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THORAX female chest Ø 3 types of tissue - o fibro o fatty o glandular – mammary gland Ø Tail of Spence AKA axillary tail Ø lactiforous glands – milk producing glands Ø lactiforous duct – Ø lactiforous sinus – storage Ø glands connected to outer covering of pectoralis major by suspensory ligaments · these form the brachial plexus Ø arterial/venous supply o internal thoracic artery/vein – med supply o lateral thoracic artery/vein – lateral supply of breast tissue
lymphatic system of the breast Ø good network Ø nodes – filtration sys where lymph fluid goes through to trap particles, bacteria, etc… Ø large amount of nodes in the axillary region Ø breast tissue under direct control of hormones Ø glandular tissue has a faster cell cycle o mammary gland population will go through cell cycle faster due to hormones when it produces cells that fast it may produce abnormal cells more often o could be benign or malignant o malignant cells can eat through the vascular network & could get to the lymph nodes & system =>vascular sys =>diff areas of body = matastisy o most of malignancy are found in the Tail of Spence (45%) 45/15/10/5% cw from T.o.S.
Anterior Chest Wall Ø skin Ø superficial fascia Ø pec major – o more of a connection to an mover of upper extremity rather than part of the thoracic wall Ø pec minor – o deep o small Ø lat/med pec nerve – these for the brachial plexus o lateral pectoral nerve – § supplies pec major o medial pectoral nerve – § pierces minor § feeds major
Osteocartlagenous Thoracic CageØ cone shaped Ø bottom covered by the diaphragm muscle Ø ribs attach to sternum by hyline cartilage (can move) Ø protects interior stuff Ø 12 pairs of ribs Ø superior thoracic aperture (aka - thoracic inlet) Ø inferior thoracic aperture (aka - thoracic outlet) Ø beginning @ rib 8 – attaches to a cart bar that 8-10 attach to – not to sternum o called false ribs = 8-12 o 11 & 12 no anterior connection – § called floating ribs
SternumØ 3 parts make up the sternum – o manubrium o body o xyphoid Ø over time time it fuses to become one bone Ø sternal angle (aka – Angle of Louie) o b/w manubrium & body Ø jugular notch
Intercostal MusclesØ external intercostal muscles o “hands in pocket” \\\\ll//// o pick up ribs in inspiration Ø internal intercostals o runs in opposite direction ////ll\\\\ o pulls down ribs in expiration Ø innermost intercostals o runs in the same direction as internal intercostals o 3 different areas § medial – transverse thoracus § lateral – innermost proper § posterior – sub costalus Ø intercostals nerve o runs b/w internal & innermost muscles o supplies intercostals Ø thoracic cage increases size during inspiration o a-p = “pump handle” o trans = “bucket handle” Ø arterial/venous supply – o thoracic aorta § posterior intercostals arteries o internal thoracic artery § connects w/ post intercostals artery (anastomes) § at 7th rib splits ü superior epigastric – continues straight down ü musculophrenic – diaphragm Ø nerve supply o out of each IVF to each intercostals space o run within, just post & inferior to rib above o thorocentesus – entry of needle to thoracic cavity to withdraw fluid Ø parietal pleura o internal covering of cavity wall o serrous or fluid producing o subdivided ü diaphragmatic parietal pleura – on diaphragm ü costal p.p. – on ribs ü cupola p.p. – in neck region o transversalis fascia – “glue” – ü what keeps it there ü holds pleura to cage wall DiaphragmØ floor of thoracic cavity Ø musculotendonous dome; striated (skeletal) muscle o steep dome meets @ costal arch/ bottom of rib cage/? Ø changes shape of thoracic cage in sup/inf diameter Ø when increase size of chamber = pressure decreases inside Ø central tendon – Ø under voluntary contraction Ø contraction causes inspiration Ø costodiaphragmatic recess – o where diaphragm meets body o wall gravity dependent Ø connected to ribs 10-12 & vertical column Ø 3 major openings that allow structures to pass from thoracic to abdominal cavity
Ø crura extension merge w/ A.L.L. to make R/L crus “leg” border of aortic hiatis Ø arterial/venous supply to diaphragm o internal thoracic artery (inside thoracic cage) o inf phrenic artery (underside of diaphragm) Ø clinical features o w/ any opening = possibility of weakness or herniation o esophageal hiatus § most common anomaly usually abdominal structures move upwards = hiatal hernia § 2 types · castroesophageal hernia o cardiac portion of stomach pushes up esophagus from underneath · paraesophageal hernia o stomach goes through hole alongside esophagus
Contents of Thorax
Ø 3 cavities o R/L pleura – lungs o mediastinum - heart (don’t forget to review previous notes about visceral & parietal pleura—wall paper on room’s walls vs. someone walking in OR fist into side of an inflated balloon) Ø root (aka hilus aka hilum) o where parietal pleura meets visceral pleura Ø transversallis fascia o “glue” keeps pleura on wall Ø visceral pleura is directly attached to lungs – no glue Ø pleural cavity o “potential space” b/w vis & parital o in this space – serous fluid to reduce friction o naming pleura depends on where it’s found § diaphragmatic p.p. – “floor” - diaphragm § costal p.p. – “walls” – ribs & intercostals muscles § cupola (aka cervical p.p.) – “ceiling” – neck
Ø lungs o on palpation – feels spongy due to air spaces = alveoli (bunch of grapes) o 2 lungs – right & left o cone shaped *(rule of 3 & 2 – usually on rt side of body things are in 3’s and on left 2’s) o lobes
§ both have apex (sup) & base (inf) o left lung § lingual – in superior lobe · tongue-like extension · maybe a 3rd lobe? some say yes § cardiac notch § cardiac impression § deep depression for left ventricle
o each lobe subdivided into lobules (aka bronchopulmonary segments) § numbered 1 thru 10 for each lung o trachea § delivers air to lungs § subdivided onto bronchi (aka primary bronchi) (aka principal bronchi) · subdivided into secondary bronchi (aka lubar bronchi) o on rt = 3 left = 2 o subdivided into tertiary bronchi (aka segmental bronchi) (aka lobular bronchi) § feeds corresponding lobules § these lobules are anatomical segments
§ foreign objects tend to go down to the right lung due to it having the first branch off the trachea & it goes straight down
o arterial/ venous supply § segmental artery § segmental vein
§ inside would be ten’s of thousand’s of alveoli § majority of alveoli found near visceral pleura § there are vessels for respiration (around alveoli) and those that supply the lungs § vessels for O2/CO2 exchange · pulmonary artery – carries un-oxygenated blood (opposite of normal) · pulmonary vein – highly oxygenated blood
o there is cartilage tissue around all air passages except bronchioli § surfactant (chemical fluid) takes over here so bronchioli don’t collapse
o lymph nodes § extensive system § purpose – filtration § if open you would see carbon § viewable along bronchi
o mediastinum § line from sternal angle to T4&5 IVD and from xyphoid process to T9 § creates a system of chambers § divided into: · superior mediastinum · inferior mediastinum o anterior ms § post to sternum § ant to cardiac sac o posterior ms § post to pericardiac sac o middle ms
§ why divided? There are vital components and like everything one doc needs to be able to talk accurately to another doc o contents of chambers: § superior · ? § middle · heart, root (aka hilus), phrenic nerves § anterior · fatty pad, thymus gland (produces t-lymphocytes [white blood cells] important to immune system)
o heart § from outside in · fibrous layer>parietal pericardium>parietal cavity>visceral layer (this needs double checked) § cardiac cavity · oblique pericardial sinus · transverse paracardial sinus sup? § pericarditis = inflammation due to friction via parietal & visceral layers § How did heart get in surrounding tissue? · developed @ 3 weeks embryo · like putting fist into wall of inflated balloon · at root (aka hilus) parietal & visceral layers are continuous (sup vena cava, pulmonary trunk, etc..) § 3 layers · epicardium = what cardiologists call visceral pp · myocardium = muscular layer of heart · endocardium = lining inside of heart o direct contact w/ blood o very rough surface – catches particulate matter § pectinate muscle – roughing area · creates turbulence and filters blood to some extent § valve of inferior vena cava – lip of tissue · important while an embryo (fetal circulation) § fossa ovalis – oval depression · embryonic – used to be opening called foramen ovale = from right to left atrium § sinus venarum – smooth are or wall of rt atrium § opening for the coronary sinus -? § rt atrioventricular opening – opening b/w rt atrium & ventrical § rt atrioventrical valve – (aka tricuspid valve - due to 3 parts) § crista terminalis – b/w pectinate & smooth tissue on wall of rt atrium § rt auricle – · looks like an ear flap · different from rt ? · contains portion of rt atrium · possible storage area for blood § rt ventricular valve – · blood moves in · 3 leaflets or cusps making up valve § rt ventrical · has roughened & smooth wall § trabeculae carne – · rough wall · rougher than pectinate § papillary muscles – · continuations of trabeculae · each strand is covered by endothelium § chordae tendinae – · connects from pappilary mus to cusps · makes sure cusps on valve don’t invert § septomarginal trabiculae · landmark of ant papillary mus to intraventricular septum · within lies a conducting system (aka moderator band) § blood out of rt vent > conus arteriosis (cone shaped) > pulmonary trunk > pulmonary semilunar valve · semilunar valve o 2 parts – nodule (raised) & lunule (edge) § blood back from lungs > left atrium via pulmonary veins · smooth walls w/ exception of 2 auricle · can see fossa ovale § > left atrioventricular valve (aka bicuspid valve aka mitral valve) § > lt ventrical · thickest & roughest myocardial wall (has to pup to all of body) · valve o aortic semilunar § cusps, chordate tendinae, papillary o ascending aorta - 3 cusps o just above valve are 2 osteum – origin of coronary arteries § blood enters during vent diastole (when valves shut)
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