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Respiratory Anatomy > Chest Wall and Diaphragm > Flashcards

Chest Wall and Diaphragm Flashcards

1
Q

What are the functions of the chest wall?

A
  • Respiration
  • Protection
  • Muscle Attachments
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2
Q

Describe the thoracic cavity

A
  • Divided into 3 major spaces
  • Heart with coverings (pericardium- pericardial cavity) + the major vessels
  • Lungs with coverings (pleura-pleural cavities)
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3
Q

What is the superior thoracic aperture?

A

Apex of thorax to 2nd rib

-Trachea, clavicle, oesophagus, sternum etc

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4
Q

What is the inferior thoracic aperture?

A

Rib cage from 2nd rib down

-Diaphragm, oesophageal hiatus, aortic hiatus etc

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5
Q

What does the chest wall consist of?

A
  • Thoracic vertebrae
  • Ribs
  • Sternum- manubrium, body, xiphoid process
  • Intercostal spaces- intercostal muscles
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6
Q

Describe a typical thoracic vertebra

A
  • Body
  • Facets for articulation with ribs
  • Facet for articulation with adjacent vertebra
  • Spinous process
  • Inferior articular process
  • Transverse process
  • Superior articular process with facet for articulation with adjacent vertebra
  • Vertebral foreamen
  • Pedicle
  • Lamina
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7
Q

What are the features of the rib cage?

A
  • Jugular notch
  • Clavicle
  • Sternoclavicular joint
  • Manubrium of sternum
  • Coracoid process
  • Sternal angle
  • Body of sternum
  • Ribs 1-10
  • Xiphoid process
  • Costal cartilage and margin
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8
Q

What are the features of a typical rib?

A
  • Costal cartilage
  • External surface
  • Costal groove
  • Internal surface
  • Angle
  • Neck
  • Tubercle
  • Neck
  • Head
  • Crest
  • Articular facets
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9
Q

How do ribs articulate with vertebrae?

A
  • Joint capsule and cavities
  • Intra-articular ligament
  • Superior, lateral and normal costotransverse ligament
  • Costotransverse joint
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10
Q

What are the features of the sternum?

A

Articular site for clavicle

  • Jugular notch
  • Manubrium of sternum
  • Attachment site for Ribs
  • Articular demi facets for rib 2
  • Sternal angle (manubriosternal joint)
  • Transverse ridges
  • Body of sternum
  • Xiphoid process
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11
Q

What are the different types of ribs?

A
  • True (1-7)= articulate with sternum via own costal cartilage
  • False (8-10)= articulate with sternum via costal cartilage of rib above
  • Floating (11-12)= do not articulate with sternum
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12
Q

What are the muscles of the chest wall?

A
  • Pectoralis major and minor
  • Serratus anterior
  • External, inner and innermost intercostal
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13
Q

What are the movements of the rib cage?

A

Inspiration:

  • Sternum moves forward because of rib elevation- pump handle superior and anterior movements
  • Elevation of lateral aspect of ribs- bucket handle movement
  • Diaphragm descends to increase thoracic cavity
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14
Q

What are the openings of the diaphragm?

A

Inferior Vena Cava= T8
Oesophagus= T10
Aorta= 12

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15
Q

What are the features of the diaphragm?

A
  • Central tendon
  • Left and Right Crus (musculo-tendinous)
  • Inferior VC, hemi-azygos vein
  • Inferior phrenic artery, superior epigastric artery, aorta
  • Right and Left phrenic nerve, greater+ lesser and least splanchnic nerve
  • Oesophagus with anterior and posterior trunks, sympathetic trunk, thoracic duct
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16
Q

Describe the thoracic diaphragm

A
  • Sheet of skeletal muscle that is critical for respiration
  • Anatomical boundary separating thorax from abdomen
  • Structures pass through or behind to move into a different cavity
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17
Q

What structures pass through or behind the diaphragm and at what vertebral level?

A
  • Inferior Vena Cava= T8 (anterior)
  • Phrenic nerve (R)= T8 (anterior)
  • Oesophagus= T10 (middle)
  • Thoracic aorta= T12 (posterior)
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18
Q

Where are the diaphragmatic muscles fibres attached to on the skeleton?

A
  • Anterior fibres attached to Xiphoid process
  • Lateral fibres (including domes) attach to internal aspect of lower 6 ribs and costal cartilages
  • Posterior fibres (particularly crura)= upper 2/3 lumbar vertebrae
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19
Q

When standing in the anatomical position, in which direction does the central tendon of the diaphragm move during inhalation/ inspiration?

A

Inferiorly

20
Q

What nerve provides motor function to the diaphragm?

A

Phrenic

21
Q

At which levels do the spinal nerves that give rise to the phrenic nerves arise?

A

C3, 4, 5 (keep the diaphragm alive)

22
Q

How might a severe neck injury at upper/lower levels of cervical spinal cord affect the diaphragm?

A

Upper cervical lesion (C1/2) would lead to paralysis of the diaphragm while a lower cervical lesion (C6,7,8) would spare the phrenic nerve

23
Q

What are hiccups?

A

Involuntary spasmodic contractions of the diaphragm can be caused by irritation to the phrenic nerve and/or the diaphragm

24
Q

What is referred pain?

A
  • Sensory information from the central region of the diaphragm is transmitted back to the spinal cord in the phrenic nerves
  • Referred pain= signals emanating from the diaphragm may be perceived by the patient in their neck/ shoulder region
25
Q

Which nerves carry sensory information from the lateral regions of the diaphragm?

A

Intercostal nerves

26
Q

How does each layer of intercostal muscle not fully cover the length of each intercostal space?

A
  • External layer= incomplete anteriorly, where it is replaced with anterior intercostal membrane
  • Internal layer= incomplete posteriorly, where it is replaced with the posterior intercostal membrane
  • Innermost layer= only present on the lateral aspects of the thoracic wall. Anteriorly, layer completed by transversus thoracis muscle (sternocostalis), posteriorly completed by subcostal muscles
27
Q

What is the fibre orientation and action of each intercostal muscle layer?

A
  • External= I/A, elevate ribs in inhalation
  • Internal= I/P, depress ribs in exhalation
  • Innermost= variable, depress ribs in exhalation
28
Q

Between which two layers of the intercostal muscles will you find the intercostal neurovascular bundle?

A

Internal and innermost

29
Q

Is the neurovascular bundle located in the superior or inferior portion of each intercostal space?

A

Superiorly at the inferior aspect of upper rib bordering space

30
Q

What is the name of the groove on the corresponding rib where the neurovascular bundle runs?

A

Subcostal groove

31
Q

Where would you insert a needle or chest drain when attempting to access the thoracic cavity?

A

Just above the superior border of the rib

32
Q

Which arteries can be found in the intercostal neurovascular bundles?

A

Anterior and posterior intercostal arteries

33
Q

From where do the anterior and posterior intercostal arteries arrive?

A 
Anterior= internal thoracic artery or branch (musculophrenic artery)
Posterior= thoracic descending aorta
34
Q

Which veins can be found in the intercostal neurovascular bundles and where do they drain?

A 
Anterior= internal thoracic vein/ musculophrenic vein
Posterior= azygous system
35
Q

Which nerves are responsible for innervating the intercostal muscles?

A

Intercostal nerves= from anterior rami of thoracic spinal nerves

36
Q

What are the accessory muscles of respiration?

A 
-Additional muscle groups recruited to aid movement during physical exertion
=Pectoralis major
=Seratus anterior
=Scalenus
-Sternocleido mastoid
37
Q

Describe the rib cage

A
  • 12 pairs of ribs which articulate with 12 thoracic vertebrae posteriorly
  • Anteriorly, rib cage completed by sternum
  • Ribs 1-7 (true ribs) articulate directly with sternum via costal cartilage
  • 8-10 (false)= articulate with sternum via costal cartilage of superior ribs
  • 11-12= suspended within muscles and fascia of back (floating ribs)
38
Q

What are typical and atypical ribs?

A 
Typical= ribs 3-9 all share common features
Atypical= 1,2,10,11,12= own distinctive features
39
Q

What muscle attaches to the scalene tubercle?

A

Anterior scalene muscle (scalenus)

40
Q

Which major blood vessels pass across the superior surface of the first rib immediately anterior and posterior to this muscle attachment? (scalene)

A

Anterior subclavian vein, posterior subclavian artery

41
Q

Describe the costovertebral joint

A

Rib 8: head of rib articulates with superior costal demi facet of T8 (vertebra at same level as rib), inferior costal demi facet of T7 (vertebrae above rib)

42
Q

Describe the costotransverse joint

A

Rib 8: tubercle of rib articulates with transverse facet of T8 (vertebra at same level as rib)

43
Q

What is the angle of Louis?

A
  • Sternal angle/ manubriosternal angle
  • Junction between manubrium and body of sternum meet, with the two parts of the sternum running at different angle to one another
  • Secondary cartilaginous joint, symphysis
  • Landmark for transverse thoracic plane
44
Q

Which pair of costal cartilages articulate with the sternum at the sternal angle?

A

2nd pair of costal cartilages linked with ribs 2

45
Q

What vertebral level is indicated by the sternal angle?

A

T4/5

46
Q

What major thoracic structures lie on the transverse thoracic plane?

A
  • Boundary line between superior and inferior parts of the mediastinum
  • Bifurcation of the trachea into left and right primary bronchi
  • Start and end of aortic arch
  • Entry of the azygous vein in superior vena cava
47
Q

How might scoliosis affect normal respiratory movements?

A

Alter position and joint attachment of ribs
Alter position and attachment of diaphragm
Restricts space in thoracic cavity

Respiratory Anatomy (3 decks)

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