Lungs, Pleura, and Thoracic Wall Flashcards
Atypical ribs
1,2, 11 and 12
True ribs (vertebrocostal)
1-7
False ribs (vertebrochondral)
8-10
Floating ribs
11 and 12
What articulates with the manubrium of the sternum
Clavicle, Costal cartilage of first rib, and the Body of the sternum and the cost cartilage of rib 2 (note that it is at the manubriosternal joint)
Rib 2 articulates with what part of the sternum
The body
Rib 2 attaches to the sternum at the
Manubriosternal joint
what ribs are attached to the body of the sternum
ribs 2, 3, 4, 5, and 6th
rib 7 is attached to the sternum at
the Xiphisternal joint
What are the three parts of the sternum
Manubrium
Body
Xiphoid process
The mediastinum located behind the sternum from the level of ____ to ____
T3 to T9
what are the general features at the vertebral end of typical ribs
- Head
- Neck
- Tubercle
- Angle
What are the general features at the middle of typical ribs
Body (shaft)
What are the general features at the sternal end of typical ribs
Articulates directly with sternum, costal cartilage, or sits in fascia
what makes up the joint of head of rib
- body of vertebra superior to rib
- Intervertebral disc
- Body of vertebra of same number as rib
What makes up the costotransverse joint of a rib
- Tubercle of the rib
- Transverse process of vertebra of same number as the rib
The intervertebral disc is composed of
- Anulus fibrosus (exterior part)
- Nucleus Pulposus (internal part)
what type of joint is the intervertebral joint
-Symphysis (secondary cartilaginous joint)
The intervertebral joint articulates with
-adjacent cerebral bodies bound together by intervertebral disc
What are the ligaments of the intervertebral joint
Anterior and posterior longitudinal
What type of joint is the costovertebral joints of head of ribs
Synovial plane of joint
The costovertebral joints of head of ribs articulations
-head of each rib with superior demarcate or costal facet of corresponding vertebral body and inferior demarcate or costal facet of vertebral body superior to it
(heads of 1st, 11th, and 12th ribs (sometimes 10th) articulate only with corresponding vertebral body
What are the ligaments of the costovertebral joints of head of ribs
Radiate and intra-articular ligaments of head of ribs
what ribs have heads that only articulate with the corresponding vertebral body
1st, 11th, and 12th ribs (sometimes 10th)
What type of joints are costotransverse joints
Synovial plane of joint
Articulations of costotransverse joints
articulation of tubercle of rib with transverse process of corresponding vertebra (11th and 12th ribs do not articulate with transverse process of corresponding vertebrae)
What are the ligaments of the costotransverse joint
Lateral and Superior costotransverse ligaments
what ribs do not articulate with the transverse process of corresponding vertebrae
11th and 12th
What type of joint is the 1st sternocostal joint
primary cartilaginous joint
What type of joint is the 2nd-7th sternocostal joints
synovial plane joints
What does the 1st sternocostal joint articulate with
articulation of the 1st costal carriages with manubrium of sternum
what does the 2nd-7th sternocostal cartilage articulate with
articulation of 2nd-7th pairs of costal cartilages with sternum
What are the ligaments of the sternocostal joints
anterior and posterior radiate sternocostal
what type of joint is the Sternoclavicular joint
Saddle type of synovial joint
What does the sternoclavicular joint articulate with
Sternal end of clavicle with manubrium and 1st costal cartilage
what are the ligaments of the sternoclavicular joints
anterior and posterior sternoclavicular ligaments; costoclavicular ligaments
the sternoclavicular joint is divided into two compartments by
Articular disc
what type of joint is the costochondral joint
primary cartilaginous joint
what are the articulations of the costochondral joints
articulation fo lateral end of costal cartilage with sentry end of rib
what are the ligaments of the costochondral joints
Cartilage and bone; bound together by periosteum
Does the costochondral joint move
normally no movement occurs
What type of joint is interchondral
Synovial plane joint
what are the articulations of the interchondral joints
articulation between costal carriages of 6th-7th,7th-8th, and 8-9th ribs
What are the ligaments of the interchondral joints
Interchondral ligaments
Articulation between costal cartilages of 9-10th ribs is
fibrous
What type of joint is the manubriosternal joint
secondary cartilaginous joint (symphysis)
What are the articulations of the manubriosternal joint
articulation between manubrium and body of sternum
What type of joint is the Xiphisternal joint
Primary cartilaginous joint (synchondrosis)
What are the articulations of Xiphisternal joint
Articulations between Xiphoid process and body of Sternum
The Manubriosternal and Xiphisternal joints often fuse and become _____ in older people
synostosis
during inspiration the sternum moves
The inferior portion moves out and up similar to a lever on a water pump
Respiration involves ____ and _____
inhalation and exhalation
during inhalation, several muscles contract to _____ the dimensions of the thoracic cavity as the lungs fill with air
increase
The thoracic cavity expands both
to cause the lungs to fill with air and to accommodate the expanding of lungs
during exhalation, some respiratory muscles contract and others relax collectively
decreasing the dimensions of the thoracic cavity and forcing air out of the lungs
Muscles of respiration are on the
anterior and posterior surfaces of the thorax
Muscles of respiration are covered by
more superficial muscles that move the upper limb
The diaphragm is innervated by
phrenic nerve (C3-C5 of the cervical plexus)
The canal opening in in the diaphragm is for the
inferior vena cava
the diaphragm is shaped like a
parachute
when inhaling the diaphragm
contracts (moves down
when exhaling the diaphragm
relaxes (moves up)
superior attachment of external intercostal muscles
inferior border of ribs
superior attachment of internal intercostal muscles
inferior border of ribs
superior attachment of innermost intercostal muscles
inferior border of ribs
inferior attachment of external intercostal muscles
superior border of ribs below
inferior attachment of internal intercostal muscles
superior border of ribs below
inferior attachment of innermost intercostal muscles
superior border of ribs below
Innervation of external intercostal muscles
intercostal nerve
Innervation of internal intercostal muscles
intercostal nerve
Innervation of innermost intercostal muscles
intercostal nerve
Main action of external intercostal muscles
During forced inspiration: elevates ribs
Main action of internal intercostal muscles
during forced inspiration: interosseous part depresses ribs; interchondral part elevates ribs
Main action of innermost intercostal muscles
during forced inspiration: interosseous part depresses ribs; interchondral part elevates ribs
Superior attachment of Transversus thoracis muscles
posterior surface of lower sternum
Inferior attachment of Transversus thoracis muscles
internal surface of costal cartilages 2-6
Main action of transversus thoracis
weakly depresses ribs
Superior attachment of subcostal muscles
internal surface of lower ribs near their angles
What is the inferior attachment of subcostal muscles
superior borders of 2nd or 3rd ribs below
What is the main action of the subcostal muscles
probably act in same manner as internal intercostal muscles, which during forced inspiration: elevates ribs
during forced inspiration: interosseous part depresses ribs; interchondral part elevates ribs
What is the superior attachment of the Levatores Costarum muscles
Transverse processes of T7-T11
What is the inferior attachment of the Levatores Costarum muscles
Subjacent ribs between tubercle and angle
What is the innervation of the levatores Costarum muscles
Posterior Rami of C8-T11 nerves
What is the main action of the Levatores Costarum muscles
Elevate ribs
What is the superior attachment of the serratus posterior superior
Nuchal ligament, spinous processes of C7-T3 vertebrae
what is the inferior attachment of serratus posterior superior
Superior borders of 2nd-4th ribs
innervation of serratus posterior superior
2nd-5th intercostal nerves
what is the main action of the serratus posterior superior
elevates ribs
what is the main action of the serratus posterior inferior
depresses ribs
what is the superior attachment of the serratus posterior inferior
spinous processes of T11-L2 vertebrae
What is the inferior attachment of serratus posterior inferior
inferior borders of 8th-12th ribs near their angles
innervation of serratus posterior inferior
9th-11th intercostal nerves, subcostal (T12) nerve
Muscles that elevate the ribs
- External intercostal muscles
- Innermost intercostal muscles (interosseous part will depress)
- Levator costarum
- Serratus Posterior Superior
muscles that depress the ribs
- Internal Intercostal muscles (interchondral part will elevate)
- Transversus Thoracis
- Subcostal Muscles
- Serratus Posterior Inferior
What is the only epaxial muscle that moves the ribs
Levator costarum
which of the muscles that move the ribs are proprioceptive
- Serratus posterior superior
- Serratus posterior inferior
- Transversus Thoracis
generally muscles that move the ribs ultimately depend
on direction of muscle fiber, and this can change depending on segment of rib
What gives rise to the large lateral cutaneous branch, the intercostobrachial nerve
it emerges form the 2nd intercostal nerve (note sometimes it is form the 3rd)
the intercostal arteries come form the
thoracic aorta
The intercostal veins drain into the
azygous vein
The subcostal nerve is inferior to the
12th rib
what are the arteries of the boracic wall
- Thoracic aorta, through the posterior intercostal and subcostal arteries
- Subclavian Artery- through the internal thoracic and supreme intercostal arteries
- Axillary artery- though the superior and lateral thoracic arteries
with the exception of the ___ and ____ intercostal spaces, each intercostal space is supplied by three arteries: ______ ( and its ____ branch) and a small pair of _____-
10th and 11th, large posterior intercostal artery (and its collateral branch), and a small pair of anterior intercostal arteries
Of the ____ and _____ intercostal spaces arise from the supreme (superior)intercostal artery, a branch of the costocervical trunk of the sublavian artery
the 1st and 2nd intercostal space
The intercostal vein, artery, and nerve run in the
costal grooves of ribs
Origin of the Posterior intercostal artery
-Supreme intercostal arteries (intercostal spaces 1 and 2) and thoracic aorta (remaining intercostal spaces)
Course of the posterior intercostal arteries
Pass between internal and innermost intercostal muscles
Distribution of Posterior intercostal arteries
Intercostal muscles and overlying skin and parietal pleura
origin of Anterior Intercostal arteries
-Internal thoracic arteries (intercostal spaces 1-6) and musculophrenic arteries (intercostal spaces 7-9)
What is the course of the anterior intercostal arteries
-Pass between internal and innermost intercostal muscles
What is the distribution of the anterior intercostal arteries
- Intercostal muscles and overlying skin
- Parietal pleura
what is the origin of the internal thoracic artery
Subclavian artery
What is the origin of the subcostal artery
Thoracic aorta
What is the course of the Internal Thoracic artery
-Passes inferiorly, lateral to sternum, between costal cartilages and internal intercostal muscles to divide into superior epigastric and musculophrenic arteries
What is the course of the subcostal artery
courses along interior border of the 12 rib
What is the distribution of the internal thoracic artery
Muscles of anterolateral abdominal wall and overlying skin
The left lung has indentions for
- Thoracic duct
- Left common carotid artery
- Vagus nerve
- Phrenic nerve
- Descending aorta
- Area of esophagus
The right lung has indentions for
- Esophagus
- vagus nerve
- phrenic nerve
- azygos vein
which main bronchus is shorter the right or the left
the right
The left main bronchus is almost a ___ angle while the right is
90 degree, while the right is more straight
blood supply to the lungs
- Left bronchial arteries (from aorta)
- Right bronchial arteries (from intercostal arteries, aorta, or left bronchial artery)
Venous drainage of the lungs
- Bronchial Veins
- Pulmonary Veins
The heart and the lungs receive sympathetic innervation primarily via which pathway
-Postganglionic sympathetic pathway
The bronchial veins drain into the ____ system
azygos
The right bronchial veins drain into
azygos vein
The left bronchial veins drain into
accessory hemiazygos vein or intercostal vein
Parasympathetic innervation of the lungs comes form the
vagus nerve
Air infiltrating the pleural cavity (pneumothorax) can break surface tension between the visceral and parietal pleura. When this happens, the elastic lung tissue will recoil (collapse) leaving air filled space within the pleural cavity that prevents expansion of the lung during inspiration
Pulmonary Collapse (collapsed lung)
blood infiltrates the pleural cavity and may also cause the lung to collapse
Hemothorax
Serous fluid in the pleural cavity that may also cause the lung to collapse
Hydrothorax
Lymph in the pleural cavity that may also cause the lung to collapse
Chylothorax
Inflammation of the pleura, may cause “scraping sounds” during auscultation, and can cause sharp stabbing pain
Pleuritis (pleurisy)
what is that common cause of pulmonary embolism
Deep vein thrombosis (DVT)
Obstruction of the pulmonary artery by blood clot, fat globule, or air bubble: is often fatal.
Pulmonary Embolism
Blood clot passes form vein into right side of heart via the vena cava and then travel through the heart and into pulmonary artery, obstructing blood flow
Pulmonary Embolism
Bronchogenic Carcinoma
- Common type of lung Cancer arising form bronchial epithelium
- Smoking a major cause
- Highly metastatic due to association of lymphatics in bronchial tissue
- Typically metastasizes to brain and cranium
Malignant Mesothelioma
- Rarer type of lung cancer affecting pleura (mesothelium)
- Caused by exposure to asbestos
- Can affect other internal organs
Pulmonary Tuberculosis (TB)
- Bacterial infection of the lungs (mycobacterium tuberculosis)
- Can spread to other organs
- contagion spread through the air through droplets from an infected individual coughing, sneezing, or talking
- 1/3 of the world’s population is currently infected with TB, but only 5%-10% become sick or infectious (active TB)
____ of the worlds population is currently infected with TB, but only _____% become sick or infectious (active TB)
1/3, 5-10%