Thorax 1 + 2 Flashcards
1
Q
Thorax (3)
A
- superior thoracic aperature -> diaphragm
- 3 cavities in thorax = R/L pleural + central pericardial cavity
- heart (perfusion) + lungs (gas exchange)
2
Q
Thorax Functions (3)
A
- conduit = structures from head/neck - ab cavity
- protection (bony structure)
- respiration (gas exchange)
3
Q
looking down body (5)
A
- trachea
- rib 1
- VB
- clavicles
- manubrium
4
Q
Inferior Thorax Boundary (3)
A
- diaphragm -> ribs 11 + 12
- Anteriorly: xiphoid process of sternum
- cavity = slanted structure
5
Q
Superior Thoracic Aperature
A
- over rib 1, manubrium, T1
- subclavian vein and artery over rib 1
6
Q
Pectoral region
A
- Superficial cmpt – mamillary glands
- Deep cmpt – muscles over bony cage
7
Q
Breast
A
- sweat gland, w/structural/support suspensory ligaments of cooper (cont w/dermis)
- axillary process on side - imp for breast exam
8
Q
Breast perfusion
A
- axillary art, thoracocaromial process, lateral thoracic artery, internal thoracic artery (TAIL)
- veins parallel these
9
Q
Lymph Drainage/Tumor spread
A
- lateral tumor -> axillary nodes
- medial tumor -> parasternal node
- inferior tumor -> subdiapraghmatic nodes
10
Q
Breast Cancer
A
- mass puts tension on ligs of cooper = skin pitting/dimpling = Peau d’range
11
Q
Pectoralis Major
A
- innervation = medial/lateral pectoral nerves
- function = adduction, medial rotation, flexion of humerus shoulder
12
Q
Subclavius
A
- innervation = nerve to subclavius
- fn = Pulls clavicle medially to stabilize sternoclavicular joint
13
Q
Pectoralis Minor
A
- innervation = Medial pectoral nerves
- Depresses tip of shoulder; protracts scapula
14
Q
breastbone
A
- costacondral junction (expansion to breathe) for ribs + sternum
- manubrium - articulation for clavicle, rib 1 + 2
- xiphoid process on bottom
15
Q
Ribs
A
- rib 8-12 = false ribs = connect to other costochondral junctions, not sternum
- 11-12 = floating ribs
16
Q
Special TV
A
T1 = small VB, complete face for rib 1 T10 = single complete facet for rib 10 T11 = no articulation pt on TP due to floating rib
17
Q
Rib structure
A
- Int surface = art, vein, nerve (protective mech)
- rib 1 = short flat rib, 2 circular pits for subclavian art/vein, scalene muscles attach
- rib 11/12 = bony finger
- other ribs similar (rib 7 biggest, most curved)
18
Q
Rib joint to VB
A
- Joint capsules btwn facets of ribs + VBs
- Superior costotransverse lig = from TP, supports capsule
- costotransverse lig + lateral costotransverse lig
- Ribs held by 3 lig connections
19
Q
Rib joints
A
- Rib 6-10 ribs = interchondral + synovial joints in cartilaginous connections
Rib 1 = fibrocartilaginous joint
upper 7 ribs = sternocostal synovial joint
20
Q
External intercostal
A
- plane (hands in pocket) btwn ribs
- innervation = intercostal nerves, T1-T11
- fn = inspiration, moves ribs superiorly
21
Q
Internal + innermost intercostal
A
- opposite plane btwn ribs – provides strength
- innervation = intercostal nerves, T1-T11
- fn = expiration, moves ribs inferiorly
22
Q
Subcostals
A
- span rib/2, connect rib to rib
- innervation = related intercostal nerves
- fn = depress ribs
23
Q
Transversis thoracis
A
- radiate out from breast bone
- innvervation = related intercostal nerves
- fn = depress costal cartilages, exhaling
24
Q
thoracic arterial system
A
- Aorta = brachiocephalic trunk, common int. carotid, subclavian + anterior/posterior intercostal
25
Subclavian
off subclavian = 2 lateral internal thoracic arteries -> bifurcate at rib 7 to terminal musculophrenic and superior epigastric art
26
Anterior + posterior intercostal
- anterior intercostal arts branch off internal thoracic arteries at each rib.
- Posterior intercostal off aorta -> costal groove -> form anastamotic connection (still bleed when cut) at midaxillary line
27
Azygos Vein
- right side = Ant + post intercostal vein -> azygos vein -> brachiocephalic vein
- left side = accessory hemiazygos (ribs 1-9) + hemiazygos (ribs 10-12) -> azygos system
- draining R/L thoracic cages
28
Thorax Lymphatics
- post thorax lymph -> intercostal nodes (in back - infections in back go to these nodes)
- Anterior -> parasternal nodes
- all return to braciocephalic nodes -> thoracic duct -> venous system
29
Thorax Wall Inntervation
all autonomic
Nipple level = T4
Xiphoid Process = T6
Umbilical/ belly button = T10
30
Intercostal nerve/space
- ventral rami, wrap around
- over sternum w/ant cutaneous branch
- space = vein, artery, nerve (VAN)
- chest tube - decompress pressure, can cause damage
31
Manubriotsternal + xiphisternal joints
symphysis
32
Pleural Cavities
- R/L pleural cavity, pericardial cavity
| - pericardial in mediastinum
33
Diff Parts of Pleura
Costa (ribs) + mediastinal (heart) +
| diaphragmatic + cervical pleura = where lungs sit
34
Pleural recess
- space for lung to expand
| - space for infection/fluid buildup
35
costodiaphragmatic recess
- space for lungs to go down on inhalation – # 1 location for fluid accumulation
36
Lungs
- Right lung = 3 lobes; left lung = 2 lobes
- mediastinal to lungs = pul art superior to pul veins
- Pleural mem – hilum – surrounds lung roof
37
Left Lung
- superior + inferior lobes separated by oblique fissure (rib 6)
- Cardiac notch = space for heart
- Lingula – tongue like projection
- depressions on mediastinal surface
38
Left Lung Vasculature
- aorta + aortic arch
| - left subclavian art + braciocephalic vein at lung apex (above superior thoracic aperature, tumor site)
39
Right Lung
- 3 lobes = superior, middle and inferior
- horizontal fissure (superior from middle at 4th intercostal)
- oblique (middle from inferior at 5th intercostal space, rib 6)
40
Right Lung Vasculature
- inferior + superior vena cava
- Azygos system
- esophagus
- subclavian art + vein
41
Trachea
- CV 6 -> TV 4, bifurcates to R/L bronchus
42
Bronchi
- R bronchus = more vertical, gets more foreign bodies (least resistance)
- L bronchus - shallow, longer, for heart
- main bronchus -> lobar/secondary bronchi (supplies lobes -> segmental/tertiary bronchi (supplies bronchopulmonary segments)
43
Bronchoscopy
- stick scope down pt’s windpipe
- Carina = bifurcation of trachea
- 3/2 secondary -> keep branching off and get smaller
44
Bronchopulmonary Segments
- Segmental bronchus
- Pul art branch
- Pul venous drainage – pass intersegmentally btwn/around margins of segments
45
Pulmonary Arteries
- Originate from pul trunk (right ventricle)
- Trunk bifurcates ~ T4-T5 (anterior/inferior to bronchus)
- Deoxygenated blood
46
Right Pulmonary Artery
- longer than left
- posterior to ascending aorta, superior vena cava and upper right pulmonary vein
- anterior to right main bronchus
47
Left Pulmonary Artery
- shorter than right
- anterior to descending aorta and left main bronchus
- posterior to superiorpulmonary vein
48
Pulmonary Veins
- each side contain two pulmonary veins
- Superior + Inferior pulmonary vein
- Carry oxygenated blood to left atrium
49
Pulmonary Vasculature
- Bronchi + pulmonary arteries pair/branch in unison.
| - Pulmonary veins from pul caps, drain toward and course in septa btwn adjacent segments.
50
Bronchial Arteries + Veins
- thoracic aorta -> post surface of bronchus
| - Veins drain to pul veins/left atrium + azygos system
51
R/L bronchial artery
- R Bronchial art - from 3rd posterior intercostal artery
| - L Bronchial art - from aorta
52
Pulmonary Innervation
- GVA/GVE via anterior and (mainly) post pul plexus
- Vagus nerve = parasymp – constrict bronchioles
- Symp (T4) chain = symp – dilate bronchioles
- pul plexus accompany bronchi + arts in lung.
53
Lymph Drainage
- Lungs drain to tracheobronchial nodes -> bronchomediastinal trunks
- Right lung + L inferior lung lymph to inferior tracheo-bronchial (carinal nodes), ascend up right side
- L superior of left lung – goes bronchopulmonary (hilar nodes) and goes up left side
54
Lymph nodes
- Pulmonary = lobar bronchi
- Bronchopul = hilum of lung (drain from superficial lymphatic plexus)
- Inf. Tracheobronchial (Carinal nodes)
- Superior tracheobronchial
- Tracheal
55
Lung Sounds
- Apex of lung – above clavicle
- Superior lobe – 3rd intercostal space on either side
- Right side – middle lobe – 5th intercostal space, close to sternum
- Inferior lobe – more axillary, 7th intercostal space
56
things you don't want in pleural space
- Pneumo (air) – from penetrative trauma, pneumothorax
- Hydro (water) – due to infection
- Hemo (blood) – infection, intenral trama
57
Thoracocentesis
- withdraw fluid – syringe on superior border of lower rib, needle at upward angle
- aim for middle 7th intercostal space mid axillary (make sure in thoracic cavity, also go as low as possible because of gravity + fluid.