review of the thorax

REVIEW OF THE THORAX

AND ABDOMEN

Shawn Beaudette, MSc Candidate

sbeaudet@uougelph.ca

Jordan Knapman, MSc Candidate

jknapman@uoguelph.ca

Course Evaluations

• Tomorrow is the last day! <http://courseeval.uoguelph.ca >

THORACIC ANATOMY

Patrick J. Lynch; illustrator; C. Carl Jaffe; MD; cardiologist Yale University Center for Advanced Instructional Media Medical

Illustrations by Patrick Lynch, generated for multimedia teaching projects by the Yale University School of Medicine, Center for

Advanced Instructional Media, 1987-2000

Thoracic Osteology (Anterior View)

Ref: Sharp Labs Inc. <http://www.growtall.com/what-makes-our-bones-

grow.htm>

SUPERIOIR THORACIC APETURE

MANUBRIUM

STERNAL ANGLE

STERNAL BODY

XIPHOID PROCESS

INFERIOR THORACIC APETURE

Sternal Osteology

JUGULAR NOTCH

CLAVICULAR NOTCH

FIRST COSTAL FACET

DEMIFACETS

FOR RIBS II & VII

Costal Articulations

• Anterior Articulation:

• Costal Cartilage (True and False Ribs)

• Posterior Articulation:

• Between Articular Facets of Ribs and costal facets of

thoracic vertebra

Costal Classifications

1

2

3

4

5

6

7

8 9

TRUE RIBS

FALSE RIBS

FLOATING RIBS

Ref: Sharp Labs Inc. <http://www.growtall.com/what-makes-our-bones-

grow.htm>

RIBS 1-7 (ARTICULATE /W

STERNUM)

RIBS 8-10 (ARTICULATE /W

COSTAL CARTILAGE OF

ABOVE RIBS)

RIBS 11-12 (NO ANTERIOR

ARTICULATION)

Muscles of Respiration

Vascularization and Innervation of the

Thoracic Wall

The Diaphragm

• Origin

• Insertion

• Innervation

Ref:<http://www.helloquizzy.com/quizzy/results?quizzyid

=16531707804588161990&resultid=426802604>

XIPHOID, COSTAL MARGIN, RIBS 11-

12, LUMBAR VERTEBRAE

CENTRAL TENDON

C3,4,5 KEEPS THE DIAPHRAM

ALIVE!!!! (PHRENIC N.)

Lung Anatomy – Left vs. Right

20th U.S. edition of Gray's Anatomy of the Human Body

LEFT RIGHT

HORIZONTAL

FISSURE

OBLIQUE

FISSURE

Trachea

20th U.S. edition of Gray's Anatomy of the Human Body

TRACHEALIS SMOOTH

MUSCLE

CARTILAGINOUS

RINGS

CARNIA

1O BRONCHUS

2O LOBAR

BRONCHUS

Parietal vs. Visceral Pleura

Lines of Plural Reflection:

• Sternal Line

• Costal Line

• Vertebral Line

SUPRAPLEURAL

MEMBRANE

REFLECTION OF PARIETAL

PLEURA @ LUNG ROOT

Mediastinum Contents

Ref: <http://medicinexplained.blogspot.ca/2011/06/mediastinum.html>

Middle Mediastinum: Pericardium

• Pericardial Layers

• A:

• B:

• C:

• Structures Associated

with outermost layer:

• Phrenic N.

• Pericardiacophrenic A.

A

B

C

VISCERAL LAYER OF

SEROUS PERICARDIUM

PARIETAL LAYER OF

SEROUS PERICARDIUM

FIBROUS PERICARDIUM

Middle Mediastinum: Cardiac Anatomy

Ref: <http://tube.medchrome.com/2011/04/coronary-circulation-anatomy.html>

AORTIC ARCH

PULMONARY TRUNK

LEFT ATRIUM

CIRCUMFLEX ART.

LEFT CORONARY ART.

ANT. INTERVENTRICULAR

ART. (LAD)

LEFT VENTRICLE

SVC

AORTIC SEMILUNAR VALVE

RIGHT ATRIUM

RIGHT CORONARY ART.

POST. INTERVENTRICULAR ART.

RIGHT MARGINAL ART.

RIGHT VENTRICLE

Cardiac Innervations:

• Sympathetic Innervation:

• Parasympathetic Innervation:

RIGHT/ LEFT

SYMPATHETIC TRUNK

RIGHT/LEFT VAGUS N.

**GIVES BRANCHES FOR GREAT, LESSER

AND LEAST SPLANCHNIC N.

Cardiac Anatomy: Right or Left Side?

Patrick J. Lynch; illustrator; C. Carl Jaffe; MD; cardiologist Yale University Center for Advanced Instructional Media Medical Illustrations by

Patrick Lynch, generated for multimedia teaching projects by the Yale University School of Medicine, Center for Advanced Instructional Media,

1987-2000

RIGHT SIDE!!

AORTA

SVC

FOSSA OVALIS

PECTINATE

MUSCLE

PULMONARY TRUNK

PULMONARY VALVE

INTERVENTRICULAR

SEPTUM

RIGHT ATRIO-

VENTRICULAR

ORFICE

TRABECULAE

CARNEAE M.

CRISTA TERMINALIS

Heart Valves

• A:

• B:

• C:

• D:

A

B

C D

PULMONARY SEMILUNAR VALVE

AORTIC SEMILUNAR VALVE

MITRAL (BICUSPED) VALVE

TRICUSPED VALVE

Remnants of the Fetal Circulation

PLACENTA 20th U.S. edition of Gray's Anatomy of

the Human Body

DUCTUS ARTERIOSUM

LIGAMENTUM ARTERIOSUM

FORAMEN OVALE

FOSSA OVALIS

DUCTUS VENOSUS

LIGAMENTUM VENOSUM

UMBILICAL VEIN

LIGAMENTUM TERES

ABDOMINAL ANATOMY

The Abdominal Wall

• Layers: • 1:

• 2:

• 3:

• 4:

• 5:

• 6:

• 7:

• 8:

• 9:

• 10:

Ref: <http://teleanatomy.com/introductiontoanatomy-Fascia.html>

SKIN

CAMPER’S FASCIA

SCARPA’S FASCIA

EXTERNAL OBLIQUE M.

INTERNAL OBLIQUE M.

TRANSVERSUS ABDOMINUS M.

FASCIA TRANSVERSALIS

EXTRA-PERITONEAL FAT

PARIETAL PERITONEUM

RECTUS ABDOMINUS M.

*2&3 combine to form

superficial layer of fascia

The Rectus Sheath

Ref:<http://academic.amc.edu/martino/grossanatomy/site/Medical/Lab%20M

anual/Gastrointestinal/answers/anterior%20wall3.htm>

Fusion of Aponeurosis @ Midline=

LINEA ALBA

Inguinal Canal

• Boundaries:

• Roof:

• Transversalis Fascia

• Internal Oblique

• Transversus Abdominus

• Anterior Wall:

• External Oblique (Aponeurosis)

• Internal Oblique

• Floor:

• Inguinal Ligament

• Posterior Wall:

• Transversalis Fascia

Layers of the Testis

Peritoneum

• Peritoneal Types:

• Contents of the

Peritoneal Cavity?

GREATER SAC

LESSER SAC

PARIETAL PERITONEUM &

VISCERAL PERITONEUM

Peritoneal Folding: Omenta

• Peritoneal Folding

Results in:

• Omenta:

• A:

• B:

• C:

• Mesentaries

• Ligaments

A B

C

Ref: <http://science.tjc.edu/Course/BIOLOGY/lsch/lsch2401/AtlasA.htm>

HEPATOGASTRIC LIG.

HEPATODUODENAL LIG.

GREATER OMENTUM.

(GASTROCOLIC LIG.)

Peritoneal Folding: Mesentaries

• Types:

• A: • Distinguishes Supracolic

from Infracolic

compartment

• B: A

B

Ref: <http://medical-

dictionary.thefreedictionary.com/_/viewer.aspx?path=dorland&name=mes

enterium.jpg>

TRANSVERSE MESOCOLON

MESENTARY OF THE

SMALL INTESTINE

Arterial Arcades

• Jejunum

• Prominent Vasa Recta

• Less Prominent Arterial

Arcades

• Ileum

• Prominent Arterial

Arcades

• Less Prominent Vasa

Recta

Ref: <http://www.studyblue.com/notes/note/n/an2-11-peritoneal-cavity-

and-abdominal-organs-part-2-clinical-correlations-etc/deck/1055200>

The Stomach

• A:

• B:

• C:

• D:

• E:

• F:

• G:

A B

C

D

E F

G

ESOPHAGUS

FUNDUS

GASTRO-OMENTAL ART. & VEIN

GREATER CURVATURE

LESSER CURVATURE

PYLORIC SPHINCTER

DUODENUM

Stomach Blood Supply – Celiac Trunk

A B

C

Ref:<http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/modules/peritoneal_dev_module/p

eritoneal_01.html>

A: B: C:

LEFT GASTRIC

ART.

LEFT GASTRO-

OMENTAL ART.

RIGHT GASTRO-

OMENTAL ART.

CELIAC TRUNK

RIGHT GASTRIC ART.

COMMON HEPATIC

ART.

LEFT GASTRIC ART. SPLENIC ART.

Duodenum

• A:

• B:

• C:

• D:

• E:

A

B

C

D

E

Ref: <http://msk-anatomy.blogspot.ca/2012/07/anatomy-of-

duodenum.html>

SUPERIOR DUODENUM

DESCENDING DUODENUM

MAJOR DUODENAL PAPILLA

INFERIOR DUODENUM

ASCENDING DUODENUM

Duodenal Blood Supply

• From the Celiac Trunk:

• A:

• B:

• C:

• From the SMA:

• D:

A

B

C

GASTRODUODENAL ART.

SUPERIOR

PANCREATICODUODENAL

ART. (ANT/POST)

INFERIOR

PANCREATICODUODENAL

ART. (ANT/POST) D

SUPRADUODENAL ART.

Ileum and Jejunum Blood Supply

VASA RECTA

ARTERIAL ARCADES

JEJUNAL AND ILIAL

BRANCHES OF SMA

The Large Intestine

Ref: <http://www.allposters.com/-sp/This-Illustration-Depicts-the-Anatomy-of-the-Large-

Intestine-Colon-Posters_i9013176_.htm>

APPENDIX

CECUM

MESOAPPENDIX

ASCENDING COLON

RIGHT COLIC FLEXTURE TRANSVERSE

COLON

LEFT COLIC

FLEXTURE

DESCENDING

COLON

SIGMOID COLON

RECTUM

Features of the Large Intestine

HAUSTRA

OMENTAL APPENDICES

TAENIAE COLI

Colonic Blood Supply

• SMA:

• A:

• Ant/Post Cecal Art.

• Appendicular Art.

• B:

• C:

• IMA:

• D:

• E:

• F:

A

B

C

D

E

F

ILEOCOLIC ART.

RIGHT COLIC ART.

MIDDLE COLIC ART.

LEFT COLIC ART.

SIGMOIDAL ART.

SUPERIOR RECTAL ART.

Rectal Blood Supply

• IMA:

• A:

• Internal Iliac Art:

• B:

• Pudendal Art:

• C:

A

B

C

SUPERIOR RECTAL ART.

MIDDLE RECTAL ART.

INFERIOR RECTAL ART.

*B) & C) stay tuned for next

semester!

Pancreatic Blood Supply

• From Gastroduodenal Art.:

• A:

• B:

• From SMA:

• C:

• D:

• From Splenic Art.:

• E:

• F:

GASTRODUODENAL

ART.

SPLENIC ART

ART.

SMA

A B

C D

E F

ANT. SUP. PANCREATICODUODENAL

POST. SUP. PANCREATICODUODENAL

ANT. INF. PANCREATICODUODENAL

POST. INF. PANCREATICODUODENAL

DORSAL PANCREATIC ART.

GREAT PANCREATIC ART.

*Don’t worry about E) & F) for

exam!

The Spleen

• Highly vascularized

organ

• Blood supply:

• Splenic Art.

• Affected by Epstein-

Barr Virus

• Mononucleosis

Ref : Madoff D.C. et al. (2005). Splenic Arterial Interventions:

Anatomy, Indications, Technical Considerations, and Potential

Complications. RadioGraphics 25, S191-S211.

The Gallbladder

• Collects an stores bile

which aids in fat

digestion in the small

intestine

• Bile:

• 85% Water

• 10% Bile salts

• <1% cholesterol

• Gallstones vs. Kidney

Stones???

Hand Anatomy