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HSF > HSF 2 - Unit 2 Anatomy: The Thorax and Diaphragm > Flashcards

HSF 2 - Unit 2 Anatomy: The Thorax and Diaphragm Flashcards

1
Q

what is the thorax?

A

the part of the body of a mammal between the neck and the abdomen, including the cavity enclosed by the ribs, sternum, and dorsal vertebrae, and containing the chief organs of circulation and respiration

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2
Q

what is the mediastinum?

A

central compartment of the chest, holds the heart

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3
Q

the thorax is made up of which compartments?

A

mediastinum, left and right pleural compartments

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4
Q

what is the floor of the respiratory cavity like?

A

convex superiorly and concave inferiorly

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5
Q

what is a barrel chest?

A

increased anteroposterior diameter of the thoracic cage; can affect people with COPD or emphysema and develop barrel chest in the later stages of the disease. this occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time

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6
Q

what are the functions of the thorax?

A

protect vital thoracic/abdominal organs from external forces; resist the negative internal pressure created by the elastic recoil of the lungs; provide attachments for and support the weight of the upper limbs; provide the origin for some upper limb muscles and attachments for muscles of the abdomen, neck, back and respiration

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7
Q

how do structures from the thoracic cavity get to the abdomen?

A

there are several holes in the diaphragm for them to pass through

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8
Q

what are the posterior wall muscles of the thorax?

A

intercostal and subcostal muscles

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9
Q

what is the anterior wall composed?

A

ribs, costal cartilages, sternum, intercostal muscles, and the transversus thoracis muscle

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10
Q

what are the skeletal components of the thoracic wall?

A

vertebral bodies, the bodies of the 1st-12th thoracic vertebrae form the bony component of the thoracic wall in the dorsal midline

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11
Q

manubrium components

A

jugular notch, clavicular notch, notch for 1st costal cartilage

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12
Q

body of the sternum components

A

notches for costal cartilages; sternal angle formed with body and manubrium

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13
Q

xiphoid process

A

can have foramen

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14
Q

what can happen to the articulations between the bones of the sternum?

A

can fuse and become a syostosis in older persons, failure of fusion between halves of the sternal bars during development can result in sternal cleft or sternal foramen

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15
Q

what are complications of a sternal fracture?

A

can break into several pieces and is classified as a comminuted fracture. most common site is the manubriosternal joint - where the manubrium meets the body of the sternum; fragments usually not displaced due to the attachments of the pectoralis muscles; high mortality rate because of heart and lung injuries which are likely to occur simultaneously with the primary trauma

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16
Q

what is poland syndrome?

A

absent pectoralis major; asymmetrical

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17
Q

ectopia cordis

A

heart develops in between a sternal cleft

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18
Q

which ribs are true?

A

1-7; attach vertebrae to the sternum

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19
Q

which ribs are false?

A

8-10; cartilages attached to the cartilages of ribs superior

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20
Q

which ribs are floating?

A

11-12; cartilages ending in the posterior abdominal wall musculature

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21
Q

what do ribs 7-10 form?

A

infrasternal angle

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22
Q

what separates the ribs and costal cartilages?

A

intercostal space

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23
Q

what makes the superior thoracic aperture? what closes it?

A

1st thoracic vertebra, 1st pair of ribs, and superior border of manubrium; diaphragm closes it

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24
Q

the heads of all but … articulate via ….

A

1st, 11th, 12th ribs; true synovial joints (the capitular joints) with two adjacent thoracic vertebrae, its own and the one above;; articulate with only their own vertebral bodies

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25
what bone markings are on the rib?
head (articular facets of head articulate with inferior and superior costal facets of adjacent thoracic vertebrae), neck, tubercle (articular facet of tubercle which articulates with costal facet of transverse process of vertebrae of the same number), angle, costal groove, shaft, sternal end
26
what are the 2 joints that each rib forms?
costotransverse, costovertebral
27
costotransverse joint
between the tubercle of the rib and the transverse costal facet of the corresponding vertebrae
28
costovertebral joint
between the head of the rib, superior costal facet of the corresponding vertebrae, and the inferior costal facet of the vertebrae above
29
what actions do each set of ribs perform at the costotransverse joints?
1-7 rotate, 8-10 glide, 11-12 do not articulate with transverse processes
30
what is a costochondral joint?
primarily cartilaginous joints and they usually do not experience movement
31
what are the interchondral joints?
some are plane synovial joints (between costal cartilages 6-9)
32
radiate ligament
head of rib; fans outwards from the head of the rib to the bodies of the two vertebrae and intervertebral disc
33
costotransverse ligament
Connects the neck of | the rib and the transverse process
34
lateral costotransverse ligament
Extends from the transverse process to the tubercle of the rib
35
Superior costotransverse ligament
Passes from the upper border of the neck of the rib to the transverse process of the vertebra superior to it
36
where in the ribs are fractures most common? what are some complications?
the middle ribs; further soft tissue injury from the broken fragments (structures most at risk are spleen, lungs, diaphragm), if more than one rib gets fractured the area is no longer under control of the thoracic muscles and causes flail chest
37
what is flail chest?
It impairs full expansion of the ribcage, thus affecting the oxygen content of the blood. flail chest is treated by fixing the affected ribs, preventing their paradoxical movement; presents with opposite movement of the chest than is normal because the flail segment will be pulled in with the decrease in pressure while the rest of the rib cage expands
38
what are supernumerary ribs?
extra ribs, can be in cervical or lumbar region
39
what is thoracic outlet syndrome?
is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the brachial plexus and/or subclavian vessels in the lower neck and upper chest
40
what are the intercostal muscles? what do they do?
external, internal, innermost, subcostal, transversus thoracis; moving the ribs and by helping to keep the intercostal spaces rigid
41
external intercostals
attache superiorly to the inferior border of the rib above and inferiorly to the superior border of the rib below, fibers run infero-anteriorly; runction to elevate ribs during forced inspiration with innervation from the intercostal nerves (T1-11), blood supply is from the ant/post intercostal v and a; musculophrenic v and a
42
internal and innermost intercostals
attach superiorly to the inferior border of the rib above and inferiorly to the superior rib below, fibers run inferoposteriorly; functions: interosseous part reduces the thoracic volume by depressing the ribcage with innervation from the intercostal nerves (T1-11), blood supply is from ant/post intercostals and musculophrenic vv and aa.
43
how can we distinguish the internal and innermost intercostals?
separated by the intercostal neurovascular bundle
44
what muscles make up the innermost layer of thoracic muscles?
transversus thoracis, innermost internals, subcostalis
45
subcostalis
Attach superiorly to internal surfaces of lower ribs near their angles and inferiorly to superior borders of ribs 2 or 3 levels below. Fibers run inferoposteriorly (blending with internal intercostals), interosseous part reduces the thoracic volume by depressing the ribcage with innervation from intercostal nerves (T1-11) with blood supply from the posterior intercostals and musculophrenic aa and vv
46
transversus thoracis
Attaches superiorly on the posterior sternum and inferiorly on costal cartilages 2-6; function to depress ribs, innervation from intercostal nerves (T1-11), blood supply from anterior intercostal and musculophrenic aa and vv
47
levator costae
``` O: Transverse processes I: Rib below between tubercle and angle. A: Elevate ribs In: Intercostal nerves T1-T11 BS: Posterior intercostals ```
48
serratus posterior superior
``` O: Spines of C7-T3 I: Ribs 2-4 A: Elevate ribs In: Intercostal nerves T1-T3 BS: Posterior intercostals ```
49
serratus posterior inferior
``` O: Spines of T11-L2 I: Ribs 8-12 A: Depress ribs In: Intercostal nerves T9-T11 BS: Posterior intercostals ```
50
in the thoracic region, the ______ ____ are in the form of...
ventral rami; intercostal nerves
51
what structures run along the costal groove?
vein, artery, nerve; in this order
52
what is a thoracotomy?
surgical opening through the thoracic wall to access the lungs, heart, esophagus, diaphragm, and the thoracic aorta
53
what is a thoracentesis?
a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest
54
what is a nerve root block?
selective nerve root block primarily used to diagnose the specific source of nerve root pain and secondarily, for therapeutic relief of low back pain and/or leg pain
55
each of the bounded intercostal spaces is fed by which blood vessels?
2 arteries- posterior and anterior intercostal artery
56
where do the posterior intercostal arteries of the upper 2 spaces derive from?
costocervical branch of the subclavian artery
57
where do all the anterior intercostal arteries derive from?
the internal thoracic branch of the subclavian artery
58
what is the artery in the first 2 intercostal spaces called?
supreme intercostal artery
59
what is the primary blood supply to the thoracic wall?
derived from branches of the aorta and the subclavian arteries
60
each posterior intercostal artery gives off...
segmented branches to the back
61
where is the main trunk of the posterior intercostal artery?
runs just above the main trunk of the intercostal nerve around toward the front of the body
62
what happens to the posterior intercostal arteries as they move anteriorly?
they stop a few inches short of the anterior end of each space; so there are separate anterior intercostal arteries for the anterior ends of each bounded intercostal space
63
what happens to the posterior intercostal arteries as the move inferiorly?
unbounded intercostal spaces (10 and 11) continue into the abdominal wall but stop well short of the anterior midline
64
each bounded intercostal space has..
(1-9) an anterior intercostal artery; these for the long intercostal spaces (1-6) come off the internal thoracic artery
65
what is the ITA
internal thoracic artery, branch of the subclavian artery and descends in the anterior thoracic wall along the sternal margin, just deep to the costal cartilages and internal intercostal muscles
66
what do the anterior intercostal arteries anastomose with?
posterior intercostal arteries a few inches from the sternum
67
for each long intercostal space, the ITA...
gives off a perforating cutaneous branch that accompanies the anterior cutaneous branch of the intercostal nerve
68
the internal thoracic vessels arise from...and divide into
subclavian artery; musculophrenic and superior epigastric arteries in intercostal space 7
69
anterior intercostals 7-10 come from...
the musculophrenic arteries
70
what is the drainage from the intercostal veins?
drain back to the musculophrenic or internal thoracic veins
71
what is the main venous drainage of the skin of the chest?
goes to the lateral thoracic vein which then goes to the axillary vein
72
each internal thoracic vein empties into
the brachiocephalic vein of its corresponding side
73
what do the 5th-11th posterior intercostal veins empty into?
azygos and hemiazygos veins
74
what happens to the 2nd posterior intercostal vein?
turns inferiorly to join the 3rd and 4th posterior intercostal veins; on the left and right side and becomes the superior intercostal vein on each side
75
what does the left superior intercostal vein empty into?
the left brachiocephalic vein deep to the manubrium
76
where is the azygos venous system? what does it consist of?
located on either side of the vertebral column and drains the viscera within the mediastinum, as well as the back and thoraco-abdominal walls; azygos vein and its 2 main tributaries: hemiazygos vein and the accessory hemiazygos vein
77
what does the azygos vein originate from? where does it move?
the posterior aspect of the inferior vena cava and the level of the renal veins; ascends within the posterior mediastinum to the level of T4 before it arches above the right pulmonary hilum, drains into the superior vena cava just before it pierces the pericardium
78
what is the hemiazygos vein formed by? where does it move?
esophageal and medistinal tributaries, the common trunk of the left ascending lumbar vein and left subcostal vein, and by the lower 3 posterior intercostal veins; ascends anterior to the vertebral column before crossing the column posterior to the aorta, esophagus and thoracic duct at the level of T8
79
what is the accessory hemiazygos vein formed by? where does it move?
formed by veins from the fourth to eighth intercostal spaces and sometimes by the left bronchial veins, descends to the left of the vertebral column before crossing T7, where it joins with the azygos vein; sometimes the common trunk drains into the azygos vein
80
what is the respiratory diaphragm?
thin muscular and tendinous septum that separates the thoracic cavity from the abdominal cavity; dome-shaped and consists of a peripheral muscular part, which arises from the lateral walls of the thorax and a centrally placed tendon; gets pierced by structures that pass between the thorax and the abdomen; is the most important muscle of respiration
81
what are the crura of the diaphragm?
musculotendinous bands that arise from the anterior surface of L1-3/IVDs & the anterior longitudinal ligament; right (L1-L3/4) is larger and longer than left (L1-L2/L3)
82
median arcuate ligament
unites the crura and forms the aortic hiatus
83
medial arcuate ligament
thickening of fascia (psoas major)
84
lateral arcuate ligament
thickening of fascia (quadratus lumborum)
85
what is the innervation of the respiratory diaphragm?
somatic motor; phrenic n. (C3-5); also carries sensory info like pain and proprioception; peripheral parts of the diaphragm also receive some sensory innervation from lower intercostal nerves
86
what is unilateral diaphragmatic paralysis?
asymptomatic and do not require treatment most times, can resolve on its own slowly over time; some patients, if severe enough dyspnea, can benefit from surgical treatment with diaphragmatic plication, which flattens the dome of the diaphragm so the lung can expand properly
87
what is bilateral diaphragmatic paralysis?
severe, treatment depends on level of severity, phrenic pacing used, which allows patients to use olfaction system and speak again since you can wean them off eventually
88
arterial supply to the diaphragm
superior surface: pericardiacophrenic (branch of ITA) and musculophrenic (branch of ITA) and superior phrenic (branch of thoracic aorta) inferior surface: inferior phrenic (branch of abdominal aorta)
89
venous drainage of the diaphragm
superior surface: Pericardiacophrenic (drain into ITV) &: Musculophrenic and R. Superior Phrenic (drain into IVC), some veins from posterior curvature drain into azygos and hemi-azygos veins inferior surface: right inferior phrenic (IVC) and left inferior phrenic (IVC and/or left suprarenal vein)
90
what are the openings of the diaphragm?
Inferior caval hiatus: T8 esophageal hiatus: T10 aortic hiatus: T12 also are small openings for sympathetic splanchnic nerves, sympathetic trunk and superior epigastric vessels
91
muscles ____ the ribs during inspiration
raise; lateral-most parts of the ribs are elevated and the transverse diameter of the thorax increases, creating a bucket handle movement; ribs are also elevated at the neck (2-6) resulting in an incease in the A-P diameter of the thorax-- pump handle movement
92
what does Boyle's law have to do with respiration?
increase volume, decrease pressure: air comes in with less effort
93
what does the diaphragm do during respiration?
contracts and moves down as inhale so lungs can expand; relaxes and moves up as exhale so lungs expire air

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