Lecture 6 Thoracic Wall and lungs Flashcards
Thoracic Cavity boundaries
Superior Boundary: thoracic outlet; root of neck
Inferior Boundary: the 3 openings
Inferior Boundary 3 openings
Caval: inferior vena cava crossing right dome T8 vertebral level
Esophageal Hiatus: T10 level, in right crus folding
Aortic hiatus: T12 level, by right and left crus of the diaphragm; median arcuate ligament
Thoracic vertebrae landmarks that articulate with ribs
-Demifacet articulates with ribs
- transverse process costal articulation with neck of rib
T1 has what for the first rib
1 full facet
T9-10 have no…
superior demifacet
T11/12 have no…
no facets on trans processes
What forms intervertebral foramen and what are its contents
The vertebral bodies and the sup/inf articulating processes form it, and It includes spinal nerves and arteries
The head of every rib except for (blank) have demifacets
1,10,11,12
How many full facets on the head of 1,10,11,12th rib
One on each
Which ribs have no tubercle on the neck?
11 and 12
Which rib articulates at the sternal angle (manubriosternal joint)
Rib 2
Which rib articulates with the facet on the xiphosternal joint
the 7th rib
The head of ribs and the demi/full facet on vertebrae form a
Costovertebral joint
The rib neck and the facet on the transverse process form a
Costotransverse joint
The inferior rib neck and superior transverse process are connected by
the Superior costotransverse ligament
This ligament is on the same level as the transverse process and the rib neck
Lateral/costotransverse ligament
Name the true ribs and where they articulate
1: manubrium
2: sternal angle
3-6: sternal body
7: xiphosternal junction
Name the false ribs and where they articulate
8-10: cartilage fused with 7th ribs cartilage (the costal margin)
11-12: floating
How many intercostal spaces are there?
11 (between every rib)
Planes of motion of true and false ribs
True ribs 1-7: coronal (pump handle)
False ribs 8-10: sagittal (bucket handle)
(blank) has only somatic motor; there is no (blank) dermatome
C1; C1
Palpateable dermatome T levels and where they are
T4: at/above nipple line or at root of breast
T6: xiphoid process level
T10: umbilical level
T12: along iliac crest to pubic tubercle
Sympathetic innervation:
Parasympathetic innervation:
-T1-T4 level; no direct innervation; descending from cervical ganglia; following ventral rami to support thoracic wall
- Vagus nerve (CN 11)
Intrinsic blood supply: superior, posterior, and anterior
Superior: Supreme intercostal artery (branch from costocervical trunk)
Posterior: posterior intercostal artery (branch from aorta)
Anterior: internal thoracic artery, branch from subclavian
- anterior intercostal
- musculophrenic along costal margin
- superior epigastricc
The subclavian artery is the midpoint of
the clavicle/ lateral border of the first rib
The axillary artery is the inferior border of the
teres major
Three parts of the axillary artery
Screw The Lawyer, Save A Patient
1) Superior thoracic artery
2) Thoracoacromial + Lateral thoracic
3) Subscapular + Anterior + Posterior circumflex
What nerves innervate organs in the thoracic cavity
T1-T4 visceral nerves and Vagus nerve (CN 10)
External intercostal fiber orientation vs Internal/innermost
External: Top left to bottom right
In: Top right to bottom left
neuromuscular bundles in intercostal space =
Major bundle: VAN, cutaneous branch; located on the inferior border of superior rib and runs between the inner and innermost intercostals
Muscular/collateral bundle: NAV; located on superior border of inferior rib; also runs between inner/innermost intercostals
The diaphragm is an
extrinsic thoracic muscle
Which diaphragm dome is higher and why
Right dome because of liver space
Intercostal nerve innervates:
transverse thoracis and subcostals
Internal intercostal muscles help with
Expiration
Break down the pleural cavity
- 2 lungs
- parietal pleura = innervated by somatic cutaneous nerves; is along the mediastinum (phrenic nerve)
- Visceral pleura - outer layer of lungs innervated by visceral sensory nerves or none at all
- intrapleural pressure is always at or below -4mmHg
Break down the mediastinum
- holds the heart in the pericardial cavity
- esophagus, trachea, bronchi, giant cardiac vessels
- 2 serous membrane layers wrap all internal organs from endoderm/mesoderm with some exceptions
Expansion vs compression of pleural cavity
Expansion = elevation of rib cage, less than -4mmHg, inspiration
Compression = depression of rib cage, back to -4mmHg, expiration
the accumulation of fluid in pleural cavity is called
Costodiaphragmatic recess
Atmospheric pressure vs pleural pressure
Atm: 760 mmHg
P: 756 mmHg
What is a pneumothorax and how is it treated
A collapsed lung when pleural cavity is above -4mmHg; tube is inserted above superior border of 5th or 6th rib to avoid cutaneous branch
right vs left lung pulmonary artery to bronchi relashionship
RALS = Right anterior Left superior
(right lung has pulm artery anterior to bronchi and left lung has pulm artery superior to bronchi)
Which bronchi is more vertical?
RIght bronchi
What supplys the lungs for normal functions
Bronchial arteries and veins
Compare the lobes and fissures on each lung
Right: 3 lobes; 2 fissures (oblique and horizontal)
Left: 2 lobes with a lingula (degenerated middle lobe) and 1 oblique fissure
Main site for O2 exchange is ..
Alveoli (single layer of specialized epithelia)
Difference between pulmonary trunk and veins
Trunk= R+L pulm artery, low O2, BLUE
R+L Veins = high O2, RED
