Samenvatting
Samenvatting Literatuur Anatomie Human Pathology
- Instelling
- Universiteit Leiden (UL)
Summary of the literature regarding the book Clinically Oriented Anatomy, relevant to the course Human Pathology
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Clinically Oriented Anatomy - Bottom LineCardiovascular system
The cardiovascular system consists of the heart and blood vessels - the arteries, veins, and
capillaries. Arteries and veins (and lymphatics) have three coats or tunics:
- Tunica intima
Single layer of flattened epithelial cells (endothelium), supported by delicate CT.
Capillaries consist only of this tunic, with blood capillaries also having a supporting
basement membrane.
- Tunica media
Consists primarily of smooth muscle
- Tunica adventitia
Outer CT layer or sheath.
Arteries have both elastic and muscle fibers in their walls, which allow them to propel blood
throughout the cardiovascular system.
Veins have thinner walls than arteries and are distinguished by valves, which prevent backflow of
blood.
As simple endothelial tubes, capillaries are the smallest blood vessels and provide the linkage
between the smallest arteries (arterioles) and veins (venules).
There are three types of arteries:
- Large elastic arteries (conducting)
- Medium muscular arteries
- Small arteries and arterioles
The lymphoid system
The lymphoid system drains surplus fluid from the extracellular spaces to the bloodstream. The
lymphoid system also constitutes a major part of the body’s defense system.
Important components of the lymphoid system are:
- Networks of lymphatic capillaries
- Lymphatic plexuses
- Lymphatic vessels
- Lymph nodes
- Lymphocytes
- Lymphoid organs
The lymphoid system provides a (relatively) predictable route for the spread of certain types of
cancerous cells throughout the body.
Inflammation of lymphatic vessels and/or enlargement of lymph nodes is an important indicator of
possible injury, infection, or disease (e.g., cancer).
Skeleton, apertures, joints, and movements of thoracic wall
Skeleton of thoracic wall
The thoracic wall protects the contents of the thoracic cavity; provides the mechanics for
breathing; and provides for attachment of neck, back, upper limb, and abdominal
musculature.
The domed shape of the thoracic cage gives it strength, and its osteocartilaginous elements
and joints give it flexibility.
Posteriorly the thoracic cage consists of a column of 12 thoracic vertebrae and interposed IV
discs.
Laterally and anteriorly the cage consists of 12 ribs that are continued anteriorly by costal
cartilages. Anteriorly, the 3-part sternum protects the central thoracic viscera.
,Apertures of thoracic wall:
Although the thoracic cage is completely peripherally, it is open superiorly and inferiorly.
The superior thoracic aperture is a small passageway for the transmittal of structures to and
from the neck and upper limbs.
The large inferior thoracic aperture provides a rim to which the diaphragm is attached.
Structures passing between the thorax and abdomen traverse openings in the diaphragm
(e.g., esophagus) or pass posterior to it (e.g., aorta).
Joints of thoracic wall:
The joints enable and determine movements of the thoracic wall.
Posteriorly, ribs articulate with the semiflexible thoracic vertebral column via costovertebral
joints. These include joints of heads of ribs and costotransverse joints, both strongly
supported by multiple ligaments.
Anteriorly, ribs articulate with costal cartilages via costochondral joints
Costal cartilages 1-7 articulate directly and costal cartilages 8-10 articulate indirectly with the
sternum via the synchondrosis of the 1st rib, synovial sternocostal joints, and interchondral
joints.
Movements of thoracic wall:
The movements of most ribs occur around a generally transverse axis that passes through
the head, neck, and tubercle of the rib.
This axis, plus the slope and curvature of the ribs, results in pimple-handle-type movements
of the upper ribs that alter the AP diameter of the thorax and bucket-handle-type movements
of lower ribs that alter its transverse diameter.
Contraction and relaxation of the superiorly convex diaphragm alters its vertical dimensions.
Increasing dimensions produce inhalation, and decreasing dimensions produce exhalation.
Muscles of thoracic wall
The thorax is overlapped by the axio-appendicular muscles of the upper limb as well as some neck,
back, and abdominal muscles.
Most of these muscles can affect deep respiration when the pectoral girdle is fixed and account for
many of the surface features of the thoracic region. The muscles that are truly thoracic, however,
provide few if any surface features.
The serratus posterior muscles are thin with small bellies that may be proprioceptive organs.
The costal muscles can move the ribs during forced respiration. The costal muscles function primarily
to support (provide tonus for) the intercostal spaces, resisting negative and positive intrathoracic
pressures.
The diaphragm is the primary muscle of respiration, responsible for most of inspiration (normal
expiration is mostly passive).
Deep fascia overlies and invests the muscles of the thoracic wall, as it does elsewhere.
Where the fleshy portions of the intercostal muscles are absent, their fascia is continuous as
intercostal membranes so that the wall is complete.
The endothoracic fascia is a thin, fibroareolar layer between the internal aspect of the thoracic cage
and the lining of the pulmonary cavities, which can be opened surgically to gain access to
intrathoracic structures.
Neurovasculature of thoracic wall
The pattern of distribution of neurovascular structures to the thoracic wall reflects the construction of
the thoracic cage. These neurovascular structures course in the intercostal spaces, parallel to the
ribs, and serve the intercostal muscles as well as the integument and parietal pleura on their
superficial and deep aspects.
Because plexus formation does not occur in relationship to the thoracic wall, the pattern of peripheral
and segmental (dermatomal) innervation is identical in this region. The intercostal nerves run a
, posterior to anterior course along the length of each intercostal space, and the anterior and posterior
intercostal arteries and veins converge toward and anastomose in approximately the anterior axillary
line.
The posterior vessels arise from the thoracic aorta and drain to the azygos venous system. The
anterior vessels arise from the internal thoracic artery, branches, and tributaries and drain to the
internal thoracic vein, branches, and tributaries.
Pleurae, lungs, and tracheobronchial tree
Each lung has a pulmonary artery supplying blood to it and two pulmonary veins draining blood from
it. The right and left PA arise from the pulmonary trunk at the level of the sternal angle. Each PA
becomes part of the root of the corresponding lung and divides secondary lobar arteries:
- The right and left superior lobar arteries
- Inferior lobar lobar artery lobar artery of the left lung
- Middle and inferior lobar arteries of the right lung
The lobar arteries divide into tertiary segmental arteries. The arteries and bronchi are paired in the
lung, branching simultaneously and running parallel courses.
The bronchi and pulmonary arteries course and branch together: the main bronchi/arteries each serve
a lung, second-order lobar branches supply two left and three right lobes, and third-order segmental
branches supply the 9-10 bronchopulmonary segments of each lung. The bronchopulmonary segment
is the smallest resectable division of the lung.
The pulmonary veins run independent intersegmental courses, draining adjacent bronchopulmonary
segments.
The structures of the roots of the lung and supporting tissues (and part of the esophagus) are
supplied by bronchial arteries.
The lymphatic drainage of the lungs follows a mostly predictable course, with most of the right lung
and the superior lobe of the left lung following ipsilateral pathways to the right lymphatic trunk and
thoracic duct. However, most of the drainage from the left inferior lobe passes to the right pathway.
Nerve fibers of the pulmonary plexuses are autonomic (bronchoconstrictive and secretomotor vagal
parasympathetic fibers; inhibitory and vasoconstrictive sympathetic fibers) and visceral afferent (reflex
and pain).
Pleurae
The thoracic cavity is divided into three compartments: two bilateral pulmonary cavities that are
entirely separated by the central mediastinum.
The pulmonary cavities are completely lined by membranous parietal pleura that reflects onto the
lungs at their roots, becoming the visceral pleura that intimately invests the lungs’ outer surface.
The pleural cavity between the two layers of the pleural sac is empty, except for a lubricating film of
pleural fluid. The pleural fluid prevents the lungs from collapsing and causes the lungs to expand
when the thorax expands for inhalation.
Most of the parietal pleura is named for the structures it covers: costal, mediastinal, and
diaphragmatic parts.
The cervical pleura extends into the root of the neck forming a dome above the anterior aspect of the
1st rib and clavicle.
Parietal pleura is sensitive, being innervated by the phrenic and intercostal nerves.
Because the lungs do not completely fill the pulmonary cavities, and because of the protrusion of the
diaphragm and underlying abdominal viscera into the inferior thoracic aperture, a peripheral gutter -
the costodiaphragmatic recess - is formed. Extrapulmonary fluids (exudates) accumulate in this place
when the trunk is erect.
Lungs
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