Thorax 1 + 2 Flashcards
Thorax (3)
- superior thoracic aperature -> diaphragm
- 3 cavities in thorax = R/L pleural + central pericardial cavity
- heart (perfusion) + lungs (gas exchange)
Thorax Functions (3)
- conduit = structures from head/neck - ab cavity
- protection (bony structure)
- respiration (gas exchange)
looking down body (5)
- trachea
- rib 1
- VB
- clavicles
- manubrium
Inferior Thorax Boundary (3)
- diaphragm -> ribs 11 + 12
- Anteriorly: xiphoid process of sternum
- cavity = slanted structure
Superior Thoracic Aperature
- over rib 1, manubrium, T1
- subclavian vein and artery over rib 1
Pectoral region
- Superficial cmpt – mamillary glands
- Deep cmpt – muscles over bony cage
Breast
- sweat gland, w/structural/support suspensory ligaments of cooper (cont w/dermis)
- axillary process on side - imp for breast exam
Breast perfusion
- axillary art, thoracocaromial process, lateral thoracic artery, internal thoracic artery (TAIL)
- veins parallel these
Lymph Drainage/Tumor spread
- lateral tumor -> axillary nodes
- medial tumor -> parasternal node
- inferior tumor -> subdiapraghmatic nodes
Breast Cancer
- mass puts tension on ligs of cooper = skin pitting/dimpling = Peau d’range
Pectoralis Major
- innervation = medial/lateral pectoral nerves
- function = adduction, medial rotation, flexion of humerus shoulder
Subclavius
- innervation = nerve to subclavius
- fn = Pulls clavicle medially to stabilize sternoclavicular joint
Pectoralis Minor
- innervation = Medial pectoral nerves
- Depresses tip of shoulder; protracts scapula
breastbone
- costacondral junction (expansion to breathe) for ribs + sternum
- manubrium - articulation for clavicle, rib 1 + 2
- xiphoid process on bottom
Ribs
- rib 8-12 = false ribs = connect to other costochondral junctions, not sternum
- 11-12 = floating ribs
Special TV
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
Rib structure
- 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)
Rib joint to VB
- 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
Rib joints
- Rib 6-10 ribs = interchondral + synovial joints in cartilaginous connections
Rib 1 = fibrocartilaginous joint
upper 7 ribs = sternocostal synovial joint
External intercostal
- plane (hands in pocket) btwn ribs
- innervation = intercostal nerves, T1-T11
- fn = inspiration, moves ribs superiorly
Internal + innermost intercostal
- opposite plane btwn ribs – provides strength
- innervation = intercostal nerves, T1-T11
- fn = expiration, moves ribs inferiorly
Subcostals
- span rib/2, connect rib to rib
- innervation = related intercostal nerves
- fn = depress ribs
Transversis thoracis
- radiate out from breast bone
- innvervation = related intercostal nerves
- fn = depress costal cartilages, exhaling
thoracic arterial system
- Aorta = brachiocephalic trunk, common int. carotid, subclavian + anterior/posterior intercostal
Subclavian
off subclavian = 2 lateral internal thoracic arteries -> bifurcate at rib 7 to terminal musculophrenic and superior epigastric art
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
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
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
Thorax Wall Inntervation
all autonomic
Nipple level = T4
Xiphoid Process = T6
Umbilical/ belly button = T10
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
Manubriotsternal + xiphisternal joints
symphysis
Pleural Cavities
- R/L pleural cavity, pericardial cavity
- pericardial in mediastinum
Diff Parts of Pleura
Costa (ribs) + mediastinal (heart) +
diaphragmatic + cervical pleura = where lungs sit
Pleural recess
- space for lung to expand
- space for infection/fluid buildup
costodiaphragmatic recess
- space for lungs to go down on inhalation – # 1 location for fluid accumulation
Lungs
- Right lung = 3 lobes; left lung = 2 lobes
- mediastinal to lungs = pul art superior to pul veins
- Pleural mem – hilum – surrounds lung roof
Left Lung
- superior + inferior lobes separated by oblique fissure (rib 6)
- Cardiac notch = space for heart
- Lingula – tongue like projection
- depressions on mediastinal surface
Left Lung Vasculature
- aorta + aortic arch
- left subclavian art + braciocephalic vein at lung apex (above superior thoracic aperature, tumor site)
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)
Right Lung Vasculature
- inferior + superior vena cava
- Azygos system
- esophagus
- subclavian art + vein
Trachea
- CV 6 -> TV 4, bifurcates to R/L bronchus
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)
Bronchoscopy
- stick scope down pt’s windpipe
- Carina = bifurcation of trachea
- 3/2 secondary -> keep branching off and get smaller
Bronchopulmonary Segments
- Segmental bronchus
- Pul art branch
- Pul venous drainage – pass intersegmentally btwn/around margins of segments
Pulmonary Arteries
- Originate from pul trunk (right ventricle)
- Trunk bifurcates ~ T4-T5 (anterior/inferior to bronchus)
- Deoxygenated blood
Right Pulmonary Artery
- longer than left
- posterior to ascending aorta, superior vena cava and upper right pulmonary vein
- anterior to right main bronchus
Left Pulmonary Artery
- shorter than right
- anterior to descending aorta and left main bronchus
- posterior to superiorpulmonary vein
Pulmonary Veins
- each side contain two pulmonary veins
- Superior + Inferior pulmonary vein
- Carry oxygenated blood to left atrium
Pulmonary Vasculature
- Bronchi + pulmonary arteries pair/branch in unison.
- Pulmonary veins from pul caps, drain toward and course in septa btwn adjacent segments.
Bronchial Arteries + Veins
- thoracic aorta -> post surface of bronchus
- Veins drain to pul veins/left atrium + azygos system
R/L bronchial artery
- R Bronchial art - from 3rd posterior intercostal artery
- L Bronchial art - from aorta
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.
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
Lymph nodes
- Pulmonary = lobar bronchi
- Bronchopul = hilum of lung (drain from superficial lymphatic plexus)
- Inf. Tracheobronchial (Carinal nodes)
- Superior tracheobronchial
- Tracheal
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
things you don’t want in pleural space
- Pneumo (air) – from penetrative trauma, pneumothorax
- Hydro (water) – due to infection
- Hemo (blood) – infection, intenral trama
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.
