Respiratory System I PDF

October 16,17,18th, 2024 Professor Dr Panagiotis Karanis Professor and Director of Anatomy Institute Coordinator Unit of Anatomy and Morphology Coordinator of the Unit Infectious Diseases and One Health UNic Medical School Shoulder Tuberculosis...

October 16,17,18th, 2024 Professor Dr Panagiotis Karanis Professor and Director of Anatomy Institute Coordinator Unit of Anatomy and Morphology Coordinator of the Unit Infectious Diseases and One Health UNic Medical School Shoulder Tuberculosis Images: own collection Landmarks Jugular notch Sternal angle (of Louis) Nipple Xiphoid process Between the neck and abdomen Shape of a truncated cone Superior thoracic aperture (thoracic inlet) Inferior thoracic aperture (thoracic outlet) Two pleural cavities A central mediastinum Superior Inferior Anterior Middle Posterior  Sternum  12 pairs of ribs and associated costal cartilages  12 thoracic vertebrae True vertebro - sternal ribs (1st-7th ribs); False ribs (Vertebro - chondral) (8th, 9th, and usually 10th ribs); Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs)  True Vertebro - sternal ribs (1st-7th ribs);  False (Vertebro - chondral) ribs; (8th, 9th, and usually 10th ribs)  Floating (vertebral, free) ribs; (11th, 12th, and sometimes 10th ribs)  Typical Ribs 3rd – 9th Head, 2 facets, crest of the head; Neck Tubercle, articular & non-articular Body, costal angle, costal groove  Atypical Ribs 1st Rib, single facet, 2 grooves for subclavian vessels 2nd Rib, 2 facets, tuberosity of serratus anterior m. 10th-12th Ribs, 1 facet, 11-12th no neck or tubercle  Costal Cartilages 1st -7th directly to sternum 8th –10th articulate with superior one 11th and 12th form caps at ends of ribs  Intercostal Spaces 11 intercostal spaces 11 intercostal nerves Subcostal space Subcostal nerve  Bilateral costal facets – demifacets- on vertebrae bodies (1st rib articulates only with T1, T10, T11, T12 only one costal facet)  Costal facets on the transverse processes  Spinous processes  Manubrium  Body  Xiphoid process Superior Thoracic outlet Posteriorly: T1 vertebra Laterally: 1st pair of ribs and their costal cartilages Anteriorly: superior border of manubrium Inferior thoracic outlet Posteriorly: 12th thoracic vertebra Posterolateral: 11th and 12th pairs of ribs Anterolateral: joined cartilages of ribs 7-10 forming the costal margins Anteriorly: Xiphosternal joint  Intervertebral joints Sternoclavicular joints Costovertebral joints Joints of head of ribs Costotransverse Costochondral Interchondral Sternocostal Manubriosternal Xiphisternal See pages 298-299, Table 4.1 in 8th edition of Moore, Dalley, Agur Accessory respiratory muscles Pectoralis major m., Pectoralis minor m., Serratus anterior m. True muscles of the thoracic wall Serratus posterior superior m. Serratus posterior inferior m. Levatores costarum m. Intercostal m. Subcostal m. Transversus thoracis m. 1.External intercostals, running forward and downward 2.Internal intercostals, at right/angles to the externals, therefore running downward and posteriorly 3.Innermost intercostals, whose fibres run in the same direction as those of the intercostals Posterior aspect of anterior thoracic wall Intercostal nerves (anterior rami of nerves T1-T11) Subcostal nerve (anterior ramus of T12 nerve) Posterior rami of thoracic spinal nerves Typical intercostal nerves Atypical intercostal nerves Typical intercostal nerves (3rd - 6th) confined to their very own intercostal spaces Rami communicantes Collateral branches Lateral cutaneous branches (lat thorac wall) Anterior cutaneous branches (ant thorac wall) Muscular branches Atypical intercostal nerves (supply other areas as well) 1st -2nd (brachial plexus, medial side arm) Intercostobrachial n. 7th – 11th (abdominal wall) Herpes zoster causes a classic, dermatomally distributed skin lesion—shingles —an agonizingly painful condition. Herpes zoster is primarily a viral disease of spinal ganglia, usually a reactivation of the varicella–zoster virus (VZV) or chickenpox virus. After invading a ganglion, the virus produces a sharp burning pain in the dermatome supplied by the involved nerve. The affected skin area becomes red, and vesicular eruptions appear. The pain may precede or follow the skin eruptions. Although primarily a sensory neuropathy (pathological change in a nerve), weakness from motor involvement occurs in 0.5–5.0% of people, commonly in elderly cancer patients. Intercostal nerve block Local anesthesia of an intercostal space is produced by injecting an anesthetic agent around the intercostal nerves between the paravertebral line and the area of required anesthesia. This procedure, an intercostal nerve block, is commonly used in patients with rib fractures and sometimes after thoracic surgery. It involves infiltration of the anesthetic around the intercostal nerve trunk and its collateral branches. The term block indicates that the nerve endings in the skin and transmission of impulses through the sensory nerves carrying information about pain are interrupted (blocked) before the impulses reach the spinal cord and brain. Because any particular area of skin usually receives innervation from two adjacent nerves, considerable overlapping of contiguous dermatomes occurs. Therefore, complete loss of sensation usually does not occur unless  Right and Left pulmonary cavities Lungs and pleurae (lining membranes)  Mediastinum Heart, thoracic part of great vessels, thoracic part of trachea, esophagus, thymus and other structures (e.g. lymph nodes) The shapes of the lungs and the larger pleural sacs that surround them during quiet respiration are demonstrated. The costodiaphragmatic recesses, not occupied by lung, are where pleural exudate accumulates when the body is erect. The outline of the horizontal fissure of the right lung clearly parallels the 4th rib. The ribs are identified by number. Right lung: right oblique and horizontal fissure 3 lobes: superior, middle, inferior Left lung: left oblique fissure 2 lobes: superior, inferior Fibrocartilagenous tube Tracheal cartilages (incomplete) D 2,5 cm adults C6 to T4-5 IV disc sternal angle Right and Left bronchi Brachiocephalic trunk related to rt side of trachea Deviation of trachea from midline signals Pathological process The respiratory bronchioli, the alveolar ducts and the alveoli (alveoli) are involved in gas exchange. Right and left pulmonary arteries (from pulmonary trunk at level of sternal angle) Lobar arteries R & L superior lobar art before entering hilum Inferior lobar art for L lung Middle and inferior lobar art for R lung Tertiary segmental arteries Superior and Inferior pulmonary veins Middle lobe vein 2 left bronchial arteries (from aorta) Right bronchial artery (aorta or upper post. Intercostal a., common trunk with l. sup. bronchial a.) Bronchial veins Superior thoracic aperture and supraclavicular fossae: The cervical pleurae and apices of the lungs pass through the superior thoracic aperture deep to the supraclavicular fossae, depressions located posterior and superior to the clavicles and lateral to the tendons of the sternocleidomastoid muscles. The anterior borders of the lungs lie adjacent to the anterior line of reflection of the parietal pleura between the 2nd and 4th costal cartilages. Here, the margin of the left pleural reflection moves laterally and then inferiorly at the cardiac notch to reach the 6th costal cartilage. The anterior border of the left lung is more deeply indented by its cardiac notch. On the right side, the pleural reflection continues inferiorly from the 4th to the 6th costal cartilage, paralleled closely by the anterior border of the right lung. Both pleural reflections and anterior lung borders pass laterally at the 6th costal cartilages. The pleural reflections reach the midclavicular line (MCL) at the level of the 8thcostal cartilage, the 10th rib at the midaxillary line (MAL), and the 12th rib at the scapular line (SL). However, the inferior margins of the lungs reach the MCL at the level of the 6th rib, the MAL at the 8th rib,