In this pppt I have described surgical anatomy of chest wall, lungs and mediastinum. This will be useful to medical students, surgical residents and surgons
The thorax is the body cavity, surrounded by the bony rib cage that contains the heart and lungs, the great vessels, the oesophagus and trachea, the thoracic duct and the autonomic innervations of these structures
At the end of this lecture you will be able to Interpret:
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Compensation
Metabolic Compensation
Partial Compensated Metabolic Acidosis
Complete Compensated Metabolic Acidosis
Partial Compensated Metabolic Alkalosis
Complete Compensated Metabolic Alkalosis
At the end of this lecture you will be able to Interpret:
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Compensation
Metabolic Compensation
Partial Compensated Metabolic Acidosis
Complete Compensated Metabolic Acidosis
Partial Compensated Metabolic Alkalosis
Complete Compensated Metabolic Alkalosis
1) Various types of neurodynamic examination and mobilization techniques.
2) The proposed mechanisms behind the neurodynamic examination and mobilization techniques
3) Apply knowledge of the various neurodynamic mobilization techniques in the planning of a comprehensive rehabilitation program
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Thoracic Cavity
It is the region of the body between the neck and the
abdomen
It is bounded by 12 pairs of ribs, vertebrae and sternum.
It contains trachea, two lungs, heart and great vessels,
esophagus and lymph nodes.
There are two openings of the thorax, the superior thoracic
opening which is also called thoracic inlet and inferior
thoracic opening.
Head and neck and upper limbs are attached with the
thoracic cavity through thoracic inlet.
Inferior thoracic opening opens into the abdominal cavity.
3. Structure of the Thoracic Wall
is formed posteriorly by the
thoracic part of the vertebral
column; anteriorly by the sternum
and costal cartilages; laterally by the
ribs and intercostal spaces;
superiorly by the suprapleural
membrane; and inferiorly by the
diaphragm, which separates the
thoracic cavity from the abdominal
cavity
The thorax is the region of the body
between the neck and the abdomen.
It is flattened in front and behind
but rounded at the sides.
4. Cont…
Superiorly, the thorax communicates with the neck,
and inferiorly it is separated from the abdomen by the
diaphragm.
The thoracic cage protects the lungs and heart and
affords attachment for the muscles of the thorax,
upper extremity, abdomen, and back.
5.
6. Cont…
The cavity of the thorax can be divided into a median
partition, called the mediastinum, and the laterally
placed pleurae and lungs.
The lungs are covered by a thin membrane called the
visceral pleura, which passes from each lung at its
root (i.e., where the main air passages and blood
vessels enter) to the inner surface of the chest wall,
where it is called the parietal pleura.
In this manner, two membranous sacs called the
pleural cavities are formed, one on each side of the
thorax, between the lungs and the thoracic walls.
7. Sternum
lies in the midline of the anterior chest wall
It is a flat bone divided into three parts: manubrium
sterni, body of the sternum, and xiphoid process.
The manubrium:
is the upper part of the sternum.
lies opposite the 3rd and 4th thoracic vertebrae
articulates with the body of the sternum at the
manubriosternal joint, with the clavicles at and with the 1st
costal cartilage and the upper part of the 2nd costal cartilages
on each side.
8.
9. Cont…
The body of the sternum:
articulates above with the manubrium at the
manubriosternal joint and below with the xiphoid process at
the xiphisternal joint.
On each side, it articulates with the 2nd to the 7th costal
cartilages
The xiphoid process:
is a thin plate of cartilage that becomes ossified at its proximal
end during adult life.
No ribs or costal cartilages are attached to it.
10. Ribs
There are 12 pairs of ribs, all of which are attached
posteriorly to the thoracic vertebrae
divided into three categories:
True ribs:
The upper seven pairs are attached anteriorly to the sternum by their
costal cartilages
False ribs:
The 8th, 9th, and 10th pairs of ribs are attached anteriorly to each
other and to the 7th rib by means of their costal cartilages and small
synovial joints.
Floating ribs:
The 11th and 12th pairs have no anterior attachment.
11. Typical Rib
A typical rib is a long, twisted, flat bone having a
rounded, smooth superior border and a sharp, thin
inferior border
The inferior border overhangs and forms the costal
groove, which accommodates the intercostal vessels
and nerve. The anterior end of each rib is attached to
the corresponding costal cartilage
A rib has a head, neck, tubercle, shaft, and angle
12. Cont…
The head:
has two facets for articulation with the numerically corresponding
vertebral body and that of the vertebra immediately above
The neck:
is a constricted portion situated between the head and the tubercle.
The tubercle:
is a prominence on the outer surface of the rib at the junction of the
neck with the shaft.
It has a facet for articulation with the transverse process of the
corresponding vertebra
The shaft:
is thin and flattened and twisted on its long axis. Its inferior border has
the costal groove.
The angle:
is where the shaft of the rib bends sharply forward.
15. Atypical Rib
The 1st rib is important clinically because of its close
relationship to the lower nerves of the brachial plexus and
the main vessels to the arm, namely, the subclavian artery
and vein
This rib is small and flattened from above downward.
The scalenus anterior muscle is attached to its upper
surface and inner border.
Anterior to the scalenus anterior, the subclavian vein
crosses the rib; posterior to the muscle attachment, the
subclavian artery and the lower trunk of the brachial plexus
cross the rib and lie in contact with the bone.
16.
17.
18. Costal Cartilages
Costal cartilages are bars of cartilage connecting the
upper seven ribs to the lateral edge of the sternum and
the 8th, 9th, & 10th ribs to the cartilage immediately
above.
The cartilages of the 11th and 12th ribs end in the
abdominal musculature.
The costal cartilages contribute significantly to the
elasticity and mobility of the thoracic walls.
19. Joints of the Chest Wall
Joints of the Sternum
The manubriosternal joint is a cartilaginous joint
between the manubrium and the body of the sternum.
A small amount of angular movement is possible during
respiration.
The xiphisternal joint is a cartilaginous joint between
the xiphoid process and the body of the sternum.
The xiphoid process usually fuses with the body of the
sternum during middle age
20. Cont…
Joints of the Ribs
Joints of the Heads of the Ribs (costovertebral joints)
The 1st rib and the three lowest ribs have a single synovial joint with
their corresponding vertebral body.
For the 2nd to 9th ribs, the head articulates by means of a synovial
joint with the corresponding vertebral body and that of the vertebra
above it.
There is a strong intraarticular ligament that connects the head to
the intervertebral disc.
Joints of the Tubercles of the Ribs (costotransverse joint)
The tubercle of a rib articulates by means of a synovial joint with the
transverse process of the corresponding vertebra
(This joint is absent on the 11th and 12th ribs.)
21.
22. Cont…
Joints of the Ribs and Costal Cartilages
These joints are cartilaginous joints. No movement is
possible.
Joints of the Costal Cartilages with the Sternum
The 1st costal cartilages articulate with the manubrium, by
cartilaginous joints that permit no movement
The 2nd to 7th costal cartilages articulate with the lateral
border of the sternum by synovial joints.
The 6th, 7th, 8th, 9th, and 10th costal cartilages articulate
with one another along their borders by small synovial joints.
The cartilages of the 11th and 12th ribs are embedded in the
abdominal musculature.
23. Openings of the Thorax
The chest cavity communicates with the root of the
neck through an opening called the thoracic outlet.
The important vessels and nerves emerge from the
thorax here to enter the neck and upper limbs.
The opening is bounded posteriorly by the 1st thoracic
vertebra, laterally by the medial borders of the 1st ribs
and their costal cartilages, and anteriorly by the
superior border of the manubrium
Through this small opening pass the esophagus and
trachea and many vessels and nerves.
24. Cont…
The thoracic cavity communicates with the abdomen
through a large opening.
The opening is bounded posteriorly by the 12th
thoracic vertebra, laterally by the curving costal
margin, and anteriorly by the xiphisternal joint
Through this large opening, which is closed by the
diaphragm, pass the esophagus and many large vessels
and nerves, all of which pierce the diaphragm
25. Intercostal Spaces
The space between two adjacent ribs is called intercostal space
There are 9 anterior and 11 posterior intercostal spaces.
Each intercostal space contains:
1- Intercostal muscles: External intercostal, Internal and innermost
2- An Intercostal nerve.
3- Intercostal vessels:
a. Intercostal arteries
Anterior & Posterior.
b. Intercostal veins
Anterior & Posterior
The intercostal nerves and blood vessels run between the intermediate and
deepest layers of muscles
They are arranged in the following order from above downward: intercostal
vein, intercostal artery, and intercostal nerve (i.e., VAN).
26.
27.
28. Suprapleural Membrane
Superiorly, the thorax opens into the root of the neck by a narrow
aperture, the thoracic outlet.
The outlet transmits structures that pass between the thorax and the
neck (esophagus, trachea, blood vessels, etc.) and for the most part lie
close to the midline.
On either side of these structures, the outlet is closed by a dense fascial
layer called the suprapleural membrane.
This tent-shaped fibrous sheet is attached laterally to the medial
border of the 1st rib and costal cartilage.
It is attached at its apex to the tip of the transverse process of the
seventh cervical vertebra and medially to the fascia investing the
structures passing from the thorax into the neck.
It protects the underlying cervical pleura and resists the changes in
intrathoracic pressure occurring during respiratory movements.
29.
30. Endothoracic Fascia
is a thin layer of loose connective tissue that separates the
parietal pleura from the thoracic wall.
The suprapleural membrane is a thickening of this fascia.
Parietal pleura
is the outer membrane which is attached to the inner surface
of the thoracic cavity
31. Intercostal Muscles
The external intercostal muscle forms the most
superficial layer.
Originate on ribs 1-11 and have their insertion on ribs 2-12
Its fibers are directed downward and forward from the
inferior border of the rib above to the superior border of
the rib below
The muscle extends forward to the costal cartilage where it
is replaced by an aponeurosis, the anterior (external)
intercostal membrane
responsible for the elevation of the ribs thus expanding the
transverse dimensions of the thoracic cavity
32.
33.
34. Cont…
The internal intercostal muscle forms the
intermediate layer.
Its fibers are directed downward and backward from
the subcostal groove of the rib above to the upper
border of the rib below
The muscle extends backward from the sternum in
front to the angles of the ribs behind, where the
muscle is replaced by an aponeurosis, the posterior
(internal) intercostal membrane
35.
36. Cont…
The innermost intercostal muscle forms the
deepest layer and corresponds to the transversus
abdominis muscle in the anterior abdominal wall.
It is an incomplete muscle layer and crosses more than
one intercostal space within the ribs.
It is related internally to fascia (endothoracic fascia)
and parietal pleura and externally to the intercostal
nerves and vessels.
37.
38. Diaphragm
The diaphragm is a thin muscular and tendinous
septum that separates the chest cavity above from the
abdominal cavity below
It is pierced by the structures that pass between the
chest and the abdomen.
The diaphragm is the most important muscle of
respiration.
It is dome shaped and consists of a peripheral
muscular part, which arises from the margins of the
thoracic opening, and a centrally placed tendon
39.
40.
41. Cont…
The origin of the diaphragm can be divided into three
parts:
A sternal part arising from the posterior surface of the
xiphoid process
A costal part arising from the deep surfaces of the lower
six ribs and their costal cartilages
A vertebral part arising by vertical columns
42. Cont…
The right crus arises from the sides of the bodies of the first three
lumbar vertebrae and the intervertebral discs
The left crus arises from the sides of the bodies of the first two lumbar
vertebrae and the intervertebral disc
Lateral to the crura the diaphragm arises from the medial and lateral
arcuate ligaments
The medial arcuate ligament extends from the side of the body of
the second lumbar vertebra to the tip of the transverse process of the
first lumbar vertebra.
The lateral arcuate ligament extends from the tip of the transverse
process of the first lumbar vertebra to the lower border of the 12th rib.
The medial borders of the two crura are connected by a median
arcuate ligament, which crosses over the anterior surface of the aorta
43.
44. Cont…
The diaphragm is inserted into a central tendon,
which is shaped like three leaves.
The superior surface of the tendon is partially fused
with the inferior surface of the fibrous pericardium.
Some of the muscle fibers of the right crus pass up to
the left and surround the esophageal orifice in a sling
like loop.
45. Shape of the Diaphragm
As seen from in front, the diaphragm curves up into right and left
domes, or cupulae.
The right dome reaches as high as the upper border of the 5th rib,
and the left dome may reach the lower border of the 5th rib. (The right
dome lies at a higher level, because of the large size of the right lobe of
the liver.)
The central tendon lies at the level of the xiphisternal joint.
The domes support the right and left lungs, whereas the central tendon
supports the heart.
The levels of the diaphragm vary with the phase of respiration, the
posture, and the degree of distention of the abdominal viscera.
The diaphragm is lower when a person is sitting or standing; it is higher
in the supine position and after a large meal.
When seen from the side, the diaphragm has the appearance of an
inverted J, the long limb extending up from the vertebral column and
the short limb extending forward to the xiphoid process
46. Functions of the Diaphragm
Muscle of inspiration:
the most important muscle used in inspiration
On contraction, the diaphragm pulls its central tendon
down and increases the vertical diameter of the thorax
Muscle of abdominal straining:
The contraction of the diaphragm assists the contraction of
the muscles of the anterior abdominal wall in raising the
intra-abdominal pressure for micturition, defecation, and
parturition.
This mechanism is further aided by the person taking a
deep breath and closing the glottis of the larynx. The
diaphragm is unable to rise because of the air trapped in
the respiratory tract.
47.
48. Cont…
Weight-lifting muscle:
In a person taking a deep breath and holding it, the diaphragm
assists the muscles of the anterior abdominal wall in raising the
intra-abdominal pressure to such an extent that it helps support
the vertebral column and prevent flexion.
This greatly assists the postvertebral muscles in the lifting of
heavy weights.
Thoracoabdominal pump:
The descent of the diaphragm decreases the intrathoracic
pressure and at the same time increases the intra-abdominal
pressure.
This pressure change compresses the blood in the inferior vena
cava and forces it upward into the right atrium of the heart
50. Intercostal Arteries
Each intercostal space contains a large single posterior
intercostal artery and two small anterior intercostal arteries
The posterior intercostal arteries of the first two spaces
are branches from the superior intercostal artery, which is a
branch of the costocervical trunk of the subclavian artery
The posterior intercostal arteries of the lower nine spaces
are branches of the descending thoracic aorta.
The anterior intercostal arteries of the first six spaces
are branches of the internal thoracic artery, which arises
from the first part of the subclavian artery.
The anterior intercostal arteries of the lower spaces are
branches of the musculophrenic artery, one of the terminal
branches of the internal thoracic artery.
51.
52.
53.
54.
55.
56. Intercostal Veins
2 in each space
Posterior intercostal veins
It drain backward into the azygos or hemiazygos veins
Anterior intercostal veins
It drain forward into the internal thoracic and the
musculophrenic veins
57.
58.
59. Intercostal nerves
They are the anterior branches of spinal thoracic
nerves fromT1 to T11.
Each nerve runs in the Intercostal space inferior to
the Intercostal vessels.
These nerves arises from the vertebrae and run
between the inner and innermost muscles of the
intercostal space.
60.
61. Cont…
The first six nerves are distributed within their
intercostal spaces (Called Typical Intercostal Nerve)
The 7th to 9th intercostal nerves leave the anterior
ends of their intercostal spaces by passing deep to the
costal cartilages, to enter the anterior abdominal wall.
The 10th and 11th nerves, since the corresponding ribs
are floating, pass directly into the abdominal wall
(called Atypical)
The 12th thoracic nerve lies in the abdomen and
runs forward in the abdominal wall as the
subcostal nerve
62.
63. Branches of intercostal nerves
Rami communicantes
It connect the intercostal nerve to a ganglion of the sympathetic
trunk
Gray ramus
It joins the nerve medial at the point at which the white ramus
leaves it
Collateral branch
It runs forward inferiorly to the main nerve on the upper border of
the rib below
lateral cutaneous branch
It reaches the skin on the side of the chest. It divides into an anterior
and a posterior branch
64. Cont…
Anterior cutaneous branch
It is the terminal portion of the main trunk. It reaches the skin
near the midline.
Muscular branches
These runs to the intercostal muscles
Pleural sensory branches
These branches goes to the parietal pleura.
Peritoneal sensory branches (7th to 11th intercostal nerves
only) they run to the parietal peritoneum.