Anatomy: Module 3
What is contained in the hilum?
- primary bronchus • pulmonary veins • pulmonary artery • bronchial vessels • pulmonary nerves • lymph vessels
lymphatic drainage of breast?
-75% to axillary lymph -medially via parasternal lymph nodes
Pericardium layers?
-Parietal pericardium -Parietal -Fibrouspericaridum (superficial)
what is the Thoracentesis? and our concern?
-Travel in ICS just inferior to rib (VAN) -avoiding damage to IC structures
L ventricle landmarks?
-bicuspid valve -aortic valve -chordae tendinae
Aorta pathway/branches?
-brachiocephalic trunk-->RCC & R subclavian -LCC -L subclavian
Landmarks of the female breast?
-circular base(ribs 2-6) -axillary tail(inferior border of pec to axilla)
2 pleural recesses?
-costodiaphragmatic (larger) -costomediastinal (antero-lateral)
Fibrous pericardium attachments?
-diaphragm -sternum via sternopericardial ligagment
L atrium landmarks?
-foramen ovale -pulmonary vein openings -bicuspid valve
Layers of the heart wall?
-myocaridum-cardiac muscle -endocardium-lining layer of heart chambers -epicardium-blends into visceral layer of serous pericardium
Intercostal veins drain to?
-posterior to azygos system (azygos/hemi/accessory hemi) -anteriorly into internal thoracic veins
R ventricle landmarks?
-tricuspid valve -papillary muscle/chordae tendinae -pulmonary valve
What is located at the sternal angle?
1)bifurcation of trachea(carina) 2)beginning and end of aortic arch 3) 2nd Rib
True Ribs & attachment
1-7 - attach directly to sternum
Floating Ribs
11 & 12
Which thoracic vertebrae do not have transverse facets?
11 & 12
How many thoracic vertebrae are there?
12
What does the costocervical trunk supply?
1st, 2nd ICS
Primary bronchi Lobar bronchi segmental bronchi
2 2 left, 3 right 10 each side
L lung anatomy?
2 lobes oblique fissure lingula & cardiac notch
R lung anatomy?
3 lobes - superior/middle/inferior 2 fissures - horizontal/oblique
R lung: How many bronchopulmonary segments/lobe?
3-superior 2-middle 5-inferior
Posterior intercostal arteries supply?
3rd-11th intercostal spaces (COMPLETE 10th&11th coverage)
Where is the nipple located? relation to apex of heart?
4th ICS -apex of heart just inferior medial to L nipple
False Ribs & attachment
8-10 - attach "indirectly" to sternum via 7th Rib
Which vertebrae only have 1 costal facet?
9-12
L Coronary artery branches
A-anterior interventricular/descending(supplies septum & left ventricle) B-Circumflex(supples L atrium/ventricle) C-Marginal(supplies L ventricle)
R coronary artery branches
A-nodal branches (supply SA/VA nodes) B-marginal(supplies R vntricle) C-posterior interventricular/descending(supplies R ventricle
The heart shadow will be widened in what chest x-ray view?
AP
Where does gas exchange start in tracheobronchial tree?
Acinus/respiratory bronchioles
Inferior mediastinum sections and contains what?
Anterior - internal thoracic vessesl, fat, lymph Middle - heart, pericardium, roots of great vessels Posterior - esophagus,descending aorta,thoracic duct,lymph nodes
vertical line along anterior axillary fold (formed by pec major)?
Anterior Axillary
What is the vertical line through sternum in mid-saggital plane?
Anterior median (midsternal) line
What is the most common site of Rib Fracture?
Costal Angle
Intercostal nerve pathway?
Exit spinal IVF--branches into anterior/posterior rami
Typical Rib Landmarks?
Head, Neck, Tubercle, Shaft, Costal Angle
Where is the Pulmonic area?
L 2nd ICS
Where is the tricuspid(area) auscultated?
L 4th or 5th ICS
Where is the Mitral/Apex?
L 5th ICS/midcalvicular line
Which intercostal veins drain directly to brachiocephalic trunk?
Left 1-4th intercsotals
Where is Erb's point?
Left 3rd ICS
vertical line though apex of axilla (armpit)?
Mid axillary line
What is the vertical through midpoints of the clavicles, parallel to median line?
Midclavicular lines (MCL)
vertical line through posterior axillary fold (formed by latissimus dorsi and teres major)?
Posterior axillary line
vertical line through spinous processes of vertebrae in mid-saggital plane?
Posterior median (midspinal or midvertebral) line
What is the most anterior valve?
Pulmonary semilunar valve
Left surface of heart also called?
Pulmonary surface
Where is the aortic area?
R 2nd ICS
Coronary Sinus drains INTO where?
R atrium
Base of the heart formed by?
R atrium(posterior aspect)
Azygos vein receives blood from where?
Right intercostals & hemi/accessory hemi veins
Conducting pathway of heart?
SA node >> AV node >> AV bundle(of his) >> bundle branches >> purkinje fibers
Azygos vein drains to?
SVC
SVC/IVC blood returns
SVC-from areas superior to diaphragm IVC-from areas inferior to diaphragm
R atrium landmarks?
SVC/IVC coronary sinus opening fossa ovalis tricuspid valve
vertical lines that pass through inferior angles of the scapula, line is parallel to posterior median line?
Scapular lines
Pulmonary trunk function?
Sends unoxygenated blood to the lungs
Mediastinum sections?
Superior/Inferior
Typical & Atypical Ribs (#'s)?
Typical: 3-9 Atypical: 1,2,10-12
Where do most breast cancers occur?
Upper outer (superior-lateral) quadrant
What is the pericardial cavity in between?
Visceral and Parietal pericardium (serous pericardium)
What is an accessory pattern?
abnormal pattern - "shrug" found in patients with COPD and other pulmonary diseases
What does the inferior aperture contain?
allows esophagus, IVC, aorta to pass to abdominal cavity
What does the internal thoracic artery supply
anterior 1-9th ICS
Superior mediastinum contains?
aorta/great vessels trachea esophagus
Coronary arteries originate where?
base of the aorta
Auscultation Ally location?
between midvertebral and scapular line
Where does the cartilage begin to dissappear in tracheobronchial tree?
bronchioles
What is the ridge of the bifurcation of trachea called?
carina
What is the ridge of the bifurcation of trachea called?
carina (@ sternal angle)
sternocostal joints connect?
costal cartilage and sternum
What are the thoracic branches of the subclavian artery?
costocervical trunk & internal thoracic artery
What is active during inspiration at rest?
diaphragm
What is active during inspiration in exercise(not extreme)?
diaphragm & external intercostals
What is active during inspiration in extreme exercsie?
diaphragm, external intercostals, SCM, scalenes, maybe PECS
Herpes Zoster (Shingles)
dormant virus in single segmental nerve
When does the aortic pressure create backflow? causing what?
early diastole filling of the coronary arteries to supply myocardium
What does the superior aperture contain?
esophagus, trachea, nerves and blood vessels to head/neck/UE
Transversus thoracis function?
expiration - depress ribs)
Layers of thoracic wall musculature superficial to deep?
external intercostals --> internal intercostals --> innermost intercostals
Coronary sinus receives blood FROM where?
great/middle/small cardiac veins and oblique vein of left atrium
What side of the rib articulates with the vertebrae?
head - via facets
What happens to thoracic wall during inspiration?
increase in AP & lateral diameter(bucket handle) and superior to inferior length
Diaphragmatic surface of heart - also called what?
inferior
subcostal artery supplies?
inferior to 12th rib
where does the trachea begin?
inferior to larynx(cricoid cartilage)
levator costarum function?
inspiration - elevate ribs
subcostal muscles function?
inspiration - elevate ribs
What does the anterior rami of intercostal nerves supply?
intercostal spaces
What veins drain the intercostal spaces?
intercostal veins
What is active during expiration in exercise?
internal intercostals & abdominals(rectus & obliques)
What are the borders of the costovertebral angle? What is located in it?
last rib(12) and spine Kidneys
Hemizygos and accessory hemizygos receive blood from where?
left 5th-12th ICS
Phrenic Nerve Action/innervation
motor/sensory to diaphragm (C3-5)
Where is the sternal angle located?
munbriosternal joint
Which pulmonary pleura lines the diaphragm?
parietal pleura
What are the branches of the thoracic aorta?
posterior intercostal & subcostal
costotransverse joints connect?
rib with transverse process
Costovertebral joint connect?
rib with vertebral body
costochondral joints connect?
ribs articulate with cartilage
Bones of the thoracic wall?
ribs, vertebrae T1-T12, sternum(manubrium/xyphoid included)
What is the hilum/root?
site where hte lung becomes covered by visceral pleura
Common landmarks of thoracic vertebrae?
spinous process, transverse process, costal facets, transverse costal facets
Regions of the diaphragm?
sternal/costal/lumbar
Anterior surface of the heart - also called what?
sternocostal surface
SC joint connection?
sternum and clavicle
Which layer or pulmonary pleura is deep?
visceral pleura
