GA-8-21-06
Terms
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- Borders of Thoracic Cavity
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Posterior = thoracic vertebrae and IV discs (12)
Anterior = sternum
Lateral and Interior = ribs - True Ribs
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- ribs 1-7
- articulate with sternum via condyl cartilage
- - False Ribs
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-ribs 8-10
-condyl cartilages fuse together and join w/ 7th rib to articulate to inferior aspect of body of sternum - Floating Ribs
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- ribs 11 and 12
-no cartilages connecting them to sternum but do have cartilaginous ends
-float freely in lateral aspects of anterior abdominal wall - Atypical Ribs
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-ribs 1, 2, 11, and 12
-1st rib is shorter and broader than other ribs and fuses to sternum via cartilaginous joint, most sharply curved of the 7 true ribs
-ribs 11 and 12 don't articulate w/ sternum, short and have no necks or tubercles
-2nd rib is thinner, less curved, and much longer than 1st rib, has 2 facets on its head for articulation with bodies of T1 and T2 vertebrae - What thoracic vertebrae is the manubrium located opposite?
- 3rd and 4th
- What thoracic vertebrae is the sternum located opposite to?
- 5th - 9th
- What thoracic vertebra is the xiphoid process located opposite to?
- T10
- Parts of the sternum
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Manubrium
Body
Xiphoid Process -
Which of the following muscles is not an accessory muscle for respiration:
pectoralias major, pectoralis minor, serratus anterior, latissimus dorsi, scalene muscles - Latissimus dorsi
- What is the angle between the manubrium and the body of the sternum called?
- Sternal Angle/ Sternal Angle of Louis
- Superior Aperture of Thorax
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-provides a space for traches, esophagus, vagus nerve, and great vessels to pass into thorax
-6.2 cm in anterior-posterior direction and 11 cm across - Boundaries of Superior Aperture of Thorax
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-1st thoracic vertebra
-first two ribs
-superior border of manubrium - Inferior Aperture of Thorax
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-larger than anterior aperture
-IVC, abdominal aorta, nerves, and lymphatics pass through here - Boundaries of Inferior Aperture of Thorax
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-inferior borders of 11th and 12th ribs
-costal cartilages anteriorly
-xiphoid process - Parts of a Typical Rib (3-9)
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-Head - w/ 2 facets that articulate to thoracic vertebrae
-Neck - connects head to body
-Tubercle - between connection of ribs head to body, provides for articulation w/ transverse process of thoracic vertebrae, rough area is for costal transverse ligament which holds that joint in place
-Angle - weakest part of rib
-Costal Groove - contains and protects intercostal VAN - Costal Transverse Ligament
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-attaches to rough part of tubercle on rib
-holds joint of rib to transverse process in place - Costal Groove
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-on inferior part of rib
-contains and protect intercostal vein, artery, and nerve - Jugular Notch
- -located at most superior aspect of manubrium
- What all does the first rib fuse with?
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1. Clavicle (synovial joint)
2. Body of Sternum (cartilaginous joint) - What kind of joints are the articulations of costal cartilages to the sternum?
- synovial joints
- What kind of joint is formed by the articulation of xiphoid process to sternum?
- cartilaginous
- What kind of joint is the attachment of the tubercle of the rib to the transverse process?
- synovial joint
- What kind of joint is the attachment of the rib to the body of the vertebra?
- synovial joint
- What is the major muscle of respiration?
- Diaphragm
- Phrenic Nerve
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-originates for C3-C5 (mainly C4 and C5)
-descends through neck, in thoracic cavity descends along lateral aspect of paricardial sac
-terminates on either side by ending in diaphragm
-innervates diaphragm - External Intercostal Muscles
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-run from the rib above it anteriorly and inferiorly to attach to the rib below it
-when contracted, elevate ribs - Internal Intercostal Muscles
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-deep to external intercostals
-depress ribs - Innermost Intercostal Muscles
- -deepest of the intercostal muscles
- Intercostal Nerve
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-primary ramus which extends laterally, all the way anteriorly
-innervates wall
-runs between Internal Intercostal muscles and innermost intercostals in a groove along w/ the artery and vein - Subcostal Muscles
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-attach from a superior rib inferiorly and cross one or two intercostal spaces
-variable - Indothoracal Fascia
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-lines all muscles of the thorax
-separates the muscles from the pleura of the lungs - Transversus Thoracis Muscle
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-antiorly beneath the sternum
-runs from inferior aspect of sternum superior and laterally crosses several intercostal spaces and attaches to 2nd through 6th ribs or costal cartilages - Idiopathic Pulmonary Fibrosis
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-lungs become fibrotic
-patients have to use a lot of accessory muscles to breathe
-scalene muscles often well developed - What innervates teh muscles of the thoracic wall?
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-ventral ramus (intercostal nerve)
-passes posteriorly, laterally, then anteriorly
-gives off a lateral and anterior cutaneous branch - Thoracic Aorta
- -gived off right and left intercostals
- Internal Thoracic Artery
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-comes off subclavian
-descends down along the anterior part of thoracic cage posterior to the sternum, continues down sternum, down to the diaphragm where it changes names to MUSCULOPHRENIC ARTERY
-frequently used in bypass surgery
-gives off two branches that are anterior intercostals, one medially and one laterally - Coarctation of Aorta
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-congenital condition
-aorta is constricted
-blood coming out of heart is not able to pass inferiorly
-to compensate, intercostal arteries and internal thoracic take over and become enlarged so blood can reach descending aorta - Azygos Vein
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-formed by joining of the right intercostal veins
-drains into SVC - Right Superior Intercostal Vein
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-formed by joining of 2nd through 4th intercostal veins
-drains into SVC - Hemiazygos Vein
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-on the left side
-formed by lower intercostal veins, segmental veins off of aorta and one from the renal vein
-crosses 8th thoracic vertebral level at midline to fuse with Azygos Vein - Accessory Azygos Vein
- -above the level where Hemiazygos splits to join w/ Azygos
- Left Superior Intercostal Vein
- -drains into left brachiocephalic
- Visceral Pleura
- -pleura that surrounds the lung itself
- Parietal Pleura
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-lines the cavity
-4 parts: costal, diaphragmatic, mediastinal, cervical - Left and Right Costodiaphragmatic Recess
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-during normal breathing the lung does not expand/extend down to fill the entire pleural space
-this is the space that is extra
-can do a thoracocentisis here - Where would you do a thoracocentesis?
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-costodiaphragmatic recess
-put needle in posteriorly and laterally into 6th, 7th, or 8th intercostal space and aspirate fluid - Horner Syndrome
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-compression of cervical chain ganglia
-results in classic triad of signs
1. constricted pupil
2. partial ptosis (droopy eyelid)
3. anhydrosis (loss of hemifacial sweating) - Pleural Effusion
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-absence of breath sounds
-build up of serous fluid between pleura - Pneumothorax
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-air in the thorax
-primarily iatrogenic in nature
-can collapse a lung if you put in a central line wrong and puncture space bt parietal and visceral pleur and introduce air into this potential space - Pleuracy
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-infection between the parietal pleura and visceral pleura
-very painful
- - Hemothorax
- blood in potential space between pleura