Thorax and Thorax and Abdomen & PelvisAbdomen & Pelvis

MOHAMED ELADLMOHAMED ELADL

Describe in the bony structures of the Thoracic cage. Describe the boundaries of the Thoracic inlet and outlet Identify the trachea, bronchial tree, pleura and Lungs. Identify the arrangement of structures in the Mediastinum. Describe the heart and its blood supply. Identify Normal chest x ray.

Thorax

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Definition: It is the space

between two ribs. Number: 11. Contents:

Intercostal muscles. Intercostal vessels. Intercostal nerve. Lymphatics.

The trachea is a fibrocartilaginous tube supported by incomplete cartilaginous tracheal rings

These rings are C-shaped, keep the trachea patent

Deficient posteriorly, and posterior free ends are connected by smooth muscle, the trachealis muscle

Beginning: in the neck below the cricoid cartilage of the larynx at the level of the body of the 6th cervical vertebra

Termination: below in the thorax at the level of the sternal angle (lower border of T4) by dividing into right and left principal bronchi

At the level of the bifurcation, the last tracheal ring is triangular in shape, called the carina

Length: 5 inches (13 cm)

Diameter: 1 inch (2.5 cm)

Relation: Anteriorly: Arch of the

aorta with the origins of brachiocephalic and left common carotid arteries

Posteriorly: Esophagus

Carina

The mucous membrane covering the carina is one of the most sensitive areas of the tracheobronchial tree and is associated with the cough reflex.

If the tracheobronchial lymph nodes enlarged then the carina is distorted, widened posteriorly and immobile.

Aspiration of foreign bodies:

The right bronchus is wider and shorter and runs more vertically than the left bronchus, foreign material is more likely to enter and lodge in it or one of its branches mainly right lower lobe bronchus

Consists of two membranes: Visceral pleura: Closely covers the lung

Parietal pleura: lines the pulmonary cavities. It has four parts: Costal, Mediastinal, Diaphragmatic, and Cervical pleura.

The lungs are the vital organ of respiration.

In child, lungs are pink; but with age, they become dark and mottled because of the inhalation of dust particles.

Each lung is conical, covered with visceral pleura, being attached to the mediastinum only by its root.

Costal surface is smooth and convex, related to costal pleura.

Mediastinal surface is concave, includes the hilum and related to middle mediastinum.

Right lung: Right lung is slightly larger than the left. Two fissures – oblique and horizontal. Three lobes – upper, middle and lower.

Left lung: One fissure – oblique, no horizontal

fissure. Two lobes – upper and lower.

Horizontal fissure extends from the oblique fissure along the 4th rib and costal cartilage anteriorly.

Definition:

Is the median partition between the two - pleural cavities.

Position:

Extends from the sternum anteriorly to the vertebral column posteriorly, and from the thoracic inlet above to the diaphragm below.

Divisions:

The mediastinum is divided into:

The superior mediastinum: above the imaginary plane between the manubrium sterni and the lower border of the 4th thoracic vertebrae.

The inferior mediastinum: below this plane and it is further subdivided into: Anterior mediastinum: Behind

the body and xiphoid process of the sternum and in front of the middle mediastinum.

Middle mediastinum: occupied by the pericardium and the heart.

Posterior mediastinum: lies behind the middle mediastinum.

Definition:Hollow muscular organ.

Size: Size of a closed fist.

Weight: Average weight of 300gm.

Site: It lies obliquely in middle mediastinum between the 2 lungs. Surrounded by pericardium

Formation: It has a base

directed upwards & to the right and an apex directed downwards & to the left.

It is formed chiefly of a muscle, the myocardium.

It has an inner epithelial, lining, the endocardium and an outer covering of connective tissue, the pericardium.

The cavity of the heart is divided completely by a median septum into right and left halves.

Each side is further subdivided into a thin walled atrium above and a thick walled ventricle below.

The Atrio-Ventricular valves guard the communication between each atrium and the corresponding ventricle (the tricuspid on the right and the mitral on the left).

The semilunar valves guard the openings of the great vessels, which arise from the ventricles (the pulmonary on the right and the aortic on the left).

Arterial supply:

The right and left

coronary arteries.

Venous drainage:

Is mainly through

coronary sinus to the

right atrium.

Describe different regions of the abdomen. Describe arrangement of different organs in the

abdomen. Mention the major abdominal blood supply. Identify the normal abdominal X ray findings.

Abdomen

Anterolateral group External Oblique. Internal oblique. Transversus

abdominis. Rectus abdominis.

Posterior group Quadiatus

lumborum. Psoas major.

The most dilated The most dilated part of the gut. part of the gut.

Parts of stomach:Parts of stomach: Cardiac end.Cardiac end. Fundus: air in x-Fundus: air in x-

rayray BodyBody Pylorus---starts Pylorus---starts

to narrow as it to narrow as it approaches approaches pyloric sphincter.pyloric sphincter.

Barium swallow:Barium swallow:

1.1. Esophagus.Esophagus.

2.2. Cardiac end of the Cardiac end of the stomach.stomach.

Plane X ray Chest:Plane X ray Chest:1.1. Arch of aorta.Arch of aorta.2.2. Right atrium.Right atrium.3.3. Left ventricle.Left ventricle.4.4. Right costophrenic Right costophrenic

angel.angel.5.5. left copula of left copula of

diaphragm .diaphragm .6.6. Tracheal air Tracheal air

shadow.shadow.7.7. Air in the stomach.Air in the stomach.

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Barium meal:Barium meal:1.1. Fundus of Fundus of

stomach.stomach.2.2. Lesser curvature.Lesser curvature.3.3. Greater curvature.Greater curvature.4.4. Jejenum.Jejenum.5.5. Mucosal folds.Mucosal folds.

20 feet long,1 inch 20 feet long,1 inch in diameter in diameter extends from the extends from the pylorus to the pylorus to the iliocaecal junction.iliocaecal junction.

Large surface area Large surface area for majority of for majority of absorptionabsorption

3 parts3 parts Duodenum-Duodenum---10 --10

inchesinches Jejunum-Jejunum---8 feet--8 feet Ileum-Ileum---12 feet--12 feet

55 feet long by feet long by 2½2½ inches in diameter inches in diameter Cecum, appendix, ascending colon, Cecum, appendix, ascending colon,

transverse colon, descending colon and transverse colon, descending colon and sigmoid colon. sigmoid colon.

RectumRectum = last 8 inches of GI tract = last 8 inches of GI tract anterior to the sacrum & coccyxanterior to the sacrum & coccyx

Anal canalAnal canal = last 1 inch of GI tract = last 1 inch of GI tract Internal sphincterInternal sphincter----smooth muscle & involuntary ----smooth muscle & involuntary ExternalExternal sphincter-sphincter----skeletal muscle & voluntary ---skeletal muscle & voluntary

controlcontrol

Barium enema:Barium enema:1.1. Ascending colon.Ascending colon.2.2. Rt. Colic flexure.Rt. Colic flexure.3.3. Transverse colon.Transverse colon.4.4. Lt. colic flexure.Lt. colic flexure.5.5. Descending colon.Descending colon.6.6. Vertebral column.Vertebral column.7.7. Sigmoid colon.Sigmoid colon.8.8. Rectum.Rectum.

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Differences between small & large IntestineDifferences between small & large Intestine

LARGE INTESTINELARGE INTESTINE SMALL INTESTINE SMALL INTESTINE Wider caliber and shorter 1.5 meter NarrowerNarrower and longerlonger 6 meters

Greater part is fixedfixed. Greater part is mobilemobile.

VilliVilli are absent VilliVilli are present

AppendicesAppendices epiploicaeepiploicae except in Caecum.

Vermiform appendix & Rectum.

NoNo

TineaTinea colicoli are present NoNo

HustrationsHustrations .as the length of tinea coli is shorter than the colon length.

NoNo

Soft lobulated Soft lobulated organ, extends in organ, extends in the posterior the posterior abdominal wall from abdominal wall from the concavity of the the concavity of the duodenum to the duodenum to the hilum of the spleen.hilum of the spleen.

Formed of 4 parts Formed of 4 parts (Head, neck, body & (Head, neck, body & tail).tail).

The pancreatic duct The pancreatic duct joins common bile joins common bile duct from the liver. duct from the liver.

Opens 4" below Opens 4" below pyloric sphincter.pyloric sphincter.

It is the largest It is the largest glandgland

Lies Below the right Lies Below the right copula of the copula of the diaphragm.diaphragm.

Right lobe larger Right lobe larger and lodges the and lodges the gallbladder.gallbladder.

Size causes right Size causes right kidney to be lower kidney to be lower than left.than left.

The Liver and GallbladderThe Liver and Gallbladder

• GallbladderGallbladder– Fundus, body & neckFundus, body & neck

Continuation of thoracic aorta at aortic opening of the diaphragm in front of T12

Terminates at lower border of L4 vertebra by dividing into right and left common iliac arteries.

Parietal branches

Inferior phrenic arteries.

Lumbar arteries. (four pairs of arteries that supply the posterior abdominal wall)

Median sacral arteries.

Visceral branches

Paired branches Middle suprarenal

artery. Renal artery Testicular (ovarian)

artery

Unpaired branches Celiac trunk: short

thick vessel that arises from the front of aorta, at the level of upper L1

Superior mesenteric artery: arises from the front of aorta, at the level of lower L1

Inferior mesenteric artery: arises from the front of aorta, at level of L3

Internal iliac vein Parietal tributaries: accompany with arteries Visceral tributaries

→superior rectal vein→inferior mesenteric v.

①Rectal venous plexus →inferior rectal vein→internal iliac v.

→anal vein→internal pudendal v.

②Vesical venous plexus → vesical v.

③Uterine venous plexus → uterine v.

External iliac vein: accompany the artery

Common iliac vein: formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4~L5 by uniting each other to form inferior vena cava.

Formed by union of two common iliac veins anterior to and just to the right of L4~L5

Ascends on the right side of aorta, pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atrium

Conveys blood from the whole body below the diaphragm to the right atrium

Chief tributaries Parietal

Paired inferior phrenic v. paired lumbar v. (four)

Visceral Right and left renal veins Right suprarenal vein (left

drain into left renal vein). Right testicular or ovarian

. (left drain into left renal vein)

Hepatic veins: right, left and intermediate

Describe in the bony structures of the pelvic girdle. Describe the boundaries of the pelvic inlet and outlet List the major differences between a male and female

pelvis Identify the articulations of the pelvis Describe the gross and relational anatomy of the

pelvic viscera Identify the structures forming the pelvic walls and

floor Be able to identify the X ray images of the pelvis, hip,

acetabulum, femur, ischial bones.

Pelvis

Lighter in structure Roomier cavity-

childbearing Wider, shallower Inlet larger and more

oval Sacrum wider and

curves more sharply posteriorly

Sacral promontory flatter

Outlet wider

Heavier More conical-deeper Obturator foramen

rounder Laterally narrower Pubic arch more acute

angle Inlet round, outlet

narrow

Superior aperature or Inlet-upper border of symphasis to sacral promontary

Inferior aperature or Outlet-inferior border of symphasis to tip of coccyx

Location of some abdominal viscera (ileum and sigmoid colon)

Bounded by abdominal wall anteriorly, the iliac fossa posteriolaterally and L5 S1 vertebrae posteriorly

Location of pelvic viscera, the urinary bladder and reproductive organs such as the uterus and ovaries

Bounded by the pelvic surfaces of the hip bones, sacrum, and coccyx

Limited inferiorly by the musculofascial pelvic diaphragm

ASIS

Iliac Crest

Symphysis Pubis

Greater Trochanter

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1. UB2. Uterus3. Rectum4. F tube5. ovary

Formed by the funnel shaped pelvic diaphragm

Consists of the levator ani and coccygeus muscles and their fascia

Stretches between the pubis anteriorly and the coccyx posteriorly and from one lateral pelvic wall to the other.

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