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SGU:Pect & Thoracic

Anatomy of Pectoral and Thoracic

QuestionAnswer
The nipple is surrounded by a circular pigmented area of skin termed: the areola
What is the function of the suspensory ligaments of the breast? to support the brest
A carcinoma in the breast has caused pitting of the skin. Why? Due to tension on the suspensory ligaments of the brest
How is the breast innervated? anterior and lateral cutaneous branches of the second to sixth intercostal nerves. Nipple is innervated by the 4th.
Where does breast cancer usually develop? lactiferous ducts, lobules of the brest, acini.
In breast cancer, what cause the appearance of an orange peal on the surface of the breast? Subcutaneous lymphatic obstruction and tumor growth pull of ligaments in brest
In brest cancer, what can cause a hard, woody texture to the skin? Further subcutaneous spread.
Describe polythelia and polymastia. polythelia: additional nipple, polymastia = additional breast
Describe the sites for rib articulation superior costal facet:articulates with part of the head of its own rib. Inferior costal facet: articulates with part of the head of the rib below. Transverse costal facet: articulates with the tubercle of its own rib.
Why are ribs 1-7 true ribs? articulate directly with sternum
Why are ribs 8-10 false ribs? do not articulate with sternum but articulate with costal cartilage of above rib.
Why are ribs 11-12 floating ribs? they make no connection with other rib or sternum.
What lies in the costal groove? Intercostal nerves and associated major arteries and veins.
Describe the arrangement of nerves, arteries and veins in the costal groove. vein is most superior structure (highest in groove), then artery, then nerve. Between internal intercostal and innermost intercostal muscles.
Describe the superior thoracic aperature. Communicates with the neck and upper extremities and is bounded by 1st body of thoracic vertebra, 1st pair of ribs and costal cartilages, and jugular notch of sternum
Describe the inferior thoracic aperature. enclosed by diaphragm and bounded by 12th vertebra, 11th and 12th pair of ribs, Costal Cartilages of ribs 7th and 10th and xiphisternal joint
What innervates the diaphragm? C3,4,5
WHere is the diaphragm located? between the thoracic and abdominal cavity
What supplied the diaphragm with blood? superiorly from the pericardiocophrenic and msuculophrenic and inferiorly from the inferior phrenic arteries.
What are the two portions of the diaphragm? peripheral-muscular part, central - aponeurotic-central tendon
What are the four developmental components of the Diaphragm? Septum Transversum, pleuroperitoneal membrane, dorsal mesentery of the esopphagus and the lateral body walls
Where does the central tendon of diaphragm originate? septum transversum
Where does the musculature of diaphragm originate? 3,4, & 5 cervical myotomes
Where does the posterlateral part of diaphragm orginate? pleuro-peritoneal folds.
Where does the crura of diaphragm originate? dorsal mesentery of esophagus
Where does the peripheral part of diaphragm orginate from? sidewall mesenchyme
Why do C3, 4 and 5 supply the diaphragm? The diaphragm develops in the neck in week 4 of development and as the dorsal embryo body grows the diaphragm seems to decend.
What is congenital diaphragmatic hernia? absent pleuroperitoneal fold causes intestine and other viscera to pass into the thorax. Common on the left. Abdomen flat when lying down. underdeveloped lungs
What is retrosternal/parasternal hernia? hiatus located between sternal & costal parts of the diaphragm. Herniation of intestine into percardial sac
What is congenital hiatal hernia? Esophageal hiatus may be abnormally large.
What is eventration of diaphragm? caused by a defective musculature in one half of the diaphragm. That half goes up with contraciton of diaphragm during respiration.
Describe Thoracic outlet syndrome .:Pain in 4th and 5th finger due to pressure on lower brachial plexus (C8,T1) due to cervical rib. Also ischemic muscle pain in the upper limb (increasing pulse when limb raised)
What innervates the external intercostal muscles? intercostal nerves (T1-T11)
What is the external intercostal muscle function? inspiration
What innervates the internal intercostal muscles? intercostal nerves (T1-T11)
What is the internal intercostal muscle function? expiration
What innervates the innermost intercostal muscles? intercostal nerves (T1-T11)
What is the innermost intercostal muscle function? act with internal intercostal muscle
What is the function of the subcostales? may depress the ribs
Function of Transversus thoracis? Depress costal cartilages
What is increased during "pump handle" respiration? increases A-P dimension
What increases during "bucket handle"? 'increases lateral dimension
What is the path of the top two posterial intercostal arteries? subclavian-costocervical trunk-supreme IA-posterior intercostal
What is the path of the bottom 9 posterial IAs? thoracic aorta - posterior intercostal
Describe the path of the internal thoracic artery. subclavian, anterior over cervical dome of pleura, vertically through superior thoracic aperature, along internal surface of thorax. At 6th rib divides into superior epigastric and musclophrenic
Describe the path of viens that drain into the superior intercostal viens. anterior and posterior, hemiazygos and accessory hemiazygos vein drain into azygos
Describe the division of the ventral rami intercoWastal nerves. T1-11, lateral cutaneous (posterior and anterior) and anterior cutaneous
What is the function of the intercostal nerves? somatic motor to muscles, somatic sensory to skin and parietal pleura, postganglionic sympathetic.
What innervates the skin of the back? dorsal rami: posterior cutaneous branch
When performing nerve block to intercostal veins where should the anesthetic be applied? between internal intercostal and innermost intercostal muscles
What structures must be passes when performing a thoracocentesis. skin, superficial fascia,external inercostal muscle, internal intercostal muscle, (VAN under rib), innermost intercostal, endothoracic fascia, parietal pleura, pleural cavity, viceral pleura, lung
What are the contents of the Thoracic cavity? two pulmonary cavities and the mediastinum
Describe the pleura serous membrane which surrounds the lung, continuous closed system with two layers
What are the two layers of the pleura? visceral pleura and parietal pleura
What are the names given to the parietal pleura and what innervates them? costal pleura:intercostal nerves, mediastinal pleura: phrenic nerves, diaphragmatic pleura (central:phrenic, peripheral:lower5-6 intercostal) and cervical pleura: intercostal (dome of pleura)
What is a pleural recess? where two adjacent parietal pleura are in contact during expiration (filled with lungs during inspiration)
What are the two pleural recesses called? costomediastinal and costodiaphragmatic
What can cause a pneumothorax? stab wound, broken rib, bursting of an air sac.
What is pleuritis? Accumulation of inflammatory exudate within the pleura cavity
Where must a thoracocentesis be performed? 8th intercostal space in the mid-axillary line along the superior border of the rib
What does the cranial bend of the intraembryonic coelom give rise to? pericardial cavity
What does the bend at the limbs of the intraembryonic coelom give rise to? pleural and peritoneal cavities
What does the somatopleuric part of the intraembryonic coelom give rise to? parietal layer of serous pericardium, pleura and peritoneum
What does the splanchnopleuric part of the intraembryonic coelom give rise to? viceral layer of serious pericardium, pleur and peritoneum
What forms the fibrous pericardium? fusion of the pleuropericardial membranes folds
What forms the posterolateral parts of the diaphragm? fusion of the pleuro-peritoneal folds with the septum transversum and dorsal mesentary of esophagus
Describe the origin of the pleural cavity. pleural cavity-intraembryonic coelom, parietal pleura-somatic layer, visceral pleura-splanchnic layer
How many fissures does the right lung have? upper, middle, and lower
How many fissures does the left lung have? upper and lower
Describe the brochi branches. primary bronchus branches into secondary lobar bronchi which in turn branches into segmental bronchi. In the right there are 3 lobes and left 2.
Describe the relationship of the bronchus, artery and vein in the right and left. right:BAV, left:ABV
What is the root of the lung? Short tubular collection of structures that attach the lung to structures in teh mediastinum
What is the hilum? region outlined by the sleeve of medistinal pleura that covers the root
What is the function of the pulmonary ligament? stabilize the position of the inferior lobe and accomodate down-up translocation of structures in the root
What is found in each root and hilum? 1 pulmonary artery, 2 pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics
What separates the bronchopulmonary segments? upper and lower separate by oblique fissure, upper and middle separated by horizontal fissure.
What forms the oblique and horizontal fissures? invaginations of the visceral pleura
Where do the bronchial arteries branch from? left bronchial arteries arise from the thoracic aorta, the right brochial arteries arise from the third posterior intercostal artery or the upper left brochial artery
Where do the bronchial veins drain into? pulmonary veins or lef atrium OR azygos vein (right), hemiazygoes or superior intercostal vein (left)
Describe the lymphatic drainage of the lungs. intrapulmonary vessels and nodes - bronchopulmonary - tracheobronchial - paratrachial - bronchomediastinal - right thoracic trunk/thoracic - systemic venous system
Created by: mnoronha