The thoracic wall Flashcards
1
Q
anterior
A
front
2
Q
posterior
A
back
3
Q
superior
A
up
4
Q
inferior
A
bottom
5
Q
neuroscience terms
A
ventral
dorsal
cranial/rostral
caudal
6
Q
mid line
A
mid sagittal line
7
Q
what are the relative porstions to the midline
A
medial lateral (further away) proximal - limbs distal - limbs superficial deep
8
Q
what are the anatomical planes
A
sagittal - parallel to the midline (parasagittal if not on the midline)
frontal/coronal
horizontal - transverse/axial
9
Q
how many thoracic vertebrae are there
A
12
10
Q
how many pairs of ribs and costal cartilage are there
A
12
11
Q
what is the role of costal cartilage
A
join rib to bone at the front (sternum)
12
Q
explain the different names of ribs
A
1-7 are true - reach sternum
8-10 are false - they reach the costal cartilage above
11 and 12 - floating they lack anterior attachment
13
Q
describe the ribs
A
different shapes and sizes
14
Q
what is the tubercle
A
sticks out of bony structure that provide attachment for ligaments and muscles
15
Q
what are the facets
A
join ribs to other bones
articular surfaces
16
Q
how does the size of the ribcage change down the thorax
A
it is bigger at the bottom
17
Q
which way do ribs slope
A
downwards
18
Q
what is the costal margin
A
where the diaphragm attaches
19
Q
3 parts of the sternum
A
manubrium
body
xiphoid
20
Q
what is the manubriosternal joint a landmark for
A
the 2nd costal cartilage
21
Q
where does the 1st costal cartilage attach
A
the manubrium
22
Q
where are the articular facets for ribs 3-7
A
the sternum
23
Q
where is the apex beat of the heart found
A
the 5th intercostal space
24
Q
what is the ring of the thoracic inlet formed of
A
the 1st thoracic vertebrae
1st ribs
manubrium
25
what are the contents of the thoracic inlet
great vessels heading for the neck and upper limb, oesophagus (down), trachea (down), nerves and lymphatics
26
what is the danger of trauma in the neck
it is not protected by the rib cage but contains large vessels
27
where is the capacity for lung expansion
in the lower parts of the thorax - where there is the most lung tissue
28
what are the great vessels
major vessels emerging from the heart
| aorta, carotid artery, jugular artery, subclavian veins and arteries
29
what is the thoracic inlet
conduit between top and bottom
30
correct name for thoracic inlet
superior thoracic aperture
31
what do nerves control in the thoracic inlet
diaphragm
| peristalsis and sensations of fullness after eating
32
describe the diaphragm
it has a central tendon with muscle radiating to costal mergin and vertebrae
33
actions of the diaphragm
dome flattens when muscles contract - increase vertical diameter of the chest
then it pulls the costal margin up to increase transverse and anteroposterior diameters
34
what are the crus
means leg
| diaphragm attaches here posteriorly
35
where does the heart sit on the diaphragm
on the tendon
36
what is the role of intercostals
stiffen chest wall to improve efficiency of breathing movements - only allow air in through airways
if struggle to breath - muscles move more than you would expect
37
describe movement of the bones in the chest to increase volume
bones move more horizontally
sternum moves up and out
dimensions increase anterioposterially and mediolaterally
38
what are the 3 layers of the intercostal muscles
external intercostals
internal
innermost
39
describe the external intercostals
downward and laterally from lower border of the rib to the rib below
replaced by intercostal membrane at costo-chondrial junction (rib cartilage)
40
describe the internal intercostals
supromedially
attachments begin anteriorally at sternum
from lower border of rib above to rib below
fibres directed at R angles to external intercostals
replaced by membrane posteriorly
41
describe the innermost intercostals
supromedially
relatively trivial
orientation same as internal intercostals
42
describe the order of the components of the neurovascular bundle of the lungs
vein (superior)
artery
then nerve (more inferior than the bottom of the rib)
43
how does the organisation of the neurovascular bundle affect surgery
don't want to damage the nerve - lose motor function and sensation (analgia)
you would insert tube to remove air from pleural cavity eg in pneumothorax - air can escape through holes
you need to insert closer to the superior of the lower rib to avoid the nerve
44
how does the structure of the rib relate to the neurovascular bundle
it has a groove so the bundle is mostly protected except for the nerve
45
where are the intercostal nerves
they run along the intercostal space along the rib from the back
46
describe the intercostal nerves
11 pairs intercostal nerve - T1-T11 plus one subcostal rib
they are mixed - afferent and efferent
branches that supply the skin and muscle on way and then have more branches
supply the intercostal spaces
made of lateral cutaneous branch - runs anteriorly and posteriorly
and anterior cutaneous branch - runs medial and laterally
47
describe the branches of the spinal nerve
ramus = branch
spinal nerve have efferent fibres at the front and afferent fibres at the back
spinal nerve - branch to back - supply erector spinae muscles
anterior ramus larger branch
48
what is the effect of damage to the pleural cavity
pleural cavity is a continuous lining
needs to be intact for air to go into the lungs
otherwise the outer membrane moves out but the lung wont inflate
49
how does the pleural cavity work to inflate the lungs
it is a continuous lining
fluid provides the surface tension
as the external lining moves it pulls the internal lining with it and inflates the lungs
50
what is the area for inserting a chest drain
the safe triangle
anterior border of latissimus dorsi - at the back
lateral border of pectoralis major muscle
line superior to the horizontal level of the nipple
apex below the axilla (5th intercostal space, anterior to the mid axillary line)
51
what is an anastomosis
the join of an artery and vein to the same region
52
describe intercostal anastomoses
vessel from the aorta at the back moves anteriorly (posterior intercostal arteries) and meets vessel from the front (anterior intercostal arteries) (running down sternum)
when they join tey supply the same region of tissue
53
describe the flow to the abdomen
bv down sternum past bottom chest into muscles of abdomen
anastomoses from bv from groin o supply skin of abdomen - continuous supply to the abdomen (from internal thoracic vessels and epigastric aretries)
54
what are the contents of the thoracic cavity
laterally filled by lungs
space between the pleural cavities is the mediastinum - it has the heart, great vessels, oesophagus, trachea, thymus, thrracic duct and major lymph trunks, lymph nodes, phrenic and vagus nerves
55
what happens to thymus that means you cant see it
it is replaced by fat
56
how does a secondry tumour occur
travels through the lymphatics and circulation
57
what do the major lymph trunks do
mop fluid up around the tissue
58
what is the heart in
the pericardial sac
59
effect of removing the lymphatic system
lymphoedema
very painful
limit mobility
60
what is the medistinum
tissue containing everything except lungs and pericardial tissue
61
where are the top of the lungs
above the clavicle
