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119 Cards in this Set
- Front
- Back
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Blood supply to mammary glands
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Internal thoracic, lateral thoracic, thoracromial, posterior intercostal arteries
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Innervation of mammary glands
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Intercostal nerves 4-6 from ventral primary rami (Somatosensory and postganglionic fibers)
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Nerves that cross lateral border of mammary gland but do not innervate?
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Thoracodorsal, long thoracic (can be damaged during a mastectomy)
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Drainage possibilities of lymph in breast?
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First to Subareolar lymphatic plexus then: Axillary nodes (75%), Parasternal nodes, Abdominal nodes, or Contralateral breast
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Muscles of Thoracic Wall
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External intercostal, internal intercostal, innermost intercostal
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External intercostal
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From vertebral bodies to costochondral junction; external intercostal membrane extends to sternum; involved with respiration
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Internal intercostal
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From sternum to angle of ribs; internal intercostal membrane extends to vertebral bodies
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Innermost intercostal
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Innermost, Subcostal, Transverse thoracis
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Intercostal veins, arteries, and nerves?
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Underneath rib in costal groove, between internal and innermost layers
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Superior Thoracic Aperture
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Trachea, Esophagus, Brachiocephalic artery, Carotid artery (2), Subclavian artery (2), Vertebral artery, Thyrocervical artery, Internal thoracic artery, Subclavian veins (2), Internal jugular veins (2), Thoracic duct, Vagus and phrenic nerves, Sympathetic chains (2), Anterior scalene muscles (2), Lateral thirds of aperture closed by suprapleural membranes
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Branches from arch of aorta
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Left subclavian, Left common carotid, Brachiocephalic (gives rise to right subclavian and right common carotid)
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Common carotid arteries
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Supply head and neck
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Subclavian arteries
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Supply upper extremities; branches: vertebral, internal thoracic, and thyrocervical arteries
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Subclavian veins
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Drain upper extremity
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Internal jugular veins
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Drain the brain
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Thoracic duct
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terminal portion of lymphatic system; empties into venous system at junction of left internal jugular and left subclavian veins; Lymphatic drainer of whole body except right upper limb, right side of head and right side of thorax
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Vagus nerves
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Cranial nerve X; parasympathetic nerves for abdomen, neck, and thorax
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Phrenic nerves
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C3-C5; innervate diaphragm; ventral primary rami
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Blood supply for diaphragm
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Superior and inferior phrenic, intercostal, and internal thoracic arteries
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Inferior thoracic aperture
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Vena cava foramen (Inferior vena cava) [T8]
Esophageal hiatus (Esophagus and vagus nerves) [T10] Aortic hiatus (Aorta, Azygos vein, Thoracic duct) [T12] |
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Line that separates superior and inferior mediastinum
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Sternal angle to inferior border of 4th thoracic vertebra
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Superior mediastinum
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Aortic arch, brachiocephalic artery, left subclavian artery, left common carotid artery, brachiocephalic veins, superior half of superior vena cava, vagus and phrenic nerves, left recurrent laryngeal nerves, esophagus, trachea, thoracic duct, thymus
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Anterior mediastinum
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Division of inferior mediastinum; lymph nodes, minor vessels, fat; in infants, thymus extends down
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Middle mediastinum
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Division of inferior mediastinum; heart, pericardial sac, ascending aorta, inferior half of superior vena cava, termination of azygos vein, pulmonary trunk and its major branches, pulmonary veins, phrenic nerves
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Posterior mediastinum
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Division of inferior mediastinum; bifurcation of trachea and primary bronchi, descending aorta, esophagus, azygos and hemiazygos veins, thoracic duct, vagus and splanchnic nerves, sympathetic chain
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Orientation of apex
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Left and inferior
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Layers of pericardium
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Fibrous--Parietal--Visceral
Pericardium cavity in between parietal and visceral layers |
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Fibrous pericardium
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Inelastic fibrous sac; Phrenic nerves lay on exterior; fused to central tendon of diaphragm; embryologic origin = pleuropericardial fold
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Parietal pericardium
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Serous layer on inside of fibrous pericardium
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Visceral pericardium
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Serous layer on surface of heart; also called epicardium
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Adhesions
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Restrict heart movement; compromise cardiac function
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Pericarditis
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Inflammation of pericardium; can cause effusion of fluid into cavity or compress heart
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Cardiac tamponade
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Extensive fluid in cavity; compresses heart
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Pericardiocentesis
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Draining of fluid from cavity
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Coronary sulcus
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Groove on heart separating atria from ventricles
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Anterior and Posterior interventricular sulcui
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Groove on heart that separate right and left ventricles
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Right coronary artery
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Supplies right atrium, right ventricle, and part of left ventricle
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Branches of right coronary artery
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Marginal--along right margin of heart
Posterior interventricular--in posterior interventricular sulcus |
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Left coronary artery
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Supplies left atrium, left ventricle, and parts of right ventricle
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Branches of left coronary artery
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Anterior interventricular--in anterior interventricular sulcus
Circumflex--passes through coronary sulcus |
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Coronary sinus
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Empties into right atrium between inferior vena cava and right atrioventricular valve; located in coronary sulcus
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Great cardiac vein
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Associated with anterior interventricular artery
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Posterior vein of left ventricle
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drains left ventricle; associated with circumflex artery
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Middle cardiac vein
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Associated with posterior interventricular artery
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Small cardiac vein
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Follows marginal artery and right coronary artery
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Anterior and Smallest Cardiac veins
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do NOT empty into coronary sinus; open directly into heart chambers
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Aortic semilunar valve
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3rd intercostal space, posterior to sternum
Best heard: right 2nd intercostal space |
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Pulmonary semilunar valve
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Left 3rd costosternal junction;
Best heard: left 2nd intercostal space |
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Right atrioventricular valve (tricuspid)
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Right 5th costosternal junction, posterior to sternum;
Best heard: Left lower sternal border |
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Left atrioventricular valve (Bicuspid)
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4th costosternal junction;
Best heard: Left 5th intercostal space (apex) |
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Glandular tissue
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In breast; lobes radially arranged around nipple
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Lactiferous duct
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Converge and open on surface of nipple
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Lactiferous sinus
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Dilation of lactiferous duct that can store milk
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Suspensory ligaments
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Fibrous bands that run deeper layer of superficial fascia to dermis; supports glandular tissue; seen in mammograms
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Retromammary space
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Between superficial and deep fascia of breast; allows for movement of breast on thoracic wall
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Functions of lymph drainage in breast
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Drain interstitial fluid and return it to venous system; filter fluid
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Carcinomas of breast usually derived from?
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Epithelial cells of lactiferous ducts
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Functions of Thoracic Wall
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Protect organs, Aid in respiration, Provide attachments for muscles
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Endothoracic fascia
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Layer of deep fascia; thickens over apex of lungs = suprapleural membrane
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Central tendon
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Strong aponeurosis for attachment of diaphragm's muscle
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Left Crus
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Attaches to first two lumbar vertebrae
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Right Crus
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Attaches to first three lumbar vertebrae
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Diaphragm attachments
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Xiphoid process, Costal cartilages, Adjacent portions of inferior 6 ribs, More superior two or three lumbar vertebrae
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Pleura
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Two continuous layers: Visceral and parietal pleura
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Pleural cavity
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Contains thin layer of serous fluid; surface tension holds visceral and parietal pleura together
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Hilum
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Doorway of the lung (place where everything enters)
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Parietal pleura
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4 regions: Cupula, Costal, Diaphragmatic, Mediastinal
In contact with endothoracic fascia Innervated by phrenic and intercostal nerves |
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Sensitive to localized pain
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Parietal pleura
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Insensitive to localized pain
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Visceral pleura
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Pleural recesses
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Costodiaphragmatic (lowest point of pleural cavity in upright individual), Costomediastinal
Places where parietal pleura is reflected back on itself |
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Hemothorax
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Bleeding into pleural cavity
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Pneumothorax
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Air in pleural cavity; can be from open or closed means
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Right Lung
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3 lobes; Horizontal and oblique fissures
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Left Lung
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2 lobes (Sup. and Inf.)
Oblique fissure Lingula and cardiac notch in sup. lobe |
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Importance of Bronchopulmonary Segments
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Interpretation of chest radiographs, Diseases often localized to segments, Knowledge of branching pattern important for postural drainage
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Branches of pulmonary arteries
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Intrasegmental
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Branches of pulmonary veins
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Intersegmental
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Trachea bifurcates at?
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Sternal angle (T4)
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Right Lung Superior Lobe
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Apical, Posterior, Anterior
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Right Lung Middle Lobe
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Lateral, Medial
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Right Lung Inferior Lobe
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Superior, Medial Basal, Anterior Basal, Lateral Basal, Posterior Basal
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Left Lung Superior Lobe
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Apicoposterior, Anterior
Lingular Division: Superior lingular, Inferior lingular |
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Left Lung Inferior Lobe
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Superior, Medial Basal, Anterior Basal, Lateral Basal, Posterior Basal
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Apex of lung rises?
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Above clavicle
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Horizontal fissure located?
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Along 4th rib and costal cartilage on right side
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Oblique fissure located?
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Starts at SP T2-T3 then runs down and around to follow curvature of 6th rib
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Cardiac notch located?
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Along 4th-6th costal cartilages left of sternum
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Superior lobe auscultation
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Anterior side of thorax
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Inferior lobe auscultation
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Posterior side of thorax
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Esophagus comprised of?
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Upper third---Skeletal
Middle third---Skeletal and Smooth Lower Third---Smooth |
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Constriction points of Esophagus
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1. Junction with pharynx
2. Crossed by arch of aorta 3. Crossed by left main bronchus 4. Passes through diaphragm |
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Left recurrent laryngeal nerve
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Branch of vagus; loops around arch of aorta
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Right recurrent laryngeal nerve
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Branch of vagus; loops around right subclavian artery
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Damaged recurrent laryngeal nerve could lead to?
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Change in someone's voice
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Postganglionic sympathetic fibers located?
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Cardiac, pulmonary, and esophageal plexi
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Preganglionic sympathetic fibers located?
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In the esophageal plexus because of greater splanchnic nerve
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Azygos vein
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Passes through posterior mediastinum; terminates in middle mediastinum; Drains posterior thorax and abdominal walls; Connects SVC to IVC for alternate route of venous return to heart
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Veins that drain into Azygos vein
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Posterior intercostal, Esophageal, Bronchial, Mediastinal
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Accessory hemiazygos vein
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Drains superior left thoracic wall; empties into azygos vein at T8; derived from proximal left supracardinal vein
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Hemiazygos vein
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Drains inferior left thoracic and abdominal wall; dumps into azygos vein at T9; derived from distal left supracardinal vein
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Inferior Vena Cava can be cut off by?
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Enlargement of liver
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Right lymphatic duct
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Drains right upper limb, right side of head, and right side of thorax; empties into junction of right internal jugular and right subclavian veins
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Tributaries of thoracic duct
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Left jugular trunk
Left subclavian trunk Left bronchomediastinal trunk Vessels from posterior intercostal and mediastinal regions |
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Tributaries of right lymphatic duct
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Right jugular trunk
Right subclavian trunk Right bronchomediastinal trunk |
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Parietal nodes of thorax
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Parasternal, intercostal, and Diaphragmatic nodes
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Visceral nodes of Thorax
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1. Anterior mediastinal nodes
2. Posterior mediastinal nodes 3. Tracheobronchial nodes |
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Anterior mediastinal nodes
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Receives vessels from heart, pericardium, thymus
Drains into right and left bronchomediastinal trunks |
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Posterior mediastinal nodes
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Receives vessels from esophagus, pericardium, diaphragm
Drain into thoracic duct |
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Tracheobronchial nodes
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5 groups of nodes: Tracheal, Superior tracheobronchial, Inferior tracheobronchial, Bronchopulmonary, Pulmonary
Receive afferent vessels from surrounding structures Drains into right and left bronchomediastinal trunks |
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Location of Tracheal nodes
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Along both sides of trachea
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Location of Superior tracheobronchial nodes
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Superior to primary bronchi
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Location of Inferior tracheobronchial nodes
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Below bifurcation of trachea
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Location of bronchopulmonary nodes
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At hilum of lungs
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Location of pulmonary nodes
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In the lungs
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Where is lymphatic system not found?
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CNS, meninges, eye, internal ear, spleen, avascular structures
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Cisterna chyli
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Dilated portion of thoracic duct at L1-2
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Branches from descending aorta?
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Supply bronchi, esophagus, diaphragm, and posterior body wall
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Branches from ascending aorta?
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Right and left coronary arteries
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Vagus nerve sends preganglionic parasympathetic fibers to?
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Esophageal, cardiac, and pulmonary plexi
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