anatomy block 4 Flashcards
extrinsic muscles
innervated by anterior rami or CN XI
intrinsic muscles
innervated by posterior rami
superficial group
-trapezius - superior nuchal line/ligamentum nuchae/C7-T12 to clavicle/acromion/spine of scapula (superficial transverse scapular artery, acromial branch of subscapular artery, dorsal branches posterior intercostal arteries)
-latissimus dorsi - ribs 10-12/T12-L5 spinous process/iliac crest/sacrum to intertubercular sulcus of humerus (thoracodorsal artery, dorsal branches of posterior intercostal arteries, lumbar arteries, thoracodorsal nerve)
-levator scapulae - C1-4 TP to upper medial border of scapula (deep branch of transverse cervical artery, dorsal scapular nerve)
-rhomboid minor - C7-T1 SP to medial border of scapula and superior to spine (deep branch of transverse cervical artery, dorsal scapular nerve)
-rhomboid major - T2-5 SP to medial border of scapula inferior to spine(deep branch of transverse cervical artery, dorsal scapular nerve)
intermediate group
-serratus posterior superior - C7-T3 SP/supraspinous ligament to ribs 2-5 (anterior rami and intercostal arteries T2-5)
-serratus posterior inferior - T11-L2 SP/supraspinous ligament to ribs 9-12 (anterior rami and intercostal arteries T9-12)
deep group (intrinsic) - posterior rami spinal nerves
-splenius capitis - superior nuchal line/mastoid process to ligamentum nuchae/C7-T4 SP
-splenius vervicus - C1-3 TP to T3-11 SP
ERRECTOR SPINAE
-logissimus - capitis to mastoid process. //. cervicis to transverse process. //. thoracis to angle of rib/tubercle
-spinalis - thoracis to SP. //. cervicis hidden to SP. //. capitis hidden to occipital bone
-iliocaostalis - cervisis to TP. //. thoracis to angle of rib. //. lumborum to angle of rib
TRANSVERSIS SPINALIS
semispinalis - capitis C4-T6 TP to between superior and inferior nuchal line (pierced by greater occipital nerve). //. thoracis/cervicis thoracic TP to thoracic/cervical SP (span 4-6 vertebrae)
-multifidus - TP to base of SP (span 2-4 vertebrae)
-rotatores - SP to inferior TP (brevis connects adjacent vertebrae, longus skips a vertebrae)
SEGMENTAL
-levatores costarum - TP to inferior rib (brevis connect adjcent rib, longus skips a rib)
-interspinalis lumborum
-intertranversarius lateralis
SUBOCCIPITAL
-rectus capitus posterior major and minor, obliquus capitis superior and inferior, TP of atlas C1)
triangle of auscultation
rhomboid major, trapezius, latissimus dorsi
amplified thoracic sounds
lumbar triangle
latissimus dorsi, external oblique, iliac crest
herniation of abdominal structures
anterior wall of axilla
subclavius, pectoralis minor, clavipectoral fascia, pectoralis major
medial wall of axilla
upper thoracic wall, serratus anterior
apex (inlet) of axilla
clavicle, superior margin of scapula, coracoid process, rib 1
posterior wall of axilla
subscapularis, teres major, long head of triceps, latissimus dorsi
lateral wall of axilla
intertubercular sulcus
base of axilla
axillary fossa, anterior and posterior axillary fold
upper brachial plexus injury
ERB Duchenne Palsy/back packers
adducted and extended at elbow, medial rotated, lateral arm sensory deficit
lower brachial plexus injury
Klumpke paralysis
intrinsic muscles of hand paralyzed (claw hand), hand and forearm sensory deficit
posterior cord injury
Saturday night palsy/crutch
posterior arm and forearm paralyzed, elbow flexion and wrist drop
axillary artery
between clavicles and inferior border of teres major
1. superior thoracic artery
2. thoracoacromial artery, lateral thoracic artery (pectoral branch)
3. anterior circumflex artery, posterior circumflex artery, subscapular artery (circumflex scapular and thoracodorsal artery)
veins in axilla
brachial vein joins basilic vein forming axillary vein
cephalic vein joins axillary vein forming subclavian vein
lymph nodes
humeral nodes, subscapular nodes, pectoral nodes join to form central nodes
central nodes to apical nodes
apical nodes to supraclavicular nodes
supraclavicular nodes to subclavian lymphatic trunk
subclavian lymphatic trunk to R or L venous angle
glenohumeral joint
joint capsule (synovial membrane and fibrous capsule), glenoid cavity, glenoid labrum
tendon sheath of long head biceps
coracohumeral ligament, transverse humeral ligament, glenohumeral ligaments (superior, middle, inferior)
acromioclavicular joint/suprascapular ligaments
acromioclavicular joint supported by AC ligament
coracoclavicular ligament (trapezoid ligament and conoid ligament)
superior trnasverse scapular ligament
coracoacromial ligament
extrinsic muscles of shoulder
superficial - trapezius, latissimus dorsi
deep - levator scapulae, rhomboid major and minor
intrinsic muscles of shoulder
SUBSCAPULAR NERVE
-supraspinatus - supraspinous fossa to greater tubercle
-infraspinatus - infraspinous fossa to greater tubercle
AXILLARY NERVE
-teres minor - lateral border to greater tubercle
-deltoid - spine/acromion/clavicle to deltoid tuberosity
LOWER SCAPULAR NERVE
-teres major - inferior angle to medial lip of intertubercular sulcus
UPPER AND LOWER SUBSCAPULAR NERVES
-subscapualris - subscapular fossa to lesser tubercle
rotator cuff
S - supraspinatus
I - infraspinatus
T - teres minor
S - subscapularis
shoulder bursa
subdeltoid, subacromial, subtendinous, bursa of subscapularis
ARMY over NAVY
suprascapular artery over superior transverse ligament, suprascapular nerve under superior transverse ligament
shoulder anastamosis
suprascapular artery, circumflex scapular artery, deep transverse cervical artery
quadrangular space
humerus, long head of triceps, teres major, teres minor
posterior humeral circumflex artery and nerve within
triangular space
teres major, teres minor, triceps long head
circumflex scapular artery within
triangular interval (hiatus)
humerus, teres major, triceps long head
deep brachial artery and radial nerve within
pectoral girdle includes
clavicles, scapulae, sternoclavicular joint
pectoral region
external to anterior thoracic wall, connects upper limb to axial skeleton, anterior wall for axilla, 2 layers
-superficial - skin, superficial fascia, breasts
-deep - muscles and relateed structures
breasts
2nd - 6th rib from lateral sternum to mid axillary line
-between breast and fascia is loose subcutaneous tissue (retromammary space)
-lactiferous duct/sinus, lobules, suspensory ligament
-branches of lateral thoracic artery, terminal branches or 2-4 posterior intercostal arteries
-lateral thoracic vein to axillary vein, internal thoracic vein to subclavian vein, posterior intercostal vein to azygous vein
-75% to axillary nodes, most remaining to parasternal nodes, inferior quadrants drain to abdominal nodes
-anterior and lateral cutaneous branches of 4th-6th intercostal nerves and subclavicular nerves (C3&4)
clavicopectoral fascia
encompasses subclavisus and pectoralis minor (between is costocorocoid membrane), inferior part attached to axillary fascia by suspensory ligament of axilla
structures piercing clavipectoral fascia
C - cephalic vein
A - acromiothoracic artery
L - laterla pectoral nerve
L - lymphatics
deltopectoral triangle contents
deltopectoral fascia, cephalic vein, deltoid branch thoracoacromial artery
pectoralis major
medial 1/2 clavicle/anterior sternum/1st-7th costalcartilages/aponeurosis of external oblique to lateral lip of bicipital groove
lateral and medial pectoral nerves
thoracoacromial and perforating branches of internal thoracic artery
pectoralis minor
ribs 3-5 to coracoid process
medial pectoral nerve
thoracoacromial and perforating branches of internal thoracic artery
subclavius
1st costochondrojunction to inferior surface clavicle
nerve to subclavius
clavicular branch of thoracoacromial artery
serratus anterior
lateral surface of ribs 1-12 and intercostal spaces to costal surface of medial border of scapula
long thoracic nerve
lateral thoracic artery
scapula
acromion, coracoid process, supraglenoid tubercle, infraglenoid tubercle
proximal humerus
head, anitomical neck, surgical neck, greater tubercle, lesser tubercle, intertubercular sulcus, deltoid tuberosity
mid diaphysis
radial groove
distal humerus
medial epicondyle, medial supracondylar ridge, lateral epicondyle, lateral supracondylar ridge, capitulum, trochlea, olecranon fossa, coronoid fossa, radial fossa
ulna
tuberosity of ulna, olecranon process
radius
radial tuberosity
what are the arm compartments separated by
medial and lateral intermuscular septa
flexor/anterior compartment
biceps, brachialis, coracobrachialis
musculocutaneous nerve
brachial artery
biceps brachi
musculocutaneous nerve (C5,6)
brachial artery
LONG HEAD - supraglenoid tubercle to radial tuberosity
SHORT HEAD - coracoid process to radial tuberosity
shoulder flexion, elbow flexion, supination of forearm
glenoid labrum (proximal long head attachment provides stability)
SLAP tear - superior labrum anterior to posterior
brachialis
musculocutaneous nerve (C5,6)
brachial artery
distal hald of anterolateral humerus to tuberosity of ulna
elbow flexion
coracobrachialis
musculocutaneous nerve (C5,6,7)
brachial artery
coracoid process to medial side of midshaft of humerus
shoulder flexion
extensor/posterior compartment
radial nerve
produndus brachii (deep brachial) artery
triceps brachii
triceps brachii
LONG HEAD - infraglenoid tubercle to olecranon process
LATERAL HEAD - posterior humerus above radial groove to olecraon process
MEDIAL HEAD - posterior humerus below radial groove to olecranon process
elbow extension
brachial artery
after teres major, under short head of biceps, starts medial and moves lateral to lie between epicondyles when crossing elbow, terminates below elbow and divides into radial and ulnar arteries
branches - profunda brachii, branches to adjacent muscles, humeral nutrient artery, superior ulnar collateral artery, inferior ulnar collateral artery
profuda brachii
posterior arm, runs in radial groove, anastamose with posterior circumflex and terminates into 2 collateral arteries which are radial and medial
veins in arm
deep - paired brachial veins run with brachial artery
superficial - basilic runs medial and becomes axillary, cephalic runs lateral and empties into axillary
lymphatics
to cubital nodes then to axillary nodes
nerves
-musculocutaneous pierces coracobrachialis and innervates anterior compartment
-median and ulnar nerves run with brachial artery proximally
-distal radial nerve continues lateral with radial artery, ulnar runs posterior to medial epicondyle to enter forearm
-posterior - radial nerve enters posterior compartment via triangular interval and gives branch to biceps and enters radial groove to give cutaneous and triceps branches
cubital fossa borders
lateral - brachioradialis and forearm extensors
medial - pronator teres and forearm flexors
superior - line between epicondyles
floor - brachialis and supinator
roof - bicipital aponeurosis, fascia, fal, skin
contents of cubital fossa (lateral to medial)
tnedon of biceps brachii, brachial artery, median nerve
superficial - median cubital vein crosses bicipital aponeurosis and runs superomedial to connect cephalic with basilic vein
venipuncture done here
biceps reflex (strike biceps tendon here) test C5 and 6
ligaments of elbow
radial collateral, ulnar collateral
radius pulled from anular ligament results in nursemaids elbow
supination muscle
supinator
pronator muscle
pronator teres, pronator quadratus
anterior compartment
mainly median nerve, a few ulnar
superficial anterior compartment
pronator teres, palmaris longus (inconcsistent), flexor carpi radialis (attached to lat wrist), flexor carpi ulnaris (ulnar nerve, attached to medial wrist)
intermediate anterior compartment
flexor digitorum superficialis (proximal medial phalanges)
deep anterior compartment
flexor digitorum profundus (1/2 median 1/2 ulnar nerves), flexor pollicis longus
posterior compartment
radial nerve (brachioradialis is anterior compartment ut also radial nerve)
superficial posterior compartment
extensor carpi ulnaris, aconeus, extensor digiti minimi, extensor digitorum
deep posterior compartment
supinator, extensor indicis
3 longus - extensor carpi radialis, extensor pollicis (snuff box), abductor pollicis
2 bravis - extensor carpi radialis, extensor pollicis
deep flexor compartment arteries
ulnar medially, radial laterally, anterior interosseous a/n
deep extensor artery and nerve
posterior interosseous
hand bones
2 rows of 4 starting at bottom thumb
So - scaphoid
Long - lunate
The - triquetrum
Pinky - pisiform
Here - hamate
Comes - capitate
The - trapezoid
Thumb - trapezium
carpal tunnel
made of carpal arch and flexor retinaculum
includes 9 tendons (flexor digitorum profundus, flexor digitorum superficialis) and the median n
wrist joints
midcarpal and radiocarpal
can flex more than extend
palmar aponeurosis
palmaris longus tendon proximally
palmaris brevis tightens aponeurosis
thenar muscles : median nerve
(superficial to deep)
abductor pollicis brevis
flexor pollicis brevis
opponens pollcis brevid
adductor pollicis brevis (ulnar n)
hypothenar muscles : ulnar n
(superficial to deep)
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi
hand interossei
PADS - palmar, adduct, ulnar n (4)
DABS - dorsal, abduct, ulnar n (4)
lumbricals
attach to extensor hoods, 4 of them
medial 2 ulnar n
lateral 2 median n
palm blood supply
ulnar and radial nerves give superficial and deep palmar arches, dorsally they give the deep dorsal arch
deep palmar arch gives off palmar metacarpal aa
superficial gives off common pamar digital aa which end in proper digital aa
deep dorsal arch also gives dorsal maetacarpal aa and proper digital aa
palm innervation
ulnar n : medial 1/2 digit 4 and all digit 5
median n : palmar branch before carpal tunnel, the rest goes through tunnel and innervates lateral 1/2 digit 4, and digit 3,2,1
posterior hand innervation
ulnar n : medial side to medial 1/2 digit 4
radian n : thumb to lateral 1/2 digit 4 (not fingertips)
median n : fingertips of thumb to lateral 1/2 digit 4
cavities lined by mesothelium
pleura, pericardial, peritoneal
thorax
between neck and abdomen
contains thoracic cavity and contents, thoracic wall surrounds it
framework of thorax
12 ribs
costal cartilages
12 thoracic vertebrae
intervertebral discs
manubrium/body of sternum
xiphoid process
superior thoracic aperture/inlet
open, narrow, continues with root of neck
inferior aperture of thorax
wide, closed by diaphram
true ribs
1-7 articulate directly with sternum
false ribs
8-10 articulate with costal cartilage of ribs above
floating ribs
11-12 no anterior attachment
rib features
head - has 2 facets, separated by crest, which articulate with vertebra superior with the same number and inferior 1 number above
neck
tubercle connects to corresponding TP
body - has costal groove for intercostal arteries and nerves
sternum
- manubrium - articulates with clavicles (sternoclavicular joint) and manubriosternal symphysis (2nd costal cartilage attaches here)
- body - T5-9
- xiphoid provess at T10
3 muscle layers in thoracic wall
- external intercostals - elevate ribs, anterior external intercostal membrane (attach inferolateral)
- internal intercostals - depress ribs, posterior internal intercostal membrane (attach inferomedial)
- innermost intercostal muscles - seperated from internal intercostals by intercostal (Vein, Artery, Nerve)
subcostal muscles
in lower thoracic wall
internal surface of angle of rib to internal surface of 2-3 ribs inferior
run in the same direction and blend with the internal intercostals (depress ribs)
transverse thoracis muscles
posterior xiphoid process/inferior sternum/adjacent costal cartilages of true ribs to insert the inferior margines of costal cartilages 3-6
depress ribs
arteries of thoracic wall
- 1st and 2nd intercostals from supreme intercostal (costocervical trunk of subclavian a)
- from aorta - posterior intercostal arteries for rib 3-11
- from subclavian a - internal thoracic aa which gives anterior intercostal arteries, (at 6th intercostal space) musculophrenic and superior epigastric aa
veins of anterior thoracic wall
posterior intercostal veins drain into brachiocephalic on same side (1st) and the rest into azygos on R or hemiazygos/accessory hemiazygos on L
superior intercostal vv - L into brachiocephalic, R into azygos
azygos v - made from lumbar vv and R subcostal vv, connects superiorly to SVC, drains R intercostals, perichardial veins, bronchial veins, vertebral venous plexuses
hemiaxygos v - receives 9th-11th intercostals and subcostal v
accessory hemiazygos v - drain 4th-8th intercostals
hemiazygos/accessory hemiaxygos join azygos at T7-8
nerves of anterior thoracic wall
T7-11 give intercostal nervers
T12 gives subcostal nerve
lymph of anterior thoracic wall
parasternal nodes drain into bronchomediastinal nodes
intercostal nodes
diaphragmatic nodes posterior to xiphoid
carpal tunnel syndrome
compression median n in carpal tunnel
phalens test (wrist flexion cause pain or tingling)
treat with splint, OMT, NSAIDs, steroids, sx
cubital tunnel syndrome
compression ulnar nerve in cubital tunnel
impaire flexion of elbow and wrist
Tinels test
treat with extension, NSAIDs, OMT sx
cervical radiculopathy
compression of a nerve root (arthritis, herniated disc)
Spurlings test, abduction relief sign
treat with rest, antiinflammatories, OMT, sx
malingering
feigned signs and symptoms
more men with antisocial personality disorder, substance abuse, symptoms are vague
angina pectoralis
coronary artery disease
women lower before menopause
chest pain with exertion
relieved by nitrate and resting
shortness of breath
EKG, stress test, CT
treat with meds, stent, bypass
barrett esophagus
stomach is source of acid leading to barretts esophagus
squamous cells transform into glandular epithelium
metaplasia
reversible change in which differentiated cell type is replaced by another
dysplasia
atypical epithelium
adenocarcinoma of esophagus
esophageal carcinoma
great vessels
aorta, SVC, IVC, pulmonary arteries and veins
pericardium
fibrous membrane with 2 layers
fibrous (superficial)
serous (deep)
boundaries of middle mediastinum, encloses roots of great vessels (blends with tunica adventitia)
coelomic sacs
pleura, pericardium, peritoneum
serous pericardium
parietal and visceral layers
heart position
R ventricle anterior usually left to midline
apex
inferolateral L ventricle
heart base
posterior, mainly L atrium
surfactes
anterior (sternocostal) - R ventricle
inferior (diaphragmatic) - L ventricle
R pulmonary - R atrium
L pulmonary - L ventricle
borders
right - R atrium
inferior - right ventricle and some L ventricle
left - L ventricle and some auricle
superior - R and L atria and auricles
surface projections
apex - 5th intercostal space at midclavicular line
superior border - 2nd L intercostal space to 3rd right intercostal space
right border - 3rd R intercostal space to 6th R intercostal space
inferior border - 6th R intercostal space to apex
left border - apex to 2nd L costal cartilage
coronary sulcus
division between atria and ventricles
trunk of coronary vessels
encircles heart
interatrial sulcus
separate atria, hidden by pulmonary trunk and aorta
2 interventricular sulci
anterior - anterior interventricular artery and great cardiac vein
posterior - posterior interventricular artery and middle cardiac vein
arteries of external heart
left coronary artery - mostly L atria and ventricle, some R atria and ventricle, anterior 2/3, interventricular septum, bundle of His
1. L anterior descending artery (R and L ventricles, apex, interventricular septum)
2. L circumflex artery (posterior lateral L ventricle, L atrium, L auricle)
R coronary artery - R atrium and ventricle, sinoatrial node, atrioventricular node, part of L ventricle, posterior 1/3 interventricular septum
1. R marginal artery (R ventrical and apex)
2. SA nodal branch (SA node)
3. posterior interventricular artery (R and L ventricle and inerventricular septum)
4. AV nodal branch (AV node)
coronary dominance
determined by coronary artery that gives posterior interventricular artery
usually R
venous drainage
all drain to coronary sinus (runs left to right in coronary sulcus on posterior, drains into R atrium)
great cardiac vein
apex to anterior interventricular sulcus, follow left circumflex artery to become coronary sinus
middle cardiac vein
apex to posterior interventricular sulcus
small cardiac vein
inferior anterior coronary sulcus between R atrium and ventricle
heart innervation
sympatethic T1-5 speed it up
parasympathetic vagus n slow it down
superficial and deep cardiac plexuses
superficial - inferior to aortic arch between aortic arch and pulmonary trunk
deep - between aortic arch and brachial bifurcation
layers of the heart
endocardium
myocardium
epicardium
endocardium layers
endothelium
inner layer - CT and smooth muscle
outer layer - blood vessels
myocardium
myocytes
epicardium
blood vessels and nerves
subepicardium
mesothelium
valves
folds of endocardium
chordae tendinae attach AV valves
4 valves : bicuspid/tricuspid (AV), aortic and pulmocary (semilunar)
conduction system
SA node (SVC and R atrium) - fastest to depolarize, pacemaker, follower cells connect with myocardium which connects AV node
AV node (septal wall near tricuspid) - slower
AV bundle - pass AP from AV node, becomes 2 bundles before purkinje fibers
purkinje fibers - ventricle conduction, functions like neurons
blood vessel layers
tunica intima - endothelium simple squamous, maybe elastic membrane
tunica media - circumferentially oriented smooth muscle, maybe collagen or elastin
tunica adventitia - may be seperated by elastic lamina, CT, neurons
artery types
large elastic - conducting arteries, media up to 60 layers, adventitia thin CT
medium muscular - distributing arteries, media 20-40 layers, adventitia thicker and inner part is external elastic membrane
arterioles - small, regulate BP, 1-2 layers, smooth muscle
precapillary sphincters
ring of smooth muscle, influence BP and thermoregulation
capillaries
continuous - tight junctions (muscle)
fenestrated - windows (intestinal vili)
sinusoid - large gaps (liver)
veins small to large
venules - intima no subepithelium, media 0-2 layers of muscles, adventitia thick
medium veins - intima has internal elastic membrane, media 1-3 layers of smooth muscle, adventitia thick with some smooth muscle
large veins - intima subendothelium thicker, media smooth muscle decreased, adventitia thick bundles of longitudinal smooth muscle
valves
in veins, allow 1 way flow
vasa vasorum
in adventitia, vessels over 1 mm
branch into tunica media and provide metabolites to outer regions of vessels
lymph vessles
capillaries - very thin walled, blind ending sacks (lacteals in GI)
vessels - all 3 layers but tunics thinner
often have valves
largest is thoracic duct (media 2 layers, poorly defined adventitia)
cardiac skeleton
dense fibrous CT
4 rings connected by trigone (thickened CT)
maintain integrity of openings, attachment for valve susps, separate atria and ventricles
stenosis
narrowing of valve
insufficiency and regurgitation is when the valves dont close completely
diastole
relaxing
systole
contracting
first heart sound (S1)
closure of AV valves in systole
second heart sound (S2)
closure of semilunar valves in diastole
right atrium
cristae terminalis divides into smooth (ava) and rough (muscular) portions
foramen ovale is opening in fetal interatrial septum, becomes fossa ovalis
right ventricle
3 papillary muscles - anterior, posterior, septal
trabeculae carnae - muscular elevations
septomarginal trabeculae - purkinje fibers (interventricular septa to anterior papillary muscle)
conus arteriosus - leads to pulmonary trunk and valve
left atrium
smooth wall (posterior half) and rough wall (anterior half with pectinate muscles)
left ventricle
walls thicker
trabeculae carne finer and more numerous
anterior and posterior papillary muscles longer
interventricular septum
thick muscular part
thin membranous part (upper)
conducting system
nodal tissue conducting fibers
SA node - spread signal across both atria
AV node - distribute signal to ventricles
AV bundle - pass through skeleton connecting atria and ventricles
Bundle branches - junction of muscular and membranous intraventricular septum
purkinje fibers - extend ventricles and stimulate papillary muscles
primitive heart field
splanchnic lateral plate mesoderm
primary heart field
induced by pharyngeal endoderm
right left symmetry established
secondary heart field in surrounding splanchnic mesoderm
carnialcaudal folding
brings heart into thorax
cardiogenic progenitors coalesce in endocardial tube
splanchnic mesoderm myocardial cells surround tube and secrete cardiac jelly, connect pericardium through dorsal mesocardium (degenerates about day 28)
secondary heart fiels
cells migrate and are incorporated into outflow tract and venous pole
fetal heart correlates to postnatal heart
aortic sac - connection to aortic arch
truncus arteriosus - ascending aorta and pulmonary trunk
conus arteriosus/cordis - infundibulum and aortic vestibule
primitive ventricle - left and right ventricles
primitive atrium - left and right atrium
sinus venosus - coronary sinus and sinus venarum
veins - vena cava
heart tube lengthens and twists
mesoderm forms septum transversum
heart septation
epithelial to mesenchyme transition
neural crest cells migrate into endocardial cushion
septum forms but with foramen primum
second septum forms with fossa ovalis
ventricular septation
starts as myocytes forming muscular septum
fully formed around 7 weeks
AV valves
cavitation occurs with developing ventricles creating trabeculae carne and cordae tendinae
intussusception
pulmonary veins incorporated into wall of L atrium
2 parts of pleura
visceral and parietal, become continuous at the base of the lung
simple squamous epithelium on thin layer of CT with collagen, elastin, blod vessels, and lymphatics
development
4 weeks laryngeotracheal diverticulum develops from foregut
tracheoesophageal ridges separate lung buds from foregut, fuse to form a septum
during separation lung forms trachea and 2 primary bronchi
15th week develop R and L primary bronchi which seperates into lobar bronchi
bronchi develop and branch, lungs move more caudal and expand into body cavity in pericardioperitoneal canals
innervation of pleura
parietal - intercostals
visceral - parietal plexus
hilum
where airways, nerves, and vessels pass into lungs
root
medial to hilum, sleeve like covering for structures
ligament
pleura from root of lung inferior to stabilize inferior lobe
within the root and hilum
pulmonary artery, 2 pulmonary veins, main bronchus, bronchial vessels, lymphatics
parietal pleura
cervical
costal
mediastinal
diaphragmatic
pleural cavities
superior - 2-4cm above rib 1 into neck
inferior - extends to level just above costal margin
medially - bound by mediastinum
endothoracic fascia
connect parietal pleura to thoracic wall
suprapleural membrane
covers cervical parietal plerua (rib 1 to C7)
phrenicopleura fascia
attach diaphram to parietal pleura (diaphragmatic)
pleural recesses
costodiaphragmatic
costomediatinal
pleura blood supply
parietal - intercostal a/v
visceral - R/L bronchial arteries and veins
breathing
inspiration - thorax pressure lower than atmospheric
exhalation - thorax pressure higher than atmospheric
lung surfaces
mediastinal, costal, diaphragmatic
lung borders
anterior, posterior, inferior
right lung
2 fissure - horizontal and oblique
3 lobes - superior, middle, inferioe
impressions - IVC, SVC, heart, esophagus, azygos vein, R subvlavian a/v, main bronchus branches
left lung
1 fissure - oblique
2 lobes - superior and inferior
landmarks - cardiac nothc and lingula, main bronchus branches in root, arch of aorta pass over root, L subclavian artery and brachiocephalic vein arches over superior lobe
topography
apex - C7/T1
inferior border - posteriorly rib 6, midaxillary rib 8, posterior rib 10
oblique fissure -posterior T4, midaxillary 5th intercostal space, anteriorly contour of rib 6
horizontal fissure - midaxillary rib 5, anteriorly rib 4 contour
trachea
extends C6 to T4/5
divides into L/R main bronchus at sternal angle
carina - hook shaped structure at bifurcation
right bronchus
shorter and wider
bronchiole order
terminal branches
respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli
alveoli
type 2 - excrete surfactant
type 11 - gas exchange
alveolar pores allow pressure to equilibriate and air to circulate
pulmonary blood supply
pulmonary artery to lobar arteries to segmental arteries
bronchial arteries
nutrition for lung, run with bronchi
bronchial veins
R drains into azygos
L drains into accessory hemiazygos
sympathetics
bronchodilation
T1-4/5
parasympathetics
vagus nerve
bronchoconstriction
lymphatics
superficial pleural plecus deep to visceral pleura to bronchopulmonary nodes
deep bronchopulmonary plexus in submucosa into intrinsic pulmonary nodes into bronchopulmonary nodes
bronchpulmonary nodes into superior and inferior tracheobronchial nodes into right and left bronchomediastinal trunks
R to other branches forming short R duct
L into thoracic duct
some to axillary
parietal pleura to nodes in thoracic wall
esophagus
compressed by L main bronchus
moves anterior to aorta
off aorta
right side - carotid a, subclavian a
left side - brachiocephalic trunk (coming off common carotid a, subclavian a)
bovine arch
L common carotid originates from brachiocephalic trunk
double aortic arch
encircles esophagus and trachea
retroesophageal aortic arch
esophagus gets compressed
mediastinum veins
inferior thyroid, internal jugular, subclavian, brachiocephalic, pericardiophrenic, superior intercostal, posterior intercostal, azygos, hemiazygos, accessory hemiazygos, ascending lumber, subcostal
mediastinum arteries
supreme intercostal, posterior intercostal, bronchial, esophageal, subcostal, superior phrenic
superior vena cava syndrome
compression by things close to SVC
azygos vein for venous collateral circulation
pericardial sinuses
oblique and transverse
nerves in mediastinum
cervical plexus, phrenic nerve, vagus nerve, recurent laryngeal nerve, esophageal plexus, anterior vagal trunk
distention of aortic arch
aneurism or dissection
lymphatics
thoracic duct crosses midline behind aorta around T4-6
left side - subclavian trunk joins jugular trunk and mediastinal trunk to drain into thoracic duct
right side - subclavian trunk joins jugular trunch forming bronchomediastinal trunk
chylothorax
laceration of thoracic duct
anterior mediastinum
thymus, sternopericardial ligament, fat, CT, lymph nodes
thymus
procuce T cells, blood supply from internal thoracic arteries, venoud drainage into L brachiocephalic or internal thoracic veins, lymph nodes are parasternal/tracheobronchial/near root of neck
T4/5 sternal angle
transverse thoracic plane - superior margin of pericardium, connection of azygos v to SVC, separation of aortic sections, carina
T5/6 to 3rd intercostal cartilage
branch point of pulmonary trunk, superior limit of heart
