The Thorax Flashcards
What separates the thorax from the abdomen
The diaphragm
What protects the thorax
thoracic cage
Contents of the thorax
- Heart
- Great vessels
- Lungs
- Airways
- Supporting circulatory and nerve networks
Define Mediastinum
the space between the lungs
3 Functions of the chest wall (thoracic cage)
- Protection of the thoracic and abdominal contents
- Breathing
- Attachements for the upper limb are located at the sternoclavicular joint
Explain how breathing occurs
Breathing occurs when the diaphragm contracts and relaxes, allowing air to enter and leave the lungs. When exertion is required the diaphragm is assisted by the intercostal, arm and neck muscles.
Where is the breast attached?
between ribs 2 and 6 (covering the pectoralis major)
Contents of the thoracic cage
- 12 ribs
- 12 vertebrae
- the sternum
- Inlet
- Outlet
Where is the throacic cage widest?
at ribs 7 and 8
What is the inlet
The inlet is the 1st thoracic vertebra posteriorly, the 1st ribs (at the sides) and the superior aspect of the manubrium sterni
List structures that pass through the inlet (7)
- Esophagus
- Trachea
- Common Carotid and Subclavian Arteries
- Jugular and Subclavian Veins
- Left and Right Vagus Nerves
- Left and Right Phrenic Nerves
- Left and Right Sympathetic Trunks
What is the outlet
The 12th thoracic vertebra, the 12th ribs passing into the 11th ribs and then the costal margin, which is the fused costal cartilage of ribs 7-10
List structures passing through the outlet (6)
- Esophagus
- Descending Aorta
- Inferior Vena Cava
- Left and Right Vagus Nerves
- Left and Right Sympathetic Trunks
- Thoracic Duct
Three components of the sternum
- Manubrium
- Body
- Xiphoid process
Manubrium
Body
Xiphoid process
What joint unites the manubrium and body of the sternum?
Manubriosternal joint
What joint unites the body and xiphoid process of the sternum?
The xiphisternal joint
The groove at the top of the manubrium is called:
The suprasternal or jugular notch
Where does the second rib articulate with?
The angle of Louis on one side and the manubriosternal joint on the other side
What is the sterna angle (of Louis)
The angle in the anteroposterior plane that is created by the manubrium joining the body
Which costal cartilages articulate laterally with the sternal body?
3, 4, 5, 6
How does the 7th rib articulate with the sternum
By way of its cartilage, it articulates between the body and the xiphoid process
True ribs
The upper 7 ribs that are directly attached to the sternum by means of its costal cartilage
False ribs
- The lower 5 pairs of ribs
- Ribs 8, 9, and 10 attach indirectly to the costal cartilage of rib 7
- Ribs 11 and 12 are floating ribs because their costal cartilages do not articulate at all
Which rib is the widest, shortest and flattest?
1st rib
Where does rib 1 articulate?
It articulates with the body of its own vertebra (T1)
Scalene tubercle
the small bump in the centre of rib 1’s upper surface
What passes through the scalene tubercle?
The subclavian vein and artery pass infront of and behind this tubercle, respectively
Components of a rib (5)
- Head
- Neck
- Tubercle
- Shaft
- Distal end
Describe how the head of a rib articulates with a vertabra
The head is pointed and has a demifacet, which articulates with the bodies of its own vertebra and the one above
Which vertebrae would rib 6 articulate with?
T5 abd T6
Which ribs articulate ONLY with their own vertebra?
1, 11, 12
How many facets does T1 have?
1.5
How many facets does T2-T9 have?
2
How many facets does T11 and T12 have?
1
The neck of the rib leads to the:
tubercle
2 parts of the tubercle
- articular surface
- non-articular part
The articular surface of the tubercle artoculates with which joint?
the costotransverse joint
The shaft of the rib
is flat and features the subcostal groove
The angle of the rib
1/3 around the shaft where the rib starts to point forward and downward
Where does the distal end of the rib attach?
its costal cartilage attaches to the sternum by means of the costosternal joint
What type of joint is the costosternal joint?
synovial
How does the head of a rib articulate with vertebrae?
The head of the rib typically has 2 demifacets that articulate with the equivalent demifacets on the bodies of two adjacet vertebrae (its own and the one above)
How is the head of the rib held in place?
- The radiate ligaments which are located anteriorly
- The intra-articular ligament deep in the joint secures the tip of the head with the disc
The tubercle of the ribs articulates with:
the articular part of the transverse (vertebral) process
How is the joint of the tubercel and transverse process strengthened?
by a large medial and smaller lateral costotransverse ligaments
Ligament of the neck
the medial ligament
Superior costotransverse ligament
- reinforces the joint of the tubercle and transverse process
- runs between the neck of the rib and the transverse process
Lateral costotransverse ligament
Superior costotransverse ligament
Lateral costotransverse ligament
Medial costotransverse ligament
Radiate ligament
Tubercle
Disc
Intra-articular ligament
Medial costotransverse ligament (ligament of the neck)
3 layers of intercostal muscles of the rib cage
- External intercostals (superficial)
- Internal intercostals (middle)
- Innermost intercostals (deep)
How do the fibers of the external intercostals point?
down and forward
Describe the composition of the external intercostals
- the posterior and lateral parts are muscular
- the anterior section is aponeurotic
How do the fibers of the internal intercostals point
down and posteriorly
Describe the composition of the internal intercostals
the aponeurosis is posterior and the muscular part is lateral and anterior
What are the 3 parts of the innermost intercostals
- Anterior (AKA the transversus thoracis)
- Lateral
- Posterior
What joins the 3 parts of the innermost intercostals?
they are joined by thin aponeuroses
Innermost intercostals
Intercostal space
Internal intercostals
External intercostals
Subcostal space
The area below the 12th rib
Intercostal space location
is located between the internal and innermost layers of muscles
What does the intercostal space contain?
intercostal vein, artey and nerve nestled in the subcostal groove
The anterior rami of the spinal nerves
are the 11 pairs of intercostal nerves (T1-T11)
Which intercostal nerve helps make up the brachial plexus?
T1
What do the collaterals supply
the sensory innervation for the skin
What do the collateral merge with?
penetrating branches from the dorsal rami and the anterior cutaneous nerves
2 sets of arteries supplying the intercostal spaces:
anterior and posterior intercostal arteries
Majority of posterior intercostal arteries arise from the:
aorta
Which arteries do not arise from the aorta? Where do they arise from?
arteries 1 and 2 arise from the supreme intercostal artery
The anterior intercostal arteries are branches of the:
internal thoracic (internal mammary) artery
The internal thoracic is a branch of the:
subclavian artery
The internal thoracic runs where? with what?
It runs down lateral to the sternum behind the costal cartilages, accompanied by its venae comitantes
Where does the internal thoracic branch bifurcate?
in the costal margin
Where do the cartilages of ribs 7-10 fuse?
the costal margin
The internal thoracic branch bifurcates into the:
superior epigastric and musculophrenic arteries
The upper 6 anterior intercostal arteries come off of the:
internal thoracic
The lower 4 anterior intercostal arteries come off of the:
musculophrenic artery
Perforating branches of which arteries supply the skin of the chest wall?
the anterior and posterior intercostal arteries
Vein
Artery
Nerve
External intercostal
Internal intercostal
Innermost intercostal
Where do the posterior intercostal veins run?
back in the upper part of the intercostal space
Where do the intercostal veins on the right side of the thorax empty?
into the azygos vein
Where does the thorax drain?
into the hemiazygos veins which themselves drain into the azygos vein
Where do the anterior intercostal veins drain?
into the venae comitantes of the internal throacic artery and eventually into the brachiocephalic veins
What is the diaphragm
a thin musculotendinous partition separating the contents of the thorax from those of the abdomen
What passes through the diaphragm
- esophagus
- aorta
- inferior vena cava
- vagi and sympathetic nerve
What innervates the diaphragm?
The left and right phrenic nerves (C3, 4, 5 keep the diaphragm alive)
What are the 3 origins of the diaphragm?
lumbar, costal and sternal
Where do the 2 crura of the lumbar component of the diaphragm arise from? what is formed?
the first 3 vertebrae and form an arch to allow the aorta to pass through
Where are the medial and lateral arcuate ligaments
lateral to the crura of the lumbar portion of the diaphragm
Which abdominal muscles do the medial and lateral arcuate ligaments bridge across?
the quadratus lumborum and the psoas
Where does the costal origin of the diaphragm travel from and to?
the costal origin continues from the lateral arcuate ligament along rib 12 and onto the lower 6 costal cartilages and then passes onto the xyphoid process (sternal origin)
What is formed as the diaphragm rises from the sternal origin?
a dome on each side of the thorax
How high does the right dome rise?
1 cm below the right nipple (in the male)
Where do the fibers of the dome insert?
central tendon
What happens to the diaphragm during inspiration?
The fibers of the dome contract, pulling the central tendon (dome) downward, thus flattening the diaphragm and expanding the vertical ‘diameter’ of the thoracic cavity
Where is the costodiaphragmatic recess
lateral to the dome of the diaphragm
Where does the aorta peirce the diaphragm
between the crura at level T12
Where does the esophagus and vagi (vagus nerve) pierce the central tendon?
T10
Where does the inferior vena cava pierces the central tendon?
T8
Inferior vena cava
Esophagus
Aorta
Right crus
Quadratus lumborum
Psoas
Lateral arcuate ligament
Medial arcuate ligament
Left crus
Central tendon
What is the job of the circulatory system? (4)
- bring oxygenated blood to all regions of the body
- deliver hormones for the endorine system
- transport nutrients from the GI tract to the liver
- carry carbon dioxide to the lungs and oxygen from the lungs
Systemic circulation
is the totality of the vessels serving the organs and tissues of the body except the lungs and the liver
Pulmonary circulation
delivers deoxyganted blood to the lungs and returns oxygenated blood to the heart
What is the portal system made up of and what does it do?
The portal system is made up of the portal vein and its tributaries delivering nutrients from the GI tract to the liver
What drives the circulatory system
the heart
Where is the heart located
in the middle mediastinum
What type of tissue is the heart made of?
cardiac muscle (a unique contractile tissue) and connective tissue
Pathway of blood through the heart to lungs
- Venous blood enters right atrium from superior and inferior vena cava
- Blood passes through the tricuspid valve into the right ventricle
- The right ventricle contracts, sending blood through the pulmonary valve into the pulmonary trunk
- The pulmonary trunk bifurcates into the left and right pulmonary arteries, which deliver blood to the left and right lungs
Pathway of blood through the heart from the lungs
- The oxygenated blood returns from the lungs in the pulmonary veins which empty into the left atrium
- The blood passes through the mitral valve into the left ventricle
- The left ventricle contracts and blood passes by the aortic valve into the aorta
The 3 regions of the aorta in order
arch of the aorta, descending (thoracic) aorta, and the abdominal aorta
3 major branches of the arch of the aorta
- brachiocephalic artery
- left common carotid artery
- left subclavian artery
the brachiocephalic artery bifuractes into
- right common carotid
- right subclavian artery
the right common carotid supplies
the head and neck
the right subclavian arteries supply
the right upper limbs
When does the descending aorta become the abdominal aorta
when it passes through the diaphragm
The abdominal aorta bifurcates into the
left and right common iliac arteries
The left and right common iliac artieries supply
the pelvis and lower limbs
The pericardium
a 3 layered protective sac around the heart
3 layers of the pericardium
- Fibrous pericardium
- Parietal layer
- Visceral layer
The parietal layer and visceral layer are what type of pericardium
serous pericardium
The fibrous pericardium is made up of
dense connective tissue
The fibrous pericardium surrounds
- the heart
- serous pericardia
- roots of the great vessels
The base of the fibrous pericardium is fused with
the central tendon of the diaphragm
How many layers is the fibrous pericardium
1
The serous pericardium is fused with
the inside of the fibrous pericardium
How many layers is the serous pericardium
2
The parietal layer is fused with the
fibrous pericardium
The visceral layer is fused to
the myocardium (muscle of the heart)
Epicardium
the outer layer of the heart between the pericardium and the heart
What allows for the free movement of the two serous layers during contraction of the heart
Between the serosa is a lubricating fluid manufactured by the serous pericardium
Fibrous pericardium
Pericardial space
Serous pericardium
Epicardium
From the front, the right border formed by
forms a verticle line with the vene cavae, and is largely formed by the right atrium
From the front, the inferior border formed by
the right ventricle
From the front, the left border formed by
left ventricle and the left atrial apendage (auricle)