pmdc step 1 review of cvs & respiratory system

Download Pmdc step 1 Review of CVS & Respiratory System

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1. PMDC Step-1 Course Review of CVS & Res Prof. Saeed Shafi Dean/Principal Sahara Medical College/SFLT PAK. 2. L 3. A Newborb infant, presented with respiratory distress. Gut sounds heard on left hemichest. What Congenital anomaly you suspect? How it can be diagnosed? Embryological basis of anomaly? Whats the incidence, management & prognosis? 4. Learning Outcomes 1. Compare the neonate & adult chest of. 2. Compare clinical manifestations & anatomical basis of mediastinal shift. 3. Why MI pain radiates to left arm? 4. Interpret anatomical basis of left dominant heart. 5. Interpret anatomico-physiological basis of tension pneumothorax. 6. What is clinical significance of CDH? 7. Interpret anatomical basis of clinical manifestations of Thoracic outlet syndrome. 5. Development of Diaphragm Septum Transversum (4th week) Pleuro-peritoneal membranes(6th week/42days) Dorsal mesentry of esophagus Muscular ingrowth from lateral body wall (9-12th week) 6. Development of Diaphragm Development of crura fusion of mesenchyme from ST, PPM & DME migration of myoblasts into dorsal mesentry of esophagus Costo-diaphragmatic recess Innervation Descent of Diaphragm 7. Development of Diaphragm 8. Development of Diaphragm 5W 6W 12W 9. Development of Diaphragm At birth 10. Positional changes of Diaphragm 24days 52days 11. Anomalies of Diaphragm 12. Anomalies of Diaphragm Posterolateral Defect/Foramen of Bochdalek Defective formation/fusion of Pleuro-peritoneal membranes 1:2200 85-90% left sided Pulmonary Hypoplasia Eventration of Diaphragm Gastroschisis & Epigastric Hernia Foramen of Morgagni / Retro-sternal Hernia Congenital Hiatal Hernia Accessory Diaphragm 13. Functional anatomy of mediastinum 14. pneumothorax 15. The Mediastinum Moore, Clinically Oriented Anatomy, 3rd Edition 16. Subdivision of the Mediastinum According to Anatomists 17. Contents of posterior mediastinum Viscus esophagus Vessels Descending thoracic aorta Azygous and hemiazygous veins Thoracic duct (lymphatic) Nerves Sympathetic chain Splanchic nerves 18. Constrictions 3 anatomical and physiological Pharyngoesophageal junction Narrowest 15cm from incisor teeth Where crossed by aortic arch and left bronchus 25 Where passes through opening in diaphragm 41cm from incisor teeth 19. Azygos system of veins Consists of: Azygos vein Hemiazygos vein (inferior hemiazygos) Accessory hemiazygos vein (superior hemiazygos) Drains thoracic wall and upper lumbar regions 20. THE PLEURA & PERICARDIUM 21. Pleura is a membrane that is single celled Normally it produces a small amount of fluid that fills gap between parietal & visceral layers of pleura WHAT IS PLEURA? 22. Parietal & visceral layers of pleura separated from each other by slit like space = pleural cavity Normally contains small amount of pleural fluid- covers surfaces of pleura as a thin film- permits two layers to move on each other with minimun friction PLEURAL CAVITY 23. LAYERS OF PLEURA PARIETAL PLEURA Lines thoracic wall Covers thoracic surface of diaphragm Lateral aspect of mediastinum Extends into root of neck VISCERAL PLEURA Completely covers outer surfaces of lung Extends into depths of interlobar fissures Two layers become continuous with each other by means of a cuff of pleura that surrounds the structures entering & 24. PARTS OF THE PARIETAL PLEURA Divided into 4 parts CERVICAL PLEURA Extends up into neck lining undersurface of suprapleural membrane Reaches level 1-1.5inches above medial 1/3 of clavicle COSTAL PLEURA Lines inner surface of ribs, costal cartilages, intercostal spaces, sides of vertebral bodies & back of sternum DIAPHRAGMATIC PLEURA Covers thoracic surface of diaphragm MEDIASTINAL PLEURA Covers & forms lateral boundary of mediastinum At hilum of lung reflected reflected as cuff around vessels & bronchi- becomes continuous with visceral pleura 25. COSTODIAPHRAGMATIC RECESSES Slit like spaces between costal & diaphragmatic pleura separated by pleural fluid Quiet respiration : costal & diaphragmatic pleura are in apposition to each other below lower border of lung Deep inspiration : margins of base of lung descend, costal & diaphragmatic pleura separate COSTOMEDIASTINAL RECESS Found along anterior margin of pleura Slit like space between costal & mediastinal pleura Separated by pleural fluid RECESSES 26. NERVE SUPPLY OF PLEURA PARIETAL PLEURA Costal : intercostal nerves Mediastinal : phrenic nerve Diaphragmatic : domes phrenic nerve; periphery lower 6 intercostal nerves VISCERAL PLEURA Pulmonary plexus 27. PERICARDIUM Definition: Fibro-serous sac enclosing heart & great vessels Lies within middle mediastinum, posterior to body of sternum & 2-6th costal cartilage 28. FIBROUS PERICARDIUM Strong fibrous part of sac firmly attached below central tendon of diaphragm Fuses with outer surfaces of great blood vessels passing though it viz. aorta, pulmonary trunk, SVC, IVC, pulmonary veins Attached in front to sternum by sternopericardial ligament 29. SEROUS PERICARDIUM PARIETAL LAYER Lines fibrous pericardium Reflected around roots of great vessels to become continuous with vicseral layer of serous pericardium VISCERAL LAYER Closely applied to heart Often called epicardium Slit like space between parietal & visceral layers = pericardial cavity filled with pericardial fluid (acts as lubricant to facilitate movement of heart) 30. PERICARDIAL SINUSES OBLIQUE SINUS Reflection of serous pericardium around large veins TRANSVERSE SINUS Short passage lying between reflection of serous pericardium around aorta & pulmonary trunk & reflection around the large veins 31. Clinical Anatomy of the Cardiovascular System 32. Heart Cardiac orientation 33. Anterior surface of the heart 34. Base of the heart. 35. Internal view of right atrium 36. Internal view of the right ventricle 37. Internal view of the left ventricle 38. Circuit diagram of circulation 39. X rays 40. Coronary circulation 41. Venous drainage 42. Coronary angiogram 43. Mechanism for perceiving heart pain in T1-4 dermatomes 44. Major vessels within the middle mediastinum. A. Anterior view. B. Posterior view. 45. Surface anatomy 46. Location of the heart valves and auscultation points 47. Developmental anomalies of heart 48. Echocardiogram 49. Plate 223 Innervation of the Heart 50. CORONARY CIRCULATION 51. CORONARY ATERIES Heart is supplied by right and left coronary arteries Both are branches of ascending aorta arising from coronary sinuses, located at the origin of the ascending aorta they run in the coronary sulcus 52. RIGHT CORONARY ARTERY Arises from the anterior aortic sinus and runs in the coronary sulcus Gives off a right marginal branch in the posterior interventricular groove and continues as posterior interventricular artery Its termination anastomoses with LAD 53. CORONARY ARTERIES The Right Coronary Artery In 60% cases it gives off an SA nodal artery, which supplies SA node In summary right coronary artery supplies the right atrium, right ventricle, posterior 1/3 of interventricular septum, SA and AV nodes 54. LEFT CORONARY ARTERY It arises from the left posterior aortic sinus and reach the coronary sulcus Divides into two terminal branches The larger anterior interventricular branch (LAD) anastomoses with right coronary artey The smaller circumflex branch run in coronary sulcus 55. CORONARY ARTERIES Left Coronary Artery Left coronary artery supplies most of the left ventricle, atrium and anterior 2/3rd of interventricular septum It also supplies part of the right atrium and may supply the SA node (10%) 56. CORONARY VEINS Venae cordis minimae Anterior cardiac veins Coronary sinus Great cardiac vein Middle cardiac vein Small cardiac vein Posterior vein of left ventricle / vein of left atrium 57. VARIATIONS OF THE CORONARY ARTERIES Right coronary artery is dominant in 90% of cases Left coronary artery is dominant in 10% of cases accessory coronary artery is present in 4% of the cases 58. MYOCARDIAL INFARCTION Occlusion of a major branch of coronary artery The region of myocardium supplied by the occluded branch becomes infarcted and soon undergoes necrosis This necrosed area is called a myocardial infarct(MI) most common reason of the occlusion is coronary atherosclerosis 59. ANGINA PECTORIS Clinical syndrome characterized by substernal discomfort resulting from myocardial ischemia Common causes are the stress and strenuous exercise after a heavy meal It is relieved by 1 or 2 min of rest and administration of sublingual nitroglycerin 60. Coronary interventions Echocardiography Angiography / angioplasty Thallium scan Coronary revascularization 61. CORONARY ANGIOGRAPHY It is the method to visualize coronary arteries by using radiopaque contrast material Radiographs or cineradiographs are taken to show the lumen of the artery and its branches, as well as ant stenotic areas that may be present 62. CORONARY BYPASS GRAFT A coronary bypass graft shunts blood from the aorta or a coronary artery to a branch of coronary artery to increase the flow distal to the occlusion Usually a segment of internal thoracic artery or great saphenous vein is used as a graft In Percutaneous transluminal coronary angioplasy(PTA) the obstruction is opened by using a catheter with a small inflatable balloon 63. PULMONARY CIRCULATION 64. Respiratory zone 65. PULMONARY VEINS They carry oxygenated blood from the lungs to the left atrium A main vein drains each bronchopulmonary segment The two pulmonary veins on each side, superior and inferior ones, opens into the posterior aspect of left atrium 66. BRONCHIAL ARTERIES & BR


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