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Unpaired (Visceral) Arteries
- Aorta-Ductus arteriosus/ligamentum arteriosum
- Bronchial a.
- Esophageal a.
- Pericardial a.
- Mediastinal a.
- *come off front of aorta
Paired (Parietal) Arteries
- Superior Intercostal-1 & 2 space via costocervical trunk
- Posterior Intercostal-3-11 via Aorta
- Subcostal-12 via Aorta
- Anterior Intercostal-1-6 via Internal thoracic
- at bottom of rib cage split into
- -superior epigastric-6th space to rectus sheath
- -musculophrenic-costal margin
- *back of aorta and run around posterior wall into intercostal spaces
System of 3 long vessels
- Azygos (Rt.)-posterior intercostal drain into-only on right side
- Hemiazygos (Lower Lt.)
- Accessory Hemiazygos (Upper Lt.)
- Continuation of ascending lumbar v.
- connect SVC with IVC-important anastomotic channel
Azygos v. origin
Origin: 1) Rt. ascending lumbar and subcostal v., 2) Rt. renal v.
Route of Azygos v.
- Origin: 1) Rt. ascending lumbar and subcostal v., 2) Rt. renal v.
- Enter thorax on rt. side of TD and aorta
- Ascends on vertebral bodies to root of lung
- Emerges under esophagus and arches forward above bronchus to SVC
Azygos v. valves
Imperfect valves: tributaries have numberous ones
Azygos v. recieves?
- 2 hemiazygos
- lower 8 post. intercostal & subcostal v.
- Rt. superior intercostal (1 & 2)
- Esophageal, pericardial, broncial, mediastinal
Hemiazygos v. origin and route
- Origin: left ascending lumbar and lt. renal v.
- Enters thorax-lt crus of diaphragm on lt. side of vertebrae
- 8-9th vertebrae cross columb behind aorta, esophagus and TD
Hemiazygos v. recieves?
lower 4-5 posterior intercostals and occasionally accessory hemiazygos
Accessory hemiazygos v. origin and route
- Origin: variable-often continuous with lt. sup. intercostal
- inversely proportional to sup. intercostal
- decends on lt. side of column to hemiazygos
Accessory hemiazygos v. receives?
3-4 post. intercostals between lt. sup. and hemiazygos
Superior Intercostals drain and empty into?
- Drain 1-5 intercostals (variable)
- Empty into lt. brachiocephalic v.
Vertebral Plexus of Veins
- Runs length of vertebral canal
- Interconnections with SVC & IVC
- No valves
- can move up or down
Thoracic duct route
- Begins with cisterna chyli (T12)
- 2 lumbar trunks and interstinal trunk
- Ascends behind aorta through hiatus
- Azygos v. (rt. ) and aorta (lt.)
- T5-deviates to left behind esophagus
- Ascends into neck behind carotid sheath and ant. to vertebral artery
- Empties into union of internal Jugualar and Subclavian
- *Main collecting duct-lower limbs, pelvis, GI tract, left upper limb and left head
- *transparent-returns protein back into venous system-if cut during surgery can be fatal within days
- Origin: T1-L2
- Leave spinal n. as White Rami Communicantes (myelinated)-lateral part
- Join thoracic chain at ganglia
- Number of preganglionic fibers < Number of ganglion cells
What occurs once preganglionic fibers enter chain
- ascend and then synapse
- descend and then synapse
- leave chain without synapse
Where do the areas of preganglionic fibers go to in the body?
- T1-T5-head, neck, upper limb, thorax-ascend
Where is the Sympathetic Chain at?
Outside posterior mediastinum-behind costal pleura
- Some rejoin spinal nerves as Gray Rami communicantes (unmyelinated)-medial aspect
- Others leave trunk to thoracic viscera-synapse at point of exit
- Superior, middle, inferior cervical (neck)
- 1st Thoracic-may be independent but often fused with inf. cervical
- 2-10 usually single, slightly below nerve
- usually only 11 ganglia (11th and 12th often fused)
- Gray Rami-to spinal nerves
- Br. to Cardiac & pulmonary plexuses
- Splanchnic (preganglionic)
- Greater-T5-T9 (10)-Exit crura of diaphragm (aortic)
- Lesser-T10-11-exit crura of diaphragm
- angina-pain referral to left limb
- pain fibers traveling with sympathetic system
- synapse with sympathetic fibers-go out to blood vessels-vasocontricution to area of skin
- area irritated-afferent pain fibers activated and back into spinal cord-somatic sources-into thalamus
- perceive pain in arm rather than heart
- sensory fibers-travel on gray then white back to spinal cord
- Hemiazygos v.-behind everything-compress=no blood crossing over
- vein (most superior) then artery, then nerve-connects to sympathetic chain with white and gray rami
- azygos v. and thoracic duct parallel with each other-azygos v. more lateral-sympathetic trunk more lateral to azygos v.
Esophagus origin and termination
- origin: cricoid cartilage (C6)
- Termination-Cardiac opening of stomach
Esophagus Constrictions (3)
- Cricoid cartilage (C6)-larynx can flatten out if constricted
- Bifurcation of trachea (T4-broncho-aortic constriction-flatten out against vertebral column)
- Esophageal hiatus of diaphragm (T 11)-spicter for esophagus-costal agents or foreign objects stuck here
Blood supply to esophagus
- Inferior thyroid
- Intercostal artery
- Lt. gastric
- Inferior phrenic
- *small sized vessels*
- *esophagus-thick and muscular*
Nerve supply to esophagus
- Vagus-rotates 90 degrees to the right: lf-ant.; rt.-posterior to esophagus
- Sympathetic chain-greater splanchnic n.
Origin of Diaphragm
- bony elements around circumference
- Sternal-2 slips
- Crura-2 bundles (lt.-3, rt.-2)
- Arcuate lig.-med. and lat. ligament
Insertion points of Diaphragm
- central tendon
- Crura-medial fibers arch around aorta
- right also loop around esophagus
- Arcuate lig.-med. over psoas mus. and lat. over quad. lumborum mus.
Nerve supply to Diaphragm
Phrenic-C3, 4, 5
Arteries supply of Diaphragm
Intercostals, musculophrenic, inf. phrenic, pericardiophrenic
Openings of Diaphragm
- a, e, i-12, 10, 8
- T 12-aorta between crura and TD, azygos v.
- T 10-esophagus and rt and lt vagus n.
- T8-IVC-central tendon and rt phrenic