Term
Describe Thoracic Wall
1. Structure
2. Function |
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Definition
1. thoracic cages, muscles between ribs, skin, muscles, fascia on anterolateral aspect (NOT back)
-also mammary glands
2. Rigidity
a. protect vital organs
b. resist negative (subatmospheric) pressure from elastic recoil of lungs
c. provide attachment for upper limbs, muscles, respiration
Flexibility- expansion during respiration |
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Term
Describe the Skeleton of Thoracic Wall
Ribs and Cartilage
1. Number
2. Rib Structure
3. Cartilage and Intercostal space |
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Definition
1. 12 pairs of ribs and costal cartilage
a. True ribs (attached to sternum): 1-7
b. False ribs (attached to cartilage to sternum): 8-10
c. Floating ribs (no sternal attachment): 11-12
2. Head has two grooves and attached to vertebrae
-neck
-tubercle: articulates with transverse part of vertebrae
-body connects back to sternum
3. Cartilage allows flexibility
-spaces named for rib above them
-filled with muscle, blood vessels, and nerves |
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Term
Describe the Skeleton of Thoracic Wall
Vertebrae |
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Definition
7 vertebrae
-bilateral costal facets for head of ribs
-facets on transverse process for tubercles
-spinous process protrudes inferiorly |
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Term
Describe the Skeleton of Thoracic Wall
Sternum |
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Definition
-attachment for ribs
-three parts ossify during adulthood
Manubrium
Body of sternum
Xiphoid Process |
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Term
| Describe the Thoracic Apertures |
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Definition
1. Superior- manubrium, rib 1, T1
2. Inferior- xiphoid, ribs 7-10, ribs 11-12
-diaphragm rises up to intercostal 4 |
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Term
Describe the movement of the Thoracic Wall
1. Inhalation
2. Expiration |
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Definition
1. Inhalation
-diaphragm causes ribs to expand
-lungs pulled open due to H bonds in pleural fluid
-active muscle movement
2. Expiration
-rib cage decreases due to diaphragm relaxation
-lungs recoil due to elastic fibers
-passive |
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Term
| Describe Paralysis of the Diaphragm |
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Definition
Diaphragm is innervated from phrenic nerve separately
-one sided paralysis will lead to paradoxical movement |
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Term
Describe Thoracic Muscles
True Muscles |
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Definition
origin and insertion of these muscles are in the thorax
-most are weak and serve propioreceptive functions
1. serratus posterior
2. levator costarum
3. intercostals/subcostals
4. transversus thoracis |
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Term
Describe Thoracic Muscles
Accessory Muscles |
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Definition
primarily affect other regions but have some affect on thoracic cage
1. scalenes
2. pectorals major/minor
3. Serratus anterior |
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Term
| Descrive Nerves, Vasculature, and Fascia of Thoracic Wall |
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Definition
Nerves T2-T12 supply dermatome via posterior and anterior ramus
-similar myotome
Vasculature
-thoracic aorta, subclavian, and axillary arteries
-posterior veins drain into azygos which runs down back wall and into SVC
-anterior drain into internal thoracic veins and IVC
Fascia
-mammary ligaments connect to pectoral fascia
-clavipectoral fascia separate minor and major pectoralis
-endothoracic lines inner wall |
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Term
| Describe structure of breast |
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Definition
mammary glands surrounded in fibrous tissue and fat
-breast lie over pectoral fascia separate by a thin retromammary space
-size determined by fat
-milk drain into nipple surrounded by areola
Lymph drainage: 75% to axillary lymph nodes
-rest goes to parasternal lymph nodes
-lymph drains further into azygos vein |
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Term
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Definition
-carcinomas arise from epithelial cells of lactiferous ducts
-most lymph goes to axillary, so lateral superior is most common quadrant
Signs:
retracted nipple, edema, abnormal contours |
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Term
Describe the following terms:
1. Polymastia
2. Amastia
3. Polythelia |
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Definition
1. extra breast
2. no breast development
3. extra nipple
-all occur on embryonic mammary crest |
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Term
Describe the Lungs
1. Surfaces
2. Fissures/Lobes |
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Definition
1. cervical, costal, mediastinal, diaphragmatic
2. 2 on right = 3 lobes
1 on left = 2 lobes |
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Term
Describe the Lungs
Mediastinal Surface
1. Depressions
2. Nerves |
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Definition
1. Both sides concave for mediastinal structures
-left lung has deep depression for apex-> cardiac notch
-also lingula= little flap
2. Phrenic nerve anterior to root
Vagus nerve posterior to root |
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Term
Describe the Tracheobronchial Tree
1. Left and Right Divisions
2. Bronchiopulmonary Segments |
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Definition
1. Right is wider, shorter and more vertical - Left is closer to 90 angle
Right has 3 lobar bronchi - Left has 2
2. Largest subdivisions within lobe
-separated by connective tissue
-each supplied by own blood supply |
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Term
Describe the Vasculature of the Lungs
1. Lung Tissue
2. Supporting tissue |
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Definition
-most lung tissue gets nutrients and oxygen from pulmonary artery
-tissues drained by two veins and return oxygenated blood to heart
-bronchial arteries arise from aorta and supply lung supporting tissue (pleura)
-bronchial veins drain into SVC |
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Term
Describe Pulmonary
1. Lymphatic Drainage
2. Innervation |
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Definition
1. Top left drains into vessel on left side
Right lung and bottom left drain into right side of body
2. parasympatheic from Vagus nerve
-stimulate alveolar gland secretions |
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Term
Describe the following Pulmonary Disorders
1. Pulmonary Collapse
2. Thoracentesis |
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Definition
1. lungs held open by surface tension between visceral and parietal pleura via pleura fluid (H bonds)
-bonds broken and lungs will collapse
-secondary atelectasis is full collapse
-segmental is partial; one segment, rest of lung will expand
2. needle goes in between 9th and 10th rib upward angle
-pleural fluid collects in costodiaphragmatic recess |
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Term
Describe the Mediastinum
1. Location
2. Movement
3. Composition |
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Definition
1. in between both pleural cavities
2. flexible, moves as you lay down or sit up
-can expand due to blood from great vessels, tumor, enlarged heart
3. heart, base of great vessels, everything but lungs |
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Term
Describe the Pericardium
1. Description
2. Composition
3. TPS |
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Definition
Membrane that surrounds heart and base of great vessels
2 parts:
a. inflexible, fibrous membrane connected with central tendon of diaphragm
b. glistening serous pericardium (mesothelium and epicardium is around heart)
-contains 15-30mls of fluid to allow heart to beat without friction
Transverse Pericardial Sinus: helpful for surgeons to clamp great vessels |
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Term
Describe the following Pericardial Abnormalities
1. Effusion
2. Tamponade |
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Definition
1. movement of fluid from blood into cavity
-heart can become compressed and inefficient
-due to inflammation or CHF
2. heart compression; heart volume is compromised because it cannot pump efficiently |
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Term
Describe the following Cardiac structures:
1. Heart Wall
2. Fibroskeleton |
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Definition
1. 3 layers
a. endocardium- interior: tunica intima
b. myocardium- thick muscle for contraction
c. epicardium- exterior: visceral pericardium
2. 4 collagen rings
a. attachment site for myocardium and valves
b. prevent heart from over expanding
c. form electrical insulator |
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Term
| Describe surface features of the heart |
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Definition
-coronary sulcus divides atria from ventricles
-interventricular sulcus divides ventricles
-heart apex is inferior to the base (tilted on side) |
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Term
Describe the Right Atrium
1. Blood receiving
2. Anterior wall vs posterior wall
3. Oval Fossa |
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Definition
1. received blood from IVC, SVC, and coronary sinus
2. anterior is rough with pectinate muscles (Stretch)
3. formerly the oval foramen, but closed at birth
-located at interatrial septum |
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Term
Describe the Right Ventricle
1. Blood movement
2. Valve
3. Moderator band |
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Definition
1. enters from RA and goes to pulmonary artery
-blood makes 140 degree U-turn (aided by supraventricular crest to conus arteriosus)
2. Tricuspid valve
3. Septomarginal trabecula
-carries electrical signal from AV bundle to anterior papillary muscles |
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Term
| Describe the Left Ventricle and Left Atrium |
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Definition
Ventricle:
-walls are 2-3x as thick
-bicuspid valve
-180 degree turn
-apex
Atrium:
-4 pulmonary veins
-base of heart |
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Term
Describe Semilunar Valves
1. Location
2. Structure
3. Function |
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Definition
1. Aorta and pulmonary artery
2. 3 concave cusps
3. during diastole, these valves prevent blood from flowing back into the heart
-blood is caught in the cusps and some drains to coronary arteries |
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Term
Describe the Vasculature of the Heart
1. RCA
2. LCA |
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Definition
1. down right side and meets LCA in back
-branches on latero side as well
2. down left side and meets RCA in back
-comes straight down front and meets branch of RCA underneath |
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Term
Describe Septal Defects
1. Atrial
2. Ventricular |
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Definition
1. 15-25% have asymptomatic opening
ASD permit blood to flow between atria
-causes enlargement of right atria and ventricle, dilation of pulmonary trunk
2. 25% of all congenital cardiac issues
-blood flows between ventricles and causes pulmonary hypertension
-can lead to death |
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Term
Describe Valve Abnormalities
1. Stenosis
2. Insufficiency
3. Mitral (Bicuspid) Prolapse
4. Pulmonary Valve Stenosis/Incompetence
5. Aortic Stenosis |
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Definition
1. failure to fully open; slows flow of blood
2. failure to fully close; causes back up
3. insufficient valve where blood flows back into left atria
-produces murmur
4. a. cusps fuse and don't allow all blood to exit RV ->causes enlargement of RV
b. thickened, inflexible, damaged valve that won't close
5. calcification of the valves don't allow them to open
-can be caused by rheumatic fever
-leads to LV hypertrophy |
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Term
Describe the following cardiac conditions:
1. MI
2. Atherosclerosis
3. Angina Pectoris |
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Definition
1. common sites are
a. anterior IV brand (down middle)
b. RCA
c. circumflex branch of LCA that wraps around
2. Lipid deposits that lead to stenosis (failure to open)
3. Acute chest pain caused by the following:
narrowed CAs->reduced blood flow->less O2->lactic acid->pain receptors |
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Term
| Describe Cardiac Referred Pain |
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Definition
-heart shares same nerves from spinal cord T1-T5
-excited nerves from MI stimulate fibers on somatic areas connected to T1-T5 |
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Term
Describe the Superior Mediastinum
1. Location
2. Contents |
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Definition
1. above base of aorta (T5)
2. Anterior to Posterior
a. Thymus
b. Veins
c. Arteries
d. Trachea
e. Esophagus
f. Thoracic duct |
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Term
Describe the Great Vessels
1. SVC
2. Aorta
3. Azygos
4. Order of alignment |
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Definition
1. jugular and subclavian come together to form SVC on right side inferior to 1st rib
-enters heart at 3rd rib into RA
2. order of branching: brachiocephalic (right carotid/subclavian), left carotid, left subclavian
3. drains much of thorax and abdomen
-provides detour if IVC is blocked
4. Ant-Post
SVC, Aorta, Pulmonary Arteries, Trachea, Esophagus |
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Term
| Describe Coarctation of Aorta |
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Definition
Stenosis (narrowing) of aorta
-commonly occurs at ductus arteriosus
(passageway from pulmonary artery from RV before birth) |
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Term
| Describe the surface anatomy of the heart |
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Definition
Apex- 5th rib
Base- 3rd rib
Aorta- directly behind sternum |
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