Breasts (mammae) In female breast:

Transcription

1 اهداف جلسه ا شناي ی با ساختمان پستان عضلات قفسه سينه ا شناي ی با ديافراگم ا شناي ی با عضلات شکم ا شناي ي با

2 Breasts (mammae) In female breast: Modified sweat glands a secondary sexual Source of nutrition for the neonate Rudementary in males In puberty: adipose tissue & secretory tissue (15-20 lobes with lactiferous duct) also connective tissue, blood vessels, lymphatics and nerves The site of malignant change (10%)

3 Each breast is a rounded eminence lying within the suprficial fascia Breast shape and size depend upon genetic, racial, dietary factors and age. Hemispherical, conical, pendulous, piriform or thin and flattend. Vertically from 2 nd 6 th rib and transvese from sternal edge to MAL.

4 Superlateral quadrant is prolonged towards the axilla along inferolateral edge of pectoralis major. 2/3 of the breast rests on the deep pectoral fascia pectoralis major and other 1/3 rests on serratus anterior Between the breast and deep pectoral fascia is a loose connective tissue or retromammary space (bursa)

5 Has suspensory ligaments (cooper`s ligaments or astley cooper), which are strong fibrous processes that support the breast and run from the dermis of the skin to the deep layer of the superfascial fascia through the breast. The nipple usually lies at the level of the 4 th intercostal space. The areola is a ring of pigmented skin around the nipple including montgomery glands

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7 Ext. intercostals Lower border of ribs Upper border of rib below Intercostal Elevate ribs in inspiration Int. intercostals Lower border of ribs Upper border of rib below Innermost intercostals Lower border of ribs Upper border of rib below Intercostal Intercostal Depress ribs; interchondral part elevates ribs Elevate ribs Transverse thoracic Post. Surface of lower sternum and xiphoid Inner surface of costal cartilages 2-6 Intercostal Depresses ribs Subcostalis Inner surface of lower ribs near their angles Upper borders of ribs 2 or 3 below Intercostal Elevates ribs

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9 Diaphragm and its openings Arises; sternal part, costal part, & lumbar part Inserts into the central tendon Principle muscle of inspiration Somatic motor; phrenic Sensory from phrenic & intercostal

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11 Right & left crus Medial arcuate ligament Lateral arcuate ligament Vena cava hiatus; -in central tendon at level of T8 and transmits IVC & R. phrenic Esophageal hiatus; -in muscular part at level of T10 and transmits esophagus, vagus nerves Aortic hiatus; -between two crura at the level of T12and transmits the aorta, thoracic duct, greater splanchnic nerve, azygos vein

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13 Abdominal cavity The part of trunk between the thorax and pelvis. Has musculotendinous walls, except posteriorly where the wall includes the lumbar vertebrae and intervertebral discs Abdominopelvic cavity; Abdominal cavity Pelvic cavity

14 Clinicians use nine region of the abdominal cavity Two midclavicular planes Transpyloric plane Transtubercular plane

15 Clinicians use four region of the abdominal cavity Median plane Transumbilical plane RUQ, RLQ, LUQ, LLQ

16 Fascia of the anterolateral abdominal wall A fatty (superficial) layer (Camper`s fascia) A membranous (deep) layer (Scarpa`s fascia) Deep fascia Transversalis Transversalis fascia

17 Rectus abdominis Origin; Pubic crest (lat.) & pubic symphysis (med.) Insertion; Xiphoid process & costal cartilages 5-75 Nerve; Intercostal n. (T7-T11); T11); subcostal n. (T12 Action; Depresses ribs; flexes trunk Intersectiones tendineae Linea semilunaris

18 Actions of anterior abdominal muscles Support for abdominal viscera Expulsive acts (micturi( micturi., Defaeca., parturi., vomit., ) Forceful expiratory (cough., sneez., ) Movement trunk (flex., lat. Flex., rot. trunk)

19 Linea alba Linea arcuata

20 Pyramidalis Origin; Pubic body Insertion; Linea alba Nerve; Subcostal n. (T12) Action; Tenses linea alba

21 External oblique Origin; Ext. surface of lower eight ribs (5-12) Insertion; ; Ant. Half of iliac crest; ant.-sup. Iliac spine; pubic tubercle; linea alba Nerve; Intercostal n. (T7- T11); subcostal n. (T12) Action; Compresses abdomen; flexes trunk; active in forced expiration

22 Inguinal ligament Lacunar lig. (gemberna) Cooper lig. (pectineal) Anulus inguinalis superficialis Crus med. & lat. Reflexum lig.. (coll( coll) Intercrural fibres

23 Internal oblique Origin; Lat. Two-thirds of inguinal ligament; iliac crest; thoracolumbar fascia Insertion; Lower four costal cartilages; linea alba; pubic crest; pectineal line Nerve; Intercostal n. (T7- T11); subcostal n. (T12); iliohypogastric & ilioinguinal n. (L1) Action; Compresses abdomen; flexes trunk; active in forced expiration

24 Linea arcuata, Interfoveolare lig., Conjoint tendon, Cremaster muscle

25 Transversus abdominis Origin; Lat. Lat. one-thirds of inguinal ligament; iliac crest; thoracolumbar fascia; lower six costal cartilages Insertion; Linea Linea alba; pubic crest; pectineal line Nerve; Intercostal n. (T7- T11); subcostal n. (T12 ); iliohypogastric & ilioinguinal n. (L1) Action; Compresses abdomen; depresses ribs

26 Cremaster Origin; Middle of inguinal ligament; lower margin of internal oblique muscle Insertion; Pubic tubercle & crest Nerve; Genitofemoral n. Action; Retracts testis

27 Muscle Muscles of the anterior abdominal wall External oblique Origin Ext.l surface of lower eight ribs (5-12) Insertion Ant. Half of iliac crest; ant.-sup. Iliac spine; pubic tubercle; linea alba Nerve Intercostal n. (T7- T11); subcostal n. (T12) Action Compresses abdomen; flexes trunk; active in forced expiration Internal oblique Lat. Two-thirds of inguinal ligament; iliac crest; thoracolumbar fascia Lower four costal cartilages; linea alba; pubic crest; pectineal line Intercostal n. (T7- T11); subcostal n. (T12); iliohypogastric & ilioinguinal n. (L1) Compresses abdomen; flexes trunk; active in forced expiration transvers e Lat. one-thirds of inguinal ligament; iliac crest; thoracolumbar fascia; lower six costal cartilages Linea alba; pubic crest; pectineal line Intercostal n. (T7- T11); subcostal n. (T12 ); iliohypogastric & ilioinguinal n. (L1) Compresses abdomen; depresses ribs Rectus abdominis Pubic crest & pubic symphysis Xiphoid process & costal cartilages 5-75 Intercostal n. (T7- T11); subcostal n. (T12 Depresses ribs; flexes trunk Pyramidal Pubic body Linea alba Subcostal n. (T12) Tenses linea alba Cremaste r Middle of inguinal ligament; lower margin of internal oblique muscle Pubic tubercle & crest Genitofemoral n. Retracts testis

28 Muscles of the posterior abdominal wall Quadratus lumborum: Transverse processes of L3-L5, iliolumbar ligament, iliac crest Lower border of last rib; Transverse processes of L1-L4 N: Subcostal n.; L1-L3 Psoas major: Transverse processes, intervertebral disks and bodies of T12-L5 Lesser trochanter N:L2-L3 Psoas minor: Intervertebral disks and bodies of T12-L1 Pectineal line, iliopectineal eminence N: L1 Iliacus: iliac fossa, iliac crest, iliolumbar ligament Lesser trochanter N: femoral

29 Muscles of the posterior abdominal wall Muscle Origin insertion Nerve action Quadratus lumborum Transverse processes of L3-L5; iliolumbar ligament; iliac crest Lower border of last rib; Transverse processes of L1-L3 Subcostal n.; L1-L3 Depresses rib 12; flexes trunk laterally Psoas major Transverse processes, intervertebral disks and bodies of T12-L5 Lesser trochanter L2-L3 Flexes thigh and trunk Psoas minor Intervertebral disks and bodies of T12-L1 Pectineal line, iliopectineal eminence L1 Aids in flexing of trunk

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