Session 32

  Describe the bony structure of the thoracic cage  Describe the structure of the musculature and neurovasculature of the thoracic and abdominal walls  Analyze the functions of the walls of the thorax and abdomen  Discuss how the structure and function of these walls apply to common dysfunctions Objectives

 Bony structure review

 Running in the costal groove: intercostal artery & vein (from supreme intercostal & internal thoracic) intercostal nerve (from anterior rami)

 Bony structure review

 Joints of the thorax

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  External Intercostal (hands in pockEts)  Internal Intercostal (hands on tIts)  Innermost Intercostal (same as internal) Intercostals Right or Left?

 Cross section

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 Intercostal membranes and Transversus thoracis

A patient with a stab wound through the thoracic wall medial to the midclavicular line will have damage to which structures? A.External Intercostal muscle B.Internal Intercostal muscle C.Transversus Thoracis

  Pleura – serous membrane inside the thorax  Parietal pleura – superficial  Visceral pleura – deep and on the lungs  Pleural cavity – space between parietal and visceral pleura  Right and Left pleural cavities are separated by the mediastinum Endothoracic fascia, parietal pleura, visceral pleura

A patient with R pneumothorax will be unable to breathe because both lungs will be affected. A.True B.False

  Camper’s fascia – contains fatty tissue  Scarpa’s fascia – membranous layer between camper’s fascia and abdominal muscles Abdominal wall – superficial fascia

  External oblique – continuation of external intercostal (hands in pockEts)  Internal oblique – continuation of internal intercostal (hands on tIts)  Tranverse oblique – horizontal fibers, function to increase intra-abdominal pressure  Posteriorly, all start around the scapular line  Anteriorly, all insert at the rectus sheath (midclavicular line) Oblique and Transverse Abdominus

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 Rectus Abdominus

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  Rectus abdominus is embedded within the rectus sheath above the arcuate line (between the 2 halves of the internal oblique aponeurosis)  Rectus abdominus is between the rectus sheath and the transversalis fascia below the arcuate line (posterior to the transverse abdominus aponeurosis Rectus sheath vs. Transversalis fascia Above or below arcuate line? Extraperitoneal fascia

What is immediately posterior to Rectus Abdominus above the arcuate line? A.Transversalis fascia B.Aponeurosis of internal oblique C.Aponeurosis of transverse abd. D.Parietal peritoneum

 Inguinal Canal

  Deep to inguinal ligament  Weakest area of abdominal wall Myopectineal Orifice

 Anterior Abdominal wall – Posterior view

  Parietal peritoneum  Visceral peritoneum  Peritoneal folds  Omentum  Mesentery  Intra-peritoneal organs vs. Retro- peritoneal organs Peritoneum

The peritoneal cavity: A.Is a space filled with fluid B.Is between the parietal peritoneum and transversalis fascia C.Contains the abdominal organs

Inguinal hernias are most likely to severely damage the femoral nerve A.True B.False

  Describe the bony structure of the thoracic cage  Describe the structure of the musculature and neurovasculature of the thoracic and abdominal walls  Analyze the functions of the walls of the thorax and abdomen  Discuss how the structure and function of these walls apply to common dysfunctions Objectives