Exam 3- Thoracic Cavity Flashcards
Thoracic Wall
Thoracic cage and skin, Fascia, and Muscles
The Cage consists of 12 pairs of ribs and costal cartilages, 12 Thoracic Vertebrae and IV discs, and Sternum
Diaphragm
The prime mover of respiration and the accessory muscles of respiration
Quiet Respiration prime mover
Innervated by a pair of Phrenic Nerves
Blood Supply from the Inferior Phrenic Artery
Ribs 1, 2, 11, 12
These are atypical ribs (Ribs 3-10 are normal)
Costochondral, Sternocostal, Costovertebral, and Costotransverse Joints
These are all somewhat mobile except for the first rib, which isn’t mobile at all
Superior Thoracic Aperture
The opening at the top of the Thoracic Cage surround by the 1st Ribs, Manubrium, and T1
Inferior Thoracic Aperture
The opening at the bottom of the Thoracic Cage surrounded by T12, Costal Cartilages 7-10, 11th and 12th pairs of Ribs, and the Xiphisternal Joint
Closed by the Muscular Diaphragm
Accessory Muscles of Respiration
Serratus Posterior Superior (proprioception), Serratus Posterior Inferior (proprioception), Levator Costarum (elevates ribs), Transcersus Thoracis (depresses ribs), Subcostal (elevates ribs), Intercostal Muscles (forced respiration and support), and Sternocleidomastoid and Scalenes (forced respiration)
Thoracic Cavity
Subdivided into 3 cavities by pleural membranes (right and left pulmonary and central mediastinum)
Muscles of Inspiration
Accessory: Sternocleidomastoid (elevates sternum), Anterior Scalenes, Middle Scalenes, and Posterior Scalenes (elevate and fix upper ribs)
Principal: External Intercostals (elevate ribs), Interchondral part of internal intercostal (elevate ribs), and Diaphragm (increase cavity and elevates ribs
Muscles of Expiration
Quiet Breathing: Results from passive recoil of lungs and rib cage
Active Breathing: Internal intercostals and Abdominals (depress lower ribs and push the diaphragm up): Rectus Abdominis, External Obliques, Internal Obliques, and Transversus Abdominis
Serous Fluid
Creates cohesion which is essential for lung inflation and lubrication which is essential for lung movements during respiration
Produced by Serous Membranes (Pleura)
If air enters the Pleural Cavity (pneumothorax), the lung will collapse due to elasticity of its tissue Excess Fluid (serous fluid or blood from trauma) may accumulate in the Plueral Cavity and Compress the lungs.
Visceral Pleura
Covers Lung
Provides surface cohesion
Insensitive to pain
Parietal Pleura
Covers wall of Thorax
4 parts: Cervical (covers apex of lung and extends into the root of the neck), Diaphragmatic (covers the superior surface of the diaphragm), Costal (covers posteriolateral and anteriolateral surfaces), and Mediastinal (covers lateral mediastinum)
Recesses
These are gaps between the lung and the parietal pleura to permit expansion
It makes provision to allow expansion of the lung in full inspiration.
It is the most dependent part of the pleural sac; if fluid appears in the pleural sac; it collects first in the costodiaphargmatic recess
Costodiaphragmatic Recess
Inferior Margin of the thoracic wall
Location of fluid collection
Costomediastinal Recess
Potential space between costal pleura and mediastinal pleura
Thoracocentesis
The process of draining fluid from the lungs
Insert a hypodermic needle through and intercostal space into the pleural cavity to remove blood or pus
Insert superior to the 9th rib in the 9th intercostal space, high enough to avoid the collateral branches and the inferior border of the lung
Pneumothorax
Pressure entering the thoracic cavity causing the lung to collapse
Penetrating wound of the parietal pleura
Result is a Collapsed Lung
Lungs
Apex- blunt end that extends above 1st rib into the root of the neck covered by cervical pleura
Base- concave surgace resting on the ipsilateral convex dome of the diaphragm
Lobes- 2 or 3 from 2 or 3 fissures
3 Surfaces- Costal, Diaphragmatic, and Mediastinal
3 Borders- Anterior, Inferior, and Posterior
The Lungs main function is an exchange of gas- CO2 Out and Oxygen In
Parasympathetic Innvervation by the Vagus Nerve
Hilum
This is where everything enters and leaves the lungs
Branchopulmonary Segments
The lungs are divided into 10 functional segments-Bronchopulmonary Segments
Rings in Trachea
They exist to prevent collapse
Divisions of Trachea
Trachea–>Primary Branch–>Secondary Branch–>Tertiary Bronchioles–>Conducting Bronchioles–>Terminal Bronchioles–>Respiratory Bronchioles–>Alveolar Ducts–>Alveolus
Things are more likely to be clogged in the Right Bronchus because it shoots down while the Left bronchus shoots left
Bronchopulmonary Arteries
The arteries supplying blood to the lungs
Lymphatics of the Lung
2 Lymphatic Plexi drain the lung: Superficial Lymphatic Plexus (deep to visceral pleura drains tissue into the bronchopulmonary lymph nodes in the hilum) and Deep Lymphatic Plexus (in lining of bronchi drains root of lung)
Both drain into the Thoracic Duct
Pulmonary Plexus
Innervates the Lungs and the Visceral Pleura
Things Vagus Nerve (CN X) does: Vasodilate, Bronchoconstrict, Stimulate gland secretion, Reflexive Receptors (cough, Hering-Breuer, pressoreceptor and chemoreceptors) or Nociceptive (pain)
Asthma Inhalers
They are sympathetics and act on these receptors to relieve symptoms
Lobes locations
Inferior Lobe is mostly the back
Middle Lobe is just a small portion of the front
Superior Lobe is mostly the front
Horizontal Fissure
Follows the Fourth rib
Oblique Fissure
Starts from the Horizontal Fissure, crosses the 5th rib and terminates at the 6th rib
Fibrous Skeleton
This acts as an Anchor
Divisions of Mediastinum
Anterior Mediastinum
Inferior Mediastinum: Middle (Contains heart and pericardium and great vessels), Posterior (Contains esophagus and vessels), and Superior (Contains vessels, thymus, and trachea)
Pericardium
Inelastic tough sac that covers heart and beginnings of vessels
Prevents heart from overinflating leading to mechanical failure
2 Layers: Fibrous Pericardium (external, continues with vessels, and is the toughest part and Serous Pericardium (2 Layers- Parietal: lines inner surface of fibrous. Visceral: adheres to the heart)
Produces Serous Fluid for lubrication
Pericardiacophrenic Artery supplies blood to the Pericardium and comes from Internal Thoracic Artery
Coronary Artery supplies blood to the Visceral Layer of the Pericardium
Phrenic Nerves are the Sensory Nerves for the Pericardium
Cardiac Tamponade and Pericardiocentesis
Excess Fluid in the Pericardial Space
From Trauma, Infection, Cancer, or Autoimmune problems
Pericardiocentesis is the process of draining the fluid (needle is placed at 5th/6th intercostal)
A procedure that uses a needle to remove fluid from the pericardial sac. This is the tissue that surrounds the heart.
Atria
Receiving chambers of blood
Ventricles
Pumping chambers of blood
Diastole
Filling of the Ventricles of the Heart
Systole
Forceful contraction and emptying of the Heart
Walls of the Heart
Epicardium (aka Visceral Pericardium)
Myocardium (Double Helical bands of cardiac muscle)
Endocardium (Covers valves, enourages smooth blood flow, and prevents clots)
Right Coronary Artery
Possibly the most important Artery in the Heart
Branches: SA Nodal Artery (SA Node), Right Marginal Branch (Right Border of the Heart), AV Nodal Branch (AV Node), and Right Interventricular Artery (Invterventricular Septum)
**Supplies R Atrium, most of R Vent, Diaphragmatic part of L Vent, IV Septum and usually AV (80%) and SA Nodes (60%)
Left Coronary Artery
Branches: Anterior Interventriucular Branch (LAD) (Left Ventricle and Interventricular Spetum), Circumflex Branch, and Left Marginal Artery (Left Border of the Heart)
Supplies L Atrium, most of L Vent, most of IV Septum, and AV Node (20%) and SA Node (40%)
Coronary Sinus
In Coronary Sulcus
Drains blood into the Right Atrium from: Great Cardiac Vein (in Anterior Interventricular Sulcus), Middle Cardiac Vein (in Posterior Interventricular Sulcus), and Small Cardiac Vein (wraps around in Coronary Sulcus)
Arterior Veins
Originate on the Anterior surface of the Right Ventricle, course over the Coronary Sulcus, and drain straight into the Right Atrium
Widowmaker
Left Anterior Descending Artery (Anterior Interventricular Artery)
Auricle
Ear- It’s a projection of extra capacity
Fossa Ovalis
Remnant of Foramen Ovalis, which bypasses the Lungs in the a Fetus
Valves
The valves prevent the backward flow of blood
The backflow of the blood is responsible for the heart sounds
The cusps are attached to Cordae Tendonae which is attached to a Papillary Muscle that helps with the opening and closing of the valves
Right AV Valve
Tricuspid Valve- 3 Cusps
Trabecula Carnae
The rough border of the inside of the Ventricles
Conus Arteriosus
Smooth Cone
Helps with a smooth outflow through the Pulmonary Trunk
Crista Terminalis
Conductive Ridge of muscle important for contractility
Ventricular Walls
The Left Ventricular Walls are about 2-3x thicker than the Right Ventricular Walls
Prolapse
A slipping forward or down of one of the parts or organs of the body
Chordae Tendonae and Nodules of Semilunar Valves prevent prolapse
Fibrous Skelton
Framework of Dense Collagen
4 Rings that surround and anchor the 4 Major Valves (Right AV Valve, Left AV Valve, Pulmonary Valve, and Aortic Semilunar Valve)
Prevent overexpansion of Valve
Provides attachment of leaflets, cusps, and Myocardium
Provides an electrical “insulator” so that Atria and Ventricles contract independentlySA Node
SA Node
Natural Pacemaker- Roughly 70 bpm
AV Node
Distributes signal through heart skeleton
Heart Pressure
The pressure goes for 0 to beyond the Aortic Pressure
Annurism
This is a common defect to the aorta
Vagal Nerve
Part of the Sympathetic and Parasympathetic innervation of the Heart
Stimulation of the Parasympathetic Vagus Nerves constricts coronary arteries
Referred Pain of the Heart
Vervical and superior 5 Thoracic Sympathetic Ganglia are sensitive to Ischemia (tissue damage due to lack of Oxygen)
This causes referred pain to the dermatomes of these regions (Chest and along the Left Arm)
Parturition
Child Birth
Abdominal Cavity
Divided into two sections: Abdominal Cavity and Pelvic Cavity
The pelvic cavity is a body cavity that is bounded by the bones of the pelvis
Subdivisions of the Abdominal Cavity From Top Left to Bottom Right. 3 per row
Right Hypochondrium, Epigastium, Left Hypochondrium
Right Flank, Umbilical, Left flank (Lumbar)
Right Inguinal, Hypogastrium, Left Inguinal
Right Upper Quadrant
Liver: Right Lobe, Gallbladder, Stomach: Pylorus, Duodenum, Pancreas: Head, Right kidney and Suprarenal Gland, Right Colic Flexure, Ascending Colon, Transverse Colon
Left Upper Quadrant
Liver: Left Lobe, Spleen, Stomach, Jejunum and Proximal Ileum, Pancreas, Body and Tail, Left Kidney and Suprarenal Gland, Left Colic Flexure, Transverse Colon, and Descending Colon
Right Lower Quadrant
Cecum, Appendix, Most of Ileum, Ascending Colon, Right Ovary, Right Uterine Tube, Right Ureter, Right Spermatic Cord, Uterus (If enlarged), and Bladder (If very full)
Left Lower Quadrant
Signmoid Colon, Descending Colon, Left Ovary, Left Uterine Tube, Left Ureter, Left Spermatic Cord, Uterus (If enlarged), and Bladder (If very full)
Transverse Planes
Subcostal and Interspinous Planes (Most Common)
Transpyloric and Interspinus Planes
Sagittal Planes
Midclavicular Lines (Most Common) Semilunar Lines
Xiphoid Process
T9
Transpyloric Plane
Pylorus, Pancreatic Neck, Duodeno-Jejunal Flexure, and Hila of Kidneys
L1
Subcostal Plane
L3
Umbilicus
L3/L4
Iliac Crest Plane
L4
Sacrum
Anterior Superior Iliac Spine
ASIS
Campers Fascia
Superficial Fatty Tissue
Looks like Popcorn
Scarpa’s Fascia
Deep Membranous
Continuous with Fascia of Perineum (Colle’s Fascia)
Looks like a sheet
Anterior Abdominal Wall Muscles
Functions are to Compress and Support Viscera and to Flex and Rotate the Trunk
The layers of the Anterior Abdominal Wall are:
Skin
Subcutaneous tissue
Fascia-Camper’s fascia (fatty superficial layer) and Scarpa’s fascia (deep fibrous layer)
Muscle: External oblique abdominal muscle, Internal oblique abdominal muscle, Rectus abdominis, Transverse abdominal muscle, Pyramidalis muscle
Fascia transversalis
Peritoneum
Abdominal Vessels
The Arteries and Veins are all paired together
Superior Epigastric Branches of Internal Thoracic
Inferior Epigastric and Deep Circumflex branches of the External Iliac
Superficial Circumflex branches from Femoral
Posterior Intercostal and Subcostal Vessels
Superior Epigastric Vessels
From: Internal Thoracic Artery
Supply: Rectus Abdominis Muscle and Superior Ubilical Regions
Inferior Epigastric Vessels
From: External Iliac Artery
Supply: Rectus Abdomins Muscle and Inferior Umbilical Regions
Superficial Circumflex Iliac Vessels
From: Femoral
Supply: Superficial Abdominal Wall of Inguinal Region and Iliac Fossa
Superficial Epigastric Vessels
From: Femoral
Supply: Superficial Abdominal Wall of Pubic and Inferior Ubilical Regions
Thoracoepigastric Vein
It’s a direct connection between Femoral Vein and Axillary Vein in the case of clogs or needs to be redirected
Lymphatics
Horizontal Bar can be palpated more easily due to being more superficial than the deep Vertical Bars
Caput Medusae
Collateral Venus Return resulting from IVC blockage or patients with Portal Vein Hypertension
Ilioinguinal Nerve
Cutaneous Field is the area surround the sex organ
Iliohypogastric
Cutaneous Field is about the area of ASIS and portion that almost looks like a pair of briefs
Lateral Cutaneous Nerve of the Thigh
Cutaneous Field is the Lateral portion of the thigh
Inguinal Ligament
Connects ASIS to the Pubic Tubercle
Clinically important site of herniation
Formed by Aponeuroses of the External Oblique
Myopectineal Orfice
Site of Hernias
Inguinal Canal
Lies superior and parallel to the Inguinal Ligament
From Deep Inguinal Ring to Superficial Inguinal Ring
Spermatic Cord (Males), Round Ligament (Females), and Genitofemoral Nerve passes through this
Ilioinguinal Nerve passes through but does not enter via Deep Inguinal Ring
Same: Ilioinguinal Nerve, Genitofemoral Nerve, Lymphatic Vessels
Different (Women): Round Ligament of Uterus
Different (Men): Spermatic Cord, Ductus (Vas) Deferens, Cremaster Muscle (Internal Oblique)
Round Ligament
In women the Round Ligament follows the same pattern as the Ductus Deferens (carries sperm)
This anchors the Uterus to the skin
Indirect vs. Direct Hernia
Indirect is lateral to the Epigastric Vessels and Direct is medial to the Epigastric Vessels
Thymus
It’s job is to recognize receptors that hold molecules
It gets worse with age (Old people get sick easier)
Superior Mediastinum Contents from Superficial to Deep
Sternum-> Thymus-> Internal Thoracic Vessels-> Brachiocephalic Veins-> Brachiocephalic Trunk-> Paratracheal Lymph Nodes-> Common Carotid Artery-> Trachea-> Subclavian Artery-> Esophagus-> Thoracic Duct
Left and Right Brachiocephalic Veins
Left is twice as long as the right as it crosses midline because the tilt causes it to need to travel a longer distance
They unite to create the Superior Vena Cava
Arteries compared to Veins
Generally Posterior
Trachea
It is not part of the mediastinum
Aortic Annurism
Could cause vocal cord injury
Ligamentum Arteriosum
Attaches inferior to Aortic Arch from pulmonary trunk
Remnant of Ductus Arteriosus in the fetus (bypasses lungs)
Branches of Aortic Arch
Brachiocephalic
Left Common Carotid
Left Subclavian
Around the areas of 1st rib/clavicle
Azygos System
On either side of vertebral column
Drains the back, Abdominal walls, medistinal viscera
Azygos, Hemiazygos, Accessory Hemiazygos
Splanchnic Nerves
3 Splanchnic Nerves: Greater Lesser, and Least
RBC path to Esophagus
Left Ventricle, Aortic Arch, Thoracic Aorta, Esophageal Aorta
Superior Mediastium from Posterior to Anterior
Esophageal Plexus then Thoracic Duct
Blood supply to Lungs, Trachea, and Esophagus
Lungs get their blood supply from the Bronchial Artery and returned via Pulmonary Veins- Comes from Thoracic Aorta
Trachea gets its blood from the Bronchial Artery
Esophagus gets its blood differently in different locations. The cervical portion is supplied by the inferior thyroid artery. The thoracic portion is supplied by bronchial and esophageal branches of the thoracic aorta. The abdominal portion is supplied by ascending branches of the left phrenic and left gastric arteries
Psoas Major
Origin: Sides of T12-L5 and discs between; Transverse Processes of all Lumbar
Insertion: Lesser Trochanter of Femur
Action: Flexes thigh at hip joint and stabilizes the joint
Nerve: Anterior Rami of Lumbar Nerves (L1, L2, L3)
Blood Supply: Lumbar branches of Iliolumbar Artery
Psoas Minor
Origin: Sides of T12-L1 and discs
Insertion: Pectineal Line, Iliopectineal Eminence via Iliopectineal Arch
Action: Flexes thigh at hip joint and stabilizes the joint
Nerve: Anterior Rami of Lumbar Nerves (L1, L2)
Blood Supply: Lumbar branches of Iliolumbar Artery
Iliacus
Origin: Iliac Crest, Iliac Fossa, Ala of Sacrum, and Anterior Sacroiliac Ligaments
Insertion: Tendon of Psoas Major, Lesser Trochanter, and Femur
Action: Flexes thigh at hip joint and stabilizes the joint
Nerve: Femoral Nerve (L2,L3)
Blood Supply: Iliac Branches of Iliolumbar Artery
Quadratus Lumborum
Origin: Medial Half of Posterior Iliac Crest and Iliolumbar Ligament
Insertion: Transverse Processes of L1-L4 and Medial half of 12th Rib
Action: Extends the Vertebral Column and also laterally flexes the vertebral column
Nerve: Subcostal Nerve and Ventral Rami of L1-L4
Blood Supply: Lumbar Artery
Rectus Sheath
The rectus sheath is made up of two parts, known as the posterior sheath and the anterior sheath
External Oblique
Origin: External Surfaces of Ribs 5-12
Insertion: Linea Alba, Pubic Tubercle, Anterior Half of Iliac Crest
Action: Compresses and Supports Abdominal Viscera, Flexes and Rotates Trunk
Nerve: Ventral Rami of 6 Inferior Thoracic Nerves
Blood Supply: Superior and Inferior Epigastric Arteries
Internal Oblique
Origin: Thoracolumbar Fascia, Anterior 2/3 of Iliac Crest, Lateral Half of Inguinal Ligament
Insertion: Inferior Borders of Ribs 10-12, Linea Alba, Pubis via Conjoint Tendon
Action: Compresses and Supports Abdominal Viscera, Flexes and Rotates Trunk
Nerve: Ventral Rami of 6 Inferior Thoracic and First Lumbar Nerves
Blood Supply: Superior and Inferior Epigastric and Deep Circumflex Iliac Arteries
Transverse Oblique
Origin: Internal Surfaces of Costal Cartilages 7-12, Thoracolumbar Fasic, Iliac Crest, Lateral Third of Inguinal Ligament
Insertion: Linea Alba, Pubic Crest, and Pecten Pubis via Conjoint Tendon
Action: Rotation, Flexion, and Lateral Flexion0
Nerve: Ventral Rmai of 6 Inferior Thoracic and First Lumbar Nerves
Blood Supply: Deep Circumflex Iliac and Inferior Epigastric Arteries
Rectus Abdominis
Origin: Pubic Symphysis, Pubic Crest
Insertion: Xiphoid Process, Costal Cartilages 5-7
Action: Flexes Trunk, Compresses Abdominal Viscera
Nerve: Ventral Rami of 6 Inferior Thoracic Nerves
Blood Supply: Superior and Inferior Epigastric Arteries
Pyramidialis
Origin: Body of Pubis, Anterior to Rectus Abdominis Insertion: Linea Alba Action: Tenses Linea Alba Nerve: Iliohypogastric Nerve Blood Supply: Inferior Epigastric Artery
Great Vessels that enter and leave the heart
Superior and Inferior Vena Cava
Pulmonary Trunk
Right and Left Pulmonary Veins
Ascending Aorta
Drain into Superior Vena Cava
Right and Left Brachiocephalic Vein and Azygous Vein
