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WEEK 18:
Introduction to main structures of thorax:
| Question | Answer |
|---|---|
| arteries in superior mediastinum (4) | aortic arch, brachiocephalic artery, left common carotid, left subclavian |
| veins in superior mediastinum (3) | brachiocephalic veins, upper half of vena cava, and left highest intercostal vein |
| structures in inferior mediastinum (6) | thymus, heart in pericardium with phrenic nerves on each side, oesophagus, thoracic duct, descending aorta, and sympathetic trunks |
| mediastinitis | inflammation of tissues in mediastinum usually due to bacterial infection/ rupture of organs |
| mediastinal widening | mediastinum has width greater than 6cm on upright PA chest x ray / 8cm on supine AP chest film |
| what can a widened mediastinum indicate (3) | aortic aneurysm, aortic dissection, and aortic rupture |
| layers of pericardium (2) | fibrous and serous |
| fibrous pericardium | outer tough layer that merges with blood vessel adventitia |
| serous pericardium layers | visceral (epicardium) and parietal (lines fibrous pericardium) |
| pericarditis | inflammation of pericardium causing sharp/ stabbing chest pain on left side |
| pericardial effusion | accumulation of fluid around heart putting pressure caused by disease, injury, bleeding, cancer of chest trauma |
| RA | Receives deoxygenated blood from the body (superior vena cava) |
| RV | Receives blood from the Right atrium and send to lungs via pulmonary arteries |
| LA | Receives oxygenated blood from the lungs via the pulmonary veins |
| LV | Pumps oxygenated blood to the body through the aorta |
| anterior/ sternocostal surface of heart | formed mostly of R (some L) ventricle |
| inferior or diaphragmatic surface of heart | mostly L (some R) ventricle |
| posterior/ base of surface of heart | L (some R) atrium and pulmonary v |
| pulmonary surface of heart | R (RA) and left (LV) |
| apex of heart | located at 5th left intercostal space |
| heart borders (4) | superior, right, inferior and left |
| superior heart border | usually hidden from view by greater vessels |
| right heart border | formed by RA |
| inferior heart border | by RV and LV |
| left heart border | LV |
| left atrioventricular valve | between LA and LV |
| right atrioventricular valve | between RA and RV |
| aortic valve | at origin of aorta and LV |
| pulmonary valve | at origin of pulmonary trunk from RV |
| how fast does irreversible brain damage occur due to lack of O2 | 4-5 minutes |
| cessation/ impairment of cardiac function cause | lack blood supply to cardiac muscle (coronary artery disease), stenosis, regurgitation in cardiac valves (valvular heart disease), intrinsic weakness of heart muscle (cardiomyopathy), or ineffective cardiac rhythms |
| common congenital cardiac malformations (2) | ventricular septal defects (VSD) and atrial septal defects |
| how to correct congenital cardiac malformations | surgery at early age |
| great vessels in heart (4) | pulmonary artery, pulmonary vein, superior vena cava, and inferior vena cava |
| aortic dissection | tear in inner wall of aorta creating 2 channels for blood flow where one is through the normal aorta lumen and another is into the wall making blood stationary |
| what happens to blood entering the wall in aortic dissection | can constrict aortic lumen, reducing blood flow, and can cause weakness + dilation of wall potentially leading to aortic aneurysm |
| aneurysm | dilation/ expansion of artery (greater than 50% of normal diameter) |
| causes of aortic aneurysm | underlying weakness of walls eg Marfan's syndrome or pathological process eg aortic dissection |
| main danger of aortic aneurysm | rupture of aorta |
| innervation of parietal pleura | intercostal and phrenic nerves - sensitive to pain |
| innervation of visceral pleura | autonomic nerves |
| types of parietal pleura (4) | mediastinal, diaphragmatic, costal and cervical |
| mediastinal parietal pleura | flat surface facing mediastinum containing impressions of mediastinal structures and hilum + pulmonary ligament |
| diaphragmatic parietal pleura | concave surface facing domes of diaphragm |
| costal parietal pleura | convex surface facing ribs |
| cervical parietal pleura | extends into neck, 2-3 cm above medial third of clavicle as apex/dome |
| pleural reflections | abrupt lines along which the pleura change direction (reflect) from one wall of pleura cavity to another |
| when do pleural reflections occur** | where costal pleura becomes continuous with mediastinal pleura anteriorly + posteriorly, and with diaphragmatic pleura inferiorly |
| clinical importance of pleural reflections | used to interpret chest xray correctly + to perform procedures eg thoracentesis |
| Pleura surface marking above clavicle | pleura begins approximately 1" above the mid-point of the medial third of the clavicle |
| Pleura surface marking at 2nd rib | both right and left pleural lines descend down the midline |
| Pleura surface marking at 4th rib | left pleural line deviates laterally to accommodate the heart |
| Pleura surface marking at 6th rib | both right and left pleural lines deviate laterally to accommodate the heart |
| Pleura surface marking at 8th rib | both right and left pleural lines pass midclavicular line (MCL) |
| Pleura surface marking at 10th rib | both right and left pleural lines pass midaxillary line (MAL) |
| Pleura surface marking at 12th rib | both right and left pleural lines travel posteriorly around the chest wall |
| pleural recesses** | area where pleural cavity not filled by lungs where opposing surfaces of parietal pleura touch |
| types of pleural recesses (2) | costodiaphragmatic and costomediastinal |
| costodiaphragmatic pleural recess | between costal pleurae and diaphragmatic pleura |
| costomediastinal pleural recess | between costal pleurae and mediastinal pleura (behind sternum) |
| clinical importance of pleural recesses | give location where fluid can collect eg pleural effusion |
| pleuritis (pleurisy) | inflammation of pleura where lung surfaces are rough (pleural rub) and cab heard with stethoscope leading to sharp chest pain when inhaling or coughing |
| oblique fissure in right + left lung | T2 vertebra posteriorly to rib 6 anteriorly |
| horizontal fissure in right lung | rib 4 to oblique fissure |
| superior and middle lobes in right lung | anterior |
| inferior lobe in right + left lung | posterior |
| superior lobe in left lung | mainly anterior and has lingula |
| difference between R + L bronchi | R more vertical and wider than L bronchi |
| each main bronchus divides into | secondary bronchi (supplying lobes) |
| each secondary bronchi divide into | tertiary bronchi (supplying segments) |
| how many segments are there in both the right and left bronchi | 10 |
| clinical importance of bronchopulmonary segments | so location of surgical resection or draining fluids is clear |
| surface anatomy includes | Reflections closest at plane of sternal angle (rib 2); Parallel down to rib 4; L indented (cardiac notch) but R continues to cc 6; Cross rib 8 at midaxillary line; Cross rib 10 at lateral border of erector spinae m |
| difference in rib 8 in visceral and parietal surface anatomy | V cross rib 8 at midaxillary line but P has rib 8 at midclavicular line |
| difference in rib 10 in visceral and parietal surface anatomy | V cross rib 10 at lateral border of erector spinae m but P at midaxillary line |
| difference in rib 12 in visceral and parietal anatomy | only P has rib 12 at lateral border of erector spinae m |
| rib 2 in both visceral and parietal anatomy | reflections closest at plane of sternal angle |
| rib 4 in both visceral and parietal anatomy | parallel down to rib 4 |
| costal cartilage and cardiac notch in visceral and parietal anatomy | L indented (cardiac notch) but R continues to costal cartilage 6 |
Created by:
kablooey
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