Pericardium And Heart Brs

Front 1

what is pericarditis?

Back 1

inflammation of the pericardium

Front 2

what can result from pericarditis?

Back 2

cardiac tamponade
pericardial effusion
precordial pain
epigastric pain
pericardial murmur/pericardial friction rub

Front 3

what is pericardial murmur/pericardial friction rub?

Back 3

surfaces of pericardium become rough and the resulting friction sounds like the rustle of silk (auscultation)

Front 4

what are the symptoms of pericardial murmur/pericardial friction rub?

Back 4

dysphagia
dyspnea
cough
inspiratory chest pain
paradoxic pulse

Front 5

what is cardiac tamponade? what causes it?

Back 5

acute compression of the heart caused by a rapid accumulation of fluid or blood in the pericardial cavity from wounds to the heart or pericardial effusion

Front 6

how do you treat cardiac tamponade?

Back 6

pericardiocentesis

Front 7

what does cardiac tamponade cause?

Back 7

-compression of venous return to the heart, resulting in decreased diastolic capacity (ventricular filling)
-reduced cardiac output with an increased heart rate
-increased venous pressure with jugular vein distention, hepatic enlargement, and peripheral edema

Front 8

what's pericardial effusion?

Back 8

accumulation of fluid in the pericardial space from inflammation caused by acute pericarditis

Front 9

what effect does pericardial effusion have?

Back 9

-accumulated fluid compresses the heart, inhibiting cardiac filling
-enlarged heart
-water bottle appearance of cardiac silhouette
-faint heart sounds
-vanished apex beat

Front 10

how do you treat pericardial effusion?

Back 10

pericardiocentesis

Front 11

what is pericardiocentesis? how does the procedure work?

Back 11

surgical puncture of the pericardial cavity for the aspiration of fluid, which relieves the pressure of accumulated fluid on the heart
-needle is inserted into the pericardial cavity thru the 5th intercostal space left to the sternum
b/c of the cardiac notch, the needle misses the pleura and lungs, but penetrates the pericardium

Front 12

what's the pericardium? what's it made up of?

Back 12

-fibroserous sac that encloses the heart and roots of the great vessels
-occupies the middle mediastinum
-made of fibrous pericardium and serous pericardium

Front 13

what does the pericardium receive blood from? innervated by?

Back 13

blood- pericardiophrenic, bronchial and esophageal arteries
nerve- vasomotor and sensory fibers from the phrenic and vagus nerves and sympathetic trunks

Front 14

what is the fibrous pericardium?

Back 14

strong, dense, fibrous layer that blends with the adventitia of the roots of great vessels and the central tendon of the diaphragm

Front 15

what is serous pericardium?

Back 15

parietal layer- lines inner surface of fibrous pericardium
visceral layer- forms outer layer (epicardium) of heart wall and roots of great vessels

Front 16

what's the pericardial cavity?

Back 16

potential space b/w the visceral layer of the serous pericardium (epicardium) and the parietal layer of the serous pericardium lining the inner surfaces of the fibrous pericardium

Front 17

what's the importance of the transverse sinus of the pericardial sinus?

Back 17

cardiac surgeon, while doing surgery on aorta or pulmonary artery, surgeon can pass finger and make ligature thru the sinus b/w arteries and veins, thus stopping blood circulation w/ the ligature

Front 18

what's the oblique sinus of the pericardial sinus?

Back 18

subdivision of the pericardial sac behind the heart

Front 19

what ventricle is the apex of the heart formed by? where is the apex of the heart? why is this important?

Back 19

-left ventricle
-left fifth intercostal space slightly medial to the midclavicular line (nipple), about 9 cm from the midline
-location to auscultate the mitral valve

Front 20

what's the base of the heart formed by?

Back 20

left atrium
posterior right atrium

Front 21

what's the right (acute) border of the heart formed by?

Back 21

SVC
right atrium
IVC

Front 22

what's the left (obtuse) border of the heart formed by?

Back 22

left ventricle
radiology: left ventricle, aortic arch, pulmonary trunk and left auricle

Front 23

what are the 3 layers of the heart wall?

Back 23

inner endocardium
middle myocardium
outer epicardium

Front 24

what's the sulcus terminalis?

Back 24

groove on the external surface of the right atrium
marks the junction of the primitive sinus venous with the atrium in the embryo
corresponds to a ridge on the internal heart surface: cristae terminalis

Front 25

what's the coronary sulcus?

Back 25

groove on external surface of heart
marks division b/w atria and ventricles

Front 26

what's the crux?

Back 26

point at which the interventricular and interatrial sulci cross the coronary sulcus

Front 27

what's the cardiovascular silhouette/cardiac shadow?

Back 27

contour of the heart and great vessels seen on posterior-inferior chest radiographs

Front 28

what's the right border of the cardiovascular silhouette formed by?

Back 28

SVC
right atrium
IVC

Front 29

what's the left border of the cardiovascular silhouette formed by?

Back 29

aortic arch --> aortic knob
pulmonary trunk
left auricle
left ventricle

Front 30

what's the inferior border of the cardiovascular silhouette formed by?

Back 30

right ventricle

Front 31

what part of heart shows no border on cardiovascular silhouette?

Back 31

left atrium

Front 32

describe the right atrium:

Back 32

anteriorly situated rough-walled atrium proper
auricle lined w/ pectinate muscles
posteriorly situated smooth walled sinus venarum, into which 2 venae cavae open

Front 33

compare the right atrium to left atrium:

Back 33

right- bigger
thinner wall
slightly lower atrial pressure
rougher walls

Front 34

describe the right atrium's sinus venarum:

Back 34

posteriorly situated smooth walled sinus venarum
2 venae cavae open into it
sinus venarum b/w 2 venae cavae is separated from atrium proper by crista terminalis

Front 35

what important parts does the right atrium have?

Back 35

eustachian valve of IVC
thebesian valve of coronary sinus
right auricle
sinus venarum (sinus venarum cavarum)
pectinate muscles
crista terminalis
venae cordis minimae
fossa ovalis

Front 36

what does the right auricle cover?

Back 36

right coronary artery

Front 37

what separates the sinus venarum/sinus venarum cavarum from the right atria? where is this junction?

Back 37

crista terminalis
-indicated externally by the sulcus terminalis

Front 38

what veins does the sinus venarum receive?

Back 38

SVC
IVC
coronary sinus
anterior cardiac veins

Front 39

what are pectinate muscles? where are they?

Back 39

prominent ridges of atrial myocardium
-interior of both auricles and right atria

Front 40

what's the crista terminalis? what's it's purpose?

Back 40

vertical muscular ridge running anteriorly along right atrial wall from the opening of the SVC to the opening of the IVC
-provides origin of the pectinate muscles

Front 41

what are the venae cordis minimae?

Back 41

smallest cardiac veins
begin in heart (endocardium and inner myocardium) and end in atria at foramina venarum minimarum cordis

Front 42

what's the fossa ovalis?

Back 42

oval-shaped depression in interatrial septum
-represents site of foramen ovale

Front 43

what's the upper rounded margin of the fossa?

Back 43

limbus fossa ovale

Front 44

how does blood flow thru foramen ovale before birth?

Back 44

from right atrium to left atrium

Front 45

where is the left atrium?

Back 45

posterior to right atrium
anterior to esophagus

Front 46

what type of blood does left atrium receive?

Back 46

oxygenated blood thru 4 pulmonary veins

Front 47

what chamber makes up the major part of the anterior surface of the heart?

Back 47

right ventricle

Front 48

what strucs does the right ventricle contain?

Back 48

trabeculae carneae cordis
papillary muscles
chordae tendineae
conus arteriosus (infundibulum)
septomarginal trabecula (moderator band)
IV septum

Front 49

what are trabeculae carneae cordis?

Back 49

anastomosing muscular ridges of myocardium in ventricles

Front 50

what are papillary muscles? what are they attached to?

Back 50

-cone-shaped muscles enveloped by endocardium
-apices attached to the chordae tendineae
-extend from anterior and posterior ventricular walls and septum

Front 51

what's the purpose of the papillary muscles?

Back 51

-contract to tighten chordae tendineae, preventing cusps of tricuspid valve from being everted into atrium by pressure developed by pumping action of heart
*this prevents regurgitation of ventricular blood into the right atrium

Front 52

where are chordae tendinae?

Back 52

extend from 1 papillary muscle to >1 cusp of tricuspid valve and bicuspid valve

Front 53

what's the purpose of chordae tendinae?

Back 53

prevents eversion of valve cusps into atrium during ventricular contractions

Front 54

what's the conus arteriosus/ infundibulum?

Back 54

upper smooth- walled part of right ventricle, which leads to pulmonary trunk

Front 55

what's the septomarginal trabecula (moderator band)?

Back 55

isolated band of trabeculae carneae that forms bridge b/w intraventricular (IV) septum and the base of anterior papillary muscle of anterior wall of right ventricle

Front 56

what's the purpose of the septomarginal trabecula?

Back 56

prevents overdistention of the ventricle
carries the right limb (Purkinje fibers) of the atrioventricular bundle from septum to sternocostal wall of ventricle

Front 57

what's the IV septum?

Back 57

place of origin of septal papillary muscle
-mostly muscular, but has small membranous upper part

Front 58

what's clinical significance of IV septum?

Back 58

the small membranous upper part is common site of ventricular septal defects

Front 59

how is the left ventricle oriented?

Back 59

apex is directed downward, forward and to the left

Front 60

how is the left ventricle divided?

Back 60

left ventricle proper and aortic vestibule (leads to aorta)

Front 61

what are some parts in the left ventricle?

Back 61

2 papillary muscles w/ chordae tendineae
meshwork of muscular ridges
trabeculae carneae cordis

Front 62

how does left ventricle compare to right ventricle?

Back 62

left:
does harder work
2-3X thicker
longer
narrower
more conical-shaped

Front 63

what's myocardial infarction? what causes it?

Back 63

myocardium necrosis b/c of local ischemia resulting from vasospasm, obstruction of blood supply, most commonly thrombus or embolus in coronary arteries

Front 64

what are the symptoms of myocardial infarction?

Back 64

severe chest pain or pressure for prolonged period (>30 min)
congestive heart failure
murmur of mitral regurgitation

Front 65

what can treat myocardial infarction? how does it work?

Back 65

nitroglycerine: prevents coronary spasm and reduced myocardial O2 demand
morphine: relieves pain and anxiety
lidocaine: reduces ventricular arrhythmias
atropine: restores conduction and increases heart rate

Front 66

what's angina pectoris?

Back 66

chest pain attacks originating in the heart and felt beneath the sternum
can radiate to the left shoulder and down the arm

Front 67

what causes angina pectoris?

Back 67

insufficient supply of O2 to the heart muscle b/c of coronary artery disease or exertion (exercise, excitement) or emotion (stress, anger, frustration)

Front 68

what are angina pectoris symptoms?

Back 68

severe chest pain or pressure for prolonged period (> 30 minutes)
congestive heart failure
murmur of mitral valve regurgitation

Front 69

how do you treat angina pectoris?

Back 69

nitroglycerin
beta-adrenergic blockers
morphine
lidocaine
atropine

Front 70

what's Prinzmetal's angina? what causes it?

Back 70

-variant form of angina pectoris caused by transient coronary artery spasm
-vasospasm happens at rest and many times the coronary arteries are normal

Front 71

how can you tell if someone has Prinzmetal's angina? what can it lead to?

Back 71

EKG shows ST segment elevation rather than depression during an attack
*prolonged vasospasm may lead to myocardial infarction and sudden death

Front 72

what treats Prinzmetal's angina?

Back 72

nitroglycerin
nifedipine
amlodipine besylate
calcium channel blockers
*these prevent artery spasm

Front 73

what's the most significant risk factor for spasm of Prinzmetal's angina?

Back 73

smoking

Front 74

what's cardiopulmonary resuscitation (cpr)? how do you do it?

Back 74

restoration of cardiac output and pulmonary ventilation after cardiac arrest and apnea by external cardiac massage
*performed by applying firm pressure to the chest vertically downward over the inferior part of sternum to move it posteriorly, forcing blood out of the heart and into the great vessels and breath in to victim

Front 75

where is the pulmonary valve? where do you hear it?

Back 75

behind medial side of left 3rd costal cartilage and adjoining part of sternum
-heard over left 2nd intercostal space just lateral to sternum

Front 76

what opens the pulmonary valve? when is it shut?

Back 76

opened by ventricular systole
shut slightly after closure of the aortic valve

Front 77

where is the aortic valve? where is it heard?

Back 77

behind left half of sternum opposite 3rd intercostal space
-heard over right 2nd intercostal space just lateral to sternum

Front 78

when is aortic valve closed?

Back 78

closed during ventricular diastole
*closure at beginning of ventricular diastole causes 2nd "dub" heart sound

Front 79

where is the tricuspid (right AV valve)? where can it be heard?

Back 79

b/w right atrium and ventricle, behind right half of sternum opposite 4th intercostal space and covered by endocardium
heard: right lower part of sternum body

Front 80

what are special parts of tricuspid valve?

Back 80

anterior, posterior and septal cusps that are attached by chordae tendineae to 3 papillary muscles that keep valve closed against pressure developed by pumping action of heart

Front 81

when is the tricuspid valve closed?

Back 81

closed during ventricular systole (contraction)
*closure contribs to 1st "lub" heart sound

Front 82

where's the bicuspid/mitral valve located? where heard?

Back 82

b/w left atrium and ventricle
behind left half of sternum @ 4th costal cartilage
heard: left 5th intercostal space at midclavicular line

Front 83

when is bicuspid valve closed?

Back 83

closed slightly before tricuspid valve by ventricular contraction (systole)
*its closure at onset of ventricular systole causes 1st "lub" heart sound

Front 84

what is mitral valve prolapse?

Back 84

valve everts into left atrium, and thus fails to close properly when the left ventricle contracts

Front 85

what are symptoms of mitral valve prolapse?

Back 85

chest pain
shortness of breath
palpitations
cardiac arrhythmia

Front 86

what is cardiac murmur?

Back 86

sound made by turbulence of blood flow thru an orifice of heart

Front 87

what's the first "lub" sound caused by?

Back 87

closure of tricuspid and mitral valves at onset of ventricular systole

Front 88

what's second "dub" sounds caused by?

Back 88

closure of aortic and pulmonary valves (and vibration of walls of heart and major vessels) at onset of ventricular diastole

Front 89

what's the conducting system of heart?

Back 89

modified, specialized cardiac muscle cells that lie immediately beneath the endocardium and carry impulses thruout cardiac muscle, signaling heart chambers to contract in proper sequence

Front 90

what is the sinoatrial node?

Back 90

small mass of specialized cardiac muscle fibers that lies in myocardium at upper end of crista terminalis near opening of SVC in right atrium

Front 91

what is another name for the sinoatrial node?

Back 91

pacemaker of heart b/c initiates heartbeat, which can be altered by autonomic nervous stimulation

Front 92

where are sinoatrial node impulses spread?

Back 92

in wave along cardiac muscle fibers of atria and also travel along internodal pathway to AV node

Front 93

what is the SA node supplied by?

Back 93

sinus node artery, a branch of the right coronary artery

Front 94

where is the AV node?

Back 94

interatrial septum, superior and medial to opening of coronary sinus in right atrium

Front 95

how does AV node interact w/ cardiac impulses?

Back 95

receives impulse from SA node and passes it to AV bundle

Front 96

what's the AV nodes blood supply?

Back 96

AV nodal artery, which comes from right coronary artery

Front 97

what innervates AV node?

Back 97

autonomic nerve fibers

Front 98

even though cardiac muscle is innervated by autonomics, the muscle fibers lack ____________.

Back 98

motor endings

Front 99

where is AV bundle (bundle of His)?

Back 99

begins at AV node and runs along membranous part of interventricular septum
*splits into right and left branches, which descend into muscular part of interventricular septum and breaks up into terminal conducting fibers (Purkinje fibers) to spread out into ventricular walls

Front 100

what does damage to the cardiac conducting system cause?

Back 100

heart block, which interferes w/ ability of ventricles to receive atrial impulses

Front 101

what does a delay or disruption of the electrical cardiac signal produce?

Back 101

irregular and slower heartbeat, reducing heart's efficiency in maintaining adequate circulation

Front 102

how do you save someone w/ heart block?

Back 102

pacemaker

Front 103

where do coronary arteries come from?

Back 103

ascending aorta

Front 104

when are coronary arteries filled w/ blood?

Back 104

during ventricular diastole
*have max blood flow during diastole and minimal blood flow during systole b/c of compression of arterial branches in myocardium during systole

Front 105

what does right coronary artery come from? what does it supply

Back 105

anterior (right) aortic sinus of ascending aorta
supplies: right atrium and ventricle

Front 106

what arteries does the right coronary artery give rise to?

Back 106

sinuatrial nodal artery
marginal artery
posterior IV (posterior descending) artery
AV nodal artery

Front 107

what does the sinuatrial nodal artery supply?

Back 107

SA node
right atrium

Front 108

what does the marginal artery supply?

Back 108

inferior margin of right ventricle

Front 109

what does the posterior IV (posterior descending) artery supply?

Back 109

part of IV septum
left ventricle
AV node

Front 110

what does the AV nodal artery supply?

Back 110

AV node

Front 111

what is the largest terminal branch of the right coronary artery?

Back 111

posterior IV (posterior descending) artery

Front 112

what is coronary atherosclerosis? what does it lead to?

Back 112

presence of sclerotic plaques containing cholesterol and lipoid material that impair myocardial blood flow
-leads to ischemia and myocardial infarction

Front 113

what's coronary angioplasty?

Back 113

angiographic reconstruction (radiographic view of vessels after injection of radiopaque material) of blood vessel made by enlarging narrowed coronary arterial lumen

Front 114

how is coronary angioplasty performed?

Back 114

peripheral intro of balloon-tip catheter
dilation of lumen on withdrawal of inflated catheter tip

Front 115

what is coronary bypass?

Back 115

take section of vein (usually saphenous v) or of internal thoracic artery or other b/w aorta and coronary a distal to obstruction in coronary a, shunting blood from aorta to coronary arteries
*alternatively, internal thoracic artery is connected to coronary artery distal to obstructive lesion

Front 116

what does the left coronary artery come from? where?

Back 116

left aortic sinus of ascending aorta, just above aortic semilunar valve

Front 117

how does left coronary artery compare to right coronary artery?

Back 117

left is shorter and usually distrib to more of myocardium

Front 118

what arteries does left coronary artery give rise to?

Back 118

anterior IV (left anterior descending) artery
circumflex artery

Front 119

what does the anterior IV (left anterior descending) artery supply?

Back 119

anterior parts of right and left ventricles
IV septum
apex

Front 120

what does the circumflex artery supply?

Back 120

left atrium
left ventricle

Front 121

what artery does circumflex artery give off? anastomoses w/?

Back 121

left marginal artery
*anastomoses w/ terminal branch of right coronary artery

Front 122

what are the cardiac veins?

Back 122

coronary sinus
great cardiac vein
middle cardiac vein
small cardiac vein
oblique vein of left atrium
anterior cardiac vein
smallest cardiac veins (venae cordis minimae)

Front 123

what's the largest vein draining the heart? where is it?

Back 123

coronary sinus: coronary sulcus

Front 124

what does the coronary sinus feed into?

Back 124

right atrium b/w opening of IVC and AV opening

Front 125

what veins does coronary sinus receive?

Back 125

great, middle and small cardiac veins
oblique vein of left atrium
posterior vein of left ventricle

Front 126

what artery does the great cardiac vein accompany?

Back 126

IV branch of left coronary artery

Front 127

what vein becomes coronary sinus?

Back 127

great cardiac vein

Front 128

what vv are in the coronary sulcus?

Back 128

great cardiac vein
small cardiac vein

Front 129

what v is in the posterior IV groove?

Back 129

middle cardiac vein

Front 130

A mad scientist made a dog and vegetable hybrid, what did he call it?

Back 130

colli-flower: (cauliflower)

Front 131

what v begins in the wall of the heart and empties directly into its chambers?

Back 131

smallest cardiac veins (veneae cordis minimae)

Front 132

what does a werewolf put on to go to the beach?

Back 132

moontan lotion!

Front 133

what v empties into right atrium?

Back 133

anterior cardiac v

Front 134

what a does the middle cardiac v accompany?

Back 134

posterior IV branch of right coronary artery

Front 135

what a does the small cardia v accompany?

Back 135

marginal a

Front 136

what v drains the anterior right ventricle?

Back 136

anterior cardiac v

Front 137

what do heart lymphatic vessels receive lymph from?

Back 137

myocardium
epicardium

Front 138

what a do the heart lymphatic vessels follow? empties where?

Back 138

follows right coronary artery --> empties into anterior mediastinal nodes
follows left coronary artery --> empties into tracheobronchial node

Front 139

what n does the cardiac plexus receive?

Back 139

superior, middle, inferior cervical and thoracic cardiac nn from sympathetic trunks and vagus nerves

Front 140

what can the cardiac plexus be divided into? where are they?

Back 140

superficial cardiac plexus: beneath aorta arch in front of pulmonary artery
deep cardiac plexus: posterior to aorta arch in front of bifurcation of trachea

Front 141

what branches of n terminate in the SA node region?

Back 141

right sympathetic and parasympathetic branches

Front 142

what branches of n terminate in AV node?

Back 142

left sympathetic and parasympathetic branches

Front 143

what do the sympathetic fibers increase? result?

Back 143

increases heart rate and force of heartbeat
-dilation of coronary aa

Front 144

what do parasympathetic fibers of heart decrease? result?

Back 144

heart rate
constrict coronary aa

Front 145

what major vessels are in the middle mediastinum?

Back 145

ascending aorta
superior vena cava

Front 146

what major vessels are in the superior mediastinum?

Back 146

aorta arch
superior vena cava

Front 147

what does ascending aorta originate from? ends?

Back 147

left ventricle w/i pericardial sac
ends at sternal angle

Front 148

what aa does the ascending aorta give off?

Back 148

right and left coronary artery

Front 149

where are the ascending aorta's 3 aortic sinuses?

Back 149

immediately above aortic valve cusps

Front 150

how does aorta arch begin? what does it arch over?

Back 150

continuation of ascending aorta
-arches over right pulmonary artery and left main bronchus

Front 151

what aa does aorta arch give rise to?

Back 151

brachiocephalic a
left common carotid a
left subclavian a

Front 152

what great vessel forms aortic knob on x-ray?

Back 152

aorta arch

Front 153

what are the great vessels?

Back 153

ascending aorta
aorta arch
superior vena cava
pulmonary trunk

Front 154

what's aortic arch aneurysm?

Back 154

sac formed by dilation of aortic arch that compresses left recurrent laryngeal n

Front 155

what are symptoms of aortic arch aneurysm?

Back 155

compression of left recurrent laryngeal n --> coughing, hoarseness, ipsilateral vocal cord paralysis
dysphagia from pressure on esophagus
dyspnea from pressure on trachea, root of lung or phrenic n

Front 156

what's Marfan's syndrome?

Back 156

inheritable disorder of connec tisue that affects skeleton, skin, eyes, heart and blood vessels

Front 157

what cardiovascular abnormalities result from Marfan's syndrome?

Back 157

aortic root dilation
aortic aneurysm
aortic regurgiatation
mitral valve prolapse

Front 158

how can you treat abnormalities from Marfan's syndrome?

Back 158

Beta-blocker medications that reduce aortic arch dilation

Front 159

what forms superior vena cava? returns blood from?

Back 159

union of right and left brachiocephalic vv
-returns blood from all strucs superior to diaphragm,except lungs and heart

Front 160

what v does superior vena cava receive?

Back 160

Azygos v

Front 161

what chamber does superior vena cava enter?

Back 161

right atrium

Front 162

where does pulmonary trunk come from? what does it bifurcate into?

Back 162

conus arteriosus of right ventricle
-bifurcates into right and left pulmonary arteries in aortic arch concavity

Front 163

what main vessel runs on left side on ascending aorta w/i fibrous pericardium?

Back 163

pulmonary trunk

Front 164

how long is esophagus? what's it continuous w/? where does it enter thorax?

Back 164

10 in long
cont. w/ pharynx in neck
enters thorax behind trachea

Front 165

where are the esophagus' 3 constrictions?

Back 165

1) level of C6 vertebra: begins
2) crossing of left main stem bronchus
3) T10 vertebra where it pierces diaphagm

Front 166

what part of heart presses against anterior surface of esophagus?

Back 166

left atrium

Front 167

where's the physiological sphincter of the esophagus?

Back 167

circular layer of smooth muscle @ gastroesophageal junc
*called inferior esophageal sphincter

Front 168

where does esophagus receive blood from?

Back 168

3 aorta branches: inferior thyroid, bronchial and esophageal aa
left gastric a
inferior phrenic a

Front 169

what's esophagus achalasia? what's it caused by?

Back 169

impaired esophageal contractions b/c of failure of relaxation of inferior esophageal sphincter
-caused by degeneration of myenteric (Auerbach's) plexus in esophagus

Front 170

what does esophagus achalasia cause?

Back 170

obstruction to passage of food in terminal esophagus
dysphagia for solids and liquids
weight loss
chest pain
nocturnal cough
recurrent bronchitis or pneumonia

Front 171

what's systemic sclerosis (scleroderma)? esophagus symptoms?

Back 171

systemic collagen vascular disease
-dysphagia for solids and liquid
-severe heartburn
-esophageal stricture

Front 172

where does thoracic aorta begin? what path does it take?

Back 172

@ level of 4th thoracic vertebra
descends on left side of vertebral column
approaches median plane to end in front of vertebral column by passing thru aortic hiatus of diaphragm

Front 173

what aa does thoracic aorta give rise to?

Back 173

9 pairs of posterior intercostal aa and 1 pair of subcostal aa
*1st 2 intercostal aa arise from highest intercostal aa of costocervical trunk

Front 174

what does posterior intercostal a give rise to? runs along where?

Back 174

collateral branch, which runs along upper border of rib below space

Front 175

what branches does thoracic aorta give rise to? P.237 Netter

Back 175

pericardial
bronchial (1 right, 2 left)
esophageal
mediastinal
superior phrenic branches

Front 176

when does coarctation of aorta occur?

Back 176

when aorta is abnormally constricted just inferior to ductus arteriosus, in which case an adequate collateral circulation develops before birth

Front 177

what does the coarctation of aorta cause?

Back 177

1) rib notching and high risk of cerebral hemorrhage
2) tortuous and enlarged blood vessels, especially internal thoracic, intercostal, epigastric and scapular aa
3) elevated blood pressure in radial a and decreased pressure in femoral a
4) femoral pulse occurs after radial pulse (normally vice versa)

Front 178

what does coarctation of aorta lead to?

Back 178

development of important collateral circulation over thorax

Front 179

what does collateral circulation occur b/w?

Back 179

1) anterior intercostal branches of internal thoracic artery and posterior intercostal aa
2) superior epigastric branch of internal thoracic a and interior epigastric a
3) superior intercostal branch of costocervical trunk and 3rd posterior intercostal a
4) posterior intercostal aa and descending scapular (dorsal scapular) a, which anastomoses w/ suprascapular and circumflex scapular aa around scapula

Front 180

what vv make up azygos venous system?

Back 180

azygos vein
hemiazygos vein
accessory hemiazygos v
superior intercostal v
posterior intercostal v

Front 181

what forms azygos v?

Back 181

union of right ascending lumbar and right subcostal vv

Front 182

what v does azygos v receive?

Back 182

right intercostal vv
right superior intercostal v
hemiazygos v
accessory hemiazygos vv

Front 183

what v from azygos venous system is connected to IVC?

Back 183

azygos v

Front 184

what does azygos v arch over? empty into?

Back 184

-arches over root of right lung
-empties into SVC

Front 185

what v is formed by the union of the left subcostal and ascending lumbar vv? lower end conn to?

Back 185

hemiazygos v
*lower end connected to left renal v

Front 186

what v ascends on left side of vertebral bodies behind thoracic aorta, receiving 9th, 10th, and 11th posterior intercostal vv?

Back 186

hemiazygos v

Front 187

what v begins at the 4th or 5th intercostal space?

Back 187

accessory hemiazygos v

Front 188

what v is formed by the union of the 2nd, 3rd, and 4th posterior intercostal vv?

Back 188

superior intercostal v

Front 189

what v receives the 4th or 5th - 8th intercostal v and ends in the azygos v?

Back 189

accessory hemiazygos v

Front 190

what v drains into the azygos v on the right and brachiocephalic v on the left?

Back 190

superior intercostal v

Front 191

the first intercostal v on ea side of posterior intercostal v v drain into what?

Back 191

corresponding brachiocephalic v

Front 192

what are the main parts of lymphatics?

Back 192

thoracic duct
right lymphatic duct

Front 193

where does thoracic duct begin?

Back 193

abdomen @ cisterna chyli: dilated junc of intestinal, lumbar and descending intercostal trunks

Front 194

what does thoracic duct of lymphatics drain?

Back 194

lower limbs
pelvis
abdomen
left thorax
left upper limb
left side of head and neck

Front 195

where does thoracic duct pass thru and ascend?

Back 195

passes thru aortic opening of diaphragm
ascends thru posterior mediastinum b/w aorta and azygos v

Front 196

what does thoracic duct arch over? path?

Back 196

arches laterally over apex of left pleura and b/w left carotid sheath in front and vertebral a behind, runs behind left internal jugular v,

Front 197

what does thoracic duct empty into?

Back 197

junc of left internal jugular and subclavian v

Front 198

what does right lymphatic duct drain?

Back 198

right sides of thorax
right upper limb
right part of head
right part of neck

Front 199

what does right lymphatic duct empty into?

Back 199

right internal jugular v
subclavian v

Front 200

what types of n make up autonomic nervous system? what's innervated?

Back 200

motor/efferent n
innerv:
cardiac muscle
smooth muscle
glands

Front 201

what neurons are involved in ANS in thorax?

Back 201

preganglionic and postganglionic
*may include general visceral afferent fibers b/c they run w/ general visceral efferent fibers

Front 202

thorax ANS symp or parasymp?

Back 202

BOTH!

Front 203

what type of fibers is thorax ANS made up of?

Back 203

cholinergic: sympathetic pregang, parasymp pregang and postgang : use Ach
adrenergic: symp postgang: use Norep
exception: sweat glands are cholinergic

Front 204

where are the preganglionic cell bodies of sympathetic nervous system?

Back 204

lateral horn or intermediolateral cell column b/w T1-L2

Front 205

where do the pregang fibers of symp nervous system synapse?

Back 205

pass thru white rami communicantes and enter sympathetic chain ganglion, where they synapse

Front 206

what do the postgang fibers of thorax ans join?

Back 206

join ea spinal n by way of gray rami communicantes and supply blood vessels, hair follicles (arrector pili muscles) and sweat glands

Front 207

what's the effect of symp nervous system of thorax ans?

Back 207

increases heart rate
dilates bronchial lumen
dilates coronary aa

Front 208

what are the main parts of symp nervous system in thorax?

Back 208

sympathetic trunk
rami communicantes
thoracic splanchnic n

Front 209

what fibers are the symp trunk of thorax ans made of?

Back 209

ascending and descending pregang symp fibers and visceral afferent fibers

Front 210

what cell bodies does symp trunk of thorax ans have?

Back 210

postgang sympathetic GVE fibers

Front 211

what ganglion does symp trunk of thorax ans have? formed how?

Back 211

cervicothoracic (or stellate) ganglion, formed by fusion of inferior cervical ganglion w/ 1st thoracic ganglion

Front 212

what branches does symp trunk of thorax ans give rise to?

Back 212

cardiac, pulmonary, mediastinal, and splanchnic branches

Front 213

how is the symp trunk of thorax ans connected to thoracic spinal nerves?

Back 213

by gray and white rami communicantes

Front 214

what's a stellate block?

Back 214

injection of local anesthetic near stellate ganglion by placing tip of needle near neck of 1st rib
*makes temporary interruption of symp func such as in patient w/ excess vasoconstriction in upper limb

Front 215

what are the parts of rami communicantes?

Back 215

white rami communicantes
gray rami communicantes

Front 216

what type of fibers does white rami communicantes have?

Back 216

pregang symp GVE (myelinated) fibers w/ cell bodies located in lateral horn (intermediolateral cell column) of spinal cord and GVA fibers w/ cell bodies located in dorsal root ganglia

Front 217

white rami communicantes are conn to spinal nn, limited to spinal cord segments b/w:

Back 217

T1 - L2

Front 218

what type of fibers do gray rami communicantes have?

Back 218

postgang symp GVE (unmyelinated) fibers that supply blood vessels, sweat glands, and arrector pili muscles of hair follicles

Front 219

gray rami communicantes are conn to every spinal n and have fibers w/ cell bodies in:

Back 219

sympathetic trunk

Front 220

name the thoracic splanchnic nn:

Back 220

greater splanchnic n
lesser splanchnic n
least splanchnic n

Front 221

thoracic splanchnic nn have what type of fibers?

Back 221

symp pregang GVE fibers w/ cell bodies in lateral horn (intermediolateral cell column) of spinal cord and GVA fibers w/ cell bodies located in DRG

Front 222

what thoracic splanchnic n comes from the 10th and 11th thoracic ganglia?

Back 222

lesser splanchnic n

Front 223

what thoracic splanchnic n comes from the 5th - 9th thoracic symp ganglia?

Back 223

greater splanchnic n

Front 224

what thoracic splanchnic n comes from the 12th thoracic ganglia?

Back 224

least splanchnic n

Front 225

what do all of the thoracic splanchnic nn perforate?

Back 225

diaphragm crus

Front 226

which thoracic splanchnic n occasionally passes thru aortic hiatus?

Back 226

greater splanchnic n

Front 227

what thoracic splanchnic n ends in ganglia of renal plexus?

Back 227

least splanchnic n

Front 228

what thoracic splanchnic n ends in aorticorenal ganglion?

Back 228

lesser splanchnic n

Front 229

what thoracic splanchnic n ends in celiac ganglion?

Back 229

greater splanchnic n

Front 230

what parts of body have no parasymp n supply?

Back 230

body wall
extremities

Front 231

what causes injury to recurrent laryngeal n?

Back 231

bronchogenic or esophageal carcinoma
enlargement of mediastinal lymph nodes
aneurysm of aortic arch

Front 232

what does injury to recurrent laryngeal n cause?

Back 232

respiratory obstruction
hoarseness
inability to speak b/c vocal cord paralyzed

Front 233

what's a vagotomy?

Back 233

transection of vagus n @ lower part of esophagus in attempt to reduce gastric secretion in peptic ulcer tx

Front 234

what are the thorax ans parts of the parasymp nervous system?

Back 234

right vagus n
left vagus n

Front 235

where are the ganglion of parasymp nervous system of thorax ans?

Back 235

cranial autonomic ganglia
terminal ganglia
inferior ganglion

Front 236

what pregang fibers of parasymp nervous system of thorax ans?

Back 236

-pregang running in cranial nn (III, VII, IX) that pass to cranial autonomic ganglia where they synapse w/ postgang neurons
-pregang fibers in CN X and in pelvic splanchnic nn (S2-S4) that pass to terminal ganglia where they synapse

Front 237

what does vagus n (CN X) supply?

Back 237

all thoracic and abdominal viscera, except descending and sigmoid colons and other pelvic viscera

Front 238

where are vagus n cell bodies located?

Back 238

-parasymp pregang fibers w/ cell bodies in medulla oblongata
-GVA fibers w/ cell bodies in inferior (nodose) ganglion

Front 239

what are the main actions of the parasymp of thorax ans?

Back 239

decreases heart rate
constricts bronchial lumen
causes vasoconstriction of coronary aa

Front 240

what nn does the right/left vagus nn give off?

Back 240

right vagus n --> right recurrent laryngeal n
left vagus n --> left recurrent laryngeal n

Front 241

what vagus n hooks around right subclavian a and ascends into neck b/w trachea and esophagus?

Back 241

right recurrent laryngeal n

Front 242

what vagus n hooks around arch of aorta to left of ligamentum arteriosum and ascends thru superior mediastinum and neck in groove b/w trachea and esophagus?

Back 242

left recurrent laryngeal n

Front 243

what vagus n crosses anterior to right subclavian a, runs posterior to SVC, and descends at right surface of trachea, and then posterior to right main bronchus?

Back 243

right vagus n

Front 244

what n enters thorax b/w left common carotid and subclavian aa and behind the left brachiocephalic v and descends on arch of aorta?

Back 244

left vagus n

Front 245

what plexi does right vagus n contrib to?

Back 245

cardiac
pulmonary
esophageal

Front 246

what n forms posterior vagal trunk (or gastric nn) at lower part of esophagus and enters abdomen thru esophageal hiatus?

Back 246

right vagus n

Front 247

what plexi does left vagus n contrib to?

Back 247

gives off thoracic cardiac branches
breaks up into pulmonary plexuses
continues into esophageal plexus
forms anterior vagal trunk

Front 248

what are effects of symp stim?

Back 248

increases heart rate
dilates coronary aa
increases blood flow thru vessels
supplying more O2 and nutrients to myocardium
bronchodilation of pulmonary vessels
vasodilation of pulmonary vessels

Front 249

what are effects of parasymp stim?

Back 249

slows heart rate
constricts coronary aa
produces bronchoconstriction (motor to smooth muscle) of pulmonary vessels
produces vasodilation of pulmonary vessels
increases glandular secretion of bronchial tree (secretomotor)