This document provides an overview of anatomy related to the thorax and abdomen. Key points include:
1) It describes the bones, muscles, and coverings of the thorax cavity including the ribs, sternum, intercostal muscles, and pleura. It also discusses the lungs, heart anatomy, and circulation.
2) The abdomen section outlines the anterior abdominal wall including the rectus sheath and hernias. It also describes the intraperitoneal and retroperitoneal organs and blood supply to the abdomen.
3) Specific organ systems are discussed like the stomach anatomy, blood supply, and innervation. The liver anatomy and referred pain patterns are also summarized.
This document provides an overview of anatomy related to the thorax and abdomen. Key points include:
1) It describes the bones, muscles, and coverings of the thorax cavity including the ribs, sternum, intercostal muscles, and pleura. It also discusses the lungs, heart anatomy, and circulation.
2) The abdomen section outlines the anterior abdominal wall including the rectus sheath and hernias. It also describes the intraperitoneal and retroperitoneal organs and blood supply to the abdomen.
3) Specific organ systems are discussed like the stomach anatomy, blood supply, and innervation. The liver anatomy and referred pain patterns are also summarized.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online from Scribd
This document provides an overview of anatomy related to the thorax and abdomen. Key points include:
1) It describes the bones, muscles, and coverings of the thorax cavity including the ribs, sternum, intercostal muscles, and pleura. It also discusses the lungs, heart anatomy, and circulation.
2) The abdomen section outlines the anterior abdominal wall including the rectus sheath and hernias. It also describes the intraperitoneal and retroperitoneal organs and blood supply to the abdomen.
3) Specific organ systems are discussed like the stomach anatomy, blood supply, and innervation. The liver anatomy and referred pain patterns are also summarized.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online from Scribd
• Bone Thorax: Anatomy of Chest Cavity o Thoracic inlet borders= manubrium, T1, rib and cartilage o Physical characteristics of thorax Sternal angle: attachment of costal cartilage of 2nd rib Sternum: manubrium, body, xiphoid process First 7 ribs: TRUE ribs, costal cartilage btwn sternum and rib (synovial joint) Ribs 8-10: cartilages fuse to undersurface (FALSE ribs) Ribs 11/12: FLOATING ribs, no attachment to sternum anteriorly, function to protect kidneys Nipple: 4th intercostal space Intercostal spaces named for rib ABOVE it • Basic dermatomes o Nipple: T4 o NO C1! o Umbilicus: T10 o C2-C8 and T1-T12 have pain fibers which are segmentally innervated and consistently located in the upper limbs and posterior chest wall • Muscles of respiration o Inspiration: Intercostals, diaphragm (Scalene muscles may assist hypertrophy) o Expiration: PASSIVE PROCESS (intercostals and abdominals may assist) o Needles inserted directly above ribs to avoid intercostals nerves/arteries • Coverings of the lung o Thin, serous, water-secreting membrane which allows diaphragm to slide over lung and lung to glide freely over surface of chest cavity o Costal pleura Internal intercostal muscle External intercostals muscle skin o Pleural potential space: between visceral and parietal pleura, can become REAL space (filled with blood, air, pus, etc.) o Diaphragmatic portion, costal portion, copular portion, mediastinal portion • General circulation o R side: pulmonary source low pressure o L side: systemic circulation high pressure • Lungs o Blood supply: bronchial artery, pulmonary artery, pulmonary vein o Right vs. left lung (lobes, fissures, etc.) Horizontal fissure on R lung: 3rd intercostal space Oblique fissure on both lungs: 5th/6th intercostal space Lingula on L lung: 4th/5th intercostal space o Trachea: series of C-shaped cartilaginous rings o Lymphatics: ultra filtrate of blood that is drawn up in the lymph system and put back into the blood system by the main thoracic duct Main thoracic duct on LEFT side o Innervation of the lungs Parasympathetic innervation from VAGUS nerve VERY FEW afferent visceral pain fibers lung tumors go unnoticed
Lecture 21: Heart 1, 2, and 3; Posterior Mediastinum
• Pericardium o Phrenic nerve and paricardiophrenic artery run along the pericardium (between fibrous pericardium and mediastinal pleura of lungs) o Fibrous layer- gives rigidity, strength to heart covering o Serous layer- folds over and becomes epicardium (coronary arteries just deep to epicardium) Between serous layer and epicardium lies the pericardial sac Epicardium= visceral pericardium Serous layer= parietal pericardium o Heart layers: epicardium, myocardium, endocardium • Heart sinuses o Oblique pericardial sinus Between R and L pulmonary veins on posterior wall of pericardial cavity. Clinical importance: infection, tumors o Transverse pericardial sinus Superior to pulmonary veins and inferior to pulmonary trunk Clinical importance: heart surgeons put their thumb on the aorta and their fingers in this sinus • General location of the heart in the thorax o Retrosternal o Base of heart: 2nd intercostal space o Apex of heart: 5th intercostal space (PMI= medial to mid-clavicular line; can be displaced down and laterally during congestive heart failure) • Heart chambers o Right atrium Thin walled, on top of R ventricle Major structures: vena cavae, coronary sinus (main vein that drains blood from heart), tricuscpid valve to R ventricle, R auricle (extra bulge of contractile muscle), pectinate muscles in lateral wall, fossa ovalis that separates R and L atria o Right ventricle Thick, below R atrium Major structures: chordae tendonae, papillary muscles, moderator band (conduction system of heart), trabeculae carnae (clinical relevance: pacemaker) o Left atrium 4 pulmonary veins enter bringing oxygenated blood from lungs o Left ventricle VERY high pressure (THICK wall) Pumps blood systemically Major structures: papillary muscles, chordae tendinae, mitral/bicuspid valve • Heart valves o Diastole: rest, ventricles are filling and AV valves are open o Systole: pump, blood exits thru outflow valves o AV valves: tricuspid, bicuspid (open/close via papillary muscle contraction) o Outflow track valves allow blood to flow passively from the ventricles (pulmonary and aortic); close as a result of elastic recoil o Stenosis: smaller opening (may cause hypertrophy) murmur during systole o Murmur of regurgitation/insufficiency: valve doesn’t close all the way and blood flows backwards murmur during diastole • Coronary circulation o R coronary artery: blood supply to the back of the heart, major blood supply for the conduction system of the heart (disease atrial fibrillation) o L coronary artery: left interventricular descending artery (coronary artery disease) o Veins: coronary sinus drains into R atrium (main venous return) • Innervation of the heart o Sympathetic: T1 to L2 o Parasympathetic: R/L vagus nerves o Referred pain: visceral pain interpreted as somatic pain, heart pain is referred to intercostals nerves (T1-T4 dermatomes) • Mediastinum (median portion of thoracic cavity) o Superior and inferior separated by arch of the aorta o Inferior: anterior, middle and posterior mediastinum o Fascial layers Infection anterior to pretracheal fascia can travel to superior mediastinum and anterior mediastinum Retropharyngeal fascia is behind pharynx (infection in neck) Fascial planes serve as routes for infection spread from neck into chest cavity Infection can NEVER spread to middle medastinum because it is completely closed off by fusing with the antitia of the major blood vessels • Posterior mediastinum
Lecture 22: Anterior Abdominal Wall
• Rectus sheath above arcuate line o Anterior layer: external oblique and ½ internal oblique o Posterior layer: ½ internal oblique and transverses abdominus o Above arcuate line/semicircular line of Douglas: much stronger than lower 1/3 of abdomen • Rectus sheath below arcuate line o NO posterior rectus sheath! o All muscle tendons/fascia comes in front of rectus abdominus o ONLY endoabdominal fascia: weaker than upper 2/3 of abdomen • Hernias o Hasselback’s Triangle Borders: rectus abdominus, inferior epigastric artery and inguinal ligament Floor: transversalis fascia Protrusion thru is a direct hernia o Indirect hernia (congenital) Processus vaginalis typically closes off at 7-8 months of development and becomes a ligament No closure (remains patent) indirect hernia into scrotum
Lecture 23: Abdomen 1, 2 and 3
• Quadrant system • Intra vs. retroperitoneal organs o Intraperitoneal: totally wrapped in visceral peritoneum, “within”, attach via mesentery to body wall (blood vessels, nerves enter/exit via mesentery) Stomach, liver, small intestines, transverse colon o Retroperitoneal: behind, organ is fused to posterior body wall, NO mesentery Kidneys, pancreas, duodenum, ascending colon, descending colon, rectum • Arterial blood supply o Visceral branches off the aorta: celiac trunk, superior mesenteric artery, inferior mesenteric artery • Stomach o Left upper quadrant o Parts of the stomach: fundus, body, cardiac part, greater and lesser curvatures, pyloric part, pyloric canal, pyloric sphincter o Disease in cardiac part feels like cardiac problem (heart burn) o Blood supply (celiac trunk) Left gastric artery lesser curvature Short gastric arteries (branch of splenic artery) greater curvature L. gastroepiploic artery greater curvature R gastroepiploic artery (branch of gastroduodenal artery) greater curvature R gastric artery (branch of proper hepatic artery) lesser curvature o Innervation Sympathetic: celiac ganglion (controls blood supply by controlling smooth muscle of the arteries) VASOCONSTRICTION Parasympathetic: Vagus nerve (LARP) Visceral pain: POORLY localized, pain referred to T5-T9; afferent fibers in vagus nerve and splanchnic nerve • Liver o R upper quadrant, intraperitoneal, well-protected by ribs o Undersurface: H o Referred pain: greater splanchnic nerve (T5-T9 on R side), R phrenic nerve (C3-C5 on R side) pain localized to R upper quadrant and R shoulder • Pancreas o “wrapped in the arms of the duodenum”, posterior abdominal wall o endocrine and exocrine functions o Intraperitoneal o Parts of the pancreas: uncinate process, head, neck, body, tail o Blood supply Superior mesenteric artery Gastroduodenal artery Splenic artery o Innervation Sympathetic: greater and lesser splanchnic nerves Referred pain: T5-T9 (mid/lower back above belly button) Inflamed pancreas direct stimulation of intercostals nerves back pain o Duct work (between liver, gallbladder, pancreas and stomach) • Duodenum (1st part of small intestine) o Retroperitoneal except parts 1 and 4 o Four parts: bulb, descending, transverse, ascending o Ulcer in the bulb can affect the gastroduodenal artery o Anterior to transverse portion is the superior mesenteric artery and vein o Blood supply: gastroduodenal artery and superior mesenteric artery o No defined pattern of referred pain o Ligaments Hepatoduodenal ligament (does NOT contain inferior vena cava) Hepatogastric ligament • Spleen o Intraperitoneal organ o L upper quadrant o Injury to the ribs can injure spleen, disease can cause expansion or contraction of the spleen • Small intestines o Upper portion= jejunum, lower portion= ileum o Ligament of Treitz: R crus of diaphragm, marks the end of the duodenum and the beginning of the jejunum (important surgical landmark) o Blood supply: branches of the superior mesenteric artery Jejunum: simple blood supply, very convoluted mucosa Ileum: more complicated blood supply, smooth mucosa, Peyer’s patches o Parasympathetic innervation: vagus nerve o VERY FEW visceral pain fibers • Ileocecal region (junction of ileum and cecum) o APPENDIX: may not be where it’s supposed to be Appendicitis: vague visceral pain near belly button, abdominal pain, appendix then becomes swollen and large contact with body wall sharp, parietal pain in R lower quadrant • Large intestine o Water absorption (products of digestion solid) o Retroperitoneal (transverse colon is intraperitoneal) o Blood supply Superior mesenteric artery and inferior mesenteric artery connected by marginal artery o Innervation Lesser/least splanchnic nerves Vagus nerve S2, S3, S4 parasympathetic to hindgut • Portal circulation (specialized venous system that drains alimentary system) o LOTS of disease o Main portal vein LIVER Major tributaries include superior mesenteric vein, splenic vein and gastric veins o Anastomoses provide potential for mixing of blood (normally insignificant in healthy people) Esophagus Rectovault Umbilical area o Liver disease (damage) increased portal vein pressure due to scarring hypertension engorged tributaries (porta cava anastomoses)
Lecture 24: Posterior Abdominal Wall
• Kidney o Retroperitoneal o Kidney is a little lower in position due to the liver (both are described as located between T11 and L3) o Collecting system: medullary rays medullary pyramids renal column renal papilla Minor calices major calices pelvis of ureter ureter o Innervation: renal/aortic plexus T10-T12: pain o Blood vessels Renal vein: IVC on L side of the aorta L testicular vein and L renal vein are a little longer than R side Renal vein runs under superior mesenteric artery Vein – Artery – Ureter (ureter deep to testicular vessels) Increased pressure in L testicular vein testicle varicoele infertility • Ureters o Runs DEEP to testicular/ovarian vessels o Runs superficial to bifurcation of iliac artery o Runs along psoas muscle and joins bladder on posterior surface o Poor blood supply lacerations take a LONG time to heal o Kidney stones= PAIN (T12-L2) • Adrenal Gland o Upper pole of each kidney o R: triangular shaped, L: semilunar shape • Muscles o Psoas major Flexes hip o Psoas minor “do nothing” o Iliacus Flexes hip o Quadratus lumborum Bends trunk from side to side • Lumbar Plexus o Subcostal nerve o Iliohypogastric nerve o Ilioinguinal nerve o Genitofemoral nerve Cremaster reflex o Lateral cutaneous nerve of the thigh Sensory ONLY o Femoral nerve Innervates quadriceps muscles (flexes hip, extends leg) o Obturator nerve Innervates ADDuctors of leg o Lumbosacral trunk