Chapter 27 - Thorax and Abdomen Flashcards
sternal/true ribs
7 upper ribs (joined to sternum by costal cartilage)
false ribs
ribs 8-10 (common cartilage that joins 7th rib before attaching to sternum)
floating ribs
ribs 11-12
unattached to sternum, do have muscular attachments
external intercostals __________ the diaphragm during ________
external intercostals elevate the diaphragm during inspiration
internal intercostals _________ the rib cage to assist with _____
internal intercostals depress the rib cage to assist with expiration
what nerve innervates the diaphragm
phrenic nerve
Right lung, # of lobes
3
left lung, # of lobes
2
Air transportation system
Trachea–> R&L primary bronchi –> secondary bronchi –> alveoli
what happens during diaphragm contraction
dome flattens, increases volume of thorax, causes inspiration
flow of blood
deoxygenated blood to right atrium to tricuspid valve to right ventricle to pulmonary valve to pulmonary artery & lungs to pulmonary vein to left atrium to mitral valve to left ventricle to aortic valve to aorta
thymus function
produces lymphocytes, which migrate to other lymphatic tissue to respond to foreign substances
kidneys (location, function)
slightly above iliac crest (T12-L3)
fx: filter metabolic wastes, ions, drugs from blood and expels via urination
contains adrenal glands on top
adrenal glands
secrete epinephrine, norepinephrine, cortisol, estrogen, aldosterone, androgen
ureters and urinary bladder (location)
bladder lies posterior to pubic symphysis
liver (location and functions)
upper right quadrant, 2 major right and left lobes
digestive and excretory functions, absorbs and stores excessive glucose, processes nutrients, detoxifies harmful chemicals, secretes bile (neutralize and dilute stomach acid & digest fat)
gallbladder (location and function)
inferior surface of liver
stores bile
pancreas (location and function)
located between small intestine and spleen
secretes pancreatic juice (critical in digestion), produces insulin and glucagon
stomach location
upper left quadrant
makes chyme
small intestine
duodenum to jejunum to ileum
digestion and absorption
large intestine
cecum to colon to rectum
appendix
extends off of cecum
it is where chyme is converted to feces
spleen
upper left quadrant, below diaphragm
lymphatic organ
resevoir for RBC’s, regulates # of RBC’s in circulation, destroys ineffective cells, produces antibodies and lymphocytes
prevention of injuries to thorax and abdomen
protective equipment,
strengthen core
empty hollow organs prior to practice
important questions to ask in a history
difficulty breathing? blood in urine? difficulty or pain with urination?
observations you should notice
breathing, symmetry of chest movement, swelling, deformity, cyanotic, guarding ab muscles, lowered BP, rapid weak pulse
Upper Right Quadrant
liver, pancreas, kidney, lung
Upper Left Quadrant
heart, spleen, kidney, stomach, lung
Lower Right
Appendix, ureter, bladder, colon, gonads
Lower Left
ureter, bladder, colon, gonads
bleeding or irritation inside abdomen cavity causes
board like rigidity in the abdomen, not voluntarily relaxable
cardiac/lung/splenic refers pain
left shoulder
diaphragmatic pain refers to
shoulders
liver/gallbladder refers pain to pain
right shoulder, upper left quadrant
appendix refers pan to
McBurney’s point
S1-S2 (heart)
systole (blood to body/lungs)
S2-S1 (heart)
diastole (filling of heart)
S1 (heart)
closing of atrioventricular valves (mitral and tricuspid)
S2 (heart)
closing of semilunar valves (aortic & pulmonic)
Aortic valve (where is it located)
2-ICS, RSB
2nd intercostal space, right sternal border
tricuspid
LLSB
lower left sternal border
Pulmonic valve
2ICS, LSB
2nd intercostal space, left sternal border
mitral
cardiac apex
5ICS, LSB
5th intercostal space, left sternal border
blood flow
body tissues superior/inferior vena cava right atrium tricuspid valve right ventricle pulmonary semilunar valves pulmonary trunk pulmonary arteries lung tissue pulmonary veins left atrium bicuspid valve left ventricle aortic semilunar valves aorta -body tissues-->vena cava -(coronary arteries-->heart tissue, coronary sinus cardiac veins, right atrium)
Cheyne-Stokes
rate speeds up and then slows down over a 1-3 minute period
Biots
a series of breaths at a normal rate are followed by a complete cessation of breathing
Apneustic
pauses in the respiratory cycle at full inspiration
thoracic
occurs without diaphragmatic breathing
wheezes/rhonchi
continuous music-like sounds with a high pitch
rales
crackling/bubbly sounds
positions for auscultation of lower lung lobes
bottom 3/4 of posterior fields
positions for auscultation for left axilla
lingula
positions for auscultation for right axilla
right middle lobe
positions for auscultation upper lobes
anterior chest and top 1/4 of posterior fields
normal bowel sounds
liquid like gurgling sounds created by peristaltic actions
about 8 gurgles per minute
absent or diminished bowel sounds
paralytic lieus or peritonitis, swelling
high pitched tinkling bowel sounds
intestinal obstruction
Rib contusion etiology
blow to ribcage may contuse intercostal muscles or produce a fracture. Breathing is very painful
rib contusion s/sx
sharp pain during breathing, point tenderness and pain elicited when rib cage is compressed
rib contusion management
rule out fx (x-ray), RICE and anti-inflammatory agents
Rib Fx etiology
direct blow, violent muscle contractions, compression of ribcage,
most common: ribs 5-9
stress fx: repeated arm movements/ coughing/laughing
flail chest
fracture 3+ consecutive ribs on the same side
rib fx s/sx
pn w/ breathing, point tender, crepitus w/ palpation
rib fx management
x-ray, rest, bracing or ace wrap,
hypostatic pneumonia
occurs when an individual does not take full inspiration because of pain
costochondral separation & dislocation etiology
direct blow to anterolateral aspect of thorax or indirectly sudden twist or fall on a ball that compresses the rib cage
pn is localized in junction of rib cartilage and rib
costochondral separation s/sx
sharp pain, hard to breathe, point tender, swelling, rib deformity, crepitus
costochondral separation/dislocation management
rest and immobilization (healing takes 1-2 months)
sternum fx etiology
high-impact blow to the chest (more likely to occur in car accidents than athletics)
may also cause contusion to the underlying cardiac muscle
sternum s/sx
point tender at site of fx, exacerbated by deep inspiration or forceful expiration.
signs of shock, weak rapid pulse, could indicate internal injury
sternum management
x-rays, monitor for signs of heart trauma
muscle injury etiology
direct blows, sudden torsion
muscle injury s/sx
pain w/ active motion, pain during breathing, laughing, coughing, or sneezing
muscle injury management
apply cold, immobilize
Breast injury etiology
violent up and down lateral movements of the breasts can bruise or strain them
stretch cooper’s ligaments
Runner’s nipples
shirt causes abrasion when running
bicyclist’s nipples
combination of cole and evaporation of sweat
breast injury management
wear a sports bra
breast cancer
self examinations every month
clinical exams every 3 years
pneumothorax
pleural cavity becomes filled with air that has entered through an opening in the chest
may cause pain, difficulty breathing, anoxia
anoxia
absence of oxygen
tension pneumothorax
pleural sac on one side fills with air and displaces the lung and the heart toward the opposite side, which compresses the opposite lung.
SOB, chest pain on one side of the injury, absence of breath sounds, cyanosis, distention of the neck veins, deviated trachea, total lung collapse
hemothorax
presence of blood within pleural cavity
caused by tearing or puncturing
pain, difficulty breathing, cyanosis, violent blow/compression,
traumatic asphyxia
violent blow/compression of the rib cage
causes cessation of breathing
s/sx: purple discoloration of upper trunk/head, bright red eye color, mouth-to-mouth resuscitation and medical attention
hyperventilation etiology
rapid rate of ventilation due to anxiety-induced stress or asthma
causes decreased CO2 in blood