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77 Cards in this Set

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what is the thoracic skeleton composed of?
12 thoracic vertebrae and associated discs, 12 pairs of ribs, costal cartilages, sternum
what are the functions of the thoracic skeleton?
protect viscera within the thoracic cavity, provide framework for attachment of muscles of respiration
what are the parts of the thoracic vertebrae?
vertebral body, transverse processes, costal facets
what part of the vertebrae articulates with the ribs? what kind of joint is this?
costal facet, synovial
what are the features of a typical rib? describe.
head, tubercle, body (costal groove, rib). head: 2 facets for articulation with vertebral bodies. tubercule: articulates with transverse process of a vertebra. body: costal groove on inferior border (VAN), angle has highest curvature (commonly fractured)
describe the atypical ribs
1st rib: flat, short, tightly curved; superior surface of body has 2 shallow grooves for subclavian artery and vein; 11th/12th: rudimentary
the head of rib 5 articulates with _____ vertebra; the tubercule articulates with _______ vertebra
T5 and T4; T5
the head of a typical rib articulates with the superior costal facet of the thoracic vertebra of the same number,the inferior costal facet of the vertebra above, and the intervertebral disc between the two vertebrae; the costal tubercle articulates with the transverse process of the vertebra of the same number
costal cartilages
Hyaline cartilage; Contribute to the elasticity of the thoracic wall; Connect to body of rib (little movement possible at these joints); Connect to sternum via sternocostal joints (most are synovial)
costal margin
formed by medial borders of costal cartilages 7-10
rib classification
True ribs (1-7) attach to sternum via their own costal cartilages; False ribs (8-10) attach to the sternum via the costal cartilages of the ribs above (do not have their own cartilage); Floating ribs (11-12) have no attachment to the sternum
manumbrium, body, xiphoid process
Jugular (suprasternal) notch on the superior border; Articulates with the clavicles at the sternoclavicular joints; Articulates with 1st and 2nd costal cartilages; Articulates with the sternal body
sternal angle
Palpable landmark at level of T4/T5 intervertebral disc, or 2nd costal cartilage; junction of sternal body and manubrium
sternal body
articulates with costal cartilages 2-7
xiphoid process
Palpable landmark, at T10 vertebral level; Ossifies and unites with body of sternum ~ 40 years of age; The xiphisternal joint marks the inferior limit of the thoracic cavity and the inferior border of the heart.
median sternotomy
splitting the sternum to allow for surgical access to underlying organs/structures (e.g., during coronary bypass surgery).
intercostal muscles
between ribs; innervated by intercostal nerves; stabilize intercostal spaces during respiration; external, internal, innermost
external intercostal muscles
fiber direction: hands in pockets; incomplete anteriorly, aponeurosis (membrane) extends to sternum
innermost intercostal muscles
fibers parallel to internal intercostals
internal intercostal muscles
fiber direction: right angle to external intercostal; incomplete posteriorly, aponeurosis (membrane) extends to vertebrae
intercostal neurovascular bundle
intercostal vein, artery, nerve (sup to inf), course between internal and innermost intercostal muscles along the costal groove
intercostal nerves
ventral rami of thoracic spinal nerves T1-T11, motor innervation to muscles of the thoracic wall and sensory innervation to the skin
subcostal nerve
ventral ramus of T12, emerges inferior to the 12th rib
collateral branches
(of intercostal nerves), travel along superior edge of the rib below
area of skin supplied by a single spinal nerve; overlap in dermatome territories of adjacent spinal nerves
what creates the segmental arrangement of dermatomes in the torso?
terminal branches of intercostal nerves along with sensory branches from corresponding posterior rami
intercostal nerve block
Anesthetic injected into the intercostal spaces close to nerves and near skin area to be anesthetized; May require multiple injections at adjacent levels to compensate for overlapping cutaneous innervation
intercostal arteries
thoracic aorta, posterior intercostal arteries, internal thoracic arteries, anterior intercostal arteries
primary blood supply of the thoracic wall
via the thoracic aorta and the internal thoracic arteries (branches of the subclavian artery)
posterior intercostal arteries
majority arise from the aorta; Course with an intercostal nerve and vein; anastomose with anterior intercostal arteries to form a cycle
anterior intercostal arteries
arise from internal thoracic arteries ; Usually two per intercostal space; One anastomoses with the collateral branch of the posterior intercostal artery, other anastomoses with the posterior intercostal a. and courses with an intercostal n. and v.
intercostal veins
drain into azygos system of veins posteriorly and internal thoracic veins anteriorly; internal thoracic veins drain into the brachiocephalic veins then to SVC
azygos system
hemiazygos vein, accessory hemiazygos vein --> azygos vein --> SVC
thoracic cavity
region enclosed by thoracic wall
serous sacs investing the lungs; visceral and parietal pleura
visceral pleura
lines the surfaces of the lung; it is closely adherent to the lungs and extends into lung fissures; no sensory (pain/temp/touch) innervation
parietal pleura
lines the walls of the thoracic cavity, continuous with visceral pleura, sensitive to pain/temp/touch due to innervation by adjacent intercostals nerves and phrenic nerves
pleuritis / pleurisy
inflammation of the pleura leading to adhesion of visceral and parietal layers, resulting in acute pain associated with elevated activity
pleural cavity
potential space between the visceral and parietal pleurae; right and left pleural cavities are separate from one another; normally contains thin layer of serious fluid a a lubricant facilitating movement of the lungs during respiration
hydrothorax / pneumothorax / hemothorax
accumulation of fluid / air / blood in pleural cavity
costodiaphragmatic recesses
inferolateral recesses within the pleural cavities; decrease with inspiration, reappear with expiration
procedure to drain excess fluid form pleural cavity; needle inserted into costodiaphragmatic recess, at the midaxillary line between ribs 9 and 10
characteristics of the lungs
elastic (shrink to 1/3 of size if thoracic wall breached), pink (darkens with exposure to air particles)
parts of the lung
root, apex, base
root of the lung
collection of structures entering/exiting the lung; pulmonary vessels and bronchi
apex of lung
superior portion extending into the base of the neck
base of lung
concave inferior portion adjacent to diaphragm
right lung
3 lobes (superior, middle, inferior), oblique fissure separating middle/inferior, horizontal separating superior/middle
left lung
2 lobes (superior, inferior), oblique fissure separates the 2 lobes; cardiac notch
cardiac notch
left lung; superior lobe on anterior margin
inferior to the larynx, bifurcates at T4/T5, palpable at suprasternal notch due to cartilaginous rings (hyaline, C-shaped, incomplete posteriorly), smooth muscle on posterior side
ridge of cartilage at the bifurcation of the trachea into right and left main bronchi (T4/T5)
right and left main bronchi
extrapulmonary, supported by C-shaped rings of cartilage
right main bronchus
wider, shorter, more vertical, aspirated foreign objects more likely to be here
lobar bronchi
divided from each main bronchus, intrapulmonary; right lung: 3 (sup/mid/inf), left lung: 2 (sup/inf)
segmental bronchi
divided from segmental bronchi, corresponding to specific bronchopulmonary segment
bronchopulmonary segments
10 per lung; area of lung supplied by a segmental bronchus and a segmental branch of the pulmonary artery; Separated from adjacent segments by connective tissue septa (can be surgically resected); Tributaries of the pulmonary veins lie in the connective tissue between adjacent segments (intersegmental)
pulmonary trunk
exits right ventricle of heart, divides into right and left pulmonary arteries which then enter the lungs
pumonary arteries
carry oxygen poor blood from the heart to the lungs for oxygenation, each divides into lobar and segmental marteries
lobar and segmental arteries
divide from pulmonary artery, paired with and running parallel with the bronchi
pulmonary veins
two on each side; carry oxygen rich blood form lungs to left atrium of the heart; lie in intersegmental connective tissue separating bronchopulmonary segments, do not course with arteries and bronchi
bronchial arteries
carry oxygen rich blood to the tissues of the lung itself; branches off the thoracic aorta
bronchial veins
return oxygen poor blood from the tissues of the lung to the azygos system or intercostal veins
lymphatic drainage of lungs
superficial lymphatic plexus drains into bronchopulmonary nodes; deep lymphatic plexus into pulmonary lymph nodes; pulmonary -> bronchopulmonary -> tracheobronchial -> tracheal; lymphatic plexus of left and right lungs communicate
innervationof the lungs
via pulmonary plexuses with contributions from vacus nerve (CN X) and sympathetic splanchnic nerves
vagus nerve
parasympathetic; achieves bronchoconstriction; preganglionic cell bodies in brain, preganglionic fibers constitute vagus nerves, postganglionic cell bodies in wall of target organ (lung); postganglionic fibers in wall of target organ (very short)
sympathetic innervation in lungs
bronchodilation; preganglionic CB in lateral horn of thoracic spinal cord; preganglionic fibers from ventral root -> spinal nerve -> white ramus communicans -> sympathetic trunk; postganglionic CB in upper thoracic paravertebral (chain) ganglia, postganglionic fibers (pulmonary nerves) travel from paravertebral ganglia to cardiac plexus in mediastinum
separates thoracic and abdominal cavities; skeletal muscle surrounding C-shaped central tendon; 2 domes (right higher than left), heart in pericardium lies on central tendon
attachments of diaphragm
all peripheral; xiphoid process, costal margin, ribs 11-12, lumbar vertebrae (via right and left crura)
diaphragm openings
caval opening (T8): through central tendon for inferior vena cava; esophageal hiatus (T10) for esophagus and vagus nerves; aortic hiatus (T12): for aorta, thoracic duct, azygos vein
sensory innervation of diaphragm
primarily phrenic nerves; periiopherally, innervation via intercostal nerves
motor innervation of diaphragm
phrenic nerves cause contractions
phrenic nerve
ventral rami of C3, C4, C5; course superficially through the mediastinum, anterior to the root of the lungs, and continuing onto the superficial aspect of the pericardium to its final target, the diaphragm; Provide motor innervation to diaphragm
and sensory innervation to diaphragm and the parietal pericardium and pleura
lesion of a phrenic nerve (to diaphragm)
paralyzes corresponding half of the diaphragm; x-ray during inspiration will show a depressed (active side) and raised (paralyzed side) of the diaphragm
diaphragm during respiration
primary muscle of inspiration: contracts, domes descend and flatten, increasing vertical dimension of the thoracic cavity; relaxes during expiration, allowing domes to rise
Contraction of the diaphragm causes the abdominal contents to be forced down, increasing vertical dimension of the thorax; Contraction of muscles that elevate the ribs (e.g., external intercostals) expands the thoracic cavity transversely ("bucket handle") and anteroposteriorly (“pump handle”); During forceful inspiration, the pectoral muscles may be recruited
thoracic cavity reduces in size due to relaxation of diaphragm and elastic recoil of lungs; During forceful expiration, abdominal muscles (e.g. external and internal obliques, rectus abdominis) are recruited to compress abdominal viscera upward, expelling air from the lungs