Unit 1 The Chest Flashcards
What is viscera?
Internal organs found within body cavities
What structured make up the thoracic cage?
The ribs, sternum and vertebrae.
What is the function of the thoracic cage?
To protect the thoracic viscera and superior abdominal viscera.
What is the superior boundary of the thoracic cage?
Called the thoracic inlet or the superior thoracic aperture
Consists of the superior surfaces of the lift/right first ribs the sternum and the body of the first thoracic vertebrae.
What is the inferior boundary of the thoracic cage?
The xiphoid process of the sternum
The costal cartilage of the 7 to 10 rib.
The twelfth and eleventh rib
The body of the twelfth vertebrae
What are the three main parts of the sternum?
Menubrium
Body
Xiphoid process
What ribs connect to the sternum?
Ribs one to ten connect to the sternum by costal cartilage
Ribs eleven and twelve do not connect to the sternum.
Name the three different parts of the sternum
Menubrium is red
Body is blue
Xiphoid process is green
What does the red arrow label?
The jugular notch
What does the blue arrow label?
The clavicular notch
Note is bilateral so same structure is also located on the other side.
What does the yellow arrow label?
Sternal angle
What do the green arrows label?
Costal notches 1 - 7
What is unique about costal notch 2?
It passes over two bones, the body of the sternum and the Menubrium of the sternum.
What makes costal notch seven unique?
Costal notch one to six are sued by ribs one to six costal cartilage to connect directly to the sternum.
Costal notch seven connects the combined cartilage of ribs seven to ten.
What are the three different types of rib?
True ribs (1 to 6) connect directly to the sternum
False ribs ( 8 to 10) connect indirectly to the sternum
Floating ribs 11 and 12 which do not connect to the sternum
What ribs fall into what category?
True ribs are 1 to 7
False ribs are 8 to 10
Floating ribs are 11 and 12
What is the tubucle on the rib?
A bony extension of the rib, articulates with the single transverse process on the inferior vertebrae (same number as rib) in thoracic vertebrae
What are the different structures on a a rib?
Head
Neck
Tubucle
Angle
Body
Costal groove.
What does the head of the rib articulate to?
The inferior and superior vertebrae.
Label the different parts of the rib
Blue is the head
Red is the neck
Yellow is the tubucle
Purple is the body
Green is the costal groove
How do the ribs move during ventilation?
The ribs are fixed to the vertebrae and sternum.
The ends remain stationary whilst the middle moves like a swing
Inferior posterior
Or
Superior and anterior
How does the sternum move during ventilation?
Fixed at the menubrium.
The bottom half of the sternum swings from this axis, like a water pump handle.
What are the green sections of surface anatomy showing?
Clavicle
Dotted is the midclavicular line
What are the red sections of surface anatomy showing?
The menubrium
The xiphoid process
The dotted line is the midsternal line
What is the red line surface anatomy showing?
The anterior mid axilary fold
What does the green dot show?
The axilary fossa
A depression in the armpit
What does the blue line show?
The mid axillary line
What does axillary mean?
Relating to the armpit
How is the nipple used for body orientation?
Is an estimate of being superficial to the fourth intercostal space.
How is the xiphoid process used in body navigation?
Is near the superior boundary of the liver and the inferior boundary of the heart.
What are the layers of intercostal muscle from superficial to deep?
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
What is the function of each intercostal muscle set?
External aids inspiration
Internal aids expiration
Innermost aids both inspiration and expiration
What is the function of the transverse thoracic muscle?
Aids the depression of ribs during expiration
Where is the transverse thoracic muscle found?
The posterior surface of the sternum body and xiphoid process
It articulates with the 4th to 7th rib cartilages
What is the subclavian muscle?
Located on the inferior surface of the clavicle
Aids the depression of the clavicle
What is the blue muscle?
The pectoralis major
What is the green muscle?
The pectoralis minor
What is meant by the intercostal space?
How are the spaces numbered?
The space between two adjacent ribs.
Named after the superior rib.
What is meant by neurovasculature?
Nerves and blood vessels.
Where is the neurvascular plane in the intercostal space?
Located in the costal groove
Between the internal and innermost intercostal muscles
What order are the neurovasculator found in the costal groove?
Starting with most superior
Vein
Artery
Nerve
How are the neurovasculature in the costal grooves named?
Rib 1 to 11
Posterior interocostal vein/ artery
Intercostal nerve
Rib 12 all named subcostal ….. as no intercostal space
What directions do fibres run for intercostal muscles?
External = runs inferomedially
Internal = runs superomedially.
Innermost = runs superomedially
What is the relationship between the fibre direction of the external and internal intercostal muscles?
Perpendicular to each other
What is the direction of fibres for the disphragm?
Runs vertically
What does the diaphragm attach to?
The lumbar vertebrae
Xiphoid princess of the sternum
Costal margins of the thoracic wall
Ends of the 11th and 12th rib
Ligaments across the posterior abdominal wall.
What are the three different opening in the diaphragm?
T8 = opening for the inferior vena cava
T10 = opening for the oesophagus
T12 = opening for the aorta
What are these three different sections on the diaphragm?
The lateral medial and median arcuate ligaments.
What forms the spinal nerve?
The combining of the anterior and posterior root of nerves from the vertebrae.
How does the spinal nerve dissolve?
First splits into the posterior ramus to supply the back and the anterior ramus to supply the front.
The anterior ramus then becomes the intercostal nerve and splits into cutaneous nerves to supply the skin.
Name the yellow structure
The external intercostal muscle
Name the red structure
The internal intercostal muscles
Name the dark blue structure
The innermost intercostal muscles
Name the green structure
The skin
Name the light blue structures
The posterior intercostal vein and artery
The intercostal nerve
Name the orange structures
The parietal pleura
The pleural cavity
The visceral pleura
Name the pink structure
Endothoracic fascia
Name the purple structure
Superficial fascia
Name the structure in the black outline box
Collateral branches
What are the active muscles ins respiration?
The diaphragm
What is the main muscle of respiration?
The diaphragm
What are accessory muscles in respiration?
Muscles that only assist respiration during forced respiration, an active process.
Intercostal muscles
Subclavian muscle
Transverse thoracic muscles
Abdominal muscles
Etc
Do the external intercostal muscles attach anteriorly to the sternum.
No
The muscles fibres do not attach to the sternum, rather the external intercostal membrane does, indirectly links the muscle.
Attach via aponeurosis
Do the innermost intercostal muscles attach to the sternum?
No
Do the interior intercostal muscles attach to the sternum?
Yes
What abdominal muscle is superficial to the lower six intercostal muscles anteriorly?
The external abdominal oblique muscle
What nerve innervates the diaphragm?
The phrenic nerve
C3 C4 C5 keep the diaphragm alive
What is the function of the diaphragm during respiration?
Diaphragm contracts and flattens, this increases the volume of the thoracic cavity aiding inspiration down a pressure gradient.
What features should be sued to orientate a transverse cross section of the thoracic cage?
The sternum
The vertebrae
The ribs
Identify the key features shown in this cross section.
What and why do ribs look like this on transverse cross sections of the thoracic cage?
Can only see small sections of multiple different ribs, inconsistent like a dotted line around the lungs.
This is due to ribs being at a 45 degree angle so slanted down the chest so a full rib length does not fall into one transverse cross section.
What is osteology?
The study of the structure and function of the Skelton and bony features.
What is the difference between typical and atypical ribs?
Ribs 2 to 10 are thought of as typical ribs, these follow the generalised rib structure
Atypical ribs 1,11,12 have large deviations from the general rib structure.
Rib 6 is the best rib to show the typical structure.
What is the difference between how superior and inferior ribs move the change the thoracic volume?
Superior ribs mainly move the change the thoracic volume post/ anteriorly.
Inferior ribs mainly change the thoracic volume laterally.
What is the red part of the thoracic vertebrae?
The body
What is the white part of the vertebrae?
The vertebral foramen
What is the yellow part of the vertebrae?
The transverse process
What is the green part of the vertebrae?
The Pedicle
What is the pink part of the vertebrae?
The lamina
What is the blue part of the vertebrae?
The spinous process
What view of the vertebrae is this?
The superior view
What is the green part?
The transverse costal facet of the vertebrae
What is the blue part?
The superior and inferior articulate facet of the vertebrae.
What is the red part?
The superior and inferior demifacet of the vertebrae.
What view is this of the vertebrae?
Lateral
Explain how to distinguish between different types of vertebrae.
Look at the posterior view of the vertebrae.
Cervical looks like an elephant
Thoracic looks like a giraffe
Lumbar looks like a cow
Name the type of vertebrae
Lumbar veterbrae
Name the type of vertebrae
Cervical
Name the type of vertebrae
Thoracic vertebrae
What is the function of the vertebral forman?
Combine to form the vertebral canal.
The spinal cord passes through.
What are the two different routes of arterial blood supply to the intercostal muscles?
The thoracic aorta then the posterior intercostal artery.
Or via the internal thoracic arteries then the anterior intercostal artery.
How does the position of the neurovascular bundle effect the insertion of a chest drain?
Must be inserted above the rib below, or the superior boundary of the inferior rib in the intercostal space.
This is to avoid the neurovascular bundle located in the costal groove on the inferior deep side of the rib, the nerve does not always fit in this groove so is vulnerable.
What are the main structures passing through the thoracic inlet?
The oesaphagus
The trachea
And major blood vessels, nerves and lymphatic system.
Examples phrenic nerve, common carotid artery, subclavian artery, jugular veins brachiocephilic vein
What are the main structures passing out of the thoracic outlet?
The oesophagus
The abdominal aorta
The inferior vena cava.
Explain how ribs attach to the vertebrae.
The head of the rib articulates to the demifacets of the superior and same numbered rib. Rib 4, vertebrae 3 and 4.
The tubucle on the rib articulates with the transverse process of the vertebrae of the same number.
How are the vertebrae connected to each other?
By the superior and inferior articulate facets.
What are the key differences between relaxed and forced respiration?
Relaxed - the diaphragm contraction is sufficient for inspiration and elastic recoil for expiration
Forced respiration - more oxygen demand, accessory muscles aid volume changes in the thorax.
How do abdominal muscles aid ventilation?
Contraction of the abdominal muscles pushes organs superiorly into the thoracic space.
This decreases the volume of the lungs aiding expiration.
Which out of expiration or inspiration is considered passive? Why?
Expiration, the diaphragm relaxes so no ATP is needed for muscle contraction, elastic recoil is sufficient.
What is the rib angle?
The sharpest deviation in rib curvature or direction, is located between the head and the body.
Where is the costal groove located on the rib?
Inferior and deep surface
Name the muscle
The external abdominal oblique muscle
Name the muscle
Latissimus dorsi muscle
Name the muscle
Seratus anterior muscle
Name the muscle
The seratus posterior muscle
What are the key notes of an ultrasound on the ribs?
Ribs are the dense dark structures, ultrasound shadow under the ribs as too dense so waves do not pass through.
Pleural membrane appears as a white shimmery line that moves when the patient breathes in and out.
Lungs tissue is a mushy grey and moves up into view during inspiration.
