Thorax and abdomen & pelvis


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Thorax and abdomen & pelvis

  1. 1. <ul><li>Thorax and Abdomen & Pelvis </li></ul>MOHAMED ELADL
  2. 2. <ul><li>Describe in the bony structures of the Thoracic cage. </li></ul><ul><li>Describe the boundaries of the Thoracic inlet and outlet </li></ul><ul><li>Identify the trachea, bronchial tree, pleura and Lungs. </li></ul><ul><li>Identify the arrangement of structures in the Mediastinum. </li></ul><ul><li>Describe the heart and its blood supply. </li></ul><ul><li>Identify Normal chest x ray. </li></ul>Thorax
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  4. 7. <ul><li>Definition: </li></ul><ul><ul><li>It is the space between two ribs. </li></ul></ul><ul><li>Number: 11 . </li></ul><ul><li>Contents: </li></ul><ul><ul><li>Intercostal muscles. </li></ul></ul><ul><ul><li>Intercostal vessels. </li></ul></ul><ul><ul><li>Intercostal nerve. </li></ul></ul><ul><ul><li>Lymphatics. </li></ul></ul>
  5. 9. <ul><li>The trachea is a fibrocartilaginous tube supported by incomplete cartilaginous tracheal rings </li></ul><ul><li>These rings are C-shaped, keep the trachea patent </li></ul><ul><li>Deficient posteriorly, and posterior free ends are connected by smooth muscle, the trachealis muscle </li></ul>
  6. 10. <ul><li>Beginning: in the neck below the cricoid cartilage of the larynx at the level of the body of the 6 th cervical vertebra </li></ul><ul><li>Termination: below in the thorax at the level of the sternal angle (lower border of T4) by dividing into right and left principal bronchi </li></ul><ul><li>At the level of the bifurcation, the last tracheal ring is triangular in shape, called the carina </li></ul>
  7. 11. <ul><li>Length: 5 inches (13 cm) </li></ul><ul><li>Diameter: 1 inch (2.5 cm) </li></ul><ul><li>Relation: </li></ul><ul><ul><li>Anteriorly: Arch of the aorta with the origins of brachiocephalic and left common carotid arteries </li></ul></ul><ul><ul><li>Posteriorly: Esophagus </li></ul></ul>
  8. 12. Carina <ul><li>The mucous membrane covering the carina is one of the most sensitive areas of the tracheobronchial tree and is associated with the cough reflex. </li></ul><ul><li>If the tracheobronchial lymph nodes enlarged then the carina is distorted, widened posteriorly and immobile. </li></ul>
  9. 13. <ul><li>Aspiration of foreign bodies : </li></ul><ul><li>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 </li></ul>
  10. 14. <ul><li>Consists of two membranes: </li></ul><ul><li>Visceral pleura: Closely covers the lung </li></ul><ul><li>Parietal pleura: lines the pulmonary cavities. It has four parts: Costal, Mediastinal, Diaphragmatic, and Cervical pleura. </li></ul>
  11. 15. <ul><li>The lungs are the vital organ of respiration. </li></ul><ul><li>In child, lungs are pink; but with age, they become dark and mottled because of the inhalation of dust particles. </li></ul><ul><li>Each lung is conical, covered with visceral pleura, being attached to the mediastinum only by its root. </li></ul>
  12. 16. <ul><li>Costal surface is smooth and convex, related to costal pleura. </li></ul><ul><li>Mediastinal surface is concave, includes the hilum and related to middle mediastinum. </li></ul>
  13. 17. <ul><li>Right lung : </li></ul><ul><li>Right lung is slightly larger than the left. </li></ul><ul><li>Two fissures – oblique and horizontal. </li></ul><ul><li>Three lobes – upper, middle and lower. </li></ul><ul><li>Left lung: </li></ul><ul><li>One fissure – oblique, no horizontal fissure. </li></ul><ul><li>Two lobes – upper and lower. </li></ul>
  14. 18. <ul><li>Horizontal fissure extends from the oblique fissure along the 4 th rib and costal cartilage anteriorly. </li></ul>
  15. 20. <ul><li>Definition : </li></ul><ul><ul><li>Is the median partition between the two - pleural cavities. </li></ul></ul><ul><li>Position : </li></ul><ul><li>Extends from the sternum anteriorly to the vertebral column posteriorly, and from the thoracic inlet above to the diaphragm below. </li></ul>
  16. 22. <ul><li>Divisions : </li></ul><ul><ul><li>The mediastinum is divided into : </li></ul></ul><ul><ul><ul><li>The superior mediastinum: above the imaginary plane between the manubrium sterni and the lower border of the 4 th thoracic vertebrae. </li></ul></ul></ul><ul><ul><ul><li>The inferior mediastinum: below this plane and it is further subdivided into: </li></ul></ul></ul><ul><ul><ul><ul><li>Anterior mediastinum: Behind the body and xiphoid process of the sternum and in front of the middle mediastinum. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Middle mediastinum: occupied by the pericardium and the heart. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Posterior mediastinum: lies behind the middle mediastinum. </li></ul></ul></ul></ul>
  17. 23. <ul><ul><li>Definition: </li></ul></ul><ul><ul><li>Hollow muscular organ. </li></ul></ul><ul><ul><li>Size: </li></ul></ul><ul><ul><li>Size of a closed fist. </li></ul></ul><ul><ul><li>Weight: </li></ul></ul><ul><ul><li>Average weight of 300gm. </li></ul></ul><ul><ul><li>Site: </li></ul></ul><ul><ul><li>It lies obliquely in middle mediastinum between the 2 lungs. </li></ul></ul><ul><ul><li>Surrounded by pericardium </li></ul></ul>
  18. 24. <ul><li>Formation: </li></ul><ul><ul><ul><li>It has a base directed upwards & to the right and an apex directed downwards & to the left. </li></ul></ul></ul><ul><ul><ul><li>It is formed chiefly of a muscle, the myocardium. </li></ul></ul></ul><ul><ul><ul><li>It has an inner epithelial, lining, the endocardium and an outer covering of connective tissue, the pericardium. </li></ul></ul></ul>
  19. 25. <ul><ul><li>The cavity of the heart is divided completely by a median septum into right and left halves. </li></ul></ul><ul><ul><li>Each side is further subdivided into a thin walled atrium above and a thick walled ventricle below. </li></ul></ul><ul><ul><li>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). </li></ul></ul><ul><ul><li>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). </li></ul></ul>
  20. 26. <ul><li>Arterial supply: </li></ul><ul><li>The right and left coronary arteries. </li></ul><ul><li>Venous drainage: </li></ul><ul><li>Is mainly through coronary sinus to the right atrium. </li></ul>
  21. 27. <ul><li>Describe different regions of the abdomen. </li></ul><ul><li>Describe arrangement of different organs in the abdomen. </li></ul><ul><li>Mention the major abdominal blood supply. </li></ul><ul><li>Identify the normal abdominal X ray findings. </li></ul>Abdomen
  22. 29. <ul><li>Anterolateral group </li></ul><ul><li>External Oblique. </li></ul><ul><li>Internal oblique. </li></ul><ul><li>Transversus abdominis. </li></ul><ul><li>Rectus abdominis. </li></ul>
  23. 30. <ul><li>Posterior group </li></ul><ul><li>Quadiatus lumborum. </li></ul><ul><li>Psoas major. </li></ul>
  24. 32. <ul><li>The most dilated part of the gut. </li></ul><ul><li>Parts of stomach: </li></ul><ul><ul><li>Cardiac end. </li></ul></ul><ul><ul><li>Fundus: air in x-ray </li></ul></ul><ul><ul><li>Body </li></ul></ul><ul><ul><li>Pylorus---starts to narrow as it approaches pyloric sphincter. </li></ul></ul>
  25. 33. <ul><li>Barium swallow: </li></ul><ul><li>Esophagus. </li></ul><ul><li>Cardiac end of the stomach. </li></ul>
  26. 34. <ul><li>Plane X ray Chest: </li></ul><ul><li>Arch of aorta. </li></ul><ul><li>Right atrium. </li></ul><ul><li>Left ventricle. </li></ul><ul><li>Right costophrenic angel. </li></ul><ul><li>left copula of diaphragm . </li></ul><ul><li>Tracheal air shadow. </li></ul><ul><li>Air in the stomach. </li></ul>7
  27. 35. <ul><li>Barium meal: </li></ul><ul><li>Fundus of stomach. </li></ul><ul><li>Lesser curvature. </li></ul><ul><li>Greater curvature. </li></ul><ul><li>Jejenum. </li></ul><ul><li>Mucosal folds. </li></ul>
  28. 37. <ul><li>20 feet long,1 inch in diameter extends from the pylorus to the iliocaecal junction. </li></ul><ul><li>Large surface area for majority of absorption </li></ul><ul><li>3 parts </li></ul><ul><ul><li>Duodenum- --10 inches </li></ul></ul><ul><ul><li>Jejunum- --8 feet </li></ul></ul><ul><ul><li>Ileum- --12 feet </li></ul></ul>
  29. 39. <ul><li>5 feet long by 2½ inches in diameter </li></ul><ul><li>Cecum, appendix, ascending colon, transverse colon, descending colon and sigmoid colon. </li></ul>
  30. 40. <ul><li>Rectum = last 8 inches of GI tract anterior to the sacrum & coccyx </li></ul>
  31. 41. <ul><li>Anal canal = last 1 inch of GI tract </li></ul><ul><ul><li>Internal sphincter ----smooth muscle & involuntary </li></ul></ul><ul><ul><li>External sphincter- ---skeletal muscle & voluntary control </li></ul></ul>
  32. 42. <ul><li>Barium enema: </li></ul><ul><li>Ascending colon. </li></ul><ul><li>Rt. Colic flexure. </li></ul><ul><li>Transverse colon. </li></ul><ul><li>Lt. colic flexure. </li></ul><ul><li>Descending colon. </li></ul><ul><li>Vertebral column. </li></ul><ul><li>Sigmoid colon. </li></ul><ul><li>Rectum. </li></ul>6
  33. 43. Differences between small & large Intestine SMALL INTESTINE LARGE INTESTINE Narrower and longer 6 meters Wider caliber and shorter 1.5 meter Greater part is mobile . Greater part is fixed . Villi are present Villi are absent No Appendices epiploicae except in Caecum. Vermiform appendix & Rectum. No Tinea coli are present No Hustrations .as the length of tinea coli is shorter than the colon length.
  34. 46. <ul><li>Soft lobulated organ, extends in the posterior abdominal wall from the concavity of the duodenum to the hilum of the spleen. </li></ul><ul><li>Formed of 4 parts (Head, neck, body & tail). </li></ul><ul><li>The pancreatic duct joins common bile duct from the liver. </li></ul><ul><li>Opens 4&quot; below pyloric sphincter. </li></ul>
  35. 48. <ul><li>It is the largest gland </li></ul><ul><li>Lies Below the right copula of the diaphragm. </li></ul><ul><li>Right lobe larger and lodges the gallbladder. </li></ul><ul><li>Size causes right kidney to be lower than left. </li></ul>
  36. 49. The Liver and Gallbladder <ul><li>Gallbladder </li></ul><ul><ul><li>Fundus, body & neck </li></ul></ul>
  37. 50. <ul><li>Continuation of thoracic aorta at aortic opening of the diaphragm in front of T12 </li></ul><ul><li>Terminates at lower border of L4 vertebra by dividing into right and left common iliac arteries. </li></ul>
  38. 51. <ul><li>Parietal branches </li></ul><ul><li>Inferior phrenic arteries. </li></ul><ul><li>Lumbar arteries. (four pairs of arteries that supply the posterior abdominal wall) </li></ul><ul><li>Median sacral arteries. </li></ul>
  39. 52. <ul><li>Visceral branches </li></ul><ul><li>Paired branches </li></ul><ul><ul><li>Middle suprarenal artery. </li></ul></ul><ul><ul><li>Renal artery </li></ul></ul><ul><ul><li>Testicular (ovarian) artery </li></ul></ul>
  40. 53. <ul><li>Unpaired branches </li></ul><ul><ul><li>Celiac trunk: short thick vessel that arises from the front of aorta, at the level of upper L1 </li></ul></ul><ul><ul><li>Superior mesenteric artery: arises from the front of aorta, at the level of lower L1 </li></ul></ul><ul><ul><li>Inferior mesenteric artery: arises from the front of aorta, at level of L3 </li></ul></ul>
  41. 54. <ul><li>Internal iliac vein </li></ul><ul><li>Parietal tributaries: accompany with arteries </li></ul><ul><li>Visceral tributaries </li></ul><ul><li> -> superior rectal vein->inferior mesenteric v. </li></ul><ul><li>① Rectal venous plexus ->inferior rectal vein->internal iliac v. </li></ul><ul><li> -> anal vein->internal pudendal v. </li></ul><ul><li>② Vesical venous plexus ->vesical v. </li></ul><ul><li>③ Uterine venous plexus ->uterine v. </li></ul>
  42. 55. <ul><li>External iliac vein : accompany the artery </li></ul><ul><li>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. </li></ul>
  43. 56. <ul><li>Formed by union of two common iliac veins anterior to and just to the right of L4~L5 </li></ul><ul><li>Ascends on the right side of aorta, pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atrium </li></ul><ul><li>Conveys blood from the whole body below the diaphragm to the right atrium </li></ul>
  44. 57. <ul><li>Chief tributaries </li></ul><ul><li>Parietal </li></ul><ul><ul><li>Paired inferior phrenic v. </li></ul></ul><ul><ul><li>paired lumbar v. (four) </li></ul></ul><ul><li>Visceral </li></ul><ul><ul><li>Right and left renal veins </li></ul></ul><ul><ul><li>Right suprarenal vein (left drain into left renal vein). </li></ul></ul><ul><ul><li>Right testicular or ovarian . (left drain into left renal vein) </li></ul></ul><ul><ul><li>Hepatic veins: right, left and intermediate </li></ul></ul>
  45. 58. <ul><li>Describe in the bony structures of the pelvic girdle. </li></ul><ul><li>Describe the boundaries of the pelvic inlet and outlet </li></ul><ul><li>List the major differences between a male and female pelvis </li></ul><ul><li>Identify the articulations of the pelvis </li></ul><ul><li>Describe the gross and relational anatomy of the pelvic viscera </li></ul><ul><li>Identify the structures forming the pelvic walls and floor </li></ul><ul><li>Be able to identify the X ray images of the pelvis, hip, acetabulum, femur, ischial bones. </li></ul>Pelvis
  46. 59. <ul><li>Lighter in structure </li></ul><ul><li>Roomier cavity-childbearing </li></ul><ul><li>Wider, shallower </li></ul><ul><li>Inlet larger and more oval </li></ul><ul><li>Sacrum wider and curves more sharply posteriorly </li></ul><ul><li>Sacral promontory flatter </li></ul><ul><li>Outlet wider </li></ul>
  47. 60. <ul><li>Heavier </li></ul><ul><li>More conical-deeper </li></ul><ul><li>Obturator foramen rounder </li></ul><ul><li>Laterally narrower </li></ul><ul><li>Pubic arch more acute angle </li></ul><ul><li>Inlet round, outlet narrow </li></ul>
  48. 63. <ul><li>Superior aperature or Inlet-upper border of symphasis to sacral promontary </li></ul><ul><li>Inferior aperature or Outlet-inferior border of symphasis to tip of coccyx </li></ul>
  49. 64. <ul><li>Location of some abdominal viscera (ileum and sigmoid colon) </li></ul><ul><li>Bounded by abdominal wall anteriorly, the iliac fossa posteriolaterally and L5 S1 vertebrae posteriorly </li></ul>
  50. 65. <ul><li>Location of pelvic viscera, the urinary bladder and reproductive organs such as the uterus and ovaries </li></ul><ul><li>Bounded by the pelvic surfaces of the hip bones, sacrum, and coccyx </li></ul><ul><li>Limited inferiorly by the musculofascial pelvic diaphragm </li></ul>
  51. 66. <ul><li>ASIS </li></ul><ul><li>Iliac Crest </li></ul><ul><li>Symphysis Pubis </li></ul><ul><li>Greater Trochanter </li></ul>
  52. 69. 6 5 1. UB 2. Uterus 3. Rectum 4. F tube 5. ovary
  53. 70. <ul><li>Formed by the funnel shaped pelvic diaphragm </li></ul><ul><li>Consists of the levator ani and coccygeus muscles and their fascia </li></ul><ul><li>Stretches between the pubis anteriorly and the coccyx posteriorly and from one lateral pelvic wall to the other. </li></ul>
  54. 72. Thank You