Anatomy Notes [PDF]

Zitiervorschau

September 16, 2013

ANATOMY: INTRODUCTION TO THE THORACIC REGION – DR. LAYGO

Thoracic Region Thoracic Cavity – Made up of Thoracic Cage Sternum Costal Cartilage – mediates as an indirect attachment for sternum and anterior ribs Ribs Thoracic Vertebra – Where posterior ribs are attached Diaphragm – Lower boundary Thoracic Inlet – Superior boundary, level of thoracic notch, at the level between T2 and T3 Thoracic Cage Shape: truncated cone Boundaries:  Anterior wall (Sternum, anterior part of 10 ribs)  Lateral wall (ribs)  Posterior wall (12 thoracic vertebrae and posterior part of the ribs)  Apertures:

Superior aperture (thoracic inlet) Measurement: 2 x 4 inches Boundaries:  Body of 1st thoracic vertebrae  1st rib  1st costal cartilage  Upper border of manubrium sterni Diaphragm of aperture: Sibson’s fascia - Extension of deep cervical fascia. - Encloses 1st part of subclavian artery, internal thoracic vessels and is also attached to the cervical/costal pleura  pleural covering of apical portion of the lungs

Inferior aperture (thoracic outlet)

Boundary: Diaphragm Two major division of the thoracic cavity:  Median partition (mediastinum) Parts of mediastinum: 1) Anterior mediastinum 2) Middle mediastinum 3) Posterior mediastinum  Laterally (pleurae and lungs) - Visceral and parietal pleura - Visceral – pleura attached to lungs - Parietal – pleura superficial to viscera and close to thoracic cage - Pleural cavity – space between parietal and visceral pleura.

Breast (See Miracles In Life Everyday) Base: 2nd – 6th ribs Lateral: anterior axillary line Medially: lateral border of the sternum Stages of development

“Time changes everything. That’s what people say, it’s not true. Doing things changes things. Not doing things leaves things exactly as they were.” – Dr. House

The Anatomy Committee Batch‘171

September 16, 2013

1. 2. 3. 4. 5. Parts: 1. 2.

ANATOMY: INTRODUCTION TO THE THORACIC REGION – DR. LAYGO

Prepubertal Breast budding Enlargement Secondary mound Single contour of breast

15 – 20 lobes Lactiferous ducts -Ampulla: dilated portion 3. Areola 4. Tubercles – alveolar glands Areolar glands of Montgomery: small rounded elevations 5. Suspensory ligaments -Separates the fibrous septa 6. Axillay tail: also called “axillary tail of Spence” -small part -Extends upward and laterally Retromammary space - Space between the mammary gland and pectoralis fascia -Supernumerary breast- Multiple nipples present, usually located at along the mammary line/ milk line

Breast Quadrants:

BLOOD SUPPLY 1. Axillary artery -Superior thoracic -Lateral thoracic: supplies lateral part -Thoracoacromial: supplies superior portion 2. Internal mammary artery: branch of subclavian artery; supplies medial part 3. Intercostals artery: perforating branch; supplies posterior portion; branch of aorta 4. Subscapular artery Venous 1. Internal thoracic/ mammary vein – eventually drain at subclavian vein  brachiocephalic drainage 2. Lateral thoracic/ mammary vein – drainage of lateral side eventually draining to axillary vein  brachiocephalic drainage Lymphatic drainage 2 Major groups of lymphatic drainage: Axillary group of lymph node (LN) -75% of breast drains on it Internal mammary group of lymph nodes -Lateral part of breast -25% of breast drains on it Others: 1. External mammary group of LN -Average of 1.7 LN -Lying on lateral side pectoralis major muscle -Medial side of axilla 2. Scapular LN -Average of 5.8 LN/ 5-7 LN -Lying together with scapular vessels -Thoracodorsal branch of scapular vessel 3. Central axillary LN -Area where most number of LN are found -12-15 LN

“Time changes everything. That’s what people say, it’s not true. Doing things changes things. Not doing things leaves things exactly as they were.” – Dr. House

The Anatomy Committee Batch‘172

September 16, 2013

ANATOMY: INTRODUCTION TO THE THORACIC REGION – DR. LAYGO

-Located within axillary fat pad -Lymph node that is easily palpable 4. Interpectoral/ rotter’s LN -1.4 LN -Lying between pectoralis major and minor muscles 5. Axillary vein LN -Lying on ventral and caudal part of the lateral axillary vein -Average of 10.7 LN -Second largest group of LN 6. Subclavian LN/ subclavicular group of LN -3.5 LN/ 3-5 LN -Underneath the subclavian vein 7. subareolar plexus of Sappey (Thorek) Abnormal Findings: 1. Paget’s Disease 2. Breast dimpling 3. Nipple discharges 4. Peau d’ Orange – skin of the orange “If you want to change your grade you have to be willing to be uncomfortable” Notetakers: ARANCA, Voltaire BUCCAT, Noel YAP, Janel

***Average Lymph Node of 35.3 lymph nodes 3 Parts of Axillary Lymph Node: a. LEVEL 1 - all axillary nodes lateral to pectralis minor - axillary vein group - external mammary - scapular b. LEVEL 2 - located underneath pectoralis minor - central group - some subclavian c. LEVEL 3 - axillary lymph node located medial to pectoralis minor apical or subclavicular

“Time changes everything. That’s what people say, it’s not true. Doing things changes things. Not doing things leaves things exactly as they were.” – Dr. House

The Anatomy Committee Batch‘173