Download - Thorax
T H O R A XT H O R A X
Selfi HandayaniSelfi Handayani
MK. ANATOMI
GAMBARAN UMUMGAMBARAN UMUM
Thorax– struktur bentuk silinder tidak Thorax– struktur bentuk silinder tidak teratur, superior sempit (apertura thoracis teratur, superior sempit (apertura thoracis superior) dan inferior lebih luas (apertura superior) dan inferior lebih luas (apertura thoracis inferior)thoracis inferior)
Musculoskeletal dinding fleksibel--- Musculoskeletal dinding fleksibel--- vertebrae, costae, otot dan sternumvertebrae, costae, otot dan sternum
Cavitas thoracis– dinding thorax dan Cavitas thoracis– dinding thorax dan diaphragma; 3 komparteme: cavum diaphragma; 3 komparteme: cavum pleurae dexter dn sinister, mediastinumpleurae dexter dn sinister, mediastinum
FUNGSIFUNGSI
Pernafasan: pulmo + (diaphragma, dinding Pernafasan: pulmo + (diaphragma, dinding thorax, costa)thorax, costa)
Proteksi organ: pulmo, cor dan vasa besar Proteksi organ: pulmo, cor dan vasa besar . Hepar, lien dan gaster o/ diaphragma. . Hepar, lien dan gaster o/ diaphragma. Ren (posterior, o/ diaphragma– costa 12 Ren (posterior, o/ diaphragma– costa 12 (kiri), costa 11,12 (kanan))(kiri), costa 11,12 (kanan))
Conduit; mediastinumConduit; mediastinum
DINDING THORAXDINDING THORAX
SKELETONSKELETON
OTOTOTOT
SKELETON THORACISSKELETON THORACIS
STERNUMSTERNUM COSTAE et CARTILAGINES COSTAE et CARTILAGINES
COSTAECOSTAE VERTEBRAE THORACICAEVERTEBRAE THORACICAE DISCI INTERVERTEBRALISDISCI INTERVERTEBRALIS
Otot dinding thoraxOtot dinding thorax
M intercostalis eksternusM intercostalis eksternus M intercostalis internusM intercostalis internus M intercostalis immusM intercostalis immus M subcostalisM subcostalis M transversus thoracisM transversus thoracis
Anterior Thoracic Wall Anterior Thoracic Wall (Superficial Dissection)(Superficial Dissection)
Pectoralis major
Pectoralis minor
Clavipectoral fascia
Thoracoacromial artery
Lateral pectoral nerve
Cephalic vein
Medial pectoral nerve
Modified from Netter (2006), Plate 188
Anterior Thoracic Wall Anterior Thoracic Wall (Deep Dissection)(Deep Dissection)
External intercostals
Internal intercostals
Pectoralis minor
Serratus anterior
Long thoracic nerve and lateral thoracic artery
Modified from Netter (2006), Plate 189
Anterior Thoracic Wall Anterior Thoracic Wall (Internal View)(Internal View)
Diaphragm
Internal intercostals
Transversus thoracis
Anterior intercostal arteries and veins
Innermost intercostals
Internal thoracic artery and vein
Modified from Netter (2006), Plate 191
APERTURA THORACIS APERTURA THORACIS SUPERIORSUPERIOR
Skeleton: corpus VT1, tepi medial costa Skeleton: corpus VT1, tepi medial costa 1,manubrium sterni1,manubrium sterni
Ke superior berhub dg collumKe superior berhub dg collum Bbrp struktur berjalan melewati pintu iniBbrp struktur berjalan melewati pintu ini
APERTURA THORACIS APERTURA THORACIS INFERIORINFERIOR
- tulang, cartilago, ligamenta
- corpus VT 12, costa 11, 12, proc xipoideus
- tertutup o/ diaphragma & struktur yg berjalan di dalamnya
DIAPHRAGMADIAPHRAGMA
Struktur musculotendinosusStruktur musculotendinosus Otot--- tepi menuju ke pusat centrum Otot--- tepi menuju ke pusat centrum
tendineumtendineum Bentuk domeBentuk dome Kontraksi--- puncak turun; vol c thoracis Kontraksi--- puncak turun; vol c thoracis
meningkatmeningkat Esophagus, v cava inferior menembus Esophagus, v cava inferior menembus
diaphragma, aorta di belakangdiaphragma, aorta di belakang
diaphragmadiaphragma
Side view to see curvature of diaphragm…
Here’s a hint for what to look for…
Visceral Pleura – on lungs
Parietal Pleura – on inside of body wall and diaphragm.•Costal, Diaphragmatic, Mediastinal, Cupola•Costodiaphragmatic Recess
CAVITAS PLEURAECAVITAS PLEURAE
Root of Lung
Note!Because heart is displaced to left, left lung smaller (only two lobes).
Right lung has three lobes.
(Smaller sections are called:BRONCIOPULMONARY SEGMENTS)
Right lung (3 lobes) Left lung (2 lobes)
pulmopulmo
Ribs move like bucket handles.
CORCOR
HeartHeart ChambersChambers ValvesValves VesselsVessels External VesselsExternal Vessels
• Coronary ArteriesCoronary Arteries
Contraction CycleContraction Cycle SystoleSystole DiastoleDiastole
• Filling of the coronary arteries occurFilling of the coronary arteries occur
CORCOR
HeartHeart General StructureGeneral Structure
• PericardiumPericardium Surrounds heartSurrounds heart VisceralVisceral ParietalParietal SerousSerous
• 35-50 ml fluid35-50 ml fluid
• EpicardiumEpicardium Outer LayerOuter Layer
• MyocardiumMyocardium Muscular layerMuscular layer
• EndocardiumEndocardium Innermost layerInnermost layer
Nervous StructureNervous Structure• SA NodeSA Node
Right AtriumRight Atrium
• Intra-atrial PathwaysIntra-atrial Pathways• AV NodeAV Node
AV JunctionAV Junction
• Bundle of HisBundle of His• Left & Right Bundle Left & Right Bundle
BranchesBranches• Purkinje FibersPurkinje Fibers
CORCOR Approximately the size of your fistApproximately the size of your fist
Wt. = 250-300 gramsWt. = 250-300 grams LocationLocation
In the mediastinum between the lungsIn the mediastinum between the lungs Superior surface of diaphragmSuperior surface of diaphragm ⅔’⅔’s of it lies to the left of the midsternal lines of it lies to the left of the midsternal line Anterior to the vertebral column, posterior to the Anterior to the vertebral column, posterior to the
sternumsternum
CORCOR
Figure 18.1
Pembungkus CorPembungkus Cor Pericardium – a double-walled sac around the Pericardium – a double-walled sac around the
heart heart Composed of:Composed of:
• A superficial A superficial fibrous pericardiumfibrous pericardium• A deep two-layer A deep two-layer serous pericardiumserous pericardium
The The parietal layerparietal layer lines the internal surface of the fibrous lines the internal surface of the fibrous pericardiumpericardium
The The visceral layervisceral layer or or epicardium epicardium lines the surface of the heartlines the surface of the heart They are separated by the fluid-filled pericardial cavity called They are separated by the fluid-filled pericardial cavity called
the pericardial cavitythe pericardial cavity
Protects and anchors the heartProtects and anchors the heart Prevents overfilling of the heart with bloodPrevents overfilling of the heart with blood Allows for the heart to work in a relatively friction-free Allows for the heart to work in a relatively friction-free
environmentenvironment
Pericardial Layers of the HeartPericardial Layers of the Heart
Figure 18.2
Dinding corDinding cor Epicardium – visceral Epicardium – visceral
pericardiumpericardium Myocardium – cardiac Myocardium – cardiac
muscle layer forming the muscle layer forming the bulk of the heartbulk of the heart
Endocardium – endothelial Endocardium – endothelial layer of the inner layer of the inner myocardial surfacemyocardial surface
Anatomi corAnatomi cor
External markings External markings Apex - pointed inferior regionApex - pointed inferior region Base - upper regionBase - upper region Coronary sulcusCoronary sulcus
• Indentation that separates atria from ventriclesIndentation that separates atria from ventricles Anterior and posterior interventricular sulcusAnterior and posterior interventricular sulcus
• Separates right and left ventricles Separates right and left ventricles
Internal divisionsInternal divisions Atria (superior) and ventricles (inferior)Atria (superior) and ventricles (inferior) Interventricular and interatrial septa Interventricular and interatrial septa
Atria CordisAtria Cordis
Atria - receiving chambers of the heartAtria - receiving chambers of the heart Receive venous blood returning to heartReceive venous blood returning to heart Separated by an interatrial septum (wall)Separated by an interatrial septum (wall)
• Foramen ovale - opening in interatrial septum in fetusForamen ovale - opening in interatrial septum in fetus• Fossa ovalis - remnant of foramen ovaleFossa ovalis - remnant of foramen ovale
Each atrium has a protruding auricleEach atrium has a protruding auricle Pectinate muscles mark atrial wallsPectinate muscles mark atrial walls Pump blood into ventricles Pump blood into ventricles Blood enters right atria from superior and inferior Blood enters right atria from superior and inferior
venae cavae and coronary sinusvenae cavae and coronary sinus Blood enters left atria from pulmonary veinsBlood enters left atria from pulmonary veins
Cor potongan frontalCor potongan frontal
Figure 18.4e
Ventriculi cordisVentriculi cordis
Ventricles are the discharging chambers of the Ventricles are the discharging chambers of the heartheart
Papillary muscles and trabeculae carneae Papillary muscles and trabeculae carneae muscles mark ventricular wallsmuscles mark ventricular walls
Separated by an interventricular septumSeparated by an interventricular septum Contains components of the Contains components of the conduction systemconduction system
Right ventricle pumps blood into the pulmonary Right ventricle pumps blood into the pulmonary trunktrunk
Left ventricle pumps blood into the aortaLeft ventricle pumps blood into the aorta Thicker myocardium due to greater work loadThicker myocardium due to greater work load
• Pulmonary circulation supplied by right ventricle is a much low Pulmonary circulation supplied by right ventricle is a much low pressure system requiring less energy output by ventriclepressure system requiring less energy output by ventricle
• Systemic circulation supplied by left ventricle is a higher Systemic circulation supplied by left ventricle is a higher pressure system and thus requires more forceful contractionspressure system and thus requires more forceful contractions
Struktur luar; aspek Anterior Struktur luar; aspek Anterior
Figure 18.4b
Struktur dinding corStruktur dinding cor
Left ventricle – Left ventricle – three times three times thicker than rightthicker than right Exerts more Exerts more
pumping forcepumping force Flattens right Flattens right
ventricle into a ventricle into a crescent shapecrescent shape
Figure 18.7
Valvula cordisValvula cordis Heart valves ensure unidirectional blood flow through the Heart valves ensure unidirectional blood flow through the
heartheart Composed of an endocardium with a connective tissue coreComposed of an endocardium with a connective tissue core
Two major typesTwo major types Atrioventricular valvesAtrioventricular valves Semilunar valvesSemilunar valves
Atrioventricular (AV) valves lie between the atria and the Atrioventricular (AV) valves lie between the atria and the ventriclesventricles R-AV valve = tricuspid valveR-AV valve = tricuspid valve L-AV valve = bicuspid or mitral valveL-AV valve = bicuspid or mitral valve
AV valves prevent backflow of blood into the atria when AV valves prevent backflow of blood into the atria when ventricles contractventricles contract
Chordae tendineae anchor AV valves to papillary muscles of Chordae tendineae anchor AV valves to papillary muscles of ventricle wallventricle wall Prevent Prevent prolapse prolapse of valve back into atriumof valve back into atrium
Valvula semilunarisValvula semilunaris Semilunar valves prevent backflow of blood into Semilunar valves prevent backflow of blood into
the ventriclesthe ventricles Have no chordae tendinae attachmentsHave no chordae tendinae attachments Aortic semilunar valve lies between the left Aortic semilunar valve lies between the left
ventricle and the aorta ventricle and the aorta Pulmonary semilunar valve lies between the Pulmonary semilunar valve lies between the
right ventricle and pulmonary trunkright ventricle and pulmonary trunk Heart sounds (“lub-dup”) due to valves closingHeart sounds (“lub-dup”) due to valves closing
““Lub” - closing of atrioventricular valvesLub” - closing of atrioventricular valves ““Dub”- closing of semilunar valvesDub”- closing of semilunar valves
Fibrous SkeletonFibrous Skeleton
Surrounds all four valvesSurrounds all four valves Composed of dense connective tissueComposed of dense connective tissue
FunctionsFunctions Anchors valve cuspsAnchors valve cusps Prevents overdilation of valve openingsPrevents overdilation of valve openings Main point of insertion for cardiac muscleMain point of insertion for cardiac muscle Blocks direct spread of electrical impulsesBlocks direct spread of electrical impulses
Heart ValvesHeart Valves
Conducting SystemConducting System
Cardiac muscle tissue has intrinsic ability Cardiac muscle tissue has intrinsic ability to:to: Generate and conduct impulsesGenerate and conduct impulses Signal these cells to contract rhythmicallySignal these cells to contract rhythmically
Conducting system Conducting system A series of specialized cardiac muscle cellsA series of specialized cardiac muscle cells Sinoatrial (SA) node sets the inherent rate of Sinoatrial (SA) node sets the inherent rate of
contractioncontraction
Conducting SystemConducting System
InnervationInnervation Heart rate is altered by Heart rate is altered by
external controlsexternal controls Nerves to the heart Nerves to the heart
include:include: Visceral sensory fibersVisceral sensory fibers Parasympathetic Parasympathetic
branches of the vagus branches of the vagus nervenerve
Sympathetic fibers – Sympathetic fibers – from cervical and upper from cervical and upper thoracic chain gangliathoracic chain ganglia
External Heart: Posterior ViewExternal Heart: Posterior View
Figure 18.4d
Vessels returning blood Vessels returning blood to to the heart include:the heart include: Superior and inferior venae cavaeSuperior and inferior venae cavae
• Open into the right atriumOpen into the right atrium• Return Return deoxygenateddeoxygenated blood from body cells blood from body cells
Coronary sinusCoronary sinus• Opens into the right atriumOpens into the right atrium• Returns Returns deoxygenated deoxygenated blood from heart muscle (coronary veins)blood from heart muscle (coronary veins)
Right and left pulmonary veinsRight and left pulmonary veins• Open into the left atriumOpen into the left atrium• Return Return oxygenatedoxygenated blood from lungs blood from lungs
Major Vessels of the HeartMajor Vessels of the Heart
Vessels conveying blood Vessels conveying blood away fromaway from the heart the heart include:include: Pulmonary trunkPulmonary trunk
• Carries deoxygenated blood from right ventricle to lungsCarries deoxygenated blood from right ventricle to lungs• Splits into right and left pulmonary arteriesSplits into right and left pulmonary arteries
Ascending aortaAscending aorta• Carries oxygenated blood away from left atrium to body organsCarries oxygenated blood away from left atrium to body organs• Three major branchesThree major branches
BrachiocephalicBrachiocephalic Left common carotid, Left common carotid, Left subclavian arteryLeft subclavian artery
Major Vessels of the Heart Major Vessels of the Heart
Blood Flow Through the HeartBlood Flow Through the Heart
Figure 18.6
VASCULARISASIVASCULARISASI
SIRKULASI SIRKULASI PULMONER:PULMONER:
- Truncus pulmonaris– Truncus pulmonaris– a. pulmonaris dexter a. pulmonaris dexter dan a. pulmonaris dan a. pulmonaris sinistersinister
- Vena pulmonaris--- Vena pulmonaris--- vv. pulmonaris dari vv. pulmonaris dari lobilobi
SIRKULASI SIRKULASI SISTEMIK:SISTEMIK:
- Aorta Aorta - Vena cava superior, Vena cava superior,
vena cava inferiorvena cava inferior
TRUNCUS PULMONALISTRUNCUS PULMONALIS
Membawa darah venosa; arteria: tekanan tinggi Membawa darah venosa; arteria: tekanan tinggi (20-30 mmHg), pulsasi +, struktur elastik sama (20-30 mmHg), pulsasi +, struktur elastik sama dengan aortadengan aorta
Membentang dari conus arteriosus ventrcl Membentang dari conus arteriosus ventrcl dexter sampai concavitas arcus aorta kiri dari dexter sampai concavitas arcus aorta kiri dari aorta ascendensaorta ascendens
Menembus pericardium fibrosa bersama2 dg Menembus pericardium fibrosa bersama2 dg aortaaorta
Stl berjalan sktr 5 cm--- terbagi dexter dg sinsterStl berjalan sktr 5 cm--- terbagi dexter dg sinster
TRUNCUS PULMONALISTRUNCUS PULMONALIS
Dexter: lebih panjang dan lebar, berjalan Dexter: lebih panjang dan lebar, berjalan di bawah arcus aortae di depan bronchus di bawah arcus aortae di depan bronchus primarius dexter sampai hilus pulmonis primarius dexter sampai hilus pulmonis dexter, sblum masuk ke hilus bercabang-2dexter, sblum masuk ke hilus bercabang-2
Sinister: lebih pendek, sempit, Sinister: lebih pendek, sempit, membentang ke lateral menuju radix membentang ke lateral menuju radix pulmonis sinster di depan bronchus prims. pulmonis sinster di depan bronchus prims. Berhub arcus aortae mll lig arteriosumBerhub arcus aortae mll lig arteriosum
VENA PULMONALISVENA PULMONALIS
Bsn tdp 5 dari setiap lobus, atas dan Bsn tdp 5 dari setiap lobus, atas dan tengah (kanan) bsn bergabung--- tdp 4 tengah (kanan) bsn bergabung--- tdp 4 masing2 ada 2 yang masuk ke atrium masing2 ada 2 yang masuk ke atrium sinsitrumsinsitrum
V yg dari bawah kanan berjalan di V yg dari bawah kanan berjalan di belakang atrium dxter dian/ pintu v cava belakang atrium dxter dian/ pintu v cava sup dan inf, dr`atas kanan menyilang di sup dan inf, dr`atas kanan menyilang di belkg v cava sup.belkg v cava sup.
AORTAAORTA
Vasa darah utamaVasa darah utama Aorta ascenden, arcus aortae, aorta Aorta ascenden, arcus aortae, aorta
descendens ( aorta thoracalis)descendens ( aorta thoracalis) Arteria elastika, tunica media tebalArteria elastika, tunica media tebal Aorta ascendens dan arcus aortae--- Aorta ascendens dan arcus aortae---
baroreseptorbaroreseptor
AORTA ASCENDENSAORTA ASCENDENS
Di mediastinum medium, radix aortae– angulus Di mediastinum medium, radix aortae– angulus sternisterni
Tertanam dlm lamina fibrosa pericardium Tertanam dlm lamina fibrosa pericardium bersama dg tr pulmonalisbersama dg tr pulmonalis
D. 3cm, p. 5cmD. 3cm, p. 5cm Pangkal menonjol– sinus aortaePangkal menonjol– sinus aortae Tr pulmonalis, conus aorticus– aorta—atrium Tr pulmonalis, conus aorticus– aorta—atrium
sinistrum, sinus transversussinistrum, sinus transversus Cab: a. coronaria dextra dan sinistraCab: a. coronaria dextra dan sinistra
ARCUS AORTAEARCUS AORTAE
Lanjt aorta ascendens, ke kiri dpan Lanjt aorta ascendens, ke kiri dpan trachea, ke dorsocaudal sbl cranial trachea, ke dorsocaudal sbl cranial bronchus sinster mnj kiri trachea dan bronchus sinster mnj kiri trachea dan esophagusesophagus
Bid sagittal di mediastinum supr– aortic Bid sagittal di mediastinum supr– aortic knuckleknuckle
NERVINERVI
N. THORACICUSN. THORACICUS N. PHRENICUSN. PHRENICUS N. VAGUSN. VAGUS TRUNCUS SYMPATHICUSTRUNCUS SYMPATHICUS PLEXUS OTONOMICUSPLEXUS OTONOMICUS
N. PHRENICUSN. PHRENICUS
Asal .n. cervicalis IV dan VAsal .n. cervicalis IV dan V Setiap n masuk ke thorax stlh berjalan di depan Setiap n masuk ke thorax stlh berjalan di depan
m scalenus anteriorm scalenus anterior Berdampingan dg pericardiacophrenica– Berdampingan dg pericardiacophrenica–
pericardium, pleura mediastinalis, bag tengah pericardium, pleura mediastinalis, bag tengah pleura diaphragmatica, angulus pleura diaphragmatica, angulus pericardiophrenicapericardiophrenica
N. PHRENICUSN. PHRENICUS
Komponen fungsional: motoris, sensoris Komponen fungsional: motoris, sensoris dan sympathisdan sympathis
Motoris: diaphragmaMotoris: diaphragma Sensoris: peritoneum, pleura Sensoris: peritoneum, pleura
diaphragmatica, pleura mediastinalis, diaphragmatica, pleura mediastinalis, pericardiumpericardium
Nyeri menjalar m trapezius, bag bawah Nyeri menjalar m trapezius, bag bawah leher sampai ujung bahuleher sampai ujung bahu
N. VAGUSN. VAGUS
c. thoracis– plx pulmonalis, plx esophageus, tr c. thoracis– plx pulmonalis, plx esophageus, tr vagalis anterior dan posterior– hiatus esophageivagalis anterior dan posterior– hiatus esophagei
Cab. N laryngeus recurrent (trachea, esophagus Cab. N laryngeus recurrent (trachea, esophagus dan larynx)dan larynx)
Cab. R cardiacus superior (cervicalis)– hub dg Cab. R cardiacus superior (cervicalis)– hub dg gln sympathicus cervicalisgln sympathicus cervicalis
Cab. R cardiacus inferior (cervicothoracicus)– Cab. R cardiacus inferior (cervicothoracicus)– gab. N cervicothoracicus tr sympathicusgab. N cervicothoracicus tr sympathicus
Komponen n XKomponen n X
Motoris– otot2 pharynx dan larynx--- pars Motoris– otot2 pharynx dan larynx--- pars cranialis n accecoriuscranialis n accecorius
Sensoris– rflx pulmonal dan Sensoris– rflx pulmonal dan kardiovasculer, m mucosa trachea, bronci kardiovasculer, m mucosa trachea, bronci dan bronchiolidan bronchioli
Parasympathis– cor u regulasi denyut Parasympathis– cor u regulasi denyut jantung, otot polos dan gld di trachea, jantung, otot polos dan gld di trachea, bronchi, bronchioli, esophagus dan viscera bronchi, bronchioli, esophagus dan viscera abdominisabdominis
TRUNCUS SYMPATHICUS & TRUNCUS SYMPATHICUS & GANGLIAGANGLIA
Tdump 10 – 11 ps gangliaTdump 10 – 11 ps ganglia Gln paravertebrale 1 bersatu dg gln cervicalis Gln paravertebrale 1 bersatu dg gln cervicalis
inferior--- gln stellatuminferior--- gln stellatum Gln ke 2--- kdg gab dg 1Gln ke 2--- kdg gab dg 1 Gln lain--- segmen intervertebralis sesuaiGln lain--- segmen intervertebralis sesuai Tr masuk ke abdomen nembs crura Tr masuk ke abdomen nembs crura
diaphragmaticadiaphragmatica R communicantesR communicantes ---- n splanchnicus---- n splanchnicus