THORAX, ABDOMEN, PELVIS AND PERINEUM Flashcards
BREAST
- modified sweat gland
- fat + glandular tissue + ducts
- cooper ligaments
- suspensory ligaments
- tumor can affect → orange-peel apparence (dimpling of the skin)
BREAST
Blood Supply
- Internal Thoracic (internal mammary)
- subclavian brach
- medial part
- Lateral Thoracic
- axillary branch
- lateral part
BREAST
Which nerve can be damage during a radical mastectomy?
Long Thoracic Nerve
- serratus anterior muscle → winged scapula (few weeks after surgery)
- demage during ligation of the lateral thoracic artery
- weakness in abdution of the arm (above 90º)
- thoracodorsal nerve can be damage too → latissumus dorsi muscle (extension and medial rotation of the arm)
BREAST
Lymphatic Drainage
- Lateral
- 75%
- quadrants: nipple + superior + inferior + lateral
- axillary nodes → pectoral group first
- Medial
- 25%
- medial quadrant
- paraesternal nodes (with internal thoracic vessels)
- opposite breast metastasis route
CHEST WALL
Thoracic Cavity
- Boundaries
- superior → neck
- inferior → diaphragm
- anterior → bony thorax
- posterior → thoracic vertebrae
- Compartments
- lateral → pulmonary
- central → mediastinum
CHEST WALL
Intercostal Space
- 11 intercostal spaces + 3 layers of muscle (and their fasciae)
-
VAN → inferior bord
- intercostal nerve block → upper
- thoracentesis → lower
- blood supply
- anterior artery → internal thoracic branch (subclavian)
- posterior artery → aorta branch
- potential collateral circulation between subclavian and aorta artery
PLEURAL CAVITY
Pleura
- mesodermal-derived membrane (serous)
- double-layered membrane
- friction-reducing movements
- parietal layer
- visceral layer
- pleural cavity → potencial space
PLEURAL CAVITY
Parietal Layer
Costal Parietal Pleura
(lateral → ribs + intercostal space)
Diaphragmatic Parietal Pleura
(inferior)
Mediastinal Parietal Pleura
(medial → reflects to become visceral pleura at hilum)
Cervical Parietal Pleura
PLEURAL CAVITY
Visceral Pleura
Tightly invest the surface of the lungs
fissures + lobes
PLEURAL CAVITY
Innervation
- Parietal Pleura
- somatic sensory innervation
- intercostal nerve → costal + diaphragmatic pleura
- phrenic nerve → diaphragmatic + mediastinal pleura
- Visceral Pleura
- visceral sensory innervation
- autonomic nerves
PLEURAL CAVITY
Pleural Cavity and Pneumothorax
- Cavity
- potencial space
- closed space + small amount of serous fluid
- negative pressure
- Pneumothorax
- introduction of air into the pleural cavity → lost negative pressure → lung collapse
- open pneumothorax x tension pneumothorax
PLEURAL CAVITY
Pleural Reflections
- pleural reflection = parietal pleura changing the direction from one wall to another wall
- 2 rib interspaces separated parietal pleura from visceral pleura
PLEURAL CAVITY
Pleural Recesses
potencial spaces not occupied by long tissue (except deep inspiration)
costodiaphragmatic
+
costomediastinal
MEDIASTINUM
Lymphatic System
Right Lymphatic Duct
+
Thoracic Duct
both drain into the junction of internal jugular and subclavian veins on their respective sides
MEDIASTINUM
Boundaries
central compartment of the thoracic cavity
- anterior - sternum
- posterior - thoracic vertebrae (12)
- lateral - pleural cavities
- superior - neck (thoracic inlet)
- inferior - diaphragma
MEDIASTINUM
Divisions
Angle of Louis - T4/T5 vertebral disc
- Superior Mediastinum
- Inferior Mediastinum
- anterior
- middle
- posterior
MEDIASTINUM
Sympathetic Trunks
Paravertebral Ganglia
(outside posterior mediastinum)
+
Prevertebral Ganglia
(greater + lesser + thoracic splanchnic nerves)
MEDIASTINUM
Superior Mediastinum
