MK.

ANATOMI

THORAX

Selfi Handayani

GAMBARAN UMUM
Thorax

struktur bentuk silinder tidak teratur, superior sempit (apertura thoracis superior) dan inferior lebih luas (apertura thoracis inferior) Musculoskeletal dinding fleksibel--vertebrae, costae, otot dan sternum Cavitas thoracis dinding thorax dan diaphragma; 3 komparteme: cavum pleurae dexter dn sinister, mediastinum

FUNGSI
Pernafasan:

pulmo + (diaphragma, dinding thorax, costa) Proteksi organ: pulmo, cor dan vasa besar . Hepar, lien dan gaster o/ diaphragma. Ren (posterior, o/ diaphragma costa 12 (kiri), costa 11,12 (kanan)) Conduit; mediastinum

DINDING THORAX
SKELETON

OTOT

SKELETON THORACIS

STERNUM COSTAE et CARTILAGINES COSTAE VERTEBRAE THORACICAE DISCI INTERVERTEBRALIS

Otot dinding thorax

M

intercostalis eksternus M intercostalis internus M intercostalis immus M subcostalis M transversus thoracis

Anterior Thoracic Wall

(Superficial Dissection) Thoracoacromial artery Pectoralis major Lateral pectoral nerve Cephalic vein Medial pectoral nerve

Clavipectoral fascia

Pectoralis minor
Modified from Netter (2006), Plate 188

Anterior Thoracic Wall

(Deep Dissection) Pectoralis minor

Long thoracic nerve and lateral thoracic artery Serratus anterior

External intercostals

Internal intercostals

Modified from Netter (2006), Plate 189

Anterior Thoracic Wall

(Internal View)

Internal thoracic artery and vein

Anterior intercostal arteries and veins

Transversus thoracis

Innermost intercostals Internal intercostals

Diaphragm
Modified from Netter (2006), Plate 191

APERTURA THORACIS SUPERIOR

Skeleton:

corpus VT1, tepi medial costa 1,manubrium sterni Ke superior berhub dg collum Bbrp struktur berjalan melewati pintu ini

APERTURA THORACIS INFERIOR

- tulang, cartilago, ligamenta - corpus VT 12, costa 11, 12, proc xipoideus - tertutup o/ diaphragma & struktur yg berjalan di dalamnya

DIAPHRAGMA
Struktur

musculotendinosus Otot--- tepi menuju ke pusat centrum tendineum Bentuk dome Kontraksi--- puncak turun; vol c thoracis meningkat Esophagus, v cava inferior menembus diaphragma, aorta di belakang

diaphragma

Side view to see curvature of diaphragm

Heres 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 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)

pulmo

Ribs move like bucket handles.

COR

Heart

Chambers Valves Vessels External Vessels

Coronary Arteries

Contraction Cycle

Systole Diastole
Filling of the coronary arteries occur

COR

Heart General Structure

Pericardium

Nervous Structure
SA Node

Right Atrium

Surrounds heart Visceral Parietal Serous 35-50 ml fluid Outer Layer Muscular layer Innermost layer

Intra-atrial Pathways AV Node

AV Junction

Epicardium

Bundle of His Left & Right Bundle Branches Purkinje Fibers

Myocardium

Endocardium

COR

Approximately the size of your fist Wt. = 250-300 grams Location In the mediastinum between the lungs Superior surface of diaphragm s of it lies to the left of the midsternal line Anterior to the vertebral column, posterior to the sternum

COR

Figure 18.1

Pembungkus Cor

Pericardium a double-walled sac around the heart

Composed of:
A superficial fibrous pericardium A deep two-layer serous pericardium

The parietal layer lines the internal surface of the fibrous pericardium The visceral layer or epicardium lines the surface of the heart They are separated by the fluid-filled pericardial cavity called the pericardial cavity

Protects and anchors the heart Prevents overfilling of the heart with blood Allows for the heart to work in a relatively friction-free environment

Pericardial Layers of the Heart

Figure 18.2

Dinding cor
Epicardium

visceral

pericardium Myocardium cardiac muscle layer forming the bulk of the heart Endocardium endothelial layer of the inner myocardial surface

Anatomi cor
External

markings

Apex - pointed inferior region Base - upper region Coronary sulcus

Indentation that separates atria from ventricles

Anterior and posterior interventricular sulcus

Separates right and left ventricles

Internal

divisions

Atria (superior) and ventricles (inferior) Interventricular and interatrial septa

Atria Cordis

Atria - receiving chambers of the heart

Receive venous blood returning to heart Separated by an interatrial septum (wall)

Foramen ovale - opening in interatrial septum in fetus Fossa ovalis - remnant of foramen ovale

Each atrium has a protruding auricle Pectinate muscles mark atrial walls Pump blood into ventricles Blood enters right atria from superior and inferior venae cavae and coronary sinus Blood enters left atria from pulmonary veins

Cor potongan frontal

Figure 18.4e

Ventriculi cordis

Ventricles are the discharging chambers of the heart Papillary muscles and trabeculae carneae muscles mark ventricular walls Separated by an interventricular septum

Contains components of the conduction system

Right ventricle pumps blood into the pulmonary trunk Left ventricle pumps blood into the aorta

Thicker myocardium due to greater work load

Pulmonary circulation supplied by right ventricle is a much low pressure system requiring less energy output by ventricle Systemic circulation supplied by left ventricle is a higher pressure system and thus requires more forceful contractions

Struktur luar; aspek Anterior

Figure 18.4b

Struktur dinding cor

Left

ventricle three times thicker than right

Exerts more pumping force Flattens right ventricle into a crescent shape

Figure 18.7

Valvula cordis

Heart valves ensure unidirectional blood flow through the heart

Composed of an endocardium with a connective tissue core

Two major types Atrioventricular valves Semilunar valves Atrioventricular (AV) valves lie between the atria and the ventricles R-AV valve = tricuspid valve L-AV valve = bicuspid or mitral valve AV valves prevent backflow of blood into the atria when ventricles contract Chordae tendineae anchor AV valves to papillary muscles of ventricle wall Prevent prolapse of valve back into atrium

Valvula semilunaris

Semilunar valves prevent backflow of blood into the ventricles Have no chordae tendinae attachments Aortic semilunar valve lies between the left ventricle and the aorta Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk Heart sounds (lub-dup) due to valves closing

Lub - closing of atrioventricular valves Dub- closing of semilunar valves

Fibrous Skeleton
Surrounds

all four valves

Composed of dense connective tissue

Anchors valve cusps Prevents overdilation of valve openings Main point of insertion for cardiac muscle Blocks direct spread of electrical impulses

Functions

Heart Valves

Conducting System
Cardiac

muscle tissue has intrinsic ability

to:

Generate and conduct impulses Signal these cells to contract rhythmically

Conducting

system

A series of specialized cardiac muscle cells Sinoatrial (SA) node sets the inherent rate of contraction

Conducting System

Innervation

Heart rate is altered by external controls Nerves to the heart include:

Visceral sensory fibers Parasympathetic branches of the vagus nerve Sympathetic fibers from cervical and upper thoracic chain ganglia

External Heart: Posterior View

Figure 18.4d

Major Vessels of the Heart

Vessels returning blood to the heart include:

Superior and inferior venae cavae

Open into the right atrium Return deoxygenated blood from body cells

Coronary sinus
Opens into the right atrium Returns deoxygenated blood from heart muscle (coronary veins)

Right and left pulmonary veins

Open into the left atrium Return oxygenated blood from lungs

Major Vessels of the Heart

Vessels conveying blood away from the heart include:

Pulmonary trunk
Carries deoxygenated blood from right ventricle to lungs Splits into right and left pulmonary arteries

Ascending aorta
Carries oxygenated blood away from left atrium to body organs Three major branches

Brachiocephalic Left common carotid, Left subclavian artery

Blood Flow Through the Heart

Figure 18.6

VASCULARISASI

SIRKULASI PULMONER: - Truncus pulmonaris a. pulmonaris dexter dan a. pulmonaris sinister - Vena pulmonaris--vv. pulmonaris dari lobi

SIRKULASI SISTEMIK: - Aorta - Vena cava superior, vena cava inferior

TRUNCUS PULMONALIS

Membawa darah venosa; arteria: tekanan tinggi (20-30 mmHg), pulsasi +, struktur elastik sama dengan aorta Membentang dari conus arteriosus ventrcl dexter sampai concavitas arcus aorta kiri dari aorta ascendens Menembus pericardium fibrosa bersama2 dg aorta Stl berjalan sktr 5 cm--- terbagi dexter dg sinster

TRUNCUS PULMONALIS
Dexter:

lebih panjang dan lebar, berjalan di bawah arcus aortae di depan bronchus primarius dexter sampai hilus pulmonis dexter, sblum masuk ke hilus bercabang-2 lebih pendek, sempit, membentang ke lateral menuju radix pulmonis sinster di depan bronchus prims. Berhub arcus aortae mll lig arteriosum

Sinister:

VENA PULMONALIS
Bsn

tdp 5 dari setiap lobus, atas dan tengah (kanan) bsn bergabung--- tdp 4 masing2 ada 2 yang masuk ke atrium sinsitrum V yg dari bawah kanan berjalan di belakang atrium dxter dian/ pintu v cava sup dan inf, dr`atas kanan menyilang di belkg v cava sup.

AORTA
Vasa

darah utama Aorta ascenden, arcus aortae, aorta descendens ( aorta thoracalis) Arteria elastika, tunica media tebal Aorta ascendens dan arcus aortae--baroreseptor

AORTA ASCENDENS

Di mediastinum medium, radix aortae angulus sterni Tertanam dlm lamina fibrosa pericardium bersama dg tr pulmonalis D. 3cm, p. 5cm Pangkal menonjol sinus aortae Tr pulmonalis, conus aorticus aortaatrium sinistrum, sinus transversus Cab: a. coronaria dextra dan sinistra

ARCUS AORTAE
Lanjt

aorta ascendens, ke kiri dpan trachea, ke dorsocaudal sbl cranial bronchus sinster mnj kiri trachea dan esophagus Bid sagittal di mediastinum supr aortic knuckle

NERVI
N.

THORACICUS N. PHRENICUS N. VAGUS TRUNCUS SYMPATHICUS PLEXUS OTONOMICUS

N. PHRENICUS

Asal .n. cervicalis IV dan V Setiap n masuk ke thorax stlh berjalan di depan m scalenus anterior Berdampingan dg pericardiacophrenica pericardium, pleura mediastinalis, bag tengah pleura diaphragmatica, angulus pericardiophrenica

N. PHRENICUS
Komponen

fungsional: motoris, sensoris dan sympathis Motoris: diaphragma Sensoris: peritoneum, pleura diaphragmatica, pleura mediastinalis, pericardium Nyeri menjalar m trapezius, bag bawah leher sampai ujung bahu

N. VAGUS

c. thoracis plx pulmonalis, plx esophageus, tr vagalis anterior dan posterior hiatus esophagei Cab. N laryngeus recurrent (trachea, esophagus dan larynx) Cab. R cardiacus superior (cervicalis) hub dg gln sympathicus cervicalis Cab. R cardiacus inferior (cervicothoracicus) gab. N cervicothoracicus tr sympathicus

Komponen n X
Motoris

otot2 pharynx dan larynx--- pars cranialis n accecorius Sensoris rflx pulmonal dan kardiovasculer, m mucosa trachea, bronci dan bronchioli Parasympathis cor u regulasi denyut jantung, otot polos dan gld di trachea, bronchi, bronchioli, esophagus dan viscera abdominis

TRUNCUS SYMPATHICUS & GANGLIA

Tdump 10 11 ps ganglia Gln paravertebrale 1 bersatu dg gln cervicalis inferior--- gln stellatum Gln ke 2--- kdg gab dg 1 Gln lain--- segmen intervertebralis sesuai Tr masuk ke abdomen nembs crura diaphragmatica R communicantes ---- n splanchnicus