B2.086 Intro to Gross Anatomy, Thoracic Wall, Lung Cavities, and Lungs Flashcards
median plane (midsagittal)
vertical plane
dividing body into right and left halves (midline)
sagittal
any plane parallel to the median plane
coronal
vertical plane
divides body into anterior and posterior
horizontal (axial) (transverse)
plane that passes through body parallel to the horizon
divides body into cranial and caudal
oblique
any section cut at any other angle
anterior (ventral)
front
posterior (dorsal)
back
superior (cranial)
nearer the head
inferior (caudal)
nearer the feet
medial
nearer to median plane
lateral
farther from medial plane
proximal
nearer to trunk or point of origin
distal
farther from trunk or point of origin
origin
proximal attachment of a muscle
insertion
distal attachment of a muscle
thorax
extends between neck and abdomen cage for breathing, protection of the heart, and support of upper arms 12 vertebrae 12 ribs and costal cartilage 1 sternum (3 parts)
parts of sternum
manubrium
body
xiphoid process
true ribs
1-7
attach to sternum anteriorly w cartilage extensions
false ribs
8-10
do not attach to sternum, costal cartilage present
floating ribs
11-12
lack costal cartilage
rib head
articulates with body of corresponding vertebra, or vertebra and vertebra immediately superior
tubercle
transverse process of corresponding vertebra
shaft/body
bulk of rib that curves anteriorly
groove on inferior surface for intercostal vein, artery, nerve
costal angle
lateral to tubercle
rib first starts to turn anteriorly
frequent site of rib fracture
lateral to angle of rib
site of insertion of iliocostalis muscles
costal angle
why do broken ribs rarely need surgical intervention
held to each other by 3 sets of interconnecting skeletal muscles
what happens when ribs are removed
grow back is periosternum is intact
cervical rib
elongation of transverse process ossification center of the 7th cervical vertebra
13th rib
present in 0.5-1% of pop
consequences of cervical rib
limit crowded thoracic aperture
lead to compression of brachial plexus nerves to the arm
compression of subclavian artery
thoracic outlet syndromes
superior thoracic aperture (thoracic outlet)
bound by T1 vertebra, 1st rib, and superior border of manubrium
arterial thoracic outlet syndrome
cervical rib compresses subclavian artery
bulge in subclavian artery downstream of the constriction
2nd bulge lateral to rib develops over time due to turbulence
neurogenic thoracic outlet syndrome
compression of c8 and T1 nerve roots as they pass over cervical rib
10% of patients w cervical rib have it
mimics ulnar neuropathy or Klumpke’s palsy
venous thoracic outlet syndrome
blood clot forms in a deep arm or shoulder vein
manubrium
triangular bone
superior edge = suprasternal notch
attachment of clavicles, 1st ribs, and half of second ribs
body of sternum
articulates w manubrium, ribs 2-7 and xiphoid process
xiphoid process
cartilaginous until 4th decade
T10 level
separation between superior and middle mediastinum
sternal angle of lewis 2nd rib junction of manubrium w nody of sternum between T4 and T5 azygous veins drain into SVC inferior part of arch of aorta
pectus excavatum
sternal abnormality
sunken sternum
mitral valve prolapse and decreased lung capacity
1:150 births
pectus carinatum
ridge projecting anteriorly
more rare than excavatum
premature sternal fusion
increased incidents of heart defects
sternal fistula
hole in sternum
uncommon
congenital heart defects
synchondrosis joint
cartilaginous joint between 1st rib and manubrium
very little fluid
sternocostal joint
synovial joint between ribs 2-7 and sternum
costochondrial joint
union of rib bone with hyaline cartilage of the same rib (synchondrosis joint)
costochondritis
chets pain due to inflammation of cartilage and bones in the chest wall
overuse in athletes
secondary to heavy exercise
muscles of thoracic wall
external intercostal
internal intercostal
innermost intercostal
external intercostal muscles
run inferiorly and medially
replaced anteriorly by a membrane
raise ribs during inspiration
internal intercostal muscles
run inferoposteriorly
replaced posteriorly by a membrane near thoracic vertebra
interchondral parts anteriorly raise ribs
lateral fibers depress ribs
innermost intercostal muscles
run inferoposteriorly
replaced anteriorly and posteriorly by a membrane
depress ribs during heavy exercise
goal of all intercostal muscles
keep intercostal space from bulging or collapsing during respiration
transverse thoracic muscles
originate on inner surface of sternum
insert onto inner anterior surface of ribs 2-6
depress ribs during heavy exercise
subcostal muscles
small slips of muscle
attach to the inner surface of the lower ribs on the posterior portion of the thoracic wall
run 2 ribs long (skip a rib)
depress ribs
serratus posterior superior
originates from nuchal ligament and spinous process of C7 to T3
inserts on superior posterior border of 3rd-6th ribs
raise ribs during inspiration
serratus posterior inferior
originates from spinous process of T11 to L2
inserts on inferior posterior border of 8th-12th ribs
depress ribs during expiration
levator costarum
small short muscle slips
originate from transverse processes of C7 to T11
insert on upper posterior edge of the rib just inferior
elevate ribs during inspiration
neck muscles
anterior, middle, and posterior scalene muscle
anterior scalene
originates from transverse process of c3-c6; inserts on to scalene tubercle of 1st rib
middle scalene
originates from transverse process of c2-c7
inserts on to 1st rib posterior to the subclavian artery groove
posterior scalene
originates from the transverse process of c5-c7
inserts on to upper surface of 2nd rib
function of scalene muscles
act as elevators of the ribs during heavy inspiration
laterally bend the neck and head to one side
pectoralis major
originates from costal margin, sternum, and medial clavicle
inserts onto crest of the greater tubercle of the humerus
functions to flex, adduct, and medially rotate arms
pectoralis minor
originates from outer surface of ribs 3-5
inserts onto the coracoid process of the scapula
fun
functions to pull scapula down and anteriorly
serratus anterior major
originates from upper outer surface of ribs 1-8
inserts onto medial angle, vertebral border of scapula
functions to pull scapula forward
intercostal nerves
ventral rami of T1 to T11
course between the internal and innermost intercostal muscles
partially under the groove of the superior ribe
lateral cutaneous branch
bran of intercostal nerve that goes to skin anterior to the angle of the ribs
anterior cutaneous branch
goes to skin near sternum
subcostal nerve
T12 under 12 rib onto abdominal wall
VAN
vein
artery
nerve
from cranial to caudal is the typical order of the structures under the groove of each rib
thoracentesis
invasive procedure to remove fluid or air from the pleural space
cannula is introduced through the space between the ribs into pleural space
thoracotomy
incision into the chest
layers a thoracentesis will penetrate
skin subcutaneous tissue external intercostal internal intercostal innermost intercostal parietal pleura
coarctation of the aorta
stenosis of the aorta
increased blood flow within the intercostal arteries
can lead to engorgement of the intercostal arteries and costal notching of the under surface of the ribs
dermatomes
areas of the skin which receive innervation from the spine
C5
clavicle
T4
teat
T7
xiphoid process
T10
umbilicus
L1
inguinal ligament
shingles
reactivation of latent herpes varicella-zoster
unilateral condition restricted to a dermatome
breast adenocarcinoma
lactiferous duct carcinomas that begin as painless masses in the upper lateral quadrant
polythelia, polymastia
extra nipples or breast that develop along the embryonic mammary ridge
thelia (nipple) more common than mastia (breast)
associated w increase incidence of renal abnormalities including duplication of ureters
breast cancer in men
1.5%
not detected until late and more deadly
masses or secretion
gynecomastia
excessive development of male mammary gland
due to ductal proliferation and periductal edema
increased estrogen levels
65% of men between 50-80
right dome of diaphragm
reaches to 4th intercostal
left dome of diaphragm
reaches to 5th intercostal
3 major openings in diaphragm
T8- inferior vena cava
T10- esophageal hiatus
T12- aortic hiatus
diaphragm innervation
phrenic nerve from C 3,4,5
runs with pericardiacophrenic artery and vein
pleurisy/pleuritis
inflammation of the pleural membrane due to viral or bacterial causes can lead to pleural friction and adhesions of the visceral and parietal layers sharp stabbing pain on inhalation rubbing can be hear w stethoscope
parietal pleura subdivisions
cervical - superior to 1st rib
costal - contact w rib cage
diaphragmatic - contact w upper diaphragm
mediastinal- contact w mediastinal structures
costomediastinal recess
costal and mediastinal pleura meet anterior to the heart
particularly in left pleural space
lingula
caudal portion of superior lobe of the left lung
adjacent to costomediastinal recess
costodiaphragmatic recess
most likely to collect excess fluid
congenital diaphragmatic hernia (CDH)
1 in 2500 births
difficulty breathing
survival rates 60-90%
bochdalek hernia
hole in back of diaphragm
90% of CDH
85% in left side
Morgagni hernia
hole in the from of diaphragm near xiphoid process
2% of CDH
why can lungs collapse
fluid in pleural cavity is 2-6 mmHg less than atmospheric pressure
pneumothorax
result of a traumatic injury to the wall of lung or an infection causing a hole in the lung
allows air into pleural space
inherent elasticity of lung causes it to collapse on itself
empyema
condition in which pus and fluid from infected tissue collects in a body cavity
empyema thoracis in pleural cavity
flotation of lungs at autopsy
lungs that take taken in air will float when cut and placed in water
lungs which have never taken a breath of lungs that inhaled water actively will sink in water
right lung impressions
groove for SVC
groove for arch of the azygous vein
right hilum
rt bronchus- superior and posterior
rt pulmonary arteries- middle
rt pulmonary veins- anterior and inferior
left lung impression
cardiac impression
groove for the arch of the aorta
left hilum
lt. bronchus- posterior
lt. pulmonary artery- superior
lt. pulmonary veins- anterior and inferior
right bronchus
wider, shorter, more vertical
more likely to receive aspirated foreign body
left bronchus
narrower, more horizontal
carina
ridge that subdivides the trachea into right and left bronchi
pleural pain
visceral pleura and lungs have no pain nerve fibers themselves
parietal pleura is innervated with pin fibers
diaphragm pain may be referred in neck and shoulder regions
mid clavicular line (anteriorly)
lungs- 6th rib
pleural - 8th rib
mid axillary line (lateral scapular line)
lungs- 8th rib
pleural- 10th rib
medial edge of scapula (posteriorly)
lungs- 10th rib
pleural- 12th rib
inhaled foreign bodies
right inferior lobar bronchus
quiet inspiration
diaphragm
external intercostals
interchondral portion of internal intercostals
quiet expiration
passive recoil of lungs and thoracic cage
abs
forced inspiration
sternocleidomastoid
scalene
levator costarum
serratus posterior superior
forced expiration
active contraction of rectus abdominis
external and internal obliques
serratus posterior inferior
transversus thoracis
hiccups
involuntary, spasmotic contractions of the diaphragm
interrupted by spasmodic closure of glottis of the larynx
