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Thoracic wall and diaphragm (anat) Flashcards

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1
Q

Components of the STA

A

1st thoracic vertebra

1st pair of ribs and their costal cartilages

Superior border of manubrium

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2
Q

Components of ITA

A

12th thoracic vertebra

Lower 6 costal cartilages

Xiphisternal joint

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3
Q

What is a thoracotomy?

A

Surgical procedure for opening the thoracic wall in order to access the lungs, esophagus and trachea

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4
Q

What are the structures that pass through the STA/thoracic inlet?

A

Trachea, esophagus, apex of lungs and it’s pleura

Nerves -> phrenic, vagus, recurrent laryngeal, sympathetic trunks

Blood vessels -> brachiocephalic trunk, left common carotid artery, left subclavian artery, internal thoracic (mammary) arteries, brachiocephalic veins

Lymphatics -> thoracic duct

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5
Q

What is the thoracic outlet?

A

Space btw the clavicle and first rib

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6
Q

What is thoracic outlet syndrome (TOS)?

A

Group of disorders that occur when blood vessels/nerves in the space btw the clavicle and first rib (thoracic outlet) are compressed, causing pain in shoulders and neck and numbness in fingers

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7
Q

What is the sternum?

A

Flat, long, elongated bone in anterior part of the thoracic skeleton/cage

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8
Q

Where is the sternal notch located?

A

In btw the 2 clavicles

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9
Q

What is the 3 parts of the sternum and where they are located?

A

Manubrium
- piece above the sternal angle

Body of sternum
- middle piece below sternal angle

Xiphoid process
- small triangle below the body of the sternum

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9
Q

Alternative name for sternal angle

A

Angle of Louis

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10
Q

Where is the angle of Louis located?

A

At the level of the 2nd sternocostal joint -> corresponds to T4/T5 vertebra
- indicates 2nd rib

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11
Q

Where is CPR conducted over?

A

Center of sternum

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12
Q

Describe the shape of ribs

A

Curved and flat bones

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13
Q

Features of ribs

A

Light weight and highly resistant

Contains hemopoietic tissue -> form blood cells

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14
Q

Types of ribs and which ribs are which

A

Typical
- 3 to 9

Atypical
- 1 and 2
- 10 to 12
- (first 2 and last 3)

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15
Q

Components of typical rib

A

Head (2 facets) -> wedged shape
- located posteriorly

Neck -> lateral to the head of the rib
- subsequent portion

Tubercle -> see at jn of neck and shaft

Shaft -> curved portion of rib
- curves at costal angle
- thin and flat

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16
Q

Where is the costal/subcostal groove located?

A

On the internal surface of typical rib

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17
Q

Fn of costal groove

A

Protects the intercostal vein, artery and nerve (neurovascular bundle)

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18
Q

Describe the articular facets on the head of the rib

A

Smooth

Correspond w/ transverse process of vertebra

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19
Q

Where is the non-articular surface of rib located?

A

On the tubercle

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20
Q

Describe the non-articular surface of the rib

A

Rough

Attached to ligament

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21
Q

Characteristic of atypical ribs

A

Dissimilar

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22
Q

Describe the 1st rib

A

Broadest and shortest

Most sharply curved of the 7 true ribs

2 grooves crossing superior surface for subclavian vessels
- separated by scalene tubercle and ridge

Only 1 facet

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23
Q

Describe the 2nd rib

A

Thinner, less curved and much longer than the 1st rib

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24
Describe the 10th-12th rib
Only 1 facet on their heads 11th and 12th ribs are short and have no neck/tubercles
25
Where are the costal facets of the thoracic vertebrae located?
On their bodies -> articulate w/ heads of ribs Transverse processes -> articulate w/ tubercles of ribs
26
Which thoracic vertebrae have no costal facets on their transverse porcesses?
T11 and 12
27
Diff btw synovial, cartilaginous and fibrous joints
Synovial joints allow more movement than cartilaginous joints Fibrous joints are usually fixed and immovable and have no joint cavity
28
Where are the synovial joints of the thoracic wall?
Btw ribs and vertebrae -> costovertebral and costotransverse joints Btw sternum and clavicles -> sternoclavicular joints
29
Features of external intercostal muscle (EICM)
Run downwards and forwards - drn is like placing hand in pocket Elevate the ribs due to contraction of muscles Muscles for inspiration
30
Features of internal intercostal muscles (IICM)
Deep to EICM Run downwards and backwards -> perpendicular to EICM Depress the ribs due to contraction of muscle Muscle for expiration
31
How many pairs of thoracic spinal nerves does the thoracic wall have?
12
32
What are the branches of intercostal nerves?
Anterior cutaneous - sensory Lateral cutaneous - sensory Muscular - motor Collateral - motor nerves - run along upper border of rib
33
Which nerve supplies the back muscles (located posteriorly)?
Dorsal pri rami
34
What happens when spinal nerve leave the intervertebral foramina?
Divide into ventral pri rami and dorsal pri rami
35
Is the ventral pri rami an intercostal nerve?
Yes - runs along extent of intercostal space - anterior rami
36
What is general somatic efferent (GSE)?
Nerve -> motor to skeletal - ventral horns (anterior) contain the cell bodies of motor neurons which innervate skeletal muscle
37
What is general somatic afferent (GSA)?
Nerve -> sensory from skin - dorsal horns contain the cell bodies of sensory neurons where many afferent (sensory) fibres terminate - convey sensation from skin to dorsal horn
38
Where does the intercostal vessels and nerves run?
Obliquely in btw internal and innermost intercostal muscle
39
Each intercostal space contains which intercostal arteries?
Posterior intercostal artery (PIA) Anterior intercostal artery (AIA)
40
Where does AIA arise from?
From internal mammary artery (IMA) or its terminal branch (aka: musculophrenic artery)
41
Where does the PIAs of upper 2 spaces arise from?
Costocervical trunk -> branch of subclavian artery
42
Where does the PIAs of IC spaces 3-11 arise from?
Thoracic aorta
43
Location of subclavian artery
Superior to the lungs on both sides
44
What does the subclavian artery bifurcate into?
Superior epigastric artery and musculophrenic artery
45
Where is the superior epigastric and musculophrenic artery located?
At 6th intercostal space
46
What is the artery and vein that runs along the length of the lungs medially?
Internal mammary artery and vein
47
What are the diff intercostal veins?
Superior vena cava (SVC) Azygos vein Brachiocephalic vein Anterior intercostal and internal mammary veins
48
Where do the anterior intercostal veins drain into?
Internal mammary veins
49
Where does the posterior intercostal veins drain into?
Azygos venous sys/brachiocephalic veins
50
Where does the azygos vein terminate?
SVC
51
Where is the azygos vein located?
On the right side of vertebral column (pt's right)
52
Where is the right and left brachiocephailc vein located?
Neck region - merge to form SVC
53
Where does the midsternal line run along?
Intersection of median plane w/ anterior chest wall
54
Where does the midclavicular line run along?
Pass through midpoints of clavicle (heart apex beat)
55
Where does the anterior axillary line run along?
Runs vertically along anterior axillary fold - side of body anteriorly
56
Where does the posterior axillary line run along?
Runs vertically along posterior axillary fold - side of body in the middle
57
Where does the midaxillary line run along?
Runs from apex of axilla, parallel to anterior axillary fold - side of body posteriorly
58
What does the breast consist of?
Mammary gland tissue, fibrous tissue, ligaments, septa and fat
59
What are the arteries that supply the breast?
Internal mammary artery -> perforating branches Anterior intercostal arteries Lateral thoracic branch of axillary artery
60
What are the veins that supply the breast?
Internal mammary veins Intercostal veins -> posterior and anterior Axillary vein -> lateral thoracic tributary
61
What are the lymphatic of the breast?
Internal thoracic nodes Axillary nodes
62
Innervation of the breast
2nd to 6th intercostal nerves
63
Innervation of the nipple
4th intercostal nerve
64
What are the mammary glands of the breast and where are they located?
Modified sweat glands Subcutaneous tissue anterior to the pectoral muscles and the anterior thoracic wall
65
What does estrogen do?
Controls the growth of the ducts
66
What does progesterone do?
Controls the growth of the glandular buds
67
How is the base of the breast attached to the body?
Extends vertically from ribs 2 to 6 and transversely from sternum to midaxillary line
68
What does the retromammary space in the breast do?
Separates breast from deep fascia -> allows for movement of breast from chest wall
69
What are the suspensory ligaments of Cooper?
Fibrocollagenous connective tissue that provides support to the breast
70
Signs and symptoms of breast cancer
Breast lump/thickening that feels different from surrounding tissue Change in size, shape/appearance of breast Changes in skin over the breast Newly inverted nipple Peeling, scaling or crusting of pigmented area of skin surrounding the nipple/breast skin Redness/pitting of skin over breast (like orange skin)
71
What is a mammogram?
Radiological examination of breast to screen breast cancer
72
Where do muscular fibers of diaphragm arise from?
Xiphoid process, lower ribs and upper lumbar vertebrae
73
Where do muscular fibers converge to?
Central tendon
74
Does each dome of the diaphragm have a separate nerve supply?
Yes
75
Where does phrenic nerve arise from?
Anterior rami of C3-C5 nerve roots
76
What does the phrenic nerve consist of?
Motor, sensory and sympathetic nerve fibers
77
What does the phrenic nerve do?
Provide complete motor innervation to the diaphragm Provide sensory innervation to central part of diaphragm Provide sympathetic innervation to blood vessels
78
What are the structures that pass through the openings in the diaphragm and which level they enter from?
Inferior vena cava (IVC) -> T8 Esophagus -> T10 Aorta -> T12 *except for aorta, no. of letters = spinal level it arises from
79
Structures passing through the diaphragm and spinal level it arises from
Vagus nerve -> T10 Thoracic duct -> T12 Azygos vein -> T12
80
Movement of thoracic wall during inspiration results in what changes to the diaphragm?
Increased vertical and transverse diameter
81
Why does thoracic cage widen during inspiration?
Ribs are elevated
82
Why does thoracic cage narrow during expiration?
Ribs are depressed
83
What is congenital diaphragmatic hernia (CDH)?
Condition resulting from a developmental defect in the diaphragm leading to protrusion of abdominal contents into thoracic cavity
84
Characteristics of babies w/ CDH and why
Have small, underdeveloped lungs and low blood O2 as movement of abdominal organs into fetus' chest crowds its lungs

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