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Netter atlas human anatomy 5th edition pdf

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Netter Atlas Of Human Anatomy 5th Edition - [Free] Netter Atlas Of Human Anatomy 5th. Edition [PDF] [EPUB] Atlas of the Sensory Organs. netter atlas of human anatomy 5th edition is available in our digital library an online . Fundamentals of Anatomy and Physiology 2nd Edition PDF – For Nursing. Netter's atlas of human anatomy [5th Edition]. hamzeh Alshare. 1 / Head and Neck page 1 1 Topographic Surface Anatomy STUDY AIMS At the end of your.


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Author: Frank Henry Netter Anatomy: A Regional Atlas of the Human Body, 6th Edition. Read more · Human Anatomy, Seventh Edition · Read more · Color Atlas and Textbook of Human Anatomy Vol 1: Locomotor System 5th Edition. Netter's Atlas of Human Anatomy 7th Edition PDF Free Atlas of Human Anatomy: with Student Consult Access, (Netter Basic Science) 5th and 6TH Editions. for netter atlas of human anatomy 5th edition and numerous books collections Fundamentals of Anatomy and Physiology 2nd Edition PDF – For Nursing and.

The breast is firmly attached to the overlying skin by condensation of connective tissue called the suspensory ligaments of Cooper , which help to support the lobules of the breast. In the past, the saphenous vein was commonly used in the bypass graft, because it is easily obtained from the lower limb and has lengthy sections without valves or branches. Dorsal and ventral primary rami of lumbar spinal nerves b. Accompany deep veins b. Lymph is called chyle when it is carrying chylomicrons fat droplets from the digestion of food in the gastrointestinal system. Small pit b.

Found on basilar membrane b. Covered by gelatinous tectorial membrane c. Contains hair cells-tips embedded in tectorial membrane d. Meninges and Brain Brain [Plate , Cerebrum: Medial Views] page 66 page 67 Is composed of six regions for purposes of description 1 Cerebral hemispheres cerebrum Largest part of brain Occupy anterior and middle cranial fossae Two, separated by longitudinal cerebral fissure Connected by transverse fiber bundle at base of longitudinal fissure: Frontal lobe: Involved in higher mental function Contains speech and language centers Parietal lobe: Initiates movement Involved in perception Temporal lobe: Involved in memory, hearing, and speech Occipital lobe: Contains visual cortex Each lobe marked by folds gyri and grooves sulci 2 Diencephalon Composed of Epithalamus Thalamus Hypothalamus Surrounds third ventricle of brain between right and left halves 3 Midbrain mesencephalon At junction of middle and posterior cranial fossae Contains narrow canal: Drains cerebral veins Confluence of sinuses sagittal sinus 2.

Contains arachnoid villi and granulations for reabsorption CSF Inferior sagittal Lower free margin falx cerebri Joins great cerebral vein sinus forming straight sinus Straight sinus Junction falx cerebri and Formed by union great cerebral vein with inferior sagittal Confluence of sinuses tentorium cerebelli sinus Transverse Lateral margin tentorium 1. Passes laterally from confluence of sinuses Sigmoid sinus sinus cerebelli 2. Left is usually larger Sigmoid sinus S-shaped course in temporal Continuation transverse sinus Internal jugular vein and occipital bones Cavernous Superior surface of body of 1.

Receives superior and inferior ophthalmic and Superior and inferior sinus sphenoid, lateral to sella superficial middle cerebral veins and sphenoparietal petrosal sinuses turcica sinus 2.

Cranial and Cervical Nerves Cranial Nerves 12 pairs of cranial nerves arise from the brain, and they are identified both by their names and by Roman numerals I through XII. The cranial nerves are somewhat unique and can contain multiple functional components: CN V has three divisions: V1 and V2 are sensory, and V3 is both motor to skeletal muscle and sensory. The following table summarizes the types of fibers in each cranial nerve and where each passes through the cranium: Cranial nerves emerge through foramina or fissures in the cranium Twelve pairs Numbered in order of origin from the brain and brain stem, rostral to caudal Contain one or more of six different types of fibers Motor fibers to voluntary muscles Somatic motor fibers to striated muscles 1 a.

Orbit b. Tongue c. Neck sternocleidomastoid and trapezius Branchial motor or special visceral efferent fibers to striated muscles derived from pharyngeal arches example: Carry sensation from viscera b. Thyrohyoid muscle b. Omohyoid b. Sternohyoid c. Usually one-sided and can affect a division of CN V, usually the mandibular, maxillary nerve. Pain can be triggered by touching a sensitive area "trigger point" The cause is not usually known Treatment is directed to controlling the pain. Ocular Nerve Palsy Alesion of the oculomotor nerve will paralyze all extraocular muscles except the lateral rectus and the superior oblique.

This leads to: Ptosis-drooping of the eyelid levator palpebrae superioris No constriction of the pupil in response to light sphincter pupillae Dilation of the pupil unopposed dilator pupillae Eyeball abducted and depressed "down and out" unopposed lateral rectus and superior oblique No accommodation of the lens for near vision ciliary muscle page 75 page 76 Mnemonics Memory Aid Names of the Cranial Nerves "On Old Olympus Towering Tops A Few Virile Germans Viewed Ample Of Hops" I: On - Olfactory II: Old - Ophthalmic III: Olympus - Oculomotor IV: Towering - Trochlear V: Tops - Trigeminal VI: A - Abducent VII: Virile - Vestibulocochlear IX: Germans - Glossopharyngeal X: Viewed - Vagus XI: Ample - Accessory XII: Olfactory Sensory II: Optic Sensor III: Oculomotor Motor IV: Trochlear Motor V: Trigeminal Both VI: Abducent Motor VII: Vestibulocochlear Sensory IX: Glossopharyngeal Both X: Vagus Both XI: Accessory Motor XII: Ascends on pharynx b.

Send branches to pharynx, prevertebral muscles, middle ear, and cranial meninges Superior thyroid a. Gives rise to superior laryngeal artery supplying larynx Lingual a. Passes deep to hypoglossal nerve, stylohyoid muscle, and posterior belly of digastric b.

Disappears beneath hyoglossus muscle and becomes deep lingual and sublingual arteries Facial a. Branches to tonsil, palate, and submandibular gland b. Hooks around middle of mandible and enters face Occipital a. Passes deep to posterior belly of the digastric b. Grooves base of skull c. Supplies posterior scalp Posterior auricular a. Passes posteriorly between external acoustic meatus and mastoid process b. Supplies muscles of region, parotid gland, facial nerve, auricle, and scalp Maxillary a.

Larger of two terminal branches b. Branches supply external acoustic meatus, tympanic membrane, dura mater and calvaria, mandible, gingivae and teeth, temporal pterygoid, masseter, and buccinator muscles Superficial temporal a. Smaller terminal branch b. Supplies temporal region of scalp Carotid Branch Course and Structures Supplied Superior thyroid Supplies thyroid gland, larynx, and infrahyoid muscles Ascending pharyngeal Supplies pharyngeal region, middle ear, meninges, and prevertebral muscles Lingual Passes deep to hyoglossus muscle to supply the tongue Facial Courses over the mandible and supplies the face Occipital Supplies SCM and anastomoses with costocervical trunk Posterior auricular Supplies region posterior to ear Maxillary Passes into infratemporal fossa described later Superficial temporal Supplies face, temporalis muscle, and lateral scalp page 79 page 80 Subclavian artery Branch of aortic arch on the left From brachiocephalic trunk on the right Enters neck between anterior and posterior scalene muscles Supplies upper limbs, neck and brain Divided for descriptive purposes into 3 parts, in relation to the anterior scalene muscle First part a.

Medial to the anterior scalene b.

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Has three branches Second part a. Posterior to the anterior scalene b. Has one branch Third part a. Lateral to anterior scalene b. Has one branch Subclavian Branch Course Part 1 Vertebral Ascends through C6-C1 transverse foramina and enters foramen magnum Internal thoracic Descends parasternally to anastomose with superior epigastric artery Thyrocervical trunk Gives rise to inferior thyroid, transverse cervical, and suprascapular arteries Part 2 Costocervical trunk Gives rise to deep cervical and superior intercostal arteries Part 3 Dorsal scapular Is inconstant; may also arise from transverse cervical artery Venous drainage Superficial veins External jugular vein EJV Drains most of scalp and side of face Formed at angle of mandible by union of retromandibular vein with posterior auricular vein Enters posterior triangle and pierces fascia of its roof Descends to terminate in subclavian vein Receives a.

Transverse cervical vein b. Suprascapular vein c. Back and Spinal Cord-Muscles and Nerves. Muscles that are readily visible are trapezius, latissimus dorsi, and teres major.

Performed for retrieval of cerebrospinal fluid CSF from the lumbar spinal cistern. The patient is placed in the left decubitus position, flexed in the fetal posture with the supracristal line vertical.

Mnemonics Memory Aids Lumbar puncture: To keep the cord alive, keep the needle between L3 and L5! No body or spinous process; articulates with occipital condyles via paired lateral masses and with the axis via the superior articular facets and dens of the axis; groove on superior aspect of the posterior arch for vertebral arteries and dorsal ramus of C1 C2 Axis: Dens odontoid process , large superior articular facets for C1 C3-C5: Short bifid spinous processes anterior tubercle of C6 is the carotid tubercle, which the carotid artery can be compressed against to control bleeding C Atypical-have some features of cervical vertebrae T5-T8: Typical T9-T Sacral hiatus termination of sacral canal that contains filum terminale Median crest: Thorax Sacroiliac SI joints.

Synovial joints see: The primary curvatures of the vertebral column in the thoracic and sacral regions develop during the fetal period and are caused by differences in height between the anterior and posterior aspects of the vertebrae.

The secondary curvatures are mainly a result of anterior-posterior differences in IV disc thickness. The cervical curvature is acquired when the infant begins to lift its head, and the lumbar curvature when the infant begins to walk. Abnormal curvatures: Kyphosis is an increased thoracic curvature, commonly seen in the elderly "Dowager hump".

It is usually caused by osteoporosis, resulting in anterior vertebral erosion or a compression fracture. An excessive lumbar curvature is termed a lordosis and is seen in association with weak trunk muscles, pregnancy, and obesity. Scoliosis is an abnormal lateral curvature of the spine, accompanied by rotation of the vertebrae.

The lumbosacral angle is created between the long axes of the lumbar vertebrae and the sacrum. It is primarily because of the anterior thickness of the L5 body. As the line of body weight passes anterior to the SI joints, anterior displacement of L5 over S1 may occur spondylolisthesis , applying pressure to the spinal nerves of the cauda equina.

Thoracic are heart-shaped since your heart is in your thorax Lumbar are kidney-bean shaped as the kidneys are in the lumbar area Craniovertebral joints: Cross Sections] Meninges Dura mater: Tough fibroelastic membrane Is continuous with the inner meningeal layer of the cranial dura Attached to the margins of the foramen magnum and posterior longitudinal ligament Separated by the epidural space from vertebral periosteum Extends as a sac from the margin of the foremen magnum to the level of S2 Pierced by spinal nerves Anchored to the coccyx by the external filum terminale Forms dural root sleeves covering the spinal nerves before fusing with the epineurium Arachnoid mater: Delicate, avascular, fibroelastic membrane lining dural sac Opposed held to inner surface to dura by CSF pressure Is external to the subarachnoid space, between arachnoid and pia, containing CSF, traversed by strands of connective tissue arachnoid trabeculae Contains the lumbar cistern, an enlargement of subarachnoid space between L2 end of spinal cord and S2 end of dural sac Pia mater: Highly vascular innermost layer covering roots of spinal nerves Continues as the filum terminale Suspends the spinal cord within the dural sac by lateral extensions between the anterior and posterior roots, called denticulate ligaments Dermatomes: Usually 3 anterior and 3 posterior longitudinal spinal veins with tributaries from the posterior medullary and radicular veins.

They drain into the valveless vertebral venous plexus. Vertebral venous plexus is continuous with the cranial dural venous sinuses and contains no valves Internal vertebral plexus lying in the extradural space drains the spinal cord External vertebral plexus connects with azygos vein, superior and inferior vena cavae Autonomic Nervous System ANS page 91 page 92 Sympathetic NS: In the fetus, the spinal cord extends down to the sacral vertebrae.

Anaesthetic injected into epidural space of the sacral canal either via the sacral hiatus caudal epidural using the sacral corneae as landmarks, or via the posterior sacral foramina transsacral epidural. The anesthetic solution spreads superiorly to act on spinal nerves S2-Co. The height to which the anesthetic ascends is affected by the amount of solution injected and the position of the patient.

Spinal block: Introduction of an anesthetic directly into the CSF in the subarachnoid space utilizing a lumbar puncture see above. Subsequent leakage of CSF may cause a headache in some individuals. Mnemonics Memory Aids Dermatomes: Muscles and Nerves The muscles of the back are divided into the extrinsic muscles that connect the upper limb to the trunk and the intrinsic deep or true muscles that specifically act on the vertebral column to produce movements and maintain posture. Extrinsic muscles of the back Superficial: Trapezius, latissimus dorsi, levator scapulae, rhomboid minor and major Intermediate: Serratus posterior superior and posterior inferior muscles of respiration [Plate , Muscles of Back: Superficial Layers] Muscle Proximal Attachment Origin Distal Attachment Innervation Main Actions Insertion Trapezius Superior nuchal line, external occipital Lateral third of Accessory nerve Elevates, retracts, and rotates protuberance, nuchal ligament, and clavicle, acromion, cranial nerve XI and scapula; lower fibers depress spinous processes of C7-T12 and spine of C3-C4 proprioception scapula scapula Latissimus Spinous processes of T7-T12, Humerus Thoracodorsal nerve Extends, adducts, and dorsi thoracolumbar fascia, iliac crest, and intertubercular C6-C8 medially rotates humerus last ribs sulcus Levator Transverse processes of C1-C4 Medial border of C3-C4 and dorsal Elevates scapula and tilts scapulae scapula scapular C5 nerve glenoid cavity inferiorly Rhomboid Minor: Intermediate Layers] Superficial: Drains to the anterior, lateral, and deep cervical nodes Trunk: Bounded by rectus capitis posterior major, obliquus capitis superior and obliquus capitis inferior, floor-atlantooccipital membrane, roof-semispinalis capitis Deep Layer Muscle Proximal Attachment Distal Attachment Innervation Main Actions Origin Insertion Rectus capitis posterior Spine of axis Lateral inferior nuchal Suboccipital nerve Extends head and rotates to major line C1 same side Rectus capitis posterior Tubercle of posterior arch Median inferior nuchal Suboccipital nerve Extends head minor of atlas line C1 Obliquus capitis Transverse process of Occipital bone Suboccipital nerve Extend head and bend it laterally superior atlas C1 Obliquus capitis inferior Spine of axis Atlas transverse Suboccipital nerve Rotates atlas to turn face to process C1 same side Branches of spinal nerves Ventral rami innervate the muscles and overlying skin of the anterior thoracic, abdominal and pelvic wall and contribute to Cervical plexus [C1-C4] see: Head and Neck Brachial plexus [C5-T1] see: Upper Limb Thoracic intercostal nerves see also: Thorax Lumbar plexus [TL4] see: Lower Limb Dorsal rami C1: Suboccipital nerve-pierces the atlantooccipital membrane and is motor to the suboccipital muscles C2: Avery common, usually self-limiting complaint, often affecting the lumbar region "low back pain".

Radiation to back of the thigh and into the leg sciatica or focal neurology suggests radiculopathy.

Back strain: Stretching and microscopic tearing of muscle fibres or ligaments, often because of a sport-related injury. The muscles subsequently go into spasm as a protective response causing pain and interfering with function.

This is a common cause of low back pain. Frequently caused by impacts from the rear in motor vehicle accidents. May cause herniation of the IV disc and subsequent radiculopathy. Mnemonics Memory Aids Deep back muscles: The thoracic cage protects the contents of the thorax, whereas the muscles assist in breathing.

It is important to identify and count ribs as they form key landmarks to the positions of the internal organs. In a fit muscular person one can identify a number of landmarks: Jugular suprasternal notch: Anterior to the T5 through T9 vertebrae and the right border of the heart Nipple: Anterior to the 4th intercostal space in males and the dome of the right hemidiaphragm; sits on the pectoralis major muscle Xiphoid process: At the level of the T10 vertebra The costal margins: Comprises the 7th through 10th costal cartilages On yourself, palpate the following: The sternoclavicular joints, lateral to the jugular notch The sternum and its parts: Midaxillary lines are perpendicular lines through the apex of the axilla on both sides Cephalic vein can be seen in some subjects lying in the deltopectoral groove between the deltoid and pectoralis major muscles.

This is called a median sternotomy.

The middle ribs are most commonly fractured, and multiple rib fractures can manifest as a "flail chest," where the injured region of the chest wall moves paradoxically, that is, in on inspiration and out on expiration.

Mammary Gland [Plate , Mammary Gland] Consists of glandular tissue in which the majority is embedded within the tela subcutanea superficial fascia of the anterior chest wall overlying the pectoral muscles. The glands are rudimentary in males and immature females.

Size and shape of the adult female breast varies; the size is determined by the amount of fat surrounding the glandular tissue.

The base of the breast is fairly consistent extending from the lateral border of the sternum to the midaxillary line and from the 2nd to the 6th ribs. The majority of the breast overlies the deep pectoral fascia of the pectoralis major muscle, with the remainder overlying the fascia of the serratus anterior.

The breast is separated from the pectoralis major muscle by the retromammary space, a potential space filled with loose connective tissue. The breast is firmly attached to the overlying skin by condensation of connective tissue called the suspensory ligaments of Cooper , which help to support the lobules of the breast. Asmall part of the mammary gland may extend toward the axilla, called the axillary tail of Spence. Structure of the Breast For descriptive purposes, the breast is divided into four quadrants: The most prominent feature of the breast is the nipple.

The nipple is surrounded by the areola, a circular pigmented area of skin. The areola is pink in Caucasians and brown in African and Asian people. The pigmentation of the areola increases during pregnancy. The areola contains sebaceous glands, following a pregnancy these secrete an oily substance to protect the mother's nipple from irritation during nursing. The breast is composed of 15 to 20 lobules of glandular tissue, formed by the septa of the suspensory ligaments. The mammary glands are modified sweat glands that are formed from the development of milk-secreting alveoli, arranged in clusters.

Each lobule is drained by a lactiferous duct Each lactiferous duct opens on the nipple. The breast is also supplied by the branches of the thoracoacromial and lateral thoracic arteries from the axillary artery. Venous drainage parallels the arterial supply and is mainly to the axillary artery and internal thoracic vein.

Lymphatic Drainage of the Breast [Plate , Lymph Vessels and Nodes of Mammary Gland] Lymph from the nipple, areola, and lobules of the mammary glands drains to a subareolar lymphatic plexus.

From there, a system of interconnecting lymphatic channels drains lymph to various lymph nodes. The majority of the lymph, especially from the lateral quadrants of the breast, drains to the pectoral nodes, and from there to the axillary nodes. The remaining amount of lymph, especially from the medial quadrants of the breast, drains into the parasternal lymph nodes along the internal thoracic vessels. Some lymph from the lower quadrants of the breast passes to the inferior phrenic nodes. It is important to note that lymph from the medial quadrants can cross to the opposite breast.

Thus secondary metastases of breast carcinoma can spread to the opposite breast in this way. The palpation should extend into the axilla to palpate the axillary tails. After palpation of one breast, the other should be palpated in the same way. Examine the skin of the breast for a change in texture or dimpling peau d'orange sign and the nipple for retraction, since these signs may indicate an underlying pathology. Pathology of the Breast Fibroadenoma: Often painless although sometimes tender on palpation.

More common in young women but can occur at any age. Intraductal carcinoma or breast cancer: This malignancy presents as a palpable mass that is hard, immobile and sometimes painful.

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Additional signs can include bloody or watery nipple discharge if the larger ducts are involved. External intercostal muscles: Have fibers that slope down and medially. Extend from the posterior tubercle of the rib to the junction of the rib and its costal cartilage anteriorly. Anteriorly, are replaced by external intercostal membranes that extend from the costochondral junctions to the sternum. Internal intercostal muscles: Lie internal to the external intercostal muscles Their fibers lie at right angles to those of the external intercostal muscles and run inferiorly and laterally.

Anteriorly extend to the lateral border of the sternum. Posteriorly extend only to the angles of the ribs; medial to the angles, are replaced by the internal intercostal membranes.

Innermost intercostal muscles Lie deep to the internal intercostal muscles Are separated from the internal intercostals by the intercostal vessels and nerves Occupy the middle parts of the intercostal spaces Connect inner surfaces of adjacent ribs All intercostal muscles are supplied by intercostal nerves corresponding in number to their intercostal space. Main action of the intercostals is to maintain the space between the ribs during inspiration and expiration.

Other muscles of the rib cage Subcostal muscles-internal to the internal intercostals, cross from the angle of one rib to internal surface of the rib 1 to 2 spaces below. Transversus thoracis-4 to 5 slips of muscle that attach to the xiphoid process and inferior sternum and pass superiorly and laterally to attach to the 2nd through 6th costal cartilages. Muscular branches supply the intercostal, levatores costarum, transversus thoracis, and serratus posterior muscles.

Atlas of Human Anatomy, 5th Edition

The lower five intercostal nerves supply the skin and muscles of the abdominal wall Contain general somatic afferent and efferent fibers, as well as general visceral efferent fibers from the sympathetic trunk via white and grey rami communicantes and general visceral afferent fibers. Ribs 1 through 7 are vertebrocostal because they attach to the sternum via a costal cartilage. Ribs 8 through 10 are vertebrochondral because their cartilages are joined to the cartilage of the rib above and via that connection to the sternum.

Ribs 11 and 12 are free or floating ribs, which do not connect even indirectly with the sternum but which have a costal cartilage on their tips. First rib is broad and sharply curved and has a tubercle of the attachment of scalene muscles. Aortic hiatus of the diaphragm; also transmits the thoracic duct T Esophageal hiatus of the diaphragm; also transmits the right and left T To avoid damage to the intercostal vein, artery, and nerve that run in the costal groove on the inferior surface of each rib, the needle is inserted well below the rib.

The needle also must be placed sufficiently above the rib below to avoid the collateral branches of intercostal nerve and vessels that run along the superior surface of each rib. Importance of Certain Intercostal Spaces Second intercostal space at the midclavicular line: Insertion of tube for an apical pneumothorax thoracostomy Fourth to 6th intercostal space at the midaxillary line: Insertion of chest drains for a hemothorax thoracostomy Left 5th intercostal space: They articulate with the C7 vertebra, but do not attach to the sternum.

They may fuse with the first rib. If a cervical rib is present, however, it may compress the subclavian artery or inferior trunk of the brachial plexus and cause ischemic pain and numbness in the shoulder and upper limb. This condition is called thoracic outlet syndrome. Bone Marrow Biopsy and Aspiration. Bone marrow aspiration and biopsy help diagnose many blood disorders and can be used to detect if cancer has spread to the bone marrow.

Bone marrow biopsy: The removal of bone and marrow for examination under the microscope. The sternum is a site of red marrow, even in adulthood, and is a good site for a bone marrow biopsy.

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Another common site is the posterior iliac crest. Abiopsy is usually conducted before performing a bone marrow aspiration. Bone marrow aspiration: The removal of a small amount of bone marrow fluid through a needle inserted into the bone.

Fluid is examined to determine if there are any problems with the blood cells made in the bone marrow Mnemonics Memory Aids Vertical order of the contents of the neurovascular bundle in the costal groove on the lower border of each rib: Lungs [Plate , Lungs in Situ: Anterior View] Thoracic Cavity, Pleurae and Pleural Cavity Thoracic cavity has two lateral pleural cavities, containing the lungs and pleurae a central compartment, the mediastinum, containing all the other thoracic structures Each lung is surrounded by, and covered with, a continuous membrane, which is defined as the visceral pleura, which covers the lungs and cannot be dissected from the lung the parietal pleura, which lines the pleural cavities The visceral and parietal pleura are continuous at the hilum of the lung where structures enter and leave the lung bronchus, pulmonary vessels, bronchial vessels, lymphatics The parietal pleura has four named parts: Costal pleura lining the internal surface of the thoracic wall Mediastinal pleura covering the sides of the mediastinum Diaphragmatic pleura covering the superior surface of the dome of each hemidiaphragm Cervical pleura-a dome of pleura extending superiorly into the superior thoracic aperture Visceral pleura does not have any general sensory innervation and is insensitive to pain The parietal pleura is very sensitive to pain because of its sensory supply by branches of the intercostal and phrenic nerves The pleural cavity is the potential space between the parietal and visceral pleura.

The pleural cavity contains a thin layer of serous pleural fluid, which lubricates and allows the pleurae to move smoothly over each other during respiration. Surface tension keeps the lung surface in contact with the thoracic wall.

The lung expands and fills with air when the thoracic cavity expands. The sternal line of pleural reflection is the sharp line along which the costal pleura becomes the mediastinal pleura The costal line of pleural reflection is the sharp line along which the costal pleura becomes the diaphragmatic pleura The vertebral line of pleural reflection is a smooth reflection of the costal pleura onto the vertebrae posteriorly.

The lines of pleural reflection on the left side can be remembered as The line of pleural reflection on the left descends in the midline of the sternum to the 4th costal cartilage, where it deviates to the left margin of the sternum at the 6th costal cartilage to accommodate the pericardium and the heart cardiac notch. This line then deviates to cross the 8th rib at the midclavicular line.

It crosses the 10th rib at the midaxillary line It then crosses the 12th rib at approximately the neck. On the right side, the line of pleural reflection descends at the midline of the sternum to the xiphoid process, and then deviates The lungs do not fully occupy the pleural cavities during expiration There are peripheral areas where the diaphragmatic and costal pleura come in contact and these are called the costodiaphragmatic recesses.

There are areas posterior to the sternum where the costal and mediastinal pleura come in contact with each other, and these are called costomediastinal recesses. The costomediastinal recess is larger on the left, because of the cardiac notch. During expiration, the lower limit of the lungs is two costal spaces above the line of pleural reflection: Thus the costodiaphragmatic recess is approximately two costal spaces deep. Lungs [Plate , Lungs: Medial Views] Organs of respiration Light, soft and elastic The right lung is larger than the left and has three lobes: The horizontal fissure runs from the oblique fissure at the midaxillary line along the 4th rib to its costal cartilage anteriorly.

The anterior margin of the left lung has an indentation-the cardiac notch, which often creates a thin process in the upper lobe called the lingula. Each lung has three surfaces: Costal Mediastinal Diaphragmatic Each lung is connected to the mediastinum by the root of the lung. Lung root contains: Main stem or lobar bronchi Pulmonary vessels and bronchi. Bronchial vessels, lymphatics, and autonomic nerves. The lung root is surrounded by a pleural sleeve, from which extends the pulmonary ligament inferiorly.

The carina is the keel-like ridge between the two openings of the main stem bronchi. The right main stem bronchus divides into upper and lower lobar bronchi before reaching the substance of the right lung. The main bronchi branch to form the bronchial tree. There are three lobar bronchi on the right: Abronchopulmonary segment Is a pyramidally shaped section of the lung with its base covered by visceral pleura Is separated from adjacent segments by connective tissue septa Is names for the segmental bronchus that supplies it Has its own bronchus and segmental branch of the pulmonary artery Each bronchopulmonary segment can be surgically resected, independent of adjacent segments The right lung has 10 bronchopulmonary segments Upper lobe: Apical Anterior Posterior Middle lobe: Medial Lateral Lower lobe: Superior Anterior basal Posterior basal Medial basal Lateral basal The left lobe has 8 to 10 bronchopulmonary segments Upper lobe: Apical may be combined with posterior to form apicoposterior Posterior Anterior Superior lingular Inferior lingular Lower lobe: Superior Anterior basal may be combined with medial to form anteromedial basal Medial basal Lateral basal Posterior basal The right main stem bronchus is wider and shorter than the left one and descends in a more vertical plane, so aspirated foreign objects are more likely to lodge in it or one of its branches Because the posterior segmental bronchus of the right lower lobe runs directly posterior, foreign objects that are inhaled when the person is lying down, such as food, may end up in this segmental bronchus.

Each pulmonary artery gives rise to lobar and segmental arteries. Intrasegmental veins drain to intersegmental veins in the pulmonary septa, which run a separate course from the pulmonary and segmental arteries and which drain to two pulmonary veins for each lung. Pulmonary veins carry oxygenated blood to the left atrium of the heart.

Bronchial arteries from the thoracic aorta carry oxygenated blood to the tissue of the lungs, traveling along the posterior surface of the bronchi.

The left bronchial arteries come from the thoracic aorta; the single right bronchial artery may also arise from the superior posterior intercostal or a left superior bronchial artery. The bronchial arteries anastomose with branches of the pulmonary arteries. Pulmonary veins drain the blood to the lungs supplied by the bronchial veins and empty into the azygos and accessory hemiazygos veins.

The lungs have a rich, freely connecting network of lymphatic vessels. Lymph from the lungs drains to Pulmonary lymph nodes along the lobar bronchi Bronchopulmonary lymph nodes along the main stem bronchi Superior and inferior tracheobronchial lymph nodes superior and inferior to the bifurcation of the trachea Innervation of the lungs Innervation is via the pulmonary plexuses located anterior and posterior to the lung roots. The plexuses contain postganglionic sympathetic fibers from the sympathetic trunks that innervate the smooth muscle of the bronchial tree, pulmonary vessels, and glands of the bronchial tree.

Sympathetic fibers are bronchodilators, vasoconstrictors, and inhibit glandular secretion. The plexuses contain preganglionic parasympathetic fibers from the vagus nerve CN X , small parasympathetic ganglia, and postganglionic parasympathetic nerves that innervate the smooth muscle of the bronchial tree, pulmonary vessels, and glands of the bronchial tree.

Parasympathetic fibers are bronchoconstrictors, vasodilators, and secretomotor to the glands. Pneumonia is frequently confined to a single lobe of one lung and is called lobar pneumonia. It can be clearly seen circumscribed to one lobe in a chest radiograph.

The entry of air into a pleural cavity because of a penetrating wound or a fractured rib is called a pneumothorax and results in partial or total collapse of the lung. The escape of fluid into the pleural cavity pleural effusion is called hydrothorax; if the fluid is blood, the condition is known as a hemothorax, and if it is chyle from the thoracic duct, it is called a chylothorax.

Inflammation of the pleurae is called pleuritis or pleurisy; resulting friction between the two pleurae pleural rub is very painful and can be heard with a stethoscope. The inflamed pleurae may adhere to each other pleural adhesion Squamous cell or oat cell carcinoma is a common cancer of the lung, usually caused by smoking, that may be indicated by a persistent cough or spitting of blood hemoptysis.

Parietal Pleura innervated by the Phrenic nerve Victor has no sensation: Visceral pleura has no sensory innervation Causes of Hilar Lymphadenopathy: Tell Some Lies: Tuberculosis, Sarcoidosis, Lymphoma Bronchopulmonary segments: Upper lobe: Apical, Anterior, Posterior; Middle lobe: Medial and Lateral; Lower lobe: The fibrous outer layer of the pericardium the fibrous pericardium consists of dense connective tissue.

The fibrous pericardium is attached to the central tendon of the diaphragm by the pericardiacophrenic ligament. It blends with the tunica adventitia of the vessels entering and leaving the heart.

It has ligamentous attachments to the sternum It is thus affected by movements of the heart, the great vessels, the sternum, and the diaphragm.

It protects the heart against overfilling because it is fibrous and unyielding The inner layer of the pericardium is a serous membrane that lines the fibrous pericardium: The serous pericardium is a mesothelial layer that reflects onto the roots of the great vessels and is continuous over the external surface of the heart, where it is called the epicardium or visceral pericardium. Between the serous pericardium parietal pericardium and the epicardium visceral pericardium is a potential space: The pericardial cavity normally contains a thin film of fluid that allows the two layers to move over each other without friction or rubbing.

There are two sinuses within the pericardial cavity: The transverse pericardial sinus runs transversely in the pericardial sac between the origins of the great vessels: The oblique pericardial sinus is a wide recess in the posterior wall of the pericardial sac bounded laterally by the entrances of the pulmonary veins and inferiorly by the orifice of the inferior vena cava. Blood supply to the layers of the pericardium is mainly from the pericardiacophrenic vessels, from the internal thoracic arteries and veins.

The nerve supply to the pericardium is from the phrenic nerves, primarily sensory fibers for pain, and the sympathetic trunks vasomotor. The right side of the heart receives poorly oxygenated blood from the superior and inferior vena cava and pumps it to the lungs for oxygenation.

The left side of the heart receives oxygenated blood from the lungs via the pulmonary veins and pumps it to the body via the aorta and its branches. The heart consists of four chambers: The chambers of the heart have walls that consist of three layers: The functions of the fibrous skeleton are: Maintains the patency of the atrioventricular valves Provides a fixed site for the attachment of the leaflets and cusps of the valves Provides a fixed site for the attachments of the cardiac muscle fibers Insulates the atria from the ventricles so that they can contract independently The cardiac cycle consists of Relaxation of the ventricles diastole followed by Contraction of the ventricles diastole Heart sounds heard with a stethoscope: Border and Surfaces [Plate , Heart: Base and Diaphragmatic Surfaces] The heart lies obliquely between the 3rd and the 5th ribs, mainly on the left side of the midline of the thorax, but with roughly a third of it slightly to the right.

The base of the heart is its posterior surface, which is the left atrium. The apex of the heart is formed from the most inferior and lateral part of the left ventricle and lies beneath the left 5th intercostal space at approximately the midclavicular line.

Borders Right border: The anterior wall is ridged with the pectinate muscles. The smooth and rough parts of the right atrium are separated internally by a smooth ridge, the crista terminalis, which presents externally as shallow groove, the sulcus terminalis. The superior vena cava opens into the superior aspect of the right atrium.

The inferior vena cava opens into the inferior part, in a direct line with the superior vena cava. An interatrial septum separates the right and left atria. An oval depression in the interatrial septum, the fossa ovalis, represents the fetal foramen ovale and its valve.

Aright atrioventricular AV orifice opens into the right ventricle Right ventricle The right ventricle is situated in front and to the left of the right AV orifice. The interior has prominent muscular ridges, the trabeculae carnea. The tricuspid valve or right AV valve usually consists of three leaflets. The bases of the leaflets or cusps are attached to the fibrous ring around the orifice. The free edge of each leaflet is attached to two of the three papillary muscles by tendinous cords chordae tendinea.

The papillary muscles are three in number: These muscles contract before the ventricle itself contracts, tightening the chordae tendinea and drawing the cusps of the valve together to prevent backflow of blood into the right atrium. The septomarginal trabecula, or moderator band, is a free band of muscle extending from the interventricular septum to the anterior wall of the ventricle, and it contains Purkinje fibers from the right bundle branch see conducting system.

The outflow tract of the ventricle is separated from the inflow tract by a smooth crest, the supraventricular crest. The outflow tract, or conus arteriosus, is smooth walled and leads to the pulmonary trunk and the valve that guards its orifice, the pulmonary valve.

It has a smooth walled portion from the developmental incorporation of a portion of the pulmonary veins and an auricular appendage which is ridged with pectinate muscles and which was the primitive left atrium. Four pulmonary veins empty into the left atrium. The interatrial septum is nearly transverse, sloping posteriorly and to the right The left atrioventricular orifice leads to the left ventricle. Left Ventricle page page The left ventricle is nearly twice as thick as the right ventricle, since it performs more work to circulate blood to the body.

It has a conical cavity, the apex of which is the apex of the heart. Its walls are lined with trabeculae carnea, which are more numerous and not as massive as the ones in the right ventricle. It contains only two papillary muscles, anterior and posterior, which both attach to the two leaflets of the left atrioventricular, or mitral, valve via chordae tendinea. These muscles contract before the ventricle itself contracts, tightening the chordae tendinea and drawing the cusps of the valve together to prevent backflow of blood into the left atrium.

The aortic orifice is located posteriorly and superiorly and, like the pulmonary orifice, is surrounded by a fibrous ring to which the three cusps of the aortic valve are attached. The aortic valve has three cusps, which open like pockets to catch blood that backflows from the aorta during ventricular diastole. There are dilations in the wall of the aorta beneath each cusp: The right coronary artery originates in the right aortic sinus, while the left coronary artery originates in the left aortic sinus.

Arteriographic Views Continued ] Arteries The arterial supply to the heart is the right and left coronary arteries, the first branches of the aorta. They arise from the corresponding aortic sinuses, just distal to the origin of the aortic valve. The left coronary artery passes between the left auricle and the pulmonary trunk. Its main branches are Acircumflex branch, which reaches the posterior surface of the heart by traveling in the atrioventricular groove around the left side of the heart In slightly less than half of all people, a sinoatrial SA nodal branch from the circumflex branch will supply the SAnode.

An anterior interventricular branch left anterior descending artery or LAD , which descends in the anterior interventricular groove to the apex of the heart and then anastomoses with the posterior interventricular artery. The right coronary artery runs in the atrioventricular groove to the right and around to the posterior surface of the heart. It gives rise to The SAnodal branch near its origin in most people Aright marginal branch to the right margin of the heart An AV nodal branch to the atrioventricular node, as the junction of the septa and four chambers of the heart on the posterior side of the heart Aposterior interventricular branch that runs in the posterior interventricular groove.

Schema] Both divisions of the autonomic nervous system provide fibers to the cardiac plexus The conducting system of the heart coordinates the cardiac cycle of contraction. It consists of The sinoatrial node SAnode , located at the superior end of the sulcus terminalis of the right atrium, near the entrance of the superior vena cava The SAnode is the so-called pacemaker of the heart, from which impulses for contraction are initiated and spread through the musculature of both atria.

Fibers from the cardiac plexus supply the SAnode. Sympathetic innervation accelerates the rate and force of contraction of heart muscle. Parasympathetic stimulation slows down the rate and force of contraction of heart muscle.

Signal from the SAnode is propagated by the cardiac muscle to the AV node. The AV node is located near the inferior end of the interatrial septum posteriorly, near the septal cusp of the tricuspid valve. The AV bundle carries the signal from the AV node through the fibrous skeleton of the heart and the membranous interventricular septum. It divides into right and left bundles that pass on either side of the muscular interventricular septum. The fibers of the right and left bundles Purkinje fibers spread into the walls and papillary muscles of the ventricles.

Purkinje fibers from the right bundle innervate the anterior papillary muscle of the right ventricle via the septomarginal trabecula or moderator band, to coordinate the timing of the contraction of the papillary muscles. Heart Sounds Clinicians need to listen to valve sounds. Blood carries sound in the direction of its flow, so valve sounds are best heard auscultated directly superficial to their location or at the end of a line of blood flow through the valve.

Similarly, stab wounds to the heart can result in the leakage of blood into the pericardial cavity. As excess blood or fluid accumulates in the pericardial cavity, the heart becomes increasingly inhibited from expanding as it beats, and blood flow to the ventricles is impeded. This situation is called cardiac tamponade and is a potentially lethal condition. Symptoms include distension of neck veins and a collapsing pulse, i. Pericardiocentesis Pericardiocentesis or drainage of fluid from the pericardial cavity is necessary to relieve cardiac tamponade.

Awide bore needle is inserted into the 5th or 6th intercostal space adjacent to the sternum but not too close because of the presence of the internal thoracic vessels.

This approach can be made because of the cardiac notch in the left lung and left parietal pleura, leaving the pericardial sac exposed. Aneedle can also be inserted into the infrasternal angle, again being careful of the internal thoracic artery and its branches, and passed superiorly and posteriorly to reach the pericardial sac.

Cardiac Referred Pain While the heart is generally insensitive to various stimuli, ischemia lack of oxygen and the resulting accumulation of metabolic products registers as pain, typically in the left pectoral and substernal regions and over the medial aspect of the left shoulder and upper limb.

The axons of visceral afferent fibers from the heart typically enter spinal cord segments from T1 through T4 or 5 on the left side. General sensory fibers from these areas also enter the same spinal cord segments Cardiac Bypass Graft CABG In this surgery, the patient has a blood vessel grafted into the coronary circulation to bypass an occlusion in one of the coronary arteries or its branches.

In the past, the saphenous vein was commonly used in the bypass graft, because it is easily obtained from the lower limb and has lengthy sections without valves or branches. The internal thoracic artery is more frequently used to shunt blood from the aorta to branches of the coronary arteries beyond the occlusion. This restores normal blood flow to the part of the heart distal to the blockage.

It can be a result of any one of several developmental anomalies, such as failure of the embryonic endocardial cushions, which form part of the septum, to fuse. Aleft to right flow of blood occurs with this defect because of the strength of contraction of the left ventricle. This increases the blood flow through the pulmonary trunk to the lungs and results in pulmonary hypertension increased blood pressure and an enlarged heart.

This condition is potentially fatal if not corrected. Pathologies of the Aorta Aneurysms of the ascending aorta An aortic aneurysm is an enlargement of a weakened area of the aorta, in this case in the distal part of the ascending aorta.

Ascending aortic aneurysms frequently cause dilation and leakage of the aortic valve, resulting in shortness of breath or even heart failure. Aortic dissection is a tearing of the internal wall of the aorta, with subsequent bleeding into the wall, as the result of an aneurysm, atherosclerosis, or high blood pressure. Coarctation of aorta is a birth defect in which the aorta is narrowed somewhere along its length, most commonly just past the point where the subclavian artery arises.

This results in low blood pressure in branches of the aorta distal to the narrowing and high blood pressure in branches between the narrowing and the heart. People with this condition often have high blood pressure in the upper body and arms or one arm and low blood pressure in the lower body and legs. The intercostal arteries can become enlarged, since the anastomoses of the anterior intercostals from the internal thoracic artery with the posterior intercostals can circumvent the narrowing.

Aortic coarctation is more common in some genetic conditions such as Turner syndrome but also can be associated with congenital abranditemities of the aortic valve such as a bicuspid aortic valve. Valvular Insufficiencies The mitral valve is the heart valve most frequently affected by disease.

It can be caused by endocarditis, myocarditis, rheumatic heart disease, or lupus erythematosus, or can result from a developmental abranditemity. The diseased mitral valve allows reversal of blood flow from the left ventricle to the left atrium mitral regurgitation.

It is characterized by a high pitched murmur, loudest over the apex of the heart. Narrowing of the pulmonary valve stenosis is caused by fusion of the valve cusps. It can result from a developmental abranditemity or diseases such as rheumatic fever or endocarditis. Pulmonary valve heard over 2nd left intercostal space AV2R: Aortic valve heard over 2nd right intercostal space Memory Aids To remember the cusps of the aortic and pulmonary valves: Mediastinum [Plate , Mediastinum: Left Lateral View] General Description page page page page page page The mediastinum is the central compartment of the thorax between the two pleural cavities.

Stretches from the thoracic inlet to the diaphragm and from the sternum to the bodies of the thoracic vertebrae posteriorly.

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Its contents include the heart, trachea, esophagus, great vessels of the heart, lymph nodes, nerves, and fat. The mediastinum is divided into two parts: Superior mediastinum contains the superior vena cava arch of the aorta and its branches trachea phrenic nerves thoracic duct esophagus vagus nerves left recurrent laryngeal nerve thymus Inferior mediastinum is subdivided into anterior mediastinum middle mediastinum posterior mediastinum The anterior mediastinum contains fat and the remnants of the thymus gland The middle mediastinum contains the heart surrounded by the pericardium and the roots of the great vessels.

The great vessels are: Pocket Atlas of Human Anatomy. Pocket Atlas Of Human Anatomy. Atlas of Human Anatomy vol. I-Musculoskeletal System. Atlas of anatomy Thieme Anatomy. Color atlas and textbook of human anatomy. Human Anatomy, 2nd Edition.

Human Anatomy, 2nd edition. Human Anatomy, 7th Edition. Human Anatomy, 3rd Edition. Human Anatomy, 6th Edition. Human Anatomy, Seventh Edition.

Locomotor System 5th Edition. Grant's Atlas of Anatomy. Grant's Atlas Of Anatomy. Atlas of Surgical Anatomy. Grant's Atlas of Anatomy, 12th Edition.