the part between the neck and the abdomen Chest X-ray

Transcription

1 The Two Fridas 1939 by Frida Kahlo Kaan Yücel M.D., Ph.D

2 the part between the neck and the abdomen Chest X-ray

3 1.1. REGIONS/T ERMS Thoracic cavity cavity between neck and abdomen protected by the thoracic wall. Thoracic wall bounds the thoracic cavity. formed by the skin, bones, fasciae, and muscles. Thoracic cage bony portion of the thoracic wall thoracic skeleton

4 1.2. SURFACES OF THE THORAX Posterior surface 12 thoracic vertebræ & posterior parts of the ribs Anterior surface sternum & costal cartilages Lateral surfaces ribs, separated by the intercostal spaces STERNUM & COSTAL CARTILAGES anteriorly 12 THORACIC VERTEBRAE & POST. RIBS posteriorly RIBS & INTERCOSTAL SPACES laterally

5 1.3. BOUNDARIES OF THE THORAX Superior Jugular notch Sternoclavicular joint Superior border of clavicle Acromion Spinous processes of C7 Inferior Xiphoid process Costal arch 12th and 11th ribs Vertebra T12

6 1.4. CONTENTS OF THE THORAX Organs of the cardiovascular, respiratory, digestive, reproductive, immune, and nervous systems

7 thoracic cage (skeleton) muscles between the ribs skin subcutaneous tissue muscles, and fascia covering its anterolateral aspect. The mammary glands of the breasts lie within the subcutaneous tissue of the thoracic wall.

8 2.1. FUNCTIONS OF THE THORACIC WALL 1) Protects vital thoracic and abdominal organs 2) Resists the negative (sub-atmospheric) internal pressures generated by the elastic recoil of the lungs and inspiratory movements. 3) Provides attachment for and support the weight of the upper limbs. 4) Provides the origins of many of the muscles that move and maintain the position of the upper limbs relative to the trunk. 5) Provides attachments for muscles of the abdomen, neck, back, and respiration.

9 3. SKELETON OF THE THORACIC WALL 1) 12 pairs of ribs and associated costal cartilages 2) 12 thoracic vertebrae and the intervertebral (IV) discs interposed between them 3) Sternum

10 4. THORACIC APERTURES Thoracic inlet Thoracic outlet

11 4.1. Superior thoracic aperture doorway between the thoracic cavity and the neck and upper limb bounded: Posteriorly vertebra T1 Laterally 1st pair of ribs and their costal cartilages Anteriorly superior border of the manubrium Trachea Esophagus nerves, and vessels that supply and drain the head, neck, and upper limbs.

12 4.2. Inferior thoracic aperture By closing the inferior thoracic aperture, the diaphragm separates the thoracic and abdominal cavities almost completely. bounded: Posteriorly 12th thoracic vertebra Posterolaterally 11th and 12th pairs of ribs Anterolaterally joined costal cartilages of ribs 7-10 costal margins Anteriorly xiphisternal joint

13 5. MOVEMENTS OF THE THORACIC WALL One of the principal functions of the thoracic wall and the diaphragm is to alter the volume of the thorax and thereby move air in and out of the lungs. During breathing, the dimensions of the thorax change in vertical, lateral, and A-P directions. Diaphragm contracts Depression Diaphragm relaxes Elevation (during passive expiration) Elevation &depression of the ribs

14 DERMATOMES Skin area supplied by a segment of the spinal cord Through its posterior ramus and the lateral and anterior cutaneous branches of its anterior ramus, most thoracic spinal nerves (T2-T12) supply a strip-like dermatome of the trunk extending from the posterior median line to the anterior median line. T2- Sternal angle T4- Nipple T6- Xiphoid process T8- Costal arch T10-Umbliculus T12-Midpoint between umbilicus and symphysis pubis

15 2. BREASTS Reproduction, back pain Aesthetics, and breast cancer Mammary glands & associated skin -connective tissues. modified sweat glands in the superficial fascia anterior to the pectoral muscles and the anterior thoracic wall.

16 2. BREASTS Mammary glands: Series of ducts and associated secretory lobules. Form 15 to 20 lactiferous ducts open nipple. Nipple is surrounded by a circular pigmented area of skin areola (L. small area).

17 FEMALE BREASTS NON-LACTING WOMEN PREDOMINANT COMPONENT: FAT LACTING WOMEN- PREDOMINANT COMPONENT: GLANDULAR TISSUE The breast rests on a bed extends transversely from lateral border of the sternum mid-axillary line vertically from the 2nd through 6th ribs

18 75% (lateral breast quadrants) Axillary lymph nodes Most of the remaining (medial breast quadrants) parasternal lymph nodes or to the opposite breast Lymph from inferior quadrants may pass deeply to abdominal lymph nodes.

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20 Trapezoidal in A-P dimensions Tipped-over pyramid in 3-D crucial organ of the human body 20

21 Right heart (Suction) poorly- oxygenated(venous) blood from the body superior vena cava & inferior vena cava right atrium right ventricle pulmonary arteries lungs Left heart (Pumping) well- oxygenated (arterial) blood from the lungs pulmonary veins left atrium left ventricle aorta the body 21

22 right and left atria & right and left ventricles Atrium plural atria Receiving chambers Ventricles Discharging chambers cardiac cycle 1. Ventricular filling (diastole) 2. Ventricular emptying (systole) Blood pressure mm/hg 22

23 The fibrous skeleton of the heart Keeps the orifices of the AV & semilunar valves patent prevents them from being overly distended by an increased volume of blood. Provides attachments for the valves & myocardium. Forms an electrical «insulator» separating impulses of the atria & ventricles they contract independently surrounding and providing passage for the initial part of the AV bundle 23

24 coronary sulcus (atrioventricular groove) between atrium & ventricles anterior & posterior interventricular (IV) sulci (grooves) between right and left ventricles 24

25 apex located inferiorly & base located superiorly Apex projects forward, downward and to the left Base faces in a posterior direction 25

26 Anterior (sternocostal) surface o mostly of right ventricle o some of the right atrium on the right o some of the left ventricle on the left Diaphragmatic (inferior) surface o formed mainly by the left ventricle o partly by the right ventricle o related to central tendon of diaphragm. Right pulmonary surface o formed by the right atrium. Left pulmonary surface o left ventricle & a portion of left atrium. 26

27 RIGHT ATRIUM forms the right border of the heart Receives venous blood from the SVC, IVC, and coronary sinus. Through the right atrioventricular orifice, discharges the poorly oxygenated blood it has received into the right ventricle. 27

28 RIGHT VENTRICLE forms largest part of the anterior surface of the heart a small part of the diaphragmatic surface almost the entire inferior border of the heart. 28

29 interventricular septum (IVS) obliquely placed partition between the right and left ventricles, forming part of the walls of each muscular and membranous parts Bulges into the cavity of the right ventricle. Superiorly and posteriorly, a thin membrane, forms the much smaller membranous part of the IVS. 29

30 LEFT ATRIUM right and left pulmonary veins enter here. Tubular, muscular left auricle, Its wall trabeculated with pectinate muscles. A semilunar depression in the interatrial septum Floor of the oval fossa surrounding ridge Valve of the oval fossa forms most of the base of the heart 30

31 LEFT VENTRICLE forms the apex of the heart, left (pulmonary) surface & border, most of the diaphragmatic surface. Compared to the right ventricle Walls 2-3 times thicker Trabeculae carneae finer and more numerous Cavity longer Anterior & posterior papillary muscles larger 31

32 aortic valve semilunar valve between the left ventricle & ascending aorta obliquely placed. 32

33 mitral valve double-leaflet mitral valve Guards the left AV orifice. Has two cusps, anterior and posterior. 33

34 6. SEMILUNAR VALVES Semilunar cusps of the pulmonary valve anterior-right-left Seminular cusps of the aortic valve posterior-right-left concave when viewed superiorly no tendinous cords to support 34

35 VASCULATURE OF THE HEART coronary arteries & cardiac veins embedded in fat course across the surface of the heart just deep to the epicardium. 35

36 supply the myocardium and epicardium first branches of the aorta Anastomoses between the branches of the coronary arteries exist, which enables the development of the collateral circulation. 36

37 STIMULATING, CONDUCTING, & REGULATING SYSTEMS OF HEART 1. sinuatrial (SA) node initiates the heartbeat & coordinates contractions of the four heart chambers 2.atrioventricular (AV) node 3.bundles highly specialized conducting fibers for conducting impulses rapidly to different areas of the heart o Propagation of the impluse o Simultaneous contraction of the cardiac striated muscle cells 37

38 pacemaker of the of the SVC & right atrium near to the superior end of the sulcus terminalis 38

39 pacemaker of the heart stimulated by sympathetic division of the autonomic nervous system to accelerate the heart rate inhibited by parasympathetic division to return to or approach its basal rate. 39

40 a smaller collection of nodal tissue than the SA node in the posteroinferior region of the interatrial septum near the opening of the coronary sinus 40

41 JOURNEY OF THE SIGNAL SA node Passed through the walls of the right atrium Propageted by the cardiac muscle Signal passed from SA node to AV node Distributed to the ventricles through the AV bundle 41

42 AV bundle the only bridge between the atrial and ventricular myocardium passes from the AV node through the fibrous skeleton of the heart and along the membranous part of the junction of membranous & muscular parts of the IVS divides into : right bundle & left bundle. 42

43 right and left bundles proceed on each side of the muscular IVS deep to the endocardium then ramify into subendocardial branches (Purkinje fibers) extend into the walls of the respective ventricles. 43

44 autonomic nervous system, cardiac plexus Cardiac plexus posterior to the ascending aorta and bifurcation of the pulmonary trunk 44

45 autonomic nervous system, cardiac plexus Parasympathetic supply presynaptic fibers of the vagus nerves Slows the heart rate Reduces the force of the contraction Constricts the coronary arteries saving energy 45

46 sympathetic supply presynaptic fibers cell bodies in the intermediolateral cell columns (IMLs) of the superior 5 or 6 thoracic segments postsynaptic sympathetic fibers cell bodies in the cervical and superior thoracic paravertebral ganglia of the sympathetic trunks. causes increased heart rate increased impulse conduction, increased force of contraction, increased blood flow through the coronary vessels increased activity. 46

47 What happens? 9. SEPTAL DEFECTS Atrial Septal Defects (ASD) congenital anomaly of the interatrial septum a hole between the two atria Oxygenated blood from the lungs Left atrium Right atrium More blood in the right heart Results in enlargement of right atrium & ventricle dilation of the pulmonary trunk 47

48 Ventricular Septal Defects (VSD) rank first on all lists of cardiac defects membranous part of the IVS common site of VSDs What happens? Oxygenated blood from the ventricles Left ventricle Right ventricle Results in in pulmonary blood flow severe pulmonary disease (hypertension) cardiac failure 48

49 10. VALVULAR HEART DISEASES Disturb pumping efficiency of the heart. Stenosis (narrowing) or insufficiency Both result in an increased workload for the heart. Valvuloplasty repairing the heart valves 49

50 Scarring and shortening of the cusps results in insufficiency Restricts the outflow of the left ventricle Leads to the hypertrophy of the myocardium During ventricular systole, blood regurgitates back to the left atrium A hurt murmur will be heard. 50

51 Narrowing of the mitral orifice. Restricts the outflow of the left atrium. A murmur will be heard during atrial contraction. 51

52 Narrowing of the pulmonary valve due to the fused cusps. Restricts the outflow of the right ventricle. Leads to the hypertrophy of the myocardium. 52

53 Incomplete closure of the cusps due to thickening of their free margins due to a disease. During diastole, blood regurgitates back to the right ventricle from the pulmonary trunk. Heart murmur could be heard. 53

54 most frequent valve abnormality Blood is unable to flow freely from left ventricle to aorta. A result of degenerative calcification, fusion of the aortic cups as a result. Causes extra work for the heart, resulting in left ventricular hypertrophy. 54

55 During diastole blood regurgitates from aorta back to the left ventricle. A hurt murmur will be heard during diastole. 55

56 a pathologic sound could be heard by stethoscope. produced due to the turbulence caused by the blood passing from a narrow opening into a larger vessel or chamber. 56

57 tricuspid valve behind the right half of the sternum opposite 4th intercostal space mitral valve behind the left half of the sternum opposite 4th costal cartilage pulmonary valve behind the medial end of the 3rd left costal cartilage and adjoining part of the sternum aortic valve behind the left half of the sternum opposite 3rd intercostal space. 57

58 S1 produced by contraction of the ventricles closure of the tricuspid & mitral valves (AV valves) S2 produced by the sharp closure of the aortic & pulmonary valves hear sounds produced at each valve with the minimum of distraction or interference 58

59 tricuspid valve right half of lower end of the body of the sternum mitral valve apex beat fifth left intercostal space, 9 cm from the midline pulmonary valve medial end of the second left intercostal space aortic valve medial end of the second right intercostal space 59

60 PERICARDIUM fibroserous membrane, covers the heart & beginning of its great vessels a closed sac with two layers fibrous pericardium serous pericardium parietal layer visceral layer heart & great vessels. 60

61 fibrous pericardium continuous superiorly w/ tunica adventitia of the great vessels & w/pretracheal layer of deep cervical fascia Continuous inferiorly w/ central tendon of the diaphragm Attached anteriorly to the sternum by sternopericardial ligaments Site of continuity pericardiacophrenic ligament Inner surface lined by parietal layer of the serous pericardium Protects the heart against sudden overfilling. 61

62 pericardial cavity potential space between opposing layers of the parietal & visceral layers of serous pericardium contains a thin film of fluid : pericardial fluid enables the heart to move and beat in a frictionless environment. 62

63 GREAT VESSELS formed by the union of internal jugular & subclavian veins posterior to the sternoclavicular (SC) joints. brachiocephalic veins unite to form the inferior border of the 1st right costal cartilage shunt blood from the head, neck, & upper limbs right atrium. 63

64 Returns blood from all structures superior to the diaphragm except the lungs & heart. Passes inferiorly and ends by entering right atrium of the heart. 64

65 begins at the aortic orifice. only branches coronary arteries, arising from the aortic sinuses. 65

66 curved continuation of the ascending aorta begins posterior to the 2nd right sternocostal (SC) joint at the level of the sternal angle. ligamentum arteriosum remnant of the fetal ductus arteriosus root of the left pulmonary artery inferior surface of the arch of the aorta The usual branches of the arch 1) brachiocephalic trunk 2) left common carotid artery 3) left subclavian artery. 66

67 first and largest branch of the arch of the aorta arises posterior to the manubrium. ascends superolaterally divides into right common carotid & right subclavian arteries. 67

68 second branch of the arch of the aorta arises o posterior to the manubrium, o slightly posterior and to the left of the brachiocephalic trunk. 68

69 third branch of the arch of the aorta arises from the posterior part of the arch posterior to left common carotid artery. ascends lateral to trachea & left common carotid artery. Leaves the thorax and enters the root of the neck. 69

70 responsible for detecting changes in blood chemistry, primarily oxygen content monitor changes in blood pressure 70

71 Abdominal aorta 71

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