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46 Cards in this Set

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Thorax

Region of trunk between neck and abdomen

Thoracic Wall

Skin, fascia, nerves, vessels, muscle, bones and breast

Thoracic cavity

Heart, Lungs, Thymus, Distal Trachea, and Esophagus

Skeleton of Thoracic Wall

Osteocartilaginous thoracic cage


- Sternum


-12 pairs of ribs and costal cartilage


-12 thoracic vertebrae and intevertebral discs


Superior thoracic aperture (thoracic inlet)

Access for thoracic cavity to communicate w/ neck, measures AP 5cm and 11cm transversly; slopes down and forward. Bounded by T1, 1st ribs/costal cartilage, superior border of manubrium. (see next card for picture)

What passes through thoracic aperture (thoracic inlet)?

Trachea, Esophagus, Common carotid arteries, jugular veins, subclavian aa & vv., Phrenic and Vagus Nerves, Thoracic Duct

Trachea, Esophagus, Common carotid arteries, jugular veins, subclavian aa & vv., Phrenic and Vagus Nerves, Thoracic Duct

Thoracic "Outlet" Syndrome (TOS)

Compression at the Superior Thoracic Outlet, involving neuro-vascular bundle (brachial plexus and subclavian vessels) causing parasthesia, numbness, cyanosis, thombosis in upper limb.

Inferior Thoracic Aperture (thoracic outlet)

Access for thoracic cavity to communicate with abdomen, closed by thoracic diaphram, slopes downward and backward.  Bounded by T12, 12th rib and costal margins, xiphisternal joint.

Access for thoracic cavity to communicate with abdomen, closed by thoracic diaphram, slopes downward and backward. Bounded by T12, 12th rib and costal margins, xiphisternal joint.

Manubrium (sternum)

-Jugular (suprasternal) notch


-Clavicular notch


-Manubriosternal Joint

-Jugular (suprasternal) notch


-Clavicular notch


-Manubriosternal Joint

Body and Xiphoid Process (sternum)

Body


-Costal Notches


-Xiphisternal joint


Xiphoid Process


-At bottom

Body


-Costal Notches


-Xiphisternal joint


Xiphoid Process


-At bottom

Vertebrae (in general)

Body-support weight


Sup &inf articular facets-articulation w/ other vertebrae; restricts movement


Transverse process and spinous process for muscle attachments

Body-support weight


Sup &inf articular facets-articulation w/ other vertebrae; restricts movement


Transverse process and spinous process for muscle attachments

Thoracic vertebrae (specifically)

Costal facets on bodies for articulations with head of ribs


Costal facets on transverse process for articulation w/tubercles of ribs


Long, inferiorly-directly spinous processes


Superior articular facets face posteriorly


Inferior articular facets face anteriorly

True Ribs

1-7; vertebrocostal ribs, costal cartilage attaches directly to sternum

1-7; vertebrocostal ribs, costal cartilage attaches directly to sternum

False Ribs

8-10, vertebrochondral ribs, costal cartilage attaches to costal cartilage of rib 7

8-10, vertebrochondral ribs, costal cartilage attaches to costal cartilage of rib 7

Floating Ribs

11 &12, no attachment to sternum

11 &12, no attachment to sternum

Typical Ribs (ribs 3-9)

See picture

See picture

Muscles of Thoracic Wall

-external intercostal (superficial)


-internal intercostal (middle)


-Innermost intercostal (deepest)


Innervated by intercostal nerve

-external intercostal (superficial)


-internal intercostal (middle)


-Innermost intercostal (deepest)


Innervated by intercostal nerve

Posterior Thoracic Wall (arteries and veins)

v&a&n are found in each intercostal space. Post. intercostal a- direct branch of desc. aorta. Post. intercostal v.-drains into hemiazygos v (l) and azygos v (r)


 

v&a&n are found in each intercostal space. Post. intercostal a- direct branch of desc. aorta. Post. intercostal v.-drains into hemiazygos v (l) and azygos v (r)


Where do the vessels and nerve lie?

Betweem the internal and innermost intercostal muscles

Betweem the internal and innermost intercostal muscles

Anterior Thoracic Wall

Internal thoracic artery and vein, Transversus thoracis, diaphragm, anterior intercostal arteries and veins, internal and innermost intercostals

Internal thoracic artery and vein, Transversus thoracis, diaphragm, anterior intercostal arteries and veins, internal and innermost intercostals

Thoracic Cavity

Space w/in thoracic walls.


3 compartments


-2 lateral compartments R&L pulmonary cavities


-1 central compartment MEDIASTINUM

Space w/in thoracic walls.


3 compartments


-2 lateral compartments R&L pulmonary cavities


-1 central compartment MEDIASTINUM

Pulmonary Cavities

Lungs and pleurae (lining membranes)


Lungs- essential organ of respiration


Pleurae-serous pleural sac consisting of two continuous membrances


Costodiaphragmatic recess- bottom things hanging off.

Formation of the pleural layers

Balloon represents the innermost layer of pleural cavity before the embryological development of the lung.

Balloon represents the innermost layer of pleural cavity before the embryological development of the lung.

Parietal Pleurae

"outer" lining, lines the inner surface of the thoracic wall and the mediastinum.  Consists of 4 parts


Costal,Diaphragmatic


mediastinal


cervical (cupola)

"outer" lining, lines the inner surface of the thoracic wall and the mediastinum. Consists of 4 parts


Costal,Diaphragmatic


mediastinal


cervical (cupola)

Visceral pleura

"inner" lining


invests the lungs


cannot be disected from the lung

Pleural cavity

Potential space between visceral & parietal pleura


Filled with pleural fluid, which acts as a lubricant.

Trachea

Begins at cricoid cartilage. 16-20 incomplete hyaline cartilaginious rings. Divides into R&L primary bronchi at the level of the sternal angle

Begins at cricoid cartilage. 16-20 incomplete hyaline cartilaginious rings. Divides into R&L primary bronchi at the level of the sternal angle

Carina

The division point. It is a keel like projection on the inside; most sensitive area of trachea; last line of defense; carcinomatous lymph nodes widen the carina.

Right primary bronchus

Wider


Shorter


More verticle


Food and other foreign particles more often go into the right primary bronchus

Wider


Shorter


More verticle


Food and other foreign particles more often go into the right primary bronchus

Left primary bronchus

Closer to pulmonary trunk and aorta.  


Each primary bronchus divides into secondary lobar bronchi and then into tertiary segmental bronchi

Closer to pulmonary trunk and aorta.


Each primary bronchus divides into secondary lobar bronchi and then into tertiary segmental bronchi

Trachea cross section

Anteriorly and laterally: cartilagenous structure


Posteriorly: Trachealis muscle

Anteriorly and laterally: cartilagenous structure


Posteriorly: Trachealis muscle

Trachealis muscle

Action: constricts the trachea, allowing for higher velocity of air during coughing

Lungs

Attach to pulmonary vessels and trachea.


Apex- blunt superior end


Lobes: R lung- larger heavier, 3 lobes (superior (horizontal fissure) middle (oblique fissure) inferior) L lung, 2 lobes (sup&inf)

Attach to pulmonary vessels and trachea.


Apex- blunt superior end


Lobes: R lung- larger heavier, 3 lobes (superior (horizontal fissure) middle (oblique fissure) inferior) L lung, 2 lobes (sup&inf)

Pulmonary circulation

Each segmental bronchus is accompanied by a segmental artery and vein for gas exchange. Thus, each bronchopulmonary segment operates independently and can be surgically removed if diseased.

Diaphragm

Chief muscle of inspiration. Dome-shaped.  Separates thoracic cavity from abdominal cavity

Chief muscle of inspiration. Dome-shaped. Separates thoracic cavity from abdominal cavity

Diaphragmatic Apertures

Permits structures to pass b/w thorax and abdomen.


Caval opening (IVC)


Esophageal hiatus (Esophagus)


Aortic hiatus (Aorta)

Permits structures to pass b/w thorax and abdomen.


Caval opening (IVC)


Esophageal hiatus (Esophagus)


Aortic hiatus (Aorta)

Caval opening

Inferior vena cava.


Located at the level of disc b/w T8 and T9

Inferior vena cava.


Located at the level of disc b/w T8 and T9

Esophageal hiatus

Esophagus


Located at the level of T10


 

Esophagus


Located at the level of T10


Aortic Hiatus

Aorta


Does not pierce diaphragm; passes posterior to median arcuate ligament and anterior to T12.

Aorta


Does not pierce diaphragm; passes posterior to median arcuate ligament and anterior to T12.

Actions of the Diaphragm

Contraction moves dome inferiorly


Pushes abdominal viscera inferiorly


Increases volume of thoracic cavity


Allows air to be taken into the lungs


Diagragm also important in circulation of blood, in abdominal straiing (as in micturition, defecation and parturition) and in weight lifting

Muscles of inspirtation

Diaphragm


External intercostals


Internal intercostals (medial)


Sternocleidomastoid


Scalenes


Serratus posterior superior and inferior


Levator costarum

Diaphragm


External intercostals


Internal intercostals (medial)


Sternocleidomastoid


Scalenes


Serratus posterior superior and inferior


Levator costarum

Inspiration

Diaphragm contracts (dome pulls inferiorly, verticle height of thorax increases, intrathoracic pressure decreases)


Ribs elevated (passively during relaxed inspiration, actively during forced inspiration)


Pleural cavities and lungs enlarge (air rushes passively into lungs, not pumped in to)


Abdominal pressure increases due to decreased abdominal volume

Muscles of Expiration

Normal: Elastic recoil of lungs


Forced: Rectus abdominus, internal intercostals (lateral), External oblique, Internal oblique and transversus abdominus.

Normal: Elastic recoil of lungs


Forced: Rectus abdominus, internal intercostals (lateral), External oblique, Internal oblique and transversus abdominus.

Expiration

Diaphragm & intercostals relax (thoracic volume decreases, intrathoracic pressure increases)


Stretch elastic tissue of lungs recoils (like an inflated balloon releasing its air (air expelled)


Ribs are depressed


Abdominal pressure is decreased

Nerves of the Diaphragm

Motor Supply: PHRENIC nerves, arise from ventral rami C3-C5


Sensory supply: primarily PHRENIC nerves (centrally) some from intercostal and subcostal nerves (peripherally)

Types of pleura and pericardium

Acute inflammation of pericardial sac (pericarditis) causes the pericardial rub during auscultation. Advanced cases end up in pericardial effusion of cardiac tamponade.

Acute inflammation of pericardial sac (pericarditis) causes the pericardial rub during auscultation. Advanced cases end up in pericardial effusion of cardiac tamponade.