Shoulder Region and Thorax3
Transcript of Shoulder Region and Thorax3
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Heart, Lungs & ThoraxPart 3
Gross Anatomy II
Pages 23-31
Lec # 5
01-24-07
2007
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ANNOUNCEMENTS
Be sure to get well oriented before removing ribs.
On page 25 where directed to remove ribs. Rather than as instructed leave only ribs7,8, 16, 17 and 18. See p r26 for removal of 1st rib (Leave Scalenus with Phrenic N.Branches) (A change from Book) Be careful on medial side of 1st rib to preserve thevessels and nerves medial to the 1st rib
Be very careful not to enter the peritoneal cavity at this time.
When you remove the lungs, be very careful and try to preserve the vagus and phrenic
nerves. Do not remove the heart and other structures of the mediastinum as directed on page
28. Leave the heart in situ.
Minimum structures on heart to identify: Chambers of the heart, left and right auricle,the coronary and interventricular grooves, the left and right coronary arteries, theligamentum arteriosum, open the left and right atria to identify the coronary sinus,fossa ovale and left and right AV valves. This may require using paper towels toremove blood/latex from the atria.
Remember to share sides and to see the horse from both the right and left
Corrections on veins in figures 2-9, 2-10, page 27 of lab guide.
Autonomics: see all possible without transecting the arteries
3 enlarged images for slides, 9, 12 & 14
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Surface Anatomy of the Lungs
Apex and base (diaphragmatic surface) Costal and medial surface
Dorsal, ventral & basal borders
Cardiac notches
Lobes: left 2 / right 3
Hilus
Root: Pulmonary A. & Vs, Bronchus, Bronchial A.,
Pulmonary Nerves, Pulmonary Lymphatics
Pulmonary Ligaments
Area of Adhesion (Normal)
Impressions
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PII140 & 141
Left
Right
PII 140 & 141
Apex (Cranial End)
15 Base (Diaphragmatic Surface)
Costal Surface (Not Pictured)
Medial Surface (Visible)3/4 Dorsal Border
6/7 Cardiac Notches
1/2 Two Lobes on Left
1/2/3 Three Lobes on Right
Hilus & Root (BAV)
13/19Pulmonary Ligaments
7/11 Tracheal
8 Aortic
9 Esophageal
10 Azygous
15/12 Costocervical
13 Cranial VC
14 Cardiac
20 Caudal VC
See S520 for Correct Labeling. Ventral
and Basal Borders on these figuresmislabeled in Popesko
1520
Ventral Border
Basal Border
Area of Adhesion
Impressions
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Review Question The pulmonary arteries as they enter the
lung should be located dorsal/ventral to
the pulmonary veins and both vessels will
in general be located dorsal/ventral to the
principal bronchus although on the left
the left pulmonary artery will approachthe lung in a position cranial to the left
principal bronchus.
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Lymph Nodes and Divisions of the Lungs
1: Left Tracheobronchial L.ns.
2: Right Tracheobronchial L.ns.
3: Middle Tracheobronchial Lns.
4: Pulmonary Lns.
Left and Right Principal (Primary Bronchi)Lobar Branches (Secondary)
Segmental Bronchus (Tertiary) plus associated
Lung Tissue = Bronchopulmonary Segment
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S522
Left
S522 Dorsal View of Horse Lungs
Right
A Cranial Lobe (apical)
C Caudal Lobe (Diaphragmatic)
D Accessory Lobe (Intermediate)
LOBES
LYMPH NODES
1 Left Tracheobronchial
2 Right Tracheobronchial
3 Middle Tracheobronchial
4 Pulmonary
Left Tracheobronchial into
Cranial Mediastinal. Right
Tracheobronchial into Middle
& Cranial Mediastinal. Middle
TB into Right TB and Cr., Mid.
& Caudal Mediastinal
A
A
C
C
D
12
3
4
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Lymphatics of the Thorax
Left, Right & Middle Tracheobronchial
Tend to be ventral to esophagus
Cranial, Middle & Caudal Mediastinal
Tend to be dorsal to the esophagus except possibly for cranial
mediastinal lns
Cranial & Caudal Sternal
Intercostals
Thoracic Aortic
Caudally located intercostal and thoracic aortic lns may drain
through aortic hiatus into celiac lns of the abdomen
Lymphatic vessels from the diaphragm and liver may
drain to the caudal and cranial sternal and caudal
mediastinal lymph nodes i.e. into the thorax
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S622
Lymphatics of the Thorax S622
1,1 Cranial & Caudal Sternal
1
1
2 Cranial Mediastinal
3 Nuchal
4 Intercostal
5 Thoracic Aortic
6 Middle and CaudalMediastinal
7 Middle Tracheobronchial
8 Left Tracheobronchial
g Thoracic Duct
Esophagus
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Clarification Question A Kupffer cell sarcoma of the liver might
reasonably metastasize and produce an
opacity in the cranial mediastinum in
both the horse and dog. True/False
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Right View of Thorax Vagus Nerve and branches including Recurrent Laryngeal Nerve
Phrenic Nerve Sympathetics
Brachiocephalic Trunk
(Left Subclavian Artery)
Costocervical Trunk (right) Deep Cervical (1st space)
Dorsal Scapular (2nd space)
Supreme Intercostal
Vertebral Artery (right) (cranial to 1st rib)
Internal Thoracic (right) (may arise after Bicarotid Trunk)
Bicarotid Trunk
Right Subclavian
Superficial Cervical (right)
Vena azygous (right azygous)
Chambers of the heart
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12Thorax from Right
PII129
PII129
Vagus, Recurrent Laryngeal, D&V Vagal Trunks
18 Esophagus, 12 Aorta & 13 Azygous
Phrenic Nerve & Sympathetic Trunk
27,28,29 Chambers of Heart, 25 Pulmonary Veins
Brachiocephalic Trunk:
Origin of Costocervical
Trunk & Vertebral A. on the
Right
Costocervical Trunk withDorsal Scapular & Deep
Cervical
Vertebral Artery
Bicarotid Trunk
Internal Thoracic
Superficial Cervical
Right Subclavian A.
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Left View of Thorax
Vagus Nerve and branches including Recurrent Laryngeal Nerve Phrenic Nerve
Sympathetics
Left Subclavian
Costocervical Trunk Dorsal Scapular (2nd space)
Supreme Intercostal
Deep Cervical (1st space)
Vertebral Artery
Internal Thoracic
Superficial Cervical
Thoracic duct
Chambers of the heart
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PII130
Thorax from Left
Vagus, Recurrent Laryngeal, D&V Vagal Trunks
Esophagus, Aorta & Left Pulmonary Artery
Phrenic Nerve & Sympathetic Trunk
39, 40, 41, 43 Chambers of Heart, 42 Pulmonary Vs
Thoracic Duct
19 Brachiocephalic Trunk
22 Left Subclavian
Costocervical Trunk,
Dorsal Scapular &Supreme Intercostal As
Deep Cervical A.
Vertebral A.
Internal Thoracic A.
Superficial Cervical A.
Axillary Artery
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Review Question The thoracic duct originates from the
________________ in the craniodorsal
________________ cavity, and passesthrough the _________________ to runon the left/right dorsolateral side of theaorta to about T7 levels (+/-) and then
passes to the left/right to run over theleft/right side of the esophagus beforeempting into the _____________ .
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Anatomical Correlates, JAVMAmay01001441 Heart murmurs were detected in 686 of 846 (81.1%) thoroughbred racehorses
48.7% 1 murmur; 24.8% 2 murmurs; 3 murmurs 6.7%; 4 murmurs 0.8%
Tricuspid Systolic 28.5%; Tricuspid Diastolic 13.7%
Pulmonary Systolic 43.1%; Pulmonary Diastolic 8.2%
Mitral Systolic 3.8%; Mitral Diastolic 1.7%
Aortic Systolic 27.4%; Aortic Diastolic 11.7%
Functional Systolic Murmurs: 57.7% of the 846 horses (81.1-57.7 = 23.4)
Was not made clear the exact criteria used for distinguishing functional murmurs
ECGs were done on a few horses with arrhythmias and Echocardiography done on 30 horses tofurther evaluate murmurs
Analysis of Race Records did not reveal a significant association between murmurs andperformance
Examination of the medical records of those against which the horses in this study were
competing found that many had such conditions as: exercise induced pulmonary hemorrhage,laryngeal hemiplegia, lameness, and COPD that were also probably performance limitingproblems
Conclusion of Study: Heart Murmurs are a common finding in racehorses and most donot appear to be clinically significant
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ND225 (2nd ed.) &
NND225 (3rd ed.)
SA NODE: VENTRAL TO CRANIAL VENA CAVA OPENING
AV NODE IN INTERATRIAL SEPTUM CRANIAL TO
OPENING OF CORONARY SINUS
3 Trabecula
Septomarginalis
RIGHTLEFT
Cardiac Conduction System
Components of SubAV
Node Conduction
System
1 Atrioventricular Bundle2 Right & Left Bundles
1
2
3
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CIRCULATION OF BLOOD
HEPATICVEINS
UNPAIRED ABDOMINAL BRANCHES
ABDOMINAL
VISCERA
PORTAL V.
LIVER
HEPATIC A.
Systemic Capillaries
Systemic Veins
Cr. & Cd. Vena Cava
Right Atrium
Rt.. Ventricle
Pulmonary Trunk
Lungs
Pulmonary Capillaries
Pulmonary Veins
Left Atrium
Left Ventricle
Aorta
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Review Question The liver receives a nutritional blood
supply from the ____________ (Vessel)
and a functional blood supply from the
______________ (vessel), and is most
likely to become congested and
edematous if there is left/right sided heartfailure.
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21Thorax from Right
PII129
PII129
Vagus, Recurrent Laryngeal, D&V Vagal Trunks
18 Esophagus, 12 Aorta & 13 Azygous
Phrenic Nerve & Sympathetic Trunk
27,28,29 Chambers of Heart, 25 Pulmonary Veins
Brachiocephalic Trunk:
Origin of Costocervical
Trunk & Vertebral A. on the
Right
Costocervical Trunk withDorsal Scapular & Deep
Cervical
Vertebral Artery
Bicarotid Trunk
Internal Thoracic
Superficial Cervical
Right Subclavian A.
Corresponds to slide 12
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PII130
Thorax from Left
Vagus, Recurrent Laryngeal, D&V Vagal Trunks
Esophagus, Aorta & Left Pulmonary Artery
Phrenic Nerve & Sympathetic Trunk
39, 40, 41, 43 Chambers of Heart, 42 Pulmonary Vs
Thoracic Duct
19 Brachiocephalic Trunk
22 Left Subclavian
Costocervical Trunk,
Dorsal Scapular &Supreme Intercostal As
Deep Cervical A.
Vertebral A.
Internal Thoracic A.
Superficial Cervical A.
Axillary Artery
Corresponds to slide 14