 195px, 2 px, 1px); display: block;"> <img src="ANATOMIA-VEZICULEI-BILIARE_files/10-c3f9dda740.png" class="absimg" sty le="left: 130px; top: 865px; width: 196px; height: 6px; clip: rect(4px, 180px, 5 px, 1px); display: block;"> </div> </div> </div> <div <div <div <div <div <div <div <div class="b_tl"></div> class="b_tr"></div> class="b_br"></div> class="b_bl"></div> class="b_t"></div> class="b_r"></div> class="b_b"></div> class="b_l"></div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_11" style=" width: 347.648px; height: 450px;"><div class="newpage" id="page11" style="width: 902px; height: 1167px; -moz-transform: scale(0.752772); -moz-transform-origin: left top; display: none;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:336px;word-spacing:8px;letter-spacing:2px" >Urmeaz tunica muscular care este o tunic fibromuscular, deoarece fibrele</span><spa n class="a" style="left:398px;top:514px;word-spacing:5px">musculare netede dispu se mai mult transversal fa de axul veziculei se intersecteaz cu</span><span class=" a" style="left:398px;top:692px;word-spacing:9px">fibre conjunctive i elastice. Sp re interior fibrele musculare au o dispoziie plexiform.</span><span class="a" styl e="left:398px;top:870px;word-spacing:3px;letter-spacing:1px">Vezicula biliar nu p osed submucoas, deoarece tunica mucoas cu stratul ei profund</span><span class="a" style="left:398px;top:1048px;word-spacing:3px">este aezat direct pe tunica muscula r. Mucoasa formeaz o serie de cute numite plicile</span><span class="a" style="lef t:398px;top:1226px;word-spacing:-3px">tunicii mucoase ale veziculei biliare.</sp an></div> <div class="ff2" style="font-size:117px"> <span class="a" style="left:663px;top:1582px;word-spacing:-3px">Vascularizaia i in ervaia cilor biliare</span></div> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:1760px;word-spacing:-3px">Vascularizaia cilo r biliare. Vezicula biliar are <span class="w6"></span>ca sursa <span class="w6"> </span>arterial principal, artera</span><span class="a" style="left:398px;top:1938 px;word-spacing:4px;letter-spacing:2px">cistic care are originea n ramura dreapt a arterei hepatice proprii. Ajunge la colul</span><span class="a" style="left:398p x;top:2115px;word-spacing:-2px">veziculei biliare i se ramific:</span><span class= "a" style="left:663px;top:2294px;word-spacing:-3px">- ramura anterioar care irig p eretele <span class="w6"></span>vezicii pe faa peritonal;</span><span class="a" st yle="left:663px;top:2471px;word-spacing:-3px">- ramura posterioar care irig perete le corespunztor fosei veziculei <span class="w6"></span>biliare.</span><span clas s="a" style="left:663px;top:2650px;word-spacing:6px">Aceste dou ramuri se anaston ozeaz la nivelul fundului veziculei biliare. Venele</span><span class="a" style=" left:398px;top:2827px;word-spacing:7px;letter-spacing:2px">de pe faa aderent se va rs n ramurile intrahepatice ale venei porte, iar venele din</span><span class="a"
style="left:372px;top:3006px;letter-spacing:1px"> pere<span class="l6">tele nvelit n <span class="w6"></span>perit<span class="l6">oneu forme<span class="l6" >az o <span class="w11"></span>singu<span class="l7">r ven <span class="w7"></span> cisti<span class="l6">c, care <span class="w7"></span>se <span class="w6"></span> vars<span class="l6"> <span class="w7"></span>n vena <span class="w8"></span>port< span class="l6"></span></span></span></span></span></span></span></span><span cla ss="a" style="left:398px;top:3183px;word-spacing:-2px">sau mai frecvent n ramura sa lobar dreapt.</span><span class="a" style="left:663px;top:3362px;word-spacing:1px">Venele cii biliare principale formeaz un <span class="w6"></span>plex venos p ericoledocian care dreneaz</span><span class="a" style="left:398px;top:3539px;wor d-spacing:-2px">n vena port i n afluenii si.</span><span class="a" style="left:663px; op:3718px;word-spacing:-3px">Limfaticele dreneaz limfa astfel:</span><span class= "a" style="left:663px;top:3895px;word-spacing:9px;letter-spacing:2px">- cele din partea aderent dreneaz parial limfa spre limfaticele din regiunea</span><span clas s="a" style="left:398px;top:4073px;word-spacing:-6px">nvecinat ficatului;</span><s pan class="a" style="left:663px;top:4251px;word-spacing:4px;letter-spacing:1px"> - cele din restul peretelui merg spre un ganglion al colului veziculei biliare i n </span><span class="a" style="left:398px;top:4429px;word-spacing:-3px">ganglioni i hepatici de la nivelul <span class="w6"></span>pediculului hepatic.</span><spa n class="a" style="left:663px;top:4607px;word-spacing:-4px">Limfaticele sunt tri butare ganglionilor hepatici <span class="w6"></span>biliari.</span><span class= "a" style="left:663px;top:4785px;word-spacing:12px;letter-spacing:2px">Inervaia ci lor biliare. Funcia complex a cilor biliare este reglat pe cale</span><span class="a " style="left:398px;top:4963px;word-spacing:-3px">nervoas i umoral.</span></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2211px;top:5473px">11</span></div> </div> </div> <div class="image_layer" style="z-index: 3"> <div class="ie_fix"> <img src="ANATOMIA-VEZICULEI-BILIARE_files/11-bae5978784.png" class="absimg" sty le="left: 130px; top: 370px; width: 232px; height: 6px; clip: rect(1px, 231px, 2 px, 1px); display: block;"> <img src="ANATOMIA-VEZICULEI-BILIARE_files/11-bae5978784.png" class="absimg" sty le="left: 130px; top: 972px; width: 232px; height: 6px; clip: rect(4px, 197px, 5 px, 1px); display: block;"> </div> </div> </div>
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<div class="outer_page only_ie6_border not_visible" id="outer_page_12" style=" width: 347.648px; height: 450px;"><div class="newpage" id="page12" style="width: 902px; height: 1167px; display: none;"> <div class="text_layer" style="z-index:2"><div class="ie_fix"> <div class="ff1" style="font-size:116px"> <span class="a" style="left:663px;top:336px;word-spacing:-2px">Inervaia este asig urat de fibre vegetative (simpatice i <span class="w6"></span>parasimpatice) care vin din</span><span class="a" style="left:372px;top:514px;word-spacing:-3px">&nb sp;plexul hepatic anterior i posterior. Din <span class="w6"></span>plexul anteri or pleac fibre pentru canalul cistic <span class="w6"></span>i</span><span class=" a" style="left:398px;top:692px;word-spacing:8px;letter-spacing:1px">vezicula bil iar, iar din cel posterior ramuri pentru coledoc i canalul hepatic comun.</span><s pan class="a" style="left:398px;top:870px;word-spacing:2px;letter-spacing:1px">Ci le biliare conin i o serie de fibre aferente cu teac de mielin care conduc stimulii< /span><span class="a" style="left:398px;top:1048px;word-spacing:-2px">dureroi de la acest nivel.</span><span class="a" style="left:663px;top:1226px">Canalul hepa tic se unete cu canalul cistic formnd canalul coledoc, care mpreun</span><span class ="a" style="left:398px;top:1404px;word-spacing:-3px">cu vena port i <span class="w 8"></span>artera hepatic formeaz pediculul hepatic.</span><span class="a" style="l eft:663px;top:1582px;word-spacing:16px;letter-spacing:2px">Can<span class="l7">a lu<span class="l7">l <span class="w" style="width:14px"></span>col<span class="l 7">edo<span class="l7">c <span class="w" style="width:13px"></span>are <span cla ss="w9"></span>o <span class="w12"></span>por<span class="l7">iu<span class="l7"> ne <span class="w10"></span>sup<span class="l7">rad<span class="l7">uod<span cla
ss="l7">ena<span class="l7">l <span class="w11"></span>car<span class="l7">e <spa n class="w" style="width:14px"></span>lip<span class="l7">se<span class="l7">te < span class="w12"></span>cn<span class="l7">d <span class="w12"></span>cis<span cl ass="l6">tic<span class="l7">ul <span class="w11"></span>i</span></span></span></ span></span></span></span></span></span></span></span></span></span></span></spa n></span></span><span class="a" style="left:398px;top:1760px;word-spacing:9px;le tter-spacing:1px">hepaticul se unesc spre a forma coledocul, urmeaz o poriune retr oduodenal situat</span><span class="a" style="left:398px;top:1938px;word-spacing:4 px">napoia prii superioare a duodenului, apoi o poriune retropancreatic dinapoia capu lui</span><span class="a" style="left:372px;top:2115px;word-spacing:-1px"> pancreasului i care se vars n <span class="w7"></span>ampula Vater sau ampula hepat o-pancreatic mpreun cu</span><span class="a" style="left:398px;top:2294px;word-spac ing:-4px">canalul pancreatic Wirsung.</span><span class="a" style="left:663px;to p:2471px;word-spacing:13px;letter-spacing:3px">Am<span class="l7">pu<span class= "l7">la <span class="w12"></span>se <span class="w" style="width:13px"></span>de <span class="l7">sc<span class="l6">hi<span class="l7">de <span class="w12"></sp an>n <span class="w12"></span>du<span class="l7">od<span class="l7">en <span clas s="w12"></span>la <span class="w12"></span>ni<span class="l7">ve<span class="l6" >lu<span class="l7">l <span class="w" style="width:15px"></span>pa<span class="l 7">pi<span class="l6">le<span class="l7">i <span class="w" style="width:15px"></ span>du<span class="l6">od<span class="l7">en<span class="l7">al<span class="l6" >e <span class="w" style="width:15px"></span>ma<span class="l7">ri<span class="l 7">. <span class="w" style="width:15px"></span>n <span class="w12"></span>pa<span class="l8">rt<span class="l6">ea</span></span></span></span></span></span></spa n></span></span></span></span></span></span></span></span></span></span></span>< /span></span></span></span><span class="a" style="left:398px;top:2650px;word-spa cing:-2px">terminal a celor dou canale, respectiv a ampulei Vater se afl sfincterul Oddi.</span></div> <div class="ff1" style="font-size:99px"> <span class="a" style="left:2211px;top:5473px">12</span></div> </div> </div> </div>
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</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [2, 1], "pageNum": 20}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 20-fb003700d3 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_20"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/20-fb003700d3.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_20" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(20); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [2, 1], "pageNum": 21}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 21-c8c402b288 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_21"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/21-c8c402b288.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_21" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(21); </script><div class="hideable_ad" id="Doc_Between_Leaderboard_BTF_728x90_2 1_container"><script src="ANATOMIA-VEZICULEI-BILIARE_files/ads_014"></script><di v id="google_ads_div_Doc_Between_Leaderboard_BTF_728x90_21_ad_container"> <ins style="width: 728px; height: 90px; display: inline-table; position: relativ e; border: 0pt none;"><ins style="width: 728px; height: 90px; display: block; po sition: relative; border: 0pt none;"><iframe style="border: 0pt none; position: absolute; top: 0pt; left: 0pt;" marginheight="0" marginwidth="0" name="google_ad s_iframe_Doc_Between_Leaderboard_BTF_728x90_21" id="google_ads_iframe_Doc_Betwee n_Leaderboard_BTF_728x90_21" frameborder="0" height="90" scrolling="no" width="7 28"></iframe></ins></ins></div> <script>GA_googleCreateDomIframe("google_ads_div_Doc_Between_Leaderboard_BTF_728 x90_21_ad_container" ,"Doc_Between_Leaderboard_BTF_728x90_21");</script></div> </div>
<div class="outer_page only_ie6_border" id="outer_page_22" style="width: 347.6 48px; height: 450px;">
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [2, 1], "pageNum": 22}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 22-b1fbd4dadd // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_22"); pageParams.contentUrl = "http://html3.scribdassets.com/20mdk9ux4w11a11 9/pages/22-b1fbd4dadd.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_22" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(22); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2,
0], "pageNum": 23}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 23-cd9d42094a // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_23"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/23-cd9d42094a.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_23" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(23); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 24}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 24-dc3b2432c0 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_24"); pageParams.contentUrl = "http://html4.scribdassets.com/20mdk9ux4w11a11 9/pages/24-dc3b2432c0.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
<div id="between_page_ads_24" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(24); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 25}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 25-273bdd2d6d // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_25"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/25-273bdd2d6d.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_25" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(25); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2], "pageNum": 26}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 26-5985e53248 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_26"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/26-5985e53248.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_26" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(26); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 5],
"pageNum": 27}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 27-88548d0e27 // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_27"); pageParams.contentUrl = "http://html3.scribdassets.com/20mdk9ux4w11a11 9/pages/27-88548d0e27.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_27" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(27); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 5], "pageNum": 28}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 28-3aa6b38e15 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_28"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/28-3aa6b38e15.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 29}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 29-7f47daf907 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_29"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/29-7f47daf907.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_29" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(29); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2, 0], "pageNum": 30}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 30-77c0f2bbef // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_30"); pageParams.contentUrl = "http://html3.scribdassets.com/20mdk9ux4w11a11 9/pages/30-77c0f2bbef.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_30" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(30); </script> </div>
"pageNum": 31}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 31-09e062f31d // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_31"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/31-09e062f31d.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_31" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(31); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 32}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 32-9d316ef899 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_32"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/32-9d316ef899.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2], "pageNum": 33}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 33-3f051a3d54 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_33"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/33-3f051a3d54.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_33" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(33); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2], "pageNum": 34}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 34-ff05d675d6 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_34"); pageParams.contentUrl = "http://html3.scribdassets.com/20mdk9ux4w11a11 9/pages/34-ff05d675d6.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_34" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(34); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p
ageNum": 35}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 35-9c39349cde // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_35"); pageParams.contentUrl = "http://html3.scribdassets.com/20mdk9ux4w11a11 9/pages/35-9c39349cde.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_35" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(35); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 36}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 36-6e80f1ce64 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_36"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/36-6e80f1ce64.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2], "pageNum": 37}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 37-2c4e2f021c // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_37"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/37-2c4e2f021c.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_37" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(37); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 38}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 38-918c4ad4f7 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_38"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/38-918c4ad4f7.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_38" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(38); </script> </div>
"pageNum": 39}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 39-1ec6b49773 // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_39"); pageParams.contentUrl = "http://html4.scribdassets.com/20mdk9ux4w11a11 9/pages/39-1ec6b49773.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_39" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(39); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 40}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 40-a162705888 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_40"); pageParams.contentUrl = "http://html3.scribdassets.com/20mdk9ux4w11a11 9/pages/40-a162705888.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 41}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 41-d41ab40738 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_41"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/41-d41ab40738.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_41" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(41); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 42}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 42-2f73379f4f // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_42"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/42-2f73379f4f.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_42" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(42); </script> </div>
ageNum": 43}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 43-b580cb8b41 // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_43"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/43-b580cb8b41.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_43" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(43); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 44}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 44-136c84a9a5 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_44"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/44-136c84a9a5.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 45}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 45-78305354b4 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_45"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/45-78305354b4.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_45" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(45); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 46}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 46-4445259120 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_46"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/46-4445259120.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_46" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(46); </script> </div>
"pageNum": 47}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 47-24e435f6b7 // 'request_host': genserve
pageParams.containerElem = document.getElementById("outer_page_47"); pageParams.contentUrl = "http://html4.scribdassets.com/20mdk9ux4w11a11 9/pages/47-24e435f6b7.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_47" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(47); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1, 2], "pageNum": 48}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 48-63a40ec050 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_48"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/48-63a40ec050.jsonp"; var page = docManager.addPage(pageParams); })(); </script>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [2, 1], "pageNum": 49}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 49-55873e4289 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_49"); pageParams.contentUrl = "http://html2.scribdassets.com/20mdk9ux4w11a11 9/pages/49-55873e4289.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_49" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(49); </script> </div>
</div> <script type="text/javascript"> (function() { var pageParams = {"origHeight": 1167, "origWidth": 902, "fonts": [1], "p ageNum": 50}; // page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 .0.0.1:3128 // page.page_name : 50-bc66e97516 // 'request_host': genserve pageParams.containerElem = document.getElementById("outer_page_50"); pageParams.contentUrl = "http://html1.scribdassets.com/20mdk9ux4w11a11 9/pages/50-bc66e97516.jsonp"; var page = docManager.addPage(pageParams); })(); </script> <div id="between_page_ads_50" class="between_page_ads" style=""> <script type="text/javascript"> Scribd.Ads.addBetweenPageUnit(50); </script> </div>
"pageNum": 51}; .0.0.1:3128
// page.uuid : 20mdk9ux4w11a119 // page.page_request.cdn_path('html') : http://127 // page.page_name : 51-e0025c6671 // 'request_host': genserve
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