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127 Cards in this Set
- Front
- Back
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Description of the thorax
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part of the trunk between the neck and the abdomen. Contains: thymus gland, heart, lungs, distal portion of the trachea, most of the esophagus.
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Skeleton of the thorax
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Rib cage. Protects: heart, liver, lungs, gall bladder, pancreas, spleen, etc.
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Bony thorax
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12 ribs, 12 thoracic vertebrae, intervertebral discs, associated intercostal cartilages, sternum.
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Thoracic vertebrae
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Have articulating facets for rib articulation (costal facets). Movement between adj. vertebrae is limited. 5-8 contact with ascending aorta.
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Location of the distal portions of the vena cava, abdominal aorta, and esophagus in relation to the diaphragm.
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Vena cava and esophagus pass through the diaphragm (holes), and the abdominal aorta passes behind the diaphragm.
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What is unique about ribs 2-9?
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They have articulating demi facets for movement with the vertebrae above.
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What is unique about the first 7 ribs?
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They are true ribs- attach to vertebrae
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Describe a thoracic vertebra
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They have costal facets for the articulation of the ribs. There is limited movement between vertebrae which protects the thoracic viscera. 5-8 touch the aorta.
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Where does the aorta pass in regard to the diaphragm?
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Passes behind it- touches vertebrae 5-8.
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Where are the vena cava and esophagus located in reference to the diaphragm?
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They both pass through it.
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Which ribs have superior demi-facets? What are they for?
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Ribs 2-9. They are for articulation with the vertebrae superior to them.
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What is the purpose of an inferior demi-facet?
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Articulation with the vertebrae below and the corresponding rib.
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Which ribs are considered to be "true ribs"?
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Ribs 1-7. Also called vertebrosternal ribs. Attach to the vertebrae posteriorly and the sternum through the costal cartilage anteriorly.
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Which ribs are considered to be "false ribs"?
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Ribs 8-10. Also called veterbrocondral ribs. They are attached to the vertebrae posteriorly and their cartilage connects to the cartilage of rib 7, which then connects to the sternum anteriorly.
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Which ribs are considered to be "floating ribs"?
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Ribs 11-12. They are connected to the vertebrae posteriorly and end within the abdominal wall musculature anteriorly.
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What is the name for the space between the ribs?
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Intercostal space.
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What occupies the intercostal spaces?
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Intercostal muscles, blood vessels, and nerves.
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Which ribs are considered to be typical ribs?
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Ribs 3-9.
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Describe a "typical" rib.
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Wedge shaped head with 2 articular facets separated by a crest. Has a neck that separates the head from the tubercle. Tubercle is located at the junction of the shaft and the neck. Each rib shaft is thin, flat, and has an angle.
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Describe the angle in a typical rib.
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The angle of typical ribs is located at the point of greatest curvature as it comes around to the front.
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What is an important clinical aspect of the angle of the rib?
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It is the point of weakness.
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Which ribs are considered to be "atypical"?
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Ribs 1, 2, 10-12.
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Describe the first rib.
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Shortest. Broad. Flat. Most curved rib.
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Describe the second rib.
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Longer, less curved, and thinner than the first; has 2 aritculating facets for movement with T1 and T2.
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Describe the tenth rib.
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Only has one facet for articulation with T10.
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Describe ribs 11 and 12.
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Floating. Have no neck and no tubercle.
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Costal cartilage
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Contributes to the elasticity of the thorax anteriorly. Made of hyaline cartilage. Connects the sternum to the ribs.
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Costal condritis
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Condition in which the constal cartilage has gone through arthritic degeneration. This makes the rib cage stiff. Breathing is difficult and painful.
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Which ribs form the infrasternal angle?
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7-10. Space where the right and left sets of ribs meets the sternum.
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Define the sternum
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Flat, thin bone that is located at the midline within the anterior portion of the thorax. It has 3 distinct parts- manubrium, body, and xiphoid process.
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Describe the manubrium
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Top portion of the sternum. Triangular in shape. Located at T3 and T4. Top of the manubrium is easily palpable- called the jugular notch.
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Clavicular notches
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Located on each side of the jugular (supraclavicular) notch.
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Where does rib pair 1 articulate?
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Just below the clavicular notch.
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Angle of Louis
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Location where the manubrium meets the body of the sternum. Lateral view shows the slant between the manubrium. Just opposite to the ends of the second costal cartilages. Located around T4/T5.
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Superior thoracic aperture
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Neck enters the thorax here. Structures passing through: trachea, esophagus, nerves, blood vessels, lymphatics. Bounded in back by T1 in back, pair 1 of ribs, manubrium.
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Body of the sternum
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Portion of sternum that coinsides with T5-T9.
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Xiphoid process
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Smallest and most variable. Bottom of the sternum. Inferior thoracic aperture located here.
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What is the inferior thoracic aperture?
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Border between the thorax and the abdomen. Covered by the diaphragm. Bounded by T12 posteriorly, rib pair 12 anteriorly, costal cartilage 7-10 anteriorly, xiphosternal joint medially.
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Why are rib fractures in infants and young children rare?
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The rib cage is highly elastic.
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How can you detect a rib fracture?
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Palpation- cannot always be seen on x-ray.
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Which ribs are the least frequently broken?
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Rib pairs 1 and 2 (covered by clavicle) and pairs 11 and 12.
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What is flail chest?
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Large section of the anterior chest is freely moveable due to multiple fractures.
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Thoracotomy
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Any procedure done on the thoracic wall
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What is a cervical rib?
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Rib that articulates with C7. Usually not significant unless they cause neurological problems.
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What is a lumbar rib?
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Rib that articulates with L1. Can be confused with a fracture of the spinous process of a lumbar vertebrae.
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What is contained within the breast?
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Mammary glands, adipose tissue, lymph nodes and vessels.
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Where are the breasts located?
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Located in the superficial fascia of the anterior thoracic wall
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What is located within the points of greatest prominence of the breast?
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Nipple and areola (pigmented area around the nipple)
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Do both males and females have breast tissue?
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YES- but breast cancer is rare within males and is fatal as there is not a large amount of breast tissue, the cancer spreads.
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What is contained within post pubescent breast tissue of females?
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20 lactiferous glands which drain into the lactiferaous duct and out of the nipple.
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Location of the breast
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Circular base- runs from ribs 2-6 in diameter, transversely from lateral border of the sternum to the midaxillary line. 1/3 within the fascia of the serratus anterior, 2/3 within the fascia of the pectoralis major.
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What is the axillary tail?
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small portion of the breast that extends superiolaterally on the inferior border of the pectoralis major.
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What is the retromammary space?
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Located between the breast and fascia- bursa like. Allows for breast movement.
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What attaches the lactiferous glands to the dermis?
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Cooper's ligaments (suspensory). Best developed in the superior portion of the breast.
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Arterial supply to the breast
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Anterior intercostal arteries, Lateral thoracic arteries, thoracoacromial artery, posterior intercostal artery
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Location of the anterior intercostal arteries that are associated with the breast
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Transverse from midline off of the thoracic arteries that are midline off the sternum. Part of the mammary artery. Also included is a branch of the subclavian
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Ascention of the subclavian, thoracic and intercostal arteries
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SUBCLAVIAN => INTERNAL THORACIC => INTERCOSTAL
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Location of thoracic lateral artery
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Branch from axillary artery. Down the lateral portion of the thorax
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Where do the posterior intracostal arteries arise from?
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The thoracic aorta
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What are the two main vessels within the breast which are responsible for venous drainage?
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Internal thoracic vein, axillary vein.
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Lymph drainage of the breast?
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Drains into subareolar plexus bilaterally
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If the lymph vessels are blocked, what is the appearance of the breast?
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Leathery. Skin appears to be dimpled due to shortening of suspensory ligaments.
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5 lymph nodes within the axillary plexus of lymph nodes
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Pectoral, subscapular, apical, lateral, central.
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Which nerves are found within the breast?
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T4, T5, T6- all are mixed motor sensory.
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External intercostals are for...?
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inspiration
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Internal intercostals are for...?
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expiration
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Spinal nerves go through vertebral. foramen and split into...
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doral and ventral ramus
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Where does the ventral ramus move?
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Through the intercostal spaces
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What does the dorsal ramus innervate?
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muscles, joints, bones, skin of the back
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Describe the arterial supply to the thoracic wall
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Posterior intercostal arteries which originate from the thoracic aorta, and anterior intercostal arteries which originate from the subclavian arteries.
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Name the compartments of the thorax
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Lateral (2) and central
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What is the pleura?
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A sac which surrounds the lung and decreases friction and tension within the thoracic cavity during breathing
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5 lymph nodes within the axillary plexus of lymph nodes
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Pectoral, subscapular, apical, lateral, central.
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Which nerves are found within the breast?
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T4, T5, T6- all are mixed motor sensory.
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External intercostals are for...?
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inspiration
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Internal intercostals are for...?
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expiration
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Spinal nerves go through vertebral. foramen and split into...
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doral and ventral ramus
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Outer parietal pleura
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adheres to the thoracic wall, mediastinum, and diaphragm.
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Costal pleura
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part of the parietal pleura on the inside surface of the lungs.
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Mediastinal pleura
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part of the pleura which lines the mediastinum
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Diaphragmatic pleura
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adheres to the superior surface of the diaphragm
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Cervical pleura
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Also known as pleural cupula. Extends 3 cm up into the neck. Dome/apex of the lung is located here.
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Inner visceral pleura
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covers the surface of the lungs and invaginates into the fissures of the lungs.
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What kind of fluid separates the pleural sacs?
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serous fluid- similar to how microscope slides stick together
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What kind of a space is the pleural space?
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A potential space. In healthy persons, there is no actual space- just a space that could exist if need be.
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How many surfaces and borders does each lung have?
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3
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Describe the costal surface of the lung
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Refers to the portion of the lungs that is in contact with the ribs. Largest surface. Goes all the way around the rib cage.
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Describe the diaphragmatic surface of the lungs
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Under portion of the lungs- in contact with the superior portion of the diaphragm.
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Describe the mediastinal surface of the lungs
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Down the midline. Goes from the front to the back of the rib cage.
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Describe the anterior border of the lung
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Where costal and mediastinal surfaces meet.anteriorly
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Describe the inferior border of the lung
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Surrounds diaphragmatic surface
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Describe the posterior border
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Where the costal and mediastinal surfaces meet posteriorly.
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Why is the right lung larger than the left lung?
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Because of the location of the heart.
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Where is the area of continuity between the visceral and parietal pleura?
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At the point of attachment between the lungs, heart, and trachea within the mediastinum.
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What is the hilum of the lung?
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"Doorway" in and out of the lung- contains: stem bronchi, pulmonary vessels, nerves.
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Right lung attributes
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Horizontal and oblique fissures. Has 3 lobes- superior, middle, inferior
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Left lung attributes
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Oblique fissure, Divided into 2 lobes- superior and inferior
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Right mainstem bronchi (RMB)
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Shorter. More vertical. **Inhaled objects tend to go into the right mainstem bronchus because of the vertical arrangement.
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Left mainstem bronchi (LMB)
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Courses below the arch of the aorta and anterior to the esophagus
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Mainstem bronchi divide into what?
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Secondary mainstem bronchi
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How many secondary bronchi does the right lung have?
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3- each bronchus supplies one lobe.
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How many secondary bronchi does the left lung have?
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2- each bronchus supplies one lobe.
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What vessel carries oxygen poor blood from the heart to the lungs?
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pulmonary arteries
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What vessel carries oxygen rich blood from the lungs to the heart?
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pulmonary veins
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What supplies the pleura and the lung tissue with oxygen rich blood?
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Bronchial arteries- arise from the thoracic aorta and after supplying lung tissue and pleura converge with the pulmonary arteries
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What is the carina?
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Point of bifurcation of the trachea and the bronchi. Triangular piece of cartilage located here. Keeps orientation and lungs from falling onto the heart.
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What are the 2 lymphatic plexuses?
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Superficial and deep. Superficial drain to tracheal bronchial lymph nodes. Deep drain to pulmonary lymph nodes along primary bronchi.
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Which nerves are associated with the function of the lungs?
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Vagus, phrenic, recurrent laryngeal
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3 important parasympathetic effects of the vagus nerve on the lungs?
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1. Bronchal constriction (motor to smooth muscle of bronchial tree)
2. Inhibits smooth muscle movement in the pulmonary vessels causing vasodilation. 3. Increases glandular secretions |
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Important sympatheic effects of the sympathetic trunk on the lungs?
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1. Bronchodilation- inhibits smooth muscle of bronchus
2. Vasoconstriction 3. Inhibits glandular secretion |
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Where does the right X nerve enter the thorax?
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to the right of the subclavian artery- moves down the thorax and gives off the esophageal and cardiac plexuses
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Describe the orientation of the recurrent laryngeal nerve.
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Moves down with the X nerve and then comes back up the thorax and moves into the bottom of the lung.
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Where does the left X nerve enter the thorax?
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descends with the aorta- gives rise to recurrent laryngeal.
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Recurrent laryngeal nerve supplies...
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All of the intrinsic muscles of the larynx
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Phrenic nerve (R+L)
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Only motor nerve to the diaphragm. 1/2 sensory. 1/2 motor. R- decends along inferior vena cava. L- descends across the L atrium and down the thorax. C3,4,5 keeps a person alive.
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What is the mediastinum?
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Central portion of the thorax between the two pleural spaces. Extends from the superior thoracic aperture to the diaphragm. Stems from sternum anteriorly to thoracic vertebrae posteriorly.
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Clinical subdivisions of mediastinum?
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Superior and inferior
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Superior mediastinum
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From superior thoracic aperture to sternal angle straigh back to T4. Contains: thymus gland, arch of the aorta, SVC, vagus, phrenic, brachiocephalic veins, trachea
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Inferior mediastinum
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Runs from sternal angle to T4 to diaphragm. Further divided into anterior middle and posterior divisions
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Anterior portion of the inferior mediastinum
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Any thing in front of the heart. Connective tissue, fat, blood vessels.
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Middle portion of the inferior mediastinum
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Heart and great vessels
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Posterior portion of the inferior mediastinum
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Thoracic aorta, thoracic duct (75% lymph return), esophagus
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What is the pericardium?
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Double walled fibrous sac around the heart and origins of the great vessels. Located behind the sternum. Runs anteriorly from ribs 2-6, posteriorly from T5-T8.
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What is a great vessel?
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Vessel which either directly enters or leaves the heart- pulmonary arteries and veins, superior and inferior vena cava, aorta.
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Fibrous outer portion of the mediastinum
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Fused with tunica externa of the great vessels and the central tendon of the diaphragm. Attached to the posterior surface of the sternum by the sternopericardial ligaments. It protects the heart. Gives the heart a mechanical advantage during contraction because it is not attached to the bone.
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Serous inner portion of the mediastinum
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Has 2 layers- inner visceral and outer parietal (attached to the fibrous.
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Pericardial space
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Space between the two pericardial layers.
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