Thorax: Wall, Pleura, and Diaphragm Flashcards by Maria Zepeda

Describe what makes up the throacic wall poterior, laterally, anteriorly

Posteriorly= 12 thoracic vertebrae
Laterally= 12 ribs on each side + 3 layers of flat muscle
Anterior= sternum (manubrium, body, xiphoid process

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approximately the same horizontal plane as the intervertebral disc between vertebrae TII and TIII.

superior aspects of the pleural cavities, which surround the lungs, lie on either side of the entrance to the mediastinum

Superior Thoracic Aperature

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Lower opening into throax. Closed by the diaphram.
* T12 vertebrae
* Xyphoid process anteriorly

inferior thoracic aperture

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seals the inferior thoracic aperture domed

Diaphram

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thick midline partition that extends from the sternum anteriorly to the thoracic vertebrae posteriorly, and from the superior thoracic aperture to the inferior thoracic aperture.

Mediastinum

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The inferior mediastinum is further divided by the ___ this is called the ___ mediastinum

Pericardium which encloses the heart; middle mediastinum

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What does this do?

Horizontal line passing through the sternal angle and the intervertebral disc between vertebrae TIV (4) and TV (5)

separates the mediastinum into superior and inferior parts

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The ____ mediastinum lies between the sternum and the pericardium

In front of heart, behind sternum

Anterior mediastinum

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The ____ mediastinum lies between the pericardium and thoracic vertebrae.

Contains blood vessels, esophagus, in front of verterbral bodies.

Vertebral bodies

posterior mediastinum

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Situated on either side of the mediastinum, holds the lungs.

Right and Left

pleural cavitys

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Location of the heart

Middle Mediastinum

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The mediastinum the region bewteen the lungs:

Anterior:
Posterior:
Superior:
Inferior:

Anterior: Sternum
Posterior: Vertebral bodies
Superior: thoracic apeture
Inferior: diaphram

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What are the 3 Major landmarks used to divide the mediastinum

Sternal Angel, Pericardium, Mediastinal Pleura

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WHat are the 3 functions of the thorax?

Breathing (inspire/expire)
Protection to vital organs (lungs/heart/vessles)
Conduit (lots of structures in and out of it)

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A vertical line starting mid clavical down to Rib 8 and on

Midclavicular Line

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Vertical line running from the center of the axilla down!

Midaxillary Line

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Simple squamous epitherlium; serous membrane

Pleura

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Wall of pleural cavity

touches outside of body

Pareietal Pleura

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Surface of the lung

on top of lungs

Visceral Pleura

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Potential Space

Pleural Cavity

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Serous fluid in pleural space

Lubricates lungs and tissues

Pleural Fluid

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Seperates the superior and middle lobes at the level of the 4th innercostal space

Only right lung

Horizontal Fissure

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Seperates middle and inferior lobe at the level of the levels of the **5th innercostal **space and contours rib #6

Oblique Fissure

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When a doctor meausures breathing with a stethascope, where does it have to be placed?

Above the oblique fissure above rib #6

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The lungs have what lobes and which lung has an extra lobe?

Both have a **superior** and **inferior** lobe, **right lung has a middle lobe**

What is the base of the lungs?

The diaphram

Where is the apex of the lungs?

Above rib #1 and root of the neck

Where is the root of the lungs? Covered by what?

short attachment connecting lung to mediastinal structures covered by mediastinal pleura

What is the hilum of the lungs?

medial surface of lung where structures enter and leave | Pulmonary artery, veins, & bronchus

# Contents within the hilum 1 within each hilum, recieve deoxygenated blood | Superior at hilum

Pulmonary arterys

# Content of the hilum 2 within each hilum, push out oxygenated blood out of lung. | Inferior at hilum

Pulmonary Veins

# Content of hilum 1 in each bronchis, branch out into primary, secondary, tertiary, | Posterior at hilum

Bronchus

What are the 6 contents of the hillum?

▪ a pulmonary artery, ▪ two pulmonary veins, ▪ a main bronchus, ▪ bronchial vessels, ▪ nerves, and ▪ lymphatics.

What two vessels pass over the superior lobes of the lungs?

Right & Left subclavian artery & vein

Form the apex of the throax, root of the neck. A LOT of important veins, arterys, nerves run through here.

Thoracic Inlet

What are the 5 great vessles that exit the throacic inlet?

1. Left common carotid artery 2. Left sublavian (up and over) artery 3. RIght Brachiocephalic trunk 4. RIght Brachiocephalic vein 5. Left brachiocephalic vein (transiton into Left subclavian)

What is posterior to the trachea and also exits out of the throacic inlet?

The esophagus

Next to apicies of the lungs, anterior to the esophagus, posterior to the manubrium of the sternum

Trachea

Nerves that exits out of the thoracic inlet next to the brachiocephalic artery and left common carotid artery

Vagus Nerve; C10 | main nerve of your parasympathetic nervous system (rest)

Nerve that **innervates the diapharam** (motor movement) , damage to this nerve can results in loss of inspiration and expiration functionality of the diaphram . Exits **Thoracic inlet bilaterally, posterior to the R & L brachiocephalic veins**

Phrenic Nerve (C3, C4, C5)

Skeletal Muscle that forms inferior margin of the thorax. Domed shaped

Diaphram

What is the significance of the dome shape of the diaphram when it comes to trauma?

It works with inhilation and exhailation; trauma to the diaphram can result in lossing the ability to break

The skeletal muscle of the diaphram (on periphery) inserts into a what? All muscles attached

Central tendon

What are the 3 orgins of the diaphram skeletal muscle?

1. Sternum; styloid process 2. Costal; cartilage & bones of rib 7-12 3. Lumbar

# Region of the Diaphram Over the top of the psoas muscle and quadratus lumborum, that attach to te vertebrae L2

Medial Acurate Ligmanet

# Region of the Diaphram Ligament that is betwen ribs 11 and 12 on both sides. Over Quadratus Lumborun

Lateral Acurate Ligament

# Region of the Diaphram Part of th arucate ligament that travels up and extends up above aortic hiatus, looping and coming back do to attached to the body of the L3.

Right Crus

# Region of the Diaphram Part of the arucate ligament that that attached to the vertebral body of L2

Left Crus

# Region of the Diaphram Arch shape band of tissue that forms the opening of the aoritic hiatus

Median Acurate Ligament

What nerve innervates the diaphram?

Phrenic nerve C3,C4,C5 | keeps you alive!

Where is the acurate Ligament?

Between ribs 11 & 12

Thick fiborus band that goes between ribs 11 and 12

Arcuate ligament

The **Arcuate ligament **crosses over which deep back muscles?

* Quadratus lumborum * Psoas

Bilateral Ligament on the diaphram that is **Anterior to the psoas**

Medial arcuate Ligament

What region of the diaphram forms the esophogeal hiatus?

The right Crus

What ligament froms the aortic hiatus?

Median arcuate ligament

What part of the arcuate ligament goes over the quadratus lumborum?

Lateral Arcuate Ligament

What part of the arcuate ligament goes over the Psoas?

Medial Arcuate Ligament

What is the path of the phrenic nerve down to the diaphram?

* Down bilateraly through superior thoracic inlet (next to r & l brachiocephalic veins) * Pass next to pericardium * Come down and peice the Diaphram; inneravating the underside.

How does the **right phrenic** nerve enter the diaphram?

Through the **Caval opening**; next to inferior vena cava

How does the **Left phrenic** nerve enter the diaphram?

Just **pierces** the diaphram.

# What diaphram opening? Opening at T8 * Inferior vena cava * Right Phrenic Nerve

Caval Hiatus

# What diaphram opening? Opening at T10 * Esophagus * Vagal trunks (from vagus nerve 10) * Esophageal branches of left gastric arterty

Esophageal Hiatus

# What diaphram opening? Opening at T12 * Aorta runs through * Thoraci Duct * Azygous vein (drains throax)

Aortic Hiatus

**Sypathetic trunks ** run close the vertebral body and** posterior to which ligament** in the diaphram?

Medial Arcuate Ligament

# What Vertebrae is each hiatus at? Caval? Esophageal? Aortic?

1. Caval= T8 2. Esophageal= T10 3. Aortic= T12

What pierces the right and left crus?

Splanchic Nerves

a collection of gas or air within the pleural cavity; Tissue elasticity causes lung to collapse!

Pneumothorax

the gas within the pleural cavity may accumulate to such an extent that the **mediastinum is “pushed” to the opposite side, compromising the other lung** urgent tx

tension pneumothorax

Can occur spontaneously or due to trauma, inflammation, smoking and other underlying pulomary diseases

Causes of pneumothoraces

Certain pulmonary metastases, such as in patients with osteosarcoma, may cause ____ ____ especially **After chemotherapy. ** the occurrence of this interferes with cancer treatment and increases mortality.

Spontaneous Pnenumothorax

Symptoms of pneumothorax?

* Pain, shortness of breath, and cardiorespiatory collapse if severe.

Ribs 1-7 attach directly from vertebrae to the sternum

True Ribs (1-7)

a noninflammatory collection of serous fluid within the pleural cavities. The effusion is clear and straw colored. unilateral or bilateral. The most common cause is cardiac failure

Hydrothroax

a collection of blood in the space between the chest wall and the lung (the pleural cavity)

Hemothorax

Ribs 8-10 joined anteriorly via costal cartilage, attached posteriorly to respectve vertebrae.

False Ribs (8-10)

RIbs 11 & 12, attached to respective vertebrae, free ventral end.

Floating Ribs (11-12)

# What part of sternum? articulates with clavicle & costal cartilage of 1st rib

Manubrium

# What part of sternum? Articulates with ribs 2-7 via costal cartilage

Body

# What part of sternum? Tip, articulates with rib 7

Xyphoid Process

What runs throught the costal groove of each rib?

1. Innercostal vein, artery, nerve

What part of the rib attaches to the dens facet for articulation on each vertebrae?

Head of rib

What part of ribs ____ attach to transveres proces of thoracic vertbrae?

Tubercle

The space between each ribs

Innercostal Space

Spinal nerve that comes off and runs in the costal groove of ribs, with sevreral branches Can be anterior or posterior

Innercostal nerve

Posterior branch of innercostal nerve will give off what branch?

Lateral Cutaneous Branch

Anterior branch of the innercostal nerve will give off what branch?

Anterior cutaneous branch

Hold together and are involved with movement of the ribs, i Innervated by innercostal nevres T1-T11

Intercostal muscles

* Inferior medial orientation (hands in pockets) * Most active in **inspiration, move ribs superiorly.**

External intercostal muscles (most superficial)

Opposite orientation to external intercostal, inbetween **Pull ribs down for exhalation**

Internal Innercostal Muscles

Run on posterior aspcect of costal groove, run same orientation as internal Most active during **expiration, moves ribs inferior**

Innermost Intercostal Muscles

Between internal and innermost intercostal muscles this is where what runs?

Intercostal Vein, Artery, Nerve (top to bottom) VAN

# What kind of repsiratory movment? Superior and** anteior** movement of the sternum when you inhale.

Pump Handle

# What respiratory movement? **Lateral **upwards movement of the shaft of the ribs when inhaling

Bucket handle moment

**Posterior Innercostal** arterys from ribs 3-12 come off what?

Aorta

anterior branches of arterys come off where?

Anterior Innercostal arterys

The anteior and posterior innercostal arterys join in a ? Lots of blood when bleeding

Anastamosis

What is the significane of an anastamosis ?

Allow for flow from one or more sources, helps compensates with obstruction. Alternative pathways of blood

Narrowing of an artery

Stenosis

Series of highly variable viens that dump into the throax into the =

Azygous System

Right vein, main vein that dumps blood from the right innercostal veins, into the SVC returning blood to the heart.

Azygous vein

2 main veins on left side of thorax where all left innercostal veins return blood too.

* Hemiazygous vein * Acessory hemiazygous vein

Both the and Hemiazygous vein and acesory hemiazygous vein dump into what?

The azygous vein

# What dermatome? Nipples

# What dermatome? Xiphoid Process

# What dermatome? Umbilicus

T10

Thorax: Wall, Pleura, and Diaphragm Flashcards

(106 cards)