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Anatomy 2 > Oct 30 - Thorax and Mediasternum > Flashcards

Oct 30 - Thorax and Mediasternum Flashcards

1
Q

What is the role of the thoracic wall?

A

The thoracic wall, or ribcage, protects the contents of the thorax (lungs, heart, great vessels, liver, spleen)

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2
Q

Name the three components of the thoracic wall

A

12 thoracic vertebrae
12 pairs of ribs
Sternum

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3
Q

What does the sternum compose of?

A

Manubrium
Body
Xiphoid process

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4
Q

Where do you find the sternal angle?

A

At the level of the second rib

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5
Q

Describe the ribs of the thoracic wall

A

Each rib has a bony part (costo-) and a cartilage part (chondro-). All 12 pairs of ribs attach posteriorly to the vertebrae (mostly synovial joints). Most ribs show an inferior and medial costal groove to protect intercostal vessels and nerves

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6
Q

What are true ribs? How many are there?

A

The costal cartilages of true ribs articulate directly with the sternum. Ribs 1 through 7 are true ribs

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7
Q

What are false ribs? How many are there?

A

The costal cartilages of false ribs connect with with the cartilage of other ribs. Ribs 8 through 10 are false ribs

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8
Q

What are floating ribs? How many are there?

A

Floating ribs don’t articulate with the sternum. Ribs 11 and 12 are floating ribs

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9
Q

What happens to the ribs during inspiration?

A

The sternum is slightly elevated, increasing the anterior-posterior dimensions of the thoracic cavity. The lower ribs are elevated, increasing the transverse diameter of the thoracic cavity

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10
Q

What are the main two muscles of the thoracic wall involved in inspiration?

A

Scalenus muscles and the external intercostal muscles elevate the ribs

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11
Q

What are the main four muscles of the thoracic wall involved in expiration?

A

The internal intercostal muscles, the innermost intercostal muscles, the transverse thoracis muscle and the subcostal muscles depress the ribs

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12
Q

Describe the external and internal intercostal muscles?

A

The external intercostal muscles go from posterior to anterior downwards (hands in pockets direction) and the internal intercostal muscles are perpendicular to the external. There is a membrane between the external intercostal muscles and the sternum and between the internal intercostal muscles and the vertebral column

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13
Q

What innervates the muscles of the thoracic wall muscles? What innervates the scalenus muscles?

A

The thoracic wall muscles are innervated by the intercostal nerves. The scalenus muscles are innervated by the cervical plexus

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14
Q

What are the openings created by the ribcage?

A

The superior and inferior thoracic aperture

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15
Q

What closes the inferior thoracic aperture?

A

The diaphragm, separating the thorax and the abdominal cavity

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16
Q

Describe the diaphram

A

Dome-shaped, musculotendinous, thin muscle. Divides in two: the right and left hemidiaphragm joined by the central tendon. It originates from the xiphoid process and the anterior surfaces of L1-L3 and inserts in the central tendon

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17
Q

Which side of the diaphragm is bigger? Why?

A

The right hemidiaphragm is bigger because of the heart on the left side and the liver in the abdominal cavity on the right

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18
Q

The diaphragm separates incompletely the thoracic cavity from the abdominal cavity. What travels through?

A

The aorta (aortic aperture), the inferior vena cava (vena caval aperture) and the esophagus (esophageal aperture)

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19
Q

When is the diaphragm active (what is the role of the diaphragm?)

A

Principal muscle of respiration. Also active during coughing

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20
Q

What innervates the diaphragm?

A

The phrenic nerve (C3, C4, C5)

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21
Q

What are the two main arteries that supply blood to the thoracic wall?

A

The thoracic aorta and the subclavian artery

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22
Q

What two arteries do they intercostal arteries derive from?

A

The posterior intercostal arteries derive from the aorta and the anterior intercostal arteries derive from the internal thoracic artery (derived from the subclavian artery)

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23
Q

Describe the thoracic venous system

A

The inferior vena cava splits into the azygous vein, which collects blood from the right posterior intercostal veins then merges with the superior vena cava. The blood from the left posterior intercostal veins drains hemiazygous vein, which connects to the azygous vein. The internal thoracic vein collects blood from the anterior intercostal veins and merges with the superior vena cava

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24
Q

What do the ventral rami of the thoracic spine do?

A

They remain segmental (they don’t form plexuses). T1-T6 are considered intercostal nerves. T7-T12 are considered thoracoabdominal nerves. They provide motor innervation for the muscles of the thoracic and abdominal wall. They also provide sensory innervation for the dermatomes and costal parts of the diaphragm. Finally they provide sympathetic innervation for the skin (sweat glands, blood vessels)

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25
Q

What is special about the ventral ramus of T12?

A

It forms the subcostal nerve (antero-lateral abdominal region)

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26
Q

What do the second and third intercostal nerves do?

A

They give rise to the intercostobrachial nerves, which at the mid axillary line penetrate the serratus anterior muscle to enter the axilla and arm

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27
Q

What is at the level of T4

A

The nipples

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28
Q

What is at the level of T10?

A

The navel

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29
Q

Name the contents of the 11 intercostal spaces

A

Intercostal muscles (external, internal and innermost), blood vessels and nerves

30
Q

Name the first layer of connective tissue deep to the ribs

A

The fascia endothoracica. It is attached to the ribs and the intercostal muscles and covers the thoracic cavity

31
Q

What is between the two pleural layers?

A

Pleural fluid, which fill the pleural cavity

32
Q

What is the pleura?

A

Serous epithelial layer with subepithelial connective tissue

33
Q

Name the two continuous parts of the pleura

A

The parietal pleura, which attached to the endothoracic fascia and the visceral pleura, which is attached to the lung surface

34
Q

How many pleural cavities are there?

A

Two, one for each lung. The two cavities are completely separate.

35
Q

Besides separating the parietal and visceral layers, what is the role of the serous fluid?

A

To reduce the friction between the pleural layers during breathing

36
Q

What happens if air enters the pleural cavity?

A

The lung will collapse

37
Q

Name the parts of the parietal pleura

A

The mediastinal pleura, the costal pleura and the diaphragmatic pleura

38
Q

Name the nerve supplies of the parietal pleura

A

The costal pleura is innervated by the intercostal nerves. The mediastinal and diaphragmatic pleura are innervated by the phrenic nerve

39
Q

Which part of the pleura can sense pain

A

The parietal pleura. The visceral pleura has no pain receptors

40
Q

What are the two parts of respiration?

A

Inspiration and expiration

41
Q

Describe inspiration

A

Muscle actions increase the thoracic space in all three dimensions. Because the parietal pleura is attached to the thoracic wall, the lungs are forced to expand, decreasing the pressure within in the lungs below that of the atmosphere. Air passively rushes inwards (down the pressure gradient)

42
Q

Describe expiration

A

It’s passive; the muscles of inspiration relax. The air in the lungs is forced to move out of the lungs because of the high elasticity and retractility of the lung tissue. Muscles of expiration work during forced expiration

43
Q

How many lobes does the left lung have?

A

Two lobes. They are separated by the oblique fissure

44
Q

How many lobes does the right lung have?

A

Three lobes. The horizontal fissure separates the superior and middle lobes and the oblique fissure separates the inferior lobe from the superior and middle lobes

45
Q

What attaches the lungs to the heart and trachea?

A

The hilum/root of the lung

46
Q

Name the contents within the hilum of the lung (8)

A

Pulmonary artery, pulmonary veins, bronchus, autonomous nerves, lymph nodes, bronchial arteries, bronchial veins, lymphatic vessels

47
Q

What is the role of bronchial arteries/veins? How are they different from pulmonary arteries/veins

A

They supply the lungs with arterial blood required to function (and return it to the heart). They pulmonary arteries/veins go to the lungs to receive oxygen and return to the heart to be pumped to the body

48
Q

What lung is more likely to receive foreign bodies during aspiration?

A

They will more likely be found in the right bronchus because the left bronchus is much more deviated laterally

49
Q

How many bronchopulmonary segments does the right lung have?

A

10 bronchopulmonary segments

50
Q

How many bronchopulmonary segments does the left lung have?

A

9 bronchopulmonary segments

51
Q

Describe the lymphatic drainage of the lungs and bronchi

A

The subpleural and peribronchial lymphatics drain into the hilar nodes. The 3 lobes of the right lung and the inferior lob of the left lung drain into the right lymphatic duct. The superior lobe of the left lung drains into the left lymphatic duct

52
Q

What type of lymph nodes drain lungs, heart and mediastinal organs

A

Tracheobronchial, retro- and partracheal lymph nodes

53
Q

What is the mediastinum?

A

It is the space between the two pleural cavities. It’s largely occupied by the heart

54
Q

Name the areas of the mediastinum

A

There’s the superior and inferior mediastinum. The inferior mediastinum can be further divided into anterior, middle and posterior. The middle inferior mediastinum is where the heart rests

55
Q

Name the major organs of the mediastinum (8)

A

Trachea, esophagus, lymph vessels and nodes, thymus, greater vessels, heart and nerves

56
Q

Name the major branches of the aorta (8)

A

Coronary arteries, the brachiocephalic trunk, the left common carotid artery, the left subclavian artery, the posterior intercostal arteries, bronchial arteries, esophageal arteries and the superior phrenic arteries

57
Q

What is the origin of the phrenic nerve?

A

The cervical plexus (C3-C5)

58
Q

The phrenic nerve supplies motor innervation of what?

A

The diaphragm

59
Q

The phrenic nerve supplies sensory innervation of what?

A

The pericardium, the mediastinal and diaphragmatic parietal pleura, and the parietal peritoneum (the underside of the diaphragm

60
Q

Where can you find the phrenic nerve? What are the benefits and the disadvantage to where it’s found?

A

It originates from the cervical plexus, on the ventral side of the anterior scalenus muscle, and descends anterior to the roots of the lungs and between the fibrous pericardium and the mediastinal pleura. This is beneficial in the case of spinal cord injury (has to be really high to effect the breathing). The disadvantage is it is easily injured

61
Q

What is the vagus nerve?

A

It is cranial nerve 10. It’s the biggest parasympathetic nerve of the body.

62
Q

Where does the vagus nerve run?

A

It runs posterior to the roots of the lung. The right and left vagal trunks are adjacent to the esophagus

63
Q

What does the vagus nerve do?

A

It contributes to cardiac, esophageal and pulmonary autonomous nerve plexuses

64
Q

What is the recurrent laryngeal nerve?

A

A branch of the vagus nerve. It courses lateral to the trachea

65
Q

What does the recurrent laryngeal nerve do?

A

Provides motor innervation of most of the muscles of the larynx. Provides sensory innervation of the inferior larynx

66
Q

How can lung cancer cause hoarsness?

A

Apical lung cancer may cause hoarsness resulting from invasion of the recurrent laryngeal nerve

67
Q

What do sphlanchnic nerves innervate?

A

They innervate abdominal organs

68
Q

Where do parasympathetic nerves derive from?

A

The vagus nerve

69
Q

What do sympathetic and parasympathetic nerves contribute to?

A

Pulmonary, esophageal and cardiac plexuses

70
Q

How do parasympathetic affect glands, bronchi and arterials?

A

They cause secretion in the glands, contraction of the smooth muscles in the bronchi and constriction of the arterials

71
Q

How do sympathetics affect glands, bronchi and arterials?

A

They inhibit secretion in the glands, dilation of the smooth muscles and dilation of the arterials

72
Q

How does the thoracic duct contribute to lymphatic drainage?

A

It drains lymph about 3/4 of the body. It drains into the left jugular-subclavian junction. It contains the chylomicrons of the small intestine

Anatomy 2 (6 decks)

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