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Thorax > Diaphragm and Breast > Flashcards

Diaphragm and Breast Flashcards

1
Q

what are the pleura

A

two protective layers of the lungs

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2
Q

what is endothoracic fascia

A

outermost membrane of the thoracic cavity - contains fat and is made up of loose connective tissue

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3
Q

throacocentesis

A

needle aspiration of pleural cavity

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4
Q

two times thoracocentesis can be used

A
  • pneumothorax
  • pleural effusion
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5
Q

explain pneumothorax

A

a punctured lung - when great pressure within a ling has caused it to contract

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6
Q

common cause of pneumothorax

A

sports injuries - large blows to thoracic wall can puncture a lung

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7
Q

main symptom of pneumothorax

A

severe breathlessness

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8
Q

where should the needle be inserted in the case of pneuomothorax

A

into the 2nd or 3rd intercostal space

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9
Q

what is pleural effusion

A

build up of fluid inside pleural cavity as a result of pnuemonia

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10
Q

where should needle be inserted in the case of pleural effusion

A

7th intercostal spave

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11
Q

important consideration when carrying out thoracocentesis

A

needle should be inserted as inferiorly as possible into the intercostal space to avoid risk of piercing the neurovascular bundle, particularly the nerve as it is the least protected by the rib

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12
Q

diaphragm

A

fibromuscular sheet separating thoracic and abdominal cavities

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13
Q

where do the muscular sources of the diaphragm derive from

A

cervical myotomes (C3, C4, & C5) which have migrated downwards into the thorax and dragged their nerve supply with them - namely the phrenic nerve

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14
Q

two effects of the migration of cervical myotomes

A
  • Nerve supply for breathing is very high up (C 3-5)
  • When stimulated can cause referred pain to shoulders and neck
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15
Q

why is the right dome of the diaphragm higher than the left

A

because the liver sits beneath it

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16
Q

levels of lobes of diaphragm during expiration

A

right lobe reaches the fourth rib and the left reaches the fifth intercostal space

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17
Q

where does the diaphragm attach anteriorly and centrally

A

to the thoracic wall at the level of the xiphoid process

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18
Q

where does the diaphragm attach posteriorly

A

T12

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19
Q

why do abdominal muscles play a role in respiration

A

some attach to the central tendon: rectus abdominus and the external obliques assist with compressing ribs and forcing diaphragm into thoracic cavity during forced expiration

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20
Q

why does the pericardium move as the diaphragm moves

A

becuase it us intermittently blended with the diaphragm

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21
Q

costal diaphragmatic recess

A

space between ribs and the diaphragm where fluid can accumulate

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22
Q

describe the shapes of the pleural cavities on the right and left

A
  • On the right: parietal pleura descends linearly
  • On the left: it undulates medially and laterally between the fourth and sixth ribs
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23
Q

why does the pleural cavity have a strange shape on the left

A

it has the cardiac notch which is moulded into the left lung to make space for the heart

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24
Q

what are the anterior attachments of diaphragmatic muscles

A

Short muscle fibres attach to the back of the xiphoid process and to the costal cartilages

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25
Q

posterior diphragmatic attachments

A
  • Median arcuate ligament - connects the crura (right and left)
  • Medial arcuate ligament - attaches to psoas major
  • Lateral arcuate ligament - thickening of fasica of quadratus lumborum muscle
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26
Q

name the three major openings in the diaphragm

A
  • aortic opening/hiatus
  • eosophageal opening/hiatus
  • caval opening
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27
Q

what is the aortic opening formed by

A

loop of median arcuate ligament

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28
Q

major vessel contained by aortic opening

A

descending aorta flanked by left and right crura on either side

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29
Q

what level is the aortic opening located at

A

T12

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30
Q

where is the eosphogeal opening

A

in the right crus

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31
Q

what major vessel does the eosophageal opening contain

A

eosophagus

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32
Q

what level is the eosophageal opening located at

A

T10

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33
Q

where is the caval opening

A

central tendon

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34
Q

what major vessel does the caval opening contain

A

inferior vena cava

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35
Q

what level is the caval opening at

A

T8

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36
Q

1.

A

caval opening

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37
Q

2

A

medial lumbocostal arch

38
Q

3

A

lateral lumbocostal arch

39
Q

4

A

right crus

40
Q

5

A

central tendon

41
Q

6

A

eosophageal opening

42
Q

7

A

aortic opening

43
Q

8

A

left crus

44
Q

minor vessel contained in caval opening

A

right phrenic nerve

45
Q

minor vessels in eosophageal opening

A

anterior and posterior trunks of the vagal nerve

46
Q

minor vessels contained in aortic opening

A

thoracic duct

47
Q

vessels that pass through left crus

A
  • greater splanchnic nerve
  • lesser splanchnic nerve
  • least splanchnic nerve
  • hemiazygous veins
48
Q

purporse of the splanchnic nerves

A

they are the sympathetic nerve supply to abdominal structures

49
Q

vessel that passes through th eright crus

A

azygous vein

50
Q

1

A

inferior vena cava

51
Q

2

A

right phrenic nerve

52
Q

3

A

inferior phrenic artery

53
Q

4

A

thoracic duct

54
Q

5

A

aorta

55
Q

6

A

right crus

56
Q

7

A

superior epigastric artery

57
Q

8

A

central tendon

58
Q

9

A

left phrenic nerve

59
Q

10

A

eosophagus with anteiror and posterior vagal trunks

60
Q

11

A

greater splanchnic nerbve

61
Q

12

A

hemiazygous vein

62
Q

13

A

lesser splanchnic nerve

63
Q

14

A

least spanchnic nerve

64
Q

15

A

left crus

65
Q

what are the upper abdomincal muscles that lie inferior to the diaphragm

A

liver, spleen, kidneys, stomach

66
Q

what part of the stomach is loacted anteriorly to the diaphragm

A

the fundus

67
Q

relations between the kidneys and the diaphragm

A

Retroperitoneal structures ie. psoas major and quadratus lumborum muscle often pass over kidney and suprarenal gland

68
Q

blood supply of diaphragm

A
  • Inferior and superior phrenic arteries
  • Branches of inferior phrenic artery radiate towards anterior and lateral origins
69
Q

nerve suppy of diaphragm

A

Left and right branches of phrenic nerve radiate in roughly the same pattern as the arteries (ie radially towards anterior and lateral origins)

70
Q

path of phrenic nerve

A
  • arises from C3, C4, and C5 then passes over the scalene muscles and between the subclavian artery and vein and down to the thorax on each side
    • On the left it crosses over to the pericardium and pierces the dome of the diaphragm
71
Q

hernia

A

pushing of abdominal viscera out through the diaphragm and alongside the eosophagus usually the fundus of the stomach

72
Q

two types of hernial

A

rolling and sliding

73
Q

rolling hernia

A

when fundus rolls through partial defect at eosophageal opening

74
Q

sliding hernia

A

when the eosophagus and gastro-eosophageal junction is pulled up through the opening

75
Q

three causes of hernias

A
  • Congenital: defects in the left lateral arcuate ligament allowing contents up into left endothorax
  • Acquired: increased intra-abdominal pressure due to chronic crouching, squatting, coughing
  • Traumatic: eg. road traffic accident or crush injury - sudden great increase of pressure that ruptures the diaphragm
76
Q

subphrenic absess

A

occurs at front of diaphragm just superior to liver when there is sepsis in the abdominal cavity pus collects on top of and along the liver, irritating the diaphragm and causing referred pain to the shoulders

77
Q

two other pathologies of diaphragm

A
  • Lower lobe pnuemonia
  • Diaphragmatic irritation can cause shoulder tip pain and hiccups
78
Q

what occurs during inspiration

A
  • Upper ribs move up and out; the pump action increases the anterior-posterior diameter and sternum slopes upward
  • Lower ribs move up and this increases transverse diameter
  • Diaphragm depresses
  • All together these increase thoracic volume, decrease thoracic pressure which in turn forces air into the lungs
79
Q

where do the breasts lie

A

in the superficial compartment of the pectoral region

80
Q

what are the breasts composed of

A

secretory mammary glands, skin, adipose tissue and connective tissue

81
Q

where is the base of the breast located

A

lateral sternal border to mid-axillary line

82
Q

where is the areola located in females

A

varies with the size/shape of breasts

83
Q

where is the areola located in men

A

its position is relatively fixed at the fourth intercostal space or the fifth rib at the mid clavicular line

84
Q

what is another name dor the axillary process of the breast

A

spence’s tail

85
Q

what is the axillary process of the breast

A
  • The inferior lateral border of breast tissue follows the inferior lateral border of the pec major muscle to the anterior axillary line
  • It is also the only part of the breast that pierces deep pectoral fascia
86
Q

what is the mammary gland made up of

A
  • 15-20 lobes arranged radially
  • Each of these lobes drains into a lactiferous duct
  • These ducts open independently onto the surface of the nipple
87
Q

what colour is the areola

A

usually pink but can develop brown pigmentation during pregnancy

88
Q

what type of ligaments is the mammary gland traversed by

A

suspensory ligaments known as cooper’s ligaments

89
Q

purpose of cooper’s ligaments

A
  • Subdivide the lobes
  • Connect skin to the deep fascia covering the chest wall
  • Provide stability and support to breast tissue
90
Q

clincal relevance of cooper’s ligaments

A

they can collapse due to breast cancer and carcinoma causing pitting of the surface skin of the breast - this is called peau d’orange

91
Q

describe glandular tissue

A
  • Glandular tissue develops and becomes more abundant in lactating women after childbirth
  • This tissue is variable from person to person and within one person’s lifetime

Thorax (9 decks)

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