Case 1 + 2- anatomy Flashcards

1
Q

Borders of the thorax

A

Superior border- superior thoracic aperture
Inferior border- diaphragm
Anterior border- sternum
Posterior border- thoracic vertebrae

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2
Q

What’s in the thorax

A

Its split into the pleural cavity which contains the lungs and pleura. The other section is the mediastinum which is the mass of tissue in the thorax between the lungs and pleura.

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3
Q

What is the mediastinum split into

A

The superior mediastinum and inferior mediastinum. The inferior mediastinum is further split into the anterior, middle and posterior mediastinum.

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4
Q

How the location of the mediastinum changes

A

In the upright position, gravity causes the soft structures in the mediastinum to sag such that they fall to a lower vertebral level than when the patient is lying down. When a patient is lying on their side, gravity will also pull the mediastinal structures down towards that side.

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5
Q

Boundaries of superior mediastinum

A

Superiorly- superior thoracic inlet
Posteriorly- thoracic vertebra
Anteriorly- sternum

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6
Q

Blood vessels within the superior mediastinum

A

Contains the arch of Aorta which splits into the Brachiocephalic artery, the left common carotid artery and the left subclavian artery. Also contains the superior vena cava with the Braciocephalic vein, the left superior intercostal vein, the supreme intercostal vein (below BV) and the Azygos vein (drains the posterior thoracic wall).

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7
Q

Structures which are’nt blood vessels in the superior mediastinum

A

There is also the right vagus nerve which runs parallel to the trachea and passes posteriorly to the superior vena cava and the right primary bronchus. The left vagus nerve ascends anteriorly to the aortic arch before travelling posteriorly to the left bronchus. There are also the phrenic nerves, the cardiac nerves and the sympathetic trunk. You also have the thymus which lies flush against the sternum, the trachea which is posterior to the ascending aorta. There is also the oesophagus and the thoracic duct on its left.

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8
Q

Anterior mediastinum

A

Contains a bit of the Thymus (gets smaller in adults). It is posterior to the sternum and anterior to the middle mediastinum. No major structures just fat, connective tissue and lymph nodes.

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9
Q

Middle mediastinum blood vessels

A

Contains the start of the Aortic arch which then goes into the ascending aorta. Also contains the pulmonary trunk which gives rise to the left and right pulmonary arteries. Has the superior vena cava which is formed from the left and right brachiocephalic veins

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10
Q

Middle mediastinum structures which aren’t blood vessel

A

Contains the heart, pericardium and left and right bronchi. Contains the cardiac plexus which is a group of nerves at the base of the heart, the sympathetic nerves are from the spinal cord and the parasympathetic nerves are supplied by the vagus nerves. There are also phrenic nerves and the tracheobronchial lymph nodes which are associated with the trachea and bronchi

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11
Q

Posterior mediastinum borders

A

Posterior to the middle mediastinum and anterior to the thoracic vertebrae.

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12
Q

Posterior mediastinum blood vessels

A

Contains the thoracic aorta (descending aorta) which branches into the posterior intercostal arteries, the bronchial arteries, the oesophageal arteries and the superior phrenic arteries. It also contains the Azygos, hemiazygos, and accessory hemiazygos veins. The hemiazygos vein drains into the azygos vein at T8 and at T7 the accessory hemiazygos vein drains into azygos.

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13
Q

Posterior mediastinum structures which aren’t blood vessels

A

The oesophagus is posterior to the thoracic aorta, it exits at the oespheagal plexus. This is a network of nerves surrounding the oesophagus including branches from the left and right vagus nerves they converge to form the anterior vagal trunk and posterior vagal trunk, which travel along the surface of the oesophagus as it exits the thorax.
There is also the thoracic duct which originates from the cisterna chyli in the abdomen and enters the mediastinum through the aortic hiatus. It is to the right of the oesophagus.

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14
Q

The thoracic vertebra

A

They become bigger as you go down. C1-C7 is cervical, T1-T12 is thoracic, L1-L5 is lumbar, S1-S5 is sacral.

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15
Q

Aortic arch

A

Splits into the brachiocephalic trunk which splits further into the right common carotid artery and the right subclavian artery. The second branch is the left common carotid artery, the third branch is the left subclavian artery

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16
Q

The branching after the aortic arch

A

The common carotid artery supplies the head and neck, it splits into the internal and external carotid artery. The subclavian artery supplies the upper limb on each side of the body. The subclavian artery becomes the axillary artery and then the brachial artery. Numerous branches are also given off these arteries to supply the structures of the upper limbs.

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17
Q

Descending aorta

A

The descending thoracic aorta splits into the POSTERIOR INTERCOSTAL arteries, meaning they go in between the ribs, supplying the muscles of the thoracic walls. It then branches into the BRONCHIAL arteries. There are also OESOPHAGEAL branches and the MEDIASTINAL branches. The branches are named after the locations they are travelling to or supplying.

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18
Q

When does the abdominal aorta start

A

When it passes through the aortic hiatus of the diaphragm

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19
Q

Abdominal aorta

A

The aorta becomes the abdominal aorta when it passes through the aortic hiatus of the diaphragm. It first branches into the COELIAC trunk at T12, this supplies the stomach and the liver. The next branch is the SUPERIOR MESENTERIC artery at L1, this supplies the intestine. You also have the LUMBAR arteries which come of at each Lumbar section, to supply the posterior muscles. The INFERIOR MESENTERIC artery comes of at L3, supplies part of the intestine. You then have the COMMON ILIAC ARTERY (left and right) which supply the lower limb, it comes of at L5. You also have the GONADAL arteries. RENAL arteries come of at L1

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20
Q

What are the inferior and superior vena cava

A

Drain deoxygenated blood into the right atrium. Superior vena cava carry’s blood from the upper limbs, head and neck. The inferior vena cava drains from the lower limbs, abdomen and pelvis

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21
Q

Superior vena cava

A

The left internal jugular vein and left subclavian vein form the left brachiocephalic vein. The right internal jugular vein and right right subclavian vein form the right brachiocephalic vein. Both brachiocephalic veins join to for the superior vena cava

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22
Q

Inferior vena cava

A

The right and left common iliac vein join together. The lumbar and renal veins will then drain into the inferior vena cava. The Hepatic veins which drain the liver are a major tributary of the IVC. There are less veins then arteries as most will go through the liver and form the hepatic vein. The inferior vena cava passes through the diaphragm at T8 at the caval opening.

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23
Q

Connective tissue

A

Supports and binds structures in the body. It also insulates, stores reserve fuel and transports substances around the body. Specialised connective tissue may have other functions.

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24
Q

Connective tissue structure

A

Consists of cells that are far apart and surrounded by the extracellular matrix. Cell types and ECM components depend on type of connective tissue (CT). The extracellular matrix is made of collagen and elastin fibre (produced by fibroblasts). Within the outside of the substance you will have a ground substance which is made of water and glycosaminoglycans.

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25
Q

Loose connective tissue

A

They have large amounts of ground substance and fewer fibres, i.e. adipose (fat).

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26
Q

Dense connective tissue

A

They have large amounts of fibre and less ground substance, They are split into dense regular and dense irregular. The dense regular is very uniform with parallel fibres. The dense irregular is not tightly packed in straight line and is in a random order. This will be stuff like ligaments and collagen as its very strong

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27
Q

Specialised connective tissue

A

Cartilage and bone as well as blood and blood vessels. Have a particular function and structural makeup.

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28
Q

What is the pericardium

A

A fibrous sac which contains the heart and the route to the great vessels

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29
Q

Function of pericardium

A
  • Fixes the heart in the mediastinum and limits its motion.
  • Prevents overfilling of the heart.
  • Lubrication. A thin film of fluid between the two layers of the serous pericardium reduces the friction of heart movement
  • Protection from infection. The fibrous pericardium serves as a physical barrier between the muscular body of the heart and adjacent organs prone to infection, such as the lungs.
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30
Q

Layers of the pericardium

A

Fibrous pericardium- outer layer, continuous with the diaphragm and adventitia of the great vessels
Serious pericardium- inner layer
Serious pericardium is split into the viscera layer which is the innermost layer then we have the parietal layer which is on the inside of the fibrous pericardium.

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31
Q

The pericardial cavity

A

Between the visceral and parietal layer, contains a little bit of fluid to lubricate the heart

32
Q

Pericardial sinuses

A

When the serious pericardium meets the great vessels it reflects off and back on itself, fusing with another part of the serious pericardium. This forms blind ended spaces between the pericardium and the heart

33
Q

Pericarditis

A

Inflammation of the pericardium, usually due to viral infection

34
Q

Transverse pericardial sinus

A

Occurs superiorly and is surrounded by the aorta and pulmonary trunk. It is the passage between the anterior and posterior reflections, it lies superior to the left atrium.

35
Q

Oblique pericardial sinus

A

Occurs posteriorly and is surrounded by the superior Vena Cava and the Pulmonary veins. It is J shaped and located behind the left atrium.

36
Q

Right and left auricle

A

Top of the right atrium, allows more blood to enter the right atrium if required. The left auricle does the dame for the left atrium

37
Q

Apex of the heart

A

At the bottom of the heart

38
Q

Coronary vessels

A

Surround the heart giving blood to the heart itself

39
Q

Borders of the heart

A

Left border- left ventricle
Inferior border- right ventricle
Right border- right atrium
Superior border- great vessels and left atrium

40
Q

Main structures in the right atrium

A
  • The opening of the coronary sinus
  • Atrioventricular orifice- the opening between the atria and the ventricle
  • Tricuspid valve- “Tri-to be right”
  • Pectinate muscles
  • Crista terminalis
  • Fossa ovalis- between the left and right atria. Remnant of Foreman ovale.
  • Interatrial septum- fibromuscular wall between left and right atria
  • Inferior and superior vena cava
41
Q

Pectinate muscle

A

Comb like muscles which can flatten to allow for more volume

42
Q

Crista terminalis

A

A smooth ridge at the end of the pectinate muscle

43
Q

Coronary sinus

A

The main vein that will drain the heart of its own blood supply, drains into the right atrium

44
Q

Papillary muscle

A

Attach to the valves to secure them in place

45
Q

Septomarginal trabecula (moderator band)

A

Travels from the interventricular septum to the anterior papillary muscle, gives a shortcut to the anterior papillary muscle so that they contract on time.

46
Q

Chordae tendinaee

A

Where the papillary muscle attaches to the valves, stops the valves from being pushed the wrong way when the ventricles contract

47
Q

Trabecular carnaee

A

The ridges of the muscles of the walls of the ventricles, allow for some of the contractions of the papillary muscles and hold the valves in places.

48
Q

Interventricular groove

A

Marks the separation between the two ventricles

49
Q

Conus arteriosus

A

Smooth portion of the right ventricle as it enters the pulmonary trunk

50
Q

Structures in the right ventricle

A

• Papillary muscle
• Septomarginal trabecula (moderator band)
• Chordae tendineae
• Trabeculae carneae
• Interventricular groove
• Interventricular septum- the fibromuscular wall between the left and right ventricle
• Conus arteriosus- smooth portion of the right ventricle as it goes into the pulmonary trunk.
- Pulmonary trunk
- Tricuspid valve

51
Q

Left atrium structures

A

1) Bicuspid valve (mitral)
2) no pectinate muscle, a lot smaller
3) left auricle
4) Atrioventricualr orifice
5) Fossa ovalis
6) Pulmonary vein

52
Q

Left ventricle

A

1) Aorta
2) Aortic valve (Semi-lunar valve)
3) chordae tendinae
4) Papillary muscle
5) Trabeculae carnae

53
Q

What surrounds the valves

A

A fibrous skeleton

54
Q

Atrioventricular valves

A

Between atrium and ventricle. Connected to the papillary muscle via the chordae tendineae. When the papillary muscles contract in the ventricles this will pull on the cusps of the valves, securing them into place. Bicuspid (mitral) valve is on the left, tricuspid valve on the right. These valves close at the start of ventricular contraction (systole). This allows blood to flow into the ventricles and not back into the atria.

55
Q

Semi-lunar valves

A

Opposite way round to the atrio-ventricular valves. They have three cusps, in the pulmonary it is left right and anterior. Stops gravity pushing the blood back into the atria. In the aortic valve instead of an anterior cusp you have a posterior cusp. There are a couple of openings for coronary arteries, if not all the blood flows straight away it will pool in these sinus’s and travel through these openings. Only in the aortic semi-lunar valve (left) and not the pulmonary (right).

56
Q

“lub-dub”

A

The “lub” sound is due to the atrioventricular valves closing and the “dub” sound is the semi-lunar valves closing.

57
Q

The hearts fibrous skeleton

A

Made of dense connective tissue and separates the atria from the ventricles. Provides support for the heart and separates the floe of electrical impulse. So the electrical impulse has to go through the AV for the ventricles to contract

58
Q

Extrinsic conducting system of the heart

A

Controlled by nerves, controls heart rate and contraction forces. Regulates heartbeat. Parasympathetic nerves inhibit the heart rate through the Vagus nerves. The Sympathetic inervation is controlled by the Sympathetic trunk, this stimulates the heart and increases its heart rate and contraction force. Superficial cardiac plexus is parasympathetic and the cardiac plexus is sympathetic

59
Q

Intrisic conducting sequence

A
  • SA node spontaneously depolarises
  • The internodal tracts, between the SA node and the AV node allow synchronised contraction of both atria and conduction of the signal to the AV node. The three internodal tracts are anterior, middle and posterior.
  • AV node receives impulse from SA node and causes a small delay so that the atria and ventricles do not contract at the same time. This happens because there are fewer gap junctions between the cells as we approach the AV node. It then transmits the signal to the atrioventricular bundle.
  • The bundle of His (atrioventricular bundle) transmits the signal down the interventricular septum, it then splits into two. The left and right bundle branches transmit action potentials to the Purkinje fibres.
  • The Purkinje fibres are specialised fibres which allow the muscle in the ventricle wall to contract from the apex upwards to the base
60
Q

Size of a heart in an x-ray

A

The cardio:thoracic ratio (CTR) should be less then 50%

61
Q

How to look at a cross-sectional image

A

It is looking from the patients feet upwards, so their left is our right

62
Q

Coronary arteries

A

Supply blood to the heart muscle, the coronary arteries get their blood in the aorta through the sinus’s. In the semi-lunar valve there are openings for the coronary artery. The left and right coronary arteries come of the aorta

63
Q

The right coronary artery and its branches

A

Comes of the aorta. The right coronary artery branches into the sino-atrial nodal artery which supplies the SA node. There is also the right marginal coronary artery on the margin of the heart. The Posterior interventricular artery (posterior descending artery) comes of the right coronary artery.

64
Q

The left coronary artery

A

Comes of the aorta. The left coronary artery splits into the Circumflex artery which travels posteriorly around the heart, and the left anterior descending coronary artery, can also be referred to as the anterior interventricular artery. You also have the left marginal coronary artery.

65
Q

Differences in how the coronary arteries are arranged

A
  • The SA nodal artery can branch of the left coronary artery instead of the right common artery, this happens 40% of the time.
  • The posterior interventricular artery comes off the left coronary artery 10% of the time and 20% of both the left and right coronary artery.
66
Q

Cardiac dominance

A

When the posterior descending artery (PDA) is a branch of the right coronary artery you are right dominance (70-85% of individuals). Co-dominance is when it comes of both coronary arteries (20% of individuals). Left dominance is when it is a branch of the left coronary artery (10% of individuals).

67
Q

Importance of cardiac dominance

A

The PDA supplies a large portion of the inferior territory of the heart so a blockage in the LCA or RCA may or may not result in damage to this territory depending on the dominance of the individual.

68
Q

What part of the heart does the right coronary artery supply

A

Right atrium and part of the right ventricle

69
Q

What part of the heart does the right marginal artery supply

A

Part of the right ventricle

70
Q

What part of the heart does the left marginal artery

A

Left ventricle

71
Q

What part of the heart does the anterior descending coronary artery

A

Part of the left but mostly the right ventricle

72
Q

What part of the heart does the circumflex supply

A

Left atrium, bit of the ventricle

73
Q

What part of the heart does the posterior interventricular artery supply

A

Part of the left and right ventricle on the posterior side

74
Q

Cardiac veins

A

The anterior interventricular vein will drain into the great cardiac vein. The middle cardiac vein sits where the posterior interventricular artery will sit. Coronary sinus is a large vein on the posterior side of the heart just below the left atrium, this drains into the right atrium, it is very obvious to see.

75
Q

Angiogram

A

A type of x-ray which uses contrast dye to visualise blood vessels