dinding thorax pulmo
TRANSCRIPT
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Thorax
sebuah rongga yg berisikan vescera thoracis
Mrpk bagian dari sist. Cardiovascular & sist. resirasi
Dilalui struktur ygn masuk dan keluar dr cavitas
Apertura thoracis superior Aertura thoracis inferior
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Apertura thoracis superior
Apertura thoracis inferior
Corpus vert. thoracalis I Costa I Manubrium sterni
( incisura jugularis sterni )
Corpus vert. thoracalis XII
Cartilaginis costa X-XII Arcus costarum Proc. Xyhoideus
Di tutupi oleh diaphragma
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DINDING THORAX
Skeleton Articulus Musculus
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SKELETON
Vert. thoracalis (12 buah) Costa (12 psg) Sternum
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ARTICULUSJunctura costovertebralis
Junctura costosternalis
Articulus capituli Articularis
costotransversarius
Di btk oleh costa & sternum Costa I membentuk
articulus dengan incisura costalis I sterni synchondrosis
Costa II – VII Diarthrosis.
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MUSCULUSLap. superficial
M. pectoralis major & minor
M. Rectus abdominis M. Obliqus externus
abdominis M. Serratus anterior M. Latissimus dorsi M. Trapezius M. Rhomboideus major M. Rhomboideus minor M. Levator scapulae M. Serratus anterior
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Lapisan intermedia
M. Intercostalis externus M. Intercostalis internus
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Lapisan profundus
M. Subcostalis M. Transversus
thoracis
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VASCULARISASI
Arteri
1.A. intercostalis anterior
cab. A.mammaria
interna
2.A.intercostalis posterior 2 arteri bgn atas berasal
dari a.thoracalis suprema
cab. Trunchus
costocervicalis.
9 lainnya cab. dari aorta
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Aliran vena
V.intercostalis posterior bgn sup. v. Intercostalis sup. v. brachiocephalic (kiri) sdgk yg kanan v.azygos
Yg lainnya ke v.azygos atau v. thoracalis interna v. brachiocephalica
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INNERVASI N. Intercostalis di btk
o/ ramus anterior n. spinalis thoracalis I-XII
Saraf yang ke XII berjalan dicaudal costa XII sbg n.subcostalis
Motoris: u/ m.intercostal, subcostal & transversus
Sensoris: u/ kulit & pleura parietal.Pd ddg sup disuplai
cab.cutaneus n.supraclavicularis
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sYST.CARDIOVASCULARS - DD.TH
SURFACE ANATOMY
Dapat dipalpasi :INCISURA JUGULARIS STERNIANGULUS STERNI LOUISIPROCESSUS XIPHOIDEUS Patokan Angulus Sterni (Costa
II) atau cekungan dibawah clavicula ruang intercostal I
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Tepi caudal m.pectoralis major setinggi costa V
Bagian plg rendah costa V setinggi xyphisternal joint a/ corpus vert.IX/X
Di dorsal tubuh bagian yg plg menonjol proc.spinosus vert. th.I a/ vert. C .VII
Vert. L.IV terletak setinggi crista iliaca.
Pada posisi berdiri scapula terletak setinggi costa I-VII, pd margo lateralisnya terdapat m.teres major.
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GARIS VERTIKAL YANG DAPAT DITARIK
Linea sternalis Linea sternalis
lateralis Linea
medioclavicularis Linea papillaris Linea axillaris
anterior – media – posterior
Linea scapularis
sYST.CARDIOVASCULARS - DD.TH
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sYST.CARDIOVASCULARS - DD.TH
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MAMMA Menurut struktur dan
perkembangan, mempunyai hubungan dgn kulit
Sistem reproduksi( ASI )
Lokalisasi : antara Costa II – Costa VI/VII, di medial tepi sternum, dilateral mencapai Linea axillaris
Struktur : kelenjar, fat dan Jaringan ikat
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Pada masa laktasi
HYPERTROPHY HYPERPIGMENTASIPost partus papilla mammae
tetap menonjol, membedakan:
NULLIPARA MULTIPARA
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VASCULARISASI Lateral: dr a.axillaris
(a.thoracalis sup, a.thoracoacromialis, a.thoracalis lat, a.subscapularis
Medial: cab.a.thoracalis interna
A.intercostalis 2 – 4 Vena berjalan
bersama arteri v.Axillaris, v.thoracalis interna, v.intercostalis
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sYST.CARDIOVASCULARS - DD.TH
INNERVASI : Ramus cutaneus anterior Ramus cutaneus lateralis
cab. Nervi intercostales ii- vi Papilla mammae di innervasi
dr n. Intercostalis iv
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MEDIASTINUMEDIASTINUMMMEDIASTINUM SUPERIUSMEDIASTINUM INFERIUS
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MEDIASTINUM SUPERIUS
Batas ventral : Manubrium sterni + m.sternohyoideus + m.sternothyroideus
Batas dorsal : Corpus v.Th.I-IV
Batas lateral : Pleura mediastinalis
Batas caudal : bidang datar melalui Angulus sternalis Louisi
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MEDIASTINUM ANTERIUS MEDIASTINUM MEDIUM MEDIASTINUM POSTERIUS
Berisi : ll.nn., jaringan ikat, fat
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MEDIASTINUM MEDIUM
Berisi : pericardium + cor, aorta asc,vena cava sup,muara v.azygos,v.pulmonalis sinistra et dextra dan n.phrenicus dexter et sinister
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MEDIASTINUM POSTERIUS
ISI : Aorta thoracalis, v.azygos,
v.hemiazygos, N.vagus, n.phrenicus, bifurcatio trachea, bronchus, oesophagus, ductus thoracicus
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pleura
Membrana serosa yang membungkus pulmo
Pleura visceralis Pleura parietalis Cavum pleura (berisi
cairan serous)
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Pleura parietalis
Pleura costalis Pleura mediastinalis Pleura diaphragmatica Cupula pleurae
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Cupula plaurae Dibtk pertemuan pleura costalis &
pleura mediastinalis di apex pulmonis
2-3 cm di cranial costa I Atap dari cavum pleurae Dasar (bag.caudal) regio colli Ditutupi oleh mm.scaleni
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Peralihan pleura visceralis menjadi pleura mediastinalis berbtk ISTHMUS & membatasi radix pulmonis
Di cranial membatasi hilus pulmonis
Di caudal membentuk LIGAMENTUM PULMONALE
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Garis refleksi pleura
Refleksi vertebralis Refleksi sternalis Refleksi costalis Recessus (sinus)
costodiapragmaticus sinister et dexter
Recessuus (sinus) costomediastinalis
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Garis refleksi sternalis sinister et dexter terletak di dorsal art.sternoclavicularis bertemu di linea mediana anterior (setinggi angulus sterni)
Garis sternalis kiri menyilang pars cartilaginis costa IV, costa VIII pd linea medioclavicularis, menyilang costa X pd linea axillaris,costa XII pd collumnya
Garis refleksi sternalis dexter menyilang costa VII,X dan XII pd tempat yg sama spt garis refleksi sternalis sinister
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Garis refleksi vertebralis sepanjang columna vertebralis (V Th I-XII)
Vascularisasi: cabang-cabang a.intercostalis,a.musculophrenica & a.bronchialis
Innervasi : n.phrenicus, n. vagus & truncus sympathicus
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Pulmo
Parenchym yang berada bersama dgn bronchus dan percabangannya
Dibungkus oleh pleura Mengikuti gerakan
dinding thorax (inspirasi/expirasi)
Bentuknya mengikuti organ yang ada disekitarnya
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Pembagian Apex Basis 2 permukaan :
Facies costalis Facies mediastinalis
3 Margo: Margo inferior Margo anterior Margo posterior
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Ingat !! Bbrp dr organ mediastinum
akan membentuk indentasi pada permukaan medial pulmo
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Hilus Pulmonalis
T.d: A.pulmonalis 2
V.pulmonalis Vasa
bronchialis Nervus Pemb.lymphe
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Pulmo Dextra
T.d. 3 lobus Dipisahkan oleh:
Fissura horizontalis Lob.sup & lob. Medius
Fissura obliqua lob.medius & lob.inf.
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Proyeksi terhadap ddg thorax Fissura obliqua setinggi level proc.spinosus IV intercostal V mengikuti costa VI
Fissura horizontalis mengikuti intercostal space IV bertemu fiss.obliqua pd intercostal V
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Pulmo sinistra
T.d . 2 lobus Dipisahkan oleh
fissura obliquaLobus Sup & lob. Inferior
Terdapat lingula
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Proyeksi terhadap ddg dada
Proc. Spinosus V Th III/IV Th V Th VI
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Pembagian segmen Paru Lobus superior dext.:
Segmen apical Segmen posterior Segmen anteriorLobus medius Segmen lateral Segmen medialLobus inferior Segmen apical Segmen mediobasalis Segmen anterobasal Segmen laterobasal Segmen posterobasalis
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Lobus superior sinisterBagian superior Segmen
apicoposterior Segmen anteriorBagian inferior Segmen lingualis sup. Segmen lingualis
inferior
Lobus inferior Segmen apical Segmen anterobasal Segmen laterobasal Segmen mediobasal Segmen
posterobasalis
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Vascularisasi: a. pulmonalis, a. bronchialis,
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Innervasi:
Sympatis, n.vagus yg membentuk plexus pulmonalis anterior dan posterior
Visceral aff berasal dr: N.vagus
konstriksi bronhiolus
Sympatis dilatasi bronchiolus
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Lymphnodus: gugusan
superficial dan profundus Superficial
terletak subpleural profundus
mengikuti percabangan vasa pulmonalis
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DIAPHRAMA
Mrpk otot utama respirasi
Btk kubah: td.otot diperifer & tendo di sentral
Kubah dextra : setinggi tepi atas costa V
Kubah sinistra: mencapai pinggir bawah costa V
Origo: di bagi 3 bagian: Pars sternalis Pars costalis Pars vertebralis
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LUBANG PADA DIAPHRAGMA
Hiatus aorticus se tinggi Vert.th XII di lalui o/ aorta, duct. Thoracicus, v.azygos
Hiatus oesoph agus setinggi Vert. th X dilalui o/ oesoph.,n.vagus kanan &kiri, ramus oesophagus av.gastrica sin. Pemb.limphe
Hiatus vena cava setinggi vert.th VIII pd centrum tendineum dilalui o/ v.cava inferior & cab. Terminal n.phrenicus kanan.
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Vascularisasi
A. musculophrenica A.
pericardicophrenic A.phrenica sup A. phrenica inferior
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PERSARAFAN N. phrenicus (C3,4,5) Sensoris u/ pleura
parietalis & peritoneum
pd bgn tengah diaph. berasal dari n. phrenicus
Sensoris u/ bgn pinggir diaph. Berasal dr. 5 n. intercostalis bgn bawah.
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Bila kontraksi ?Bila relaxasi ?
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