Breast and Thoracic Wall Flashcards by Garrett Oberst

Mammary gland origin

Epidermis of the skin (modified sweat gland)

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Location of mammary glands

Superficial fascia

Superficial to pec major

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Glandular Tissue composition and location

15-20 lobes radially arranged around nipple

Made of several lobules with ducts that converge and open on the surface of the nipple

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Lactiferus ducts

Have dilation towards nipple that serves as a reservoir for milk

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Reservoir for milk names

Ampulla or sinus

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What part of mammary extends toward axilla?

Axillary tail of spence

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Suspensory ligaments composition, locaiton, and functiojn

Fibrous bands running from deeper (membranous) layer of superficial fascia to the dermis
Surrounds and supports glandular tissues
Can be seen on a mammogram

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Retromammary space function and location

Between superficial and deep fascia overlying pec major and serratus anterior…allows for movement of the breast on thoracic wall

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Blood supply of mammary glands and origins/additional branches

Internal thoracic artery (perforating branches and anterior intercostal branches)
Lateral thoracic and thoracoacromial arteries (from axillary)
Posterior intercostal arteries (from thoracic aorta)

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Which two arteries of mammary will anastomose

Posterior intercostal and anterior intercostal

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Innervation of mammary glands and types of fibers found within

Intercostal nerves 4-6 (ventral primary rami)

Somatomotor, somatosensory, postganglionic sympathetic

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Which two nerves pass lateral to mammary gland that cna be injured during masectomy?

Long thoracic and thoracodorsal

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Most drainage of breast first passes to

Subareolar lymphatic plexus

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Most drainage goes from subareolar lymphatic plexus to the

Axillary lymph nodes ------
Pectoral (ant)
Subscap (post)
Lateral
Central
Apical (to subclav trunk)

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Parasternal nodes and where they drain (also artery associated with)

Can receive drainage from subareolar lymphatic plexus

Will then go to deep lymphatics associated with internal thoracic artery

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Other route than drainage can go from subareolar lymph plex besdies parasternal and axillary nodes

Abdominal nodes and to contralateral breas t

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Carcinomas of breast usually derived from

Epithelial cells of the lactiferous ducts

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Primary and secondary spread of breast cancer

Lymphatic

Venous

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What causes orange peel appearnace?

Edema of the skin from interference with lymph drainage

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What does fibrosis cause and mechanism

Dimpling of the skin caused by shortening of the suspensory ligament

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Invasion of retromammary space can

Fix the breast to the thoracic wall

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General functions of the thoracic wall

Protection of organs
Respiration
Muscle attachment

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Superior thoracic aperture and what is found on lateral thirds

Superior opening of the thoracic

Suprapleural membranes

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Inferior thoracic aperture and what it is covered by

Inferior boundary of the thorax

Diaphragm

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What passes throoug hthe inferior thoracic aperture

Aorta, esophagus, azygos v., inferior vena cava, and nerves

Endothoracic fascia and what does it form?

Deep fascia | Thickens over lungs to form suprapleural membrane

What lies deep to endothoracic fascia in areas adjacent to the lungs?

Parietal pleura

External intercostal - direction and attachments

Most superficial layer Inferior and medially (on the front) Vertebral bodies to the costochondral junction DOES NOT EXTEND TO STERNUM LIKE THE EXTERNAL INTERCOSTAL MEMBRANE

Internal intercostal muscles - direction and attachments

Second layer From sternum to angle of the ribs DOES NOT EXTEND TO VERTEBRAL BODIES LIKE THE MEMBRANE DOES

Innermost intercostals - attachments

Track with the internal intercostals | Subcostal (extend more than one intercostal space near vertebral bodies )

Transversus thoracis

Part of innermost intercostals on posterior surface of lower sternum

Costal groove contents from superior to inferior and what layers found between

Intercostal vein, artery, and nerve | Between internal and innermost muscle layers

Best location for thoracocentesis?

Between ribs so that you won't hit neurovascular bundle

What are suprapleural membranes?

Thicken endothoracic fascia over the apices of the lungs

Trachea location and what is it continuous with superiorly?

Larynx superiorly | Anterior to the esophagus

Esophagus continuous with what superiorly?

Pharynx

What artery is found on right but not left and what does it give origin to?

Brachiocephalic | Origin to the right common carotid and right subclavian

Brachiocephalic artery

Branch of the aorta | Gives origin to right common carotid and right subclavian

Left common carotid artery origin and supply

Supplies head and neck | Branch of aorta

Left subclavian origin and supply

Left upper extermity | Branch of the aorta

Subclavian artery location and branches

Posterior to the anterior scalenes | Vertebral, internal thoracic and thyrocervical arteries

Subclavian veins location and function

Drain upper extremities | Anterior to the anterior scalenes

Internal jugular veins function and what it forms

Drains the brain | Joins with subclavian veins to form brachiocephalic veins

Thoracic duct and where it empties

Terminal portion of lymphatic system | Empties into venous at left internal jugular and left subclavian veins

Vagus nerves

Cranial nerve 10 | Parasympathetic for neck, thorax, and abdomen

Phrenic nerves and location

C3, C4, and C5 Innervate the diaphragm On the anterior scalene muscles

Anterior scalene muscles and location relative to Brachial plexus

Anterior | Muscles of the neck

Thoracic diaphragm

Dome shaped musculofibrous septum that separates the thoracic cavity from abdominla cavity

Primary muscle of respiration

Thoracic diaphragm

Right crus attahcment

First three lumbar vertebrae

Left crus attachment

First 2 lumbar vertebrae

Central tendon of thoracic diaphragm

Strong aponeurosis for attachment of diaphragm muscles

Foramen of the vena cava located

In the central tendon of the thoracic diaphragm

Contraction of diaphragm does what to central tendon?

Lowers it

Diaphragm innervation

Phrenic nerves - motor and sensory | Intercostal nerves - some sensory arround the edges

Blood supply of the diaphragm

Superior and inferior phrenic arteries (from aorta) Intercostal arteries Internal thoracic arteries

Vertebrae level of central tendon attachment

Vertebrae level of vena cava foramen and what passes through

T8 | Inferior vena cava

Level of esophageal hiatus and what passes through

T10 Esophagus Vagus nerves

Level of aortic hiatus and what passes through

T12 Aorta Azygos vein Thoracic duct

Respiratory mechanics

Superior - inferior: Action of diaphragm Anterior - posterior: Pump-handle Lateral - Lateral: Bucket handle

Quiet inspiration muscles

Primarily diaphragm

Quiet expiration

Passive recoil

Forced inspiration

Diaphragm External intercostals Scalens Sternocleidomastoid

Forced expiration

Abdominal wall muscles INternal intercostals Transversus thoracis

Cartilaginous joints of the thoracic wall

``` Intervertebral Costochondral 1st sternocostal joint (1st rib and manubrium) Manubriosternal Xiphisternal ```

Synovial joints of thoracic wall

Costovertebral (head of rib with vertebra) 2-7 sternocostal joints Interchondral