Undocumented thoughts about Week 6 lab objectives
10/6/99 W. Crone (303 FTZ, 629-7439, cronewil@hvcc.edu, www.hvcc.edu/academ/faculty/crone/index.html)
Included on this sheet are some thoughts to help you be oriented with the different lab objectives. Feel free to expand and elaborate for your own purposes--I'm not intending this to be exhaustive!
NB: for muscles: O-origin, I-insertion, N-enervation, A-action
- r.,l. phrenic n.:
from C3, 4, 5, they course anterioromedially along pericardium, with motor and sensory to central diaphragm (and sensory to pericardium)--hence, referred pain patterns
- esophagus:
posterior in position in thorax
- descending aorta:
in the posterior mediastinum; we will note the posterior intercostal aa. off of it.
- intercostal v., a., n.:
ant. intercostals send branches through intercostal mm to supply pectoral region. Intercostal veins drain into the azygos vein. The nerves are ventral rami of T1-11 (T12 subcostal n)
- sympathetic trunk (ganglia):
collection of neuroectodermal ganglia, paravertebral. Thoracolumbar outflow from T1-L2, so first leg often into a chain of ganglia into each body segment. Consisting of ascending and descending fibers.
- rami communicantes:*
white: myelinated preganglionic fibers from T1-L2. Grey postganglionic fibers into spinal nerves."The further you get from home, the dirtier you get" as a mnemonic.
- greater splanchnic n.:
splanchnic n. main source of symp. nerves into abdomen. Coming from T5-9 to celiac ganglion. p.48 Moore and Dalley gives an overview. Preganglionic fibers that pass via white rami comm. Greater runs medial to symp trunk to reach celiac ganglion and so supplies liver, spleen, stomach region (some visceral pain afferent fibers that pass back via white rami comm to dorsal root, so referred pain patterns)
- apex of lung:
round, tapered superior end of lung, above clavicle
- costal surface of lung:
large, smooth convex
- medial surface of lung:
mediastinal surface, surface with the root of the lung
- basal (diaphragmatic) surface of lung:
domed in relationship to diaphragm
- cardiac impression (l. lung):
as a reflection of the leftward rotation of the heart
- groove for arch and descending aorta (l. lung):
note the tight packing of structures in the thorax even as the lung is in its own pleural cavity
- hilus of lung:
where the root is attached to the lung
- primary (main) bronchus:
R is wider, more vertical than L, so aspirated material there
- pulmonary a., v.:
2 pulm veins each side, superior, inferior
- lobar bronchi:
equiv. to secondary bronchi, so 2 on L, 3 on R.
- segmental bronchi:
equiv. to tertiary bronchi, or those bronchi supplying bronchopulmonary segments
- bronchopulmonary segments:
depends on our progress: I don't think we'll memorize these, but look for an example of tertiary bronchi and the surrounding material
- superior, anterior mediastinum:
sup: thoracic inlet to sternal angle. Thymus, great vessels. ant: ant to pericardium (post to sternum)à the (large) thymus in youth
- middle, posterior mediastinum:
middle: pericardium and heart, main bronchi, lung roots. Posterior: posterior to pericardium, with esophagus and desc. thoracic aorta
- parietal pericardium:
part of serous pericardium, underneath fibrous pericardium
- visceral pericardium (epicardium):
part of serous pericardium, on top of myocardium
- pericardial cavity:
potential space with some serous fluid; cardiac tamponade as a concern
- superior vena cava:
returns blood from superior part of body: forelimbs, head, neck, and most of abdominal and thoracic body wall, with contributing tributaries of azygos and brachiocephalic veins
- ascending aorta, arch:
R-L, brachiocephalic, L common carotid, L subclavian a. off of the arch
- pulmonary trunk and artery:
R, L pulm arteries, with branches to lobar and segmental branches
- ligamentum arteriosum:
remnant of ductus arteriosus in fetus. From pulm art to desc. aorta. Often a site near coartaction; also a site of ripping of aorta in trauma.
- 1. vagal n.:
CN X that wanders down to be main thoracic, much of abd parasympathetic source. Hangs out near gut (esophagus). Descending aortic arches pull vagal fibers to gill arch mm into a loop.
- 1. recurrent laryngeal n.:*
this hook around lig. art. (motor source to larynx, so hoarseness if damaged or impinged)
- transverse pericardial sinus:
trapping of original pericardial cavity as the atria fold up onto ventricles, so this sinus is in a narrow chamber between 2 sets of pericardial reflections (can control flow through great vessels once into pericardial sac during heart surgery)
- oblique pericardial sinus:
reflection of serous pericardium, between 2 lower pulmonary veins
- r. coronary a.:
found in AV groove, supplies right side of heart and nodes (see separately listed branches)
- anterior interventricular branch (LAD):
in interventric groove, supplying ant. septum and ant. LV wall
- inferior vena cava:
drains inf. body. Before birth, IVC valve aimed towards foramen ovale. (valve on inf side, nonfunctional after birth)
- pulmonary vv.:
open to post. aspect of LA (bronchial v into azygos system)
- atrioventricular (coronary) groove (sulcus):
where the RCA runs through, encircles superior part of heart, separates atria from ventricles
- interventricular grooves, anterior and posterior:
ant., post., separates ventricles
- 1. coronary a.:
between L auricle and pulm trunk to reach coronary groove. Supplies most of LV and LA and IV septum (including AV bundles)
- aortic semilunar valve:
thicker valves than pulmonary valves
- circumflex branch of l. coronary a.:
L border of heart to poster. surface, commonly anastomosing with RCA, so LA and left surface of heart
- marginal branch* of r. coronary a.:
to supply R wall. RCA:RA, RV, SA and AV nodes
- anterior r. atrial branch of r. coronary a.:
supplying right atrium
- nodal a. (sinus node a.):
supplies SA node in majority of people--off of RCA
- posterior interventricular branch:
the largest branch of RCA, supplies both ventricles in that region
- coronary sinus:
main vein of heart post. part of coronary groove, other cardiac v. drain into this.
- great cardiac v.:
travels with LAD, then L circumflex a. to reach coronary sinus
- middle cardiac v.:
travels with posterior interventricular a. to coronary sinus
- r. atrium:
primitive RA is the auricle. Deoxygenated blood collected here.
- pectinate m.:
anterior part with rough mm. edges, smooth part where vessels have grown in, developmentally speaking
- crista terminalis:
ridge between the pectinate muscles and the smooth part of the atrial walls
- valve of coronary sinus:
a slight covering for this opening into the right atrium
- tricuspid valve:
ant. cusp between orifice and inf. end of conus arteriosus. Others are posterior and septal
- fossa ovalis:
remnant of the fetal foramen ovale,"in line" with blood entering from IVC
- sinuatrial node position:
lateral RA where SVC goes in, near mm. ridge
- atrioventricular node position:
IA septum on the ventricular side of the coronary sinus orifice
- r. ventricle:
tapers into conus arteriosus before pulm. trunk
- tricuspid valve:
R AV valve
- chordae tendineae:
threads from papillary mm, prevent cusp inversion in systole
- papillary m.:
conical projections mentioned above with bases attached to wall of ventricle
- trabeculae carnae:
fleshy little timbers, anchored only at ends: highlihts primitive spongy characteristics of myocardium
- septomarginal trabecula (moderator band):*
crosses from IV septum to ant. papillary mm., carries some of R branch of AV bundle
- pulmonary semilunar valve:
ant., right, left cusps.
- infundibulum (conus arteriosus):
smooth, funnel-shaped part of RV
- 1. atrium:
L auricle primitive part, 4 pulmonary v. drain in
- mitral (bicuspid) valve:
most commonly affected by RF, ant. cusp, larger, to right
- 1. ventricle:
again, auricle with pectinate mm (primitive auricle)
- interventricular septum, muscular and membranous parts:
contains conduction system; membranous portion is where VSDs more likely to occur, up near aortic valve
- r. border of heart: -
RA, e.g., on CXR
- 1. border of heart: -
LV
- apex, base of heart:
blunt, formed by LV, L 5 ICS, medial to L MCL
- inferior border: -
RV
- r. vagal n.:
post to SVC and breaks up into plexuses, eg cardiac; R recurrent around R subclavian
- thoracic duct:
main lymphatic duct, starts from cisterna chyli, post.; dumps into L subclavian/ L int. jugular junction
- azygos v.:
drains post wall of thorax, drains into SVC
- descending aorta:
thoracic duct, azygos v. on R side of it going thru aortic hiatus of diaphragm as well
- anterior, posterior intercostal aa.:
part of the intercostal VAN that anastomose from internal thoracic and descending aorta, respectively
- lesser splanchnic n.* (thoracic):
T10-T11, runs to superior mesenteric ganglion on abdominal aorta, innervates small intestine and proximal large intestine
- diaphragm:
represents about 75% of respiratory effort
- thymus:*
T cell maturation, large in childhood, involutes, ant./sup. mediastinum, can go down to xiphoid process
- r., l. brachiocephalic vv.:
also known as innominate v., no valves, feed into SVC, from jugular, subclavian vv. R brachiocephalic receives R lymphatic duct, L brachiocephalic v. recieves thoracic duct
- brachiocephalic a.:
soon divides into r. subclavian a., r. common carotid a.
- 1. common carotid a.:
a direct branch off of the aortic arch
- 1. subclavian a.:
off of aortic arch as well
- vagus n. (CN X):
will see see it branching in thorax to contribute to cardiac, pulmonary, and esophageal plexuses for parasympathetic innervation
- tracheobronchial lymph nodes:
drainage around the bifurcation
- bifurcation of the trachea:
note how r. main stem bronchus is more in line and slightly wider than l. main stem bronchus.
- carina:
keel-like ridge between the bronchal orifices, sensitive so cough reflex. Distortions seen in bronchoscopy imply disease process, e.g., from enlargement of tracheobronchial lymph nodes
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