situs thoracis(anat 123) semester 2 kd 2 anatomy
DESCRIPTION
SEMESTER 2 kd 2 anatomyTRANSCRIPT
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CAVUM THORACIS
• Hubungan cavum thoracis. CRANIAL: APERTURA THORACIS SUPERIOR Colli CAUDAL: APERTURA THORACIS
INFERIOR Abdomen
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APERTURA THORACIS SUPERIOR.DIBENTUK OLEH.
Tepi atas vertebra thoracalis 1Costa 1
Incisura jugularis sterni
APERTURA THORACIS INFERIOR.DIBENTUK OLEH
VERTEBRA THORACALISTEPI BAWAH 6 COSTA TERAKHIRARTICULATIO XIPHYSTERNALIS
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PERKEMBANGAN BENTUK THORAX
• Waktu lahir : ratio ukuran anterior posterior hampir sama.
• Masa anak : ap < transversal.• Masa dewasa: ap << transversal.
• Index thoracis:
Diameter antero posterior
Diameter transversal
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BATAS THORAX• CRANIAL :
Garis yang menghubungkan incisura jugularis sterni articulatio coraco clavicularis processus spinosus vertebra thoracalis VII
• CAUDAL : Garis yang menghubungkan processus xyphoideus arcus costarum ujung costa X - XII vertebra thoracalis XII
• ANTERIOR :SternumCartilago costaeBagian ventral costae
• POSTERIOR :Vertebra thoracalis I – XIIBagian posterior costae
• LATERAL :Corpus costae
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FAKTOR YANG MENENTUKAN BENTUK THORAX.
• SKELETON THORAX• OTOT THORAX• USIA• JENIS KELAMIN• ANOMALI DAN DEFORMITAS THORAX PARALITICUS, BARREL CHEST, FUNNEL CHEST, PIGEON BREAST DLL.
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GARIS ORIENTASI1. MID STERNAL LINE2. STERNAL LINE3. PARASTERNAL LINE4. MID CLAVICULAR LINE.5. ANTERIOR AXILLARY LINE6. MIDAXILLARY LINE7. POSTERIOR AXILLARY LINE.8. SCAPULAR LINE9. VERTEBRAL LINE.
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DINDING THORAX
1. DILUAR BAGIAN TULANG2. BAGIAN TULANG3. DIDALAM BAGIAN TULANG
DILUAR BAGIAN TULANG
1. KULIT. 2. LEMAK JARINGAN SUBCUTAN DAN MAMMAE.3. FASCIA PECTORALIS SUPERFICIALIS.4. FASCIA DORSALIS SUPERFICIALIS.5. OTOT THORAX DAN ABDOMEN.
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BAGIAN TULANG.
1. M. INTERCOSTALIS EXTERNA.2. M. INTERCOSTALIS INTERNA.3. M. SUBCOSTALIS.4. M.TRANSVERSUS THORACIS.
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DIDALAM BAGIAN TULANG.
1. FASCIA ENDOTHORACICA.2. PLEURA PARIETALIS.
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MAMMAE
• RETINACULUM CUTIS• BENTUK ditentukan oleh :
1. USIA2. JENIS KELAMIN3. JUMLAH LEMAK4. PENYAKIT
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BENTUK MAMMAE
• DISCOID : T< R• HEMISFER : T=R• CONICAL : T >R• PENDULANS : T>>R
tinggi
diameter
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BAGIAN MAMMAE• PAPILLA MAMMAE• AREOLA MAMMAE
UKURAN MAMMAE• vertical : costa II - VI.• transversal : dari sternum sampai axillae• t i n g g i : 3 - 5 cm.• diameter cranio-caudal : 10 - 12 cm.• b e r a t : 150 - 200 gram.• berat waktu menyusui 400 - 500 gram.
Pada umumnya mammae kiri sedikit lebih besar dari yang kanan.
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VASCULARISASI1. A. thoracica interna (a. mammaria interna)
memberi darah untuk mammae bagi-an medial.
2. A. thoracalis lateralis memberi cabang rr. mammarii externa untuk mammae bagian lateral.
3. Aa. intercostalis II-VII yang memberikan mammae bagian dalam..
4. Aa. intercostales untuk papilla mammae dan subareolaris
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INNERVASI• Mammae mendapatkan inner-vasi dari rr. cutanei anteriores dan rr.
cutanei laterales nn. intercostales IV -VI.
ALIRAN LYMPHE
1. Lat. atas : menuju ke lnn.axillaris pars pectoralis (lnn.Sorgii) lnn. axillaris centralis.
2.Medial : sebagian menembus m. pectoralis major, minor dan m. intercostales menuju lnn. mammarii interna diblkg sternum (retro-sternal). Sebag. lagi menuju ke lnn.mammae sisi kontra-lateral.
3.Caudal : menuju plexus subdiaphragmatica dan sarung rectus
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OTOT DINDING THORAXI. Otot lapisan luar :
Termasuk disini adalah m. intercostalis externus.
II. Otot-otot lapisan tengah :Termasuk dalam golongan ini adalah m. intercostalis internus.
III. Otot-otot lapisan dalam :Termasuk disini adalah m. intercostalis intima, m. subcostalis dan m. transversus thoracis.
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BAGIAN BAGIAN DIAFRAGMA
1. Pars sternalis : berorigo pada bagian bela-kang processus xyphoideus.
2. Pars costalis : yang berorigo pada permu-kaan dalam rawan costa VII - X dan costa XI - XII.
3. Pars lumbalis : dibagi menjadi dua : - arcus lumbo-
costalis lat. dan med. - crura
diaphragmatica dex et sin
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Lubang-lubang pada diaphragma • Hiatus aortae:
Dilewati aorta, v. azygos dan ductus thoracicus. • Hiatus oesophagii
Dilewati n.vagus dan oesophagus. • Foramen venae cavae
Dilewati v.cava inferior dan n. phrenicus dextra. Lubang kecil diafragma
• pd crura dextra yg dilalui o/ n. sphlanchnicus major & minor dextra.• tiga lubang kecil pada crura sinistra yang dilalui oleh n. sphlanchnicus major dan minor sinistra dan v. hemiazygos.• arcus lumbocostarum medialis yang dilalui oleh truncus sympathicus.• trigonum sternocostalis Larry (foramen Morgagni) dilalui oleh a. epigastrica superior serta pembuluh lymphe• pada pars costalis bagian kiri yang dilewati oleh n. phrenicus sinistra.
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VASCULARISASI• a.musculophrenica
• a.pericardiacophrenica
• Bag perifer diaphragma memperoleh persyarafan dr nn. intercostales.• Bag tengah dari n. phrenicus yg
INNERVASI
ALIRAN LYMPHEAnterior: menerima lymphe dari konveksitas hepar serta dari diaphragma bagian anterior dan meneruskan aliran lymphenya ke lnn. sternales
Medial : menerima aliran lymphe dari bagian tengah diaphragma dan juga konveksitas hepar serta meneruskan lymphe ke lymphonodi mediastinalis posterior.
Posterior : terletak dorsal dari crura diaphragmatica dan meneruskan lymphe ke lymphonodi mediastinalis posterior.
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HERNIA DIAFRAGMA1. Trigonum lumbocostalis Bochdalecki. 2. Pada umumnya bentuk hernia ini merupakan
hernia yang congenital.3. Hiatus oesophagei 4. Trigonum sternocostalis Larrey.5. Kadang-kadang dapat pula terjadi6. Ditempat dimana sebagian diaphragma tidak terbentuk.
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VASCULARISASI DINDING THORAX.A. INTERCOSTALISA. SUBCOSTALIS
A. THORACICA INTERNA.
INNERVASI
N. INTERCOSTALIS.N. SUBCOSTALIS.
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PLEURA• PLEURA PARIETALIS
1. CUPOLA PLEURA2. PLEURA COSTALIS3. PLEURA MEDIASTINALIS4. PLEURA DIAPHRAGMATICA.
• PLEURA VISCERALIS
SINUS PLEURA
SINUS PHRENICOCOSTALISSINUS COSTOMEDIASTINALIS
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Vascularisasi Pleura• Pleura parietalis
1. Vasa. intercostalis2. Vasa. mammaria interna ( a.thoracica interna)3. Vasa. musculo phrenica
• Pleura visceralisVasa Bronchialis
Innervasi PleuraPleura Parietalis
- Pleura costalis : N. intercostalis- Pleura mediastinalis & diaphragmatica : N. Phrenicus
Pleura visceralis- Symphatis/parasymphatis
- Plexus pulmonalis
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vcvi
vThiv
Panjang : 11 cm
Diameter : 2- 2,5 cm
Jumlah : 16 –20 ruas
Lokasi tracheotomie
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Lig. annulare
Pars Membranacea
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Batas-batas trachea :Ventral : Di leher : - isthmus glandula thyreoidea.
- V. thyreoidea inferior.- A. thyreoidea ima.- M. sternothyreoid, M. sternohyoid- Fascia colli media.
Dithorax : - manubrium sterni.- Sisa2 glandula thymus.- V. brachiocephalica sinistra.- Arcus aortae.- A. brachiocephalica - A. carotis communis sinistra.- Plexus cardiacus profundus.
Dorsal : Melekat pada oesophagus.
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I
Isthmus glandula thyreoidea.
V.thyreoidea inferior.
M.sternothyreoidea/ sternohyoideus.
Lateral:
- A.carotis comm.
- Lobus sinistra et
dexter thyreoidea.
- A. thyreoidea
inferior dan nn.
recurrentes
Ventral
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V.brachiocephalica sin.
Arcus aortae.
Oesophagus
A.brachiocephalic
A.carotiscommunissinistra.
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Vaskularisasi a. thyreoidea inferior (utama) a. thyreoidea superior a. mammaria interna a. bronchialis.Innervasi n. vagus, nn. recurrentes, truncus sympathicus.Lymphe disalurkan ke kelenjar lymphe regional.
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BRONCHUS(DILIHAT DARI DORSAL)
OESOPHAGUS
V.AZYGOS
TRACHEA
ARCUS AORTA
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THEORY PERTUMBUHAN BRONCHUS
• Teori reduksi Aeby
• Teori migrasi Naradh
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PULMO
• kanan ± 625 gram • kiri 560 gram • Paru-paru pria beratnya sekitar 1/37 BB
Paru-paru wanita beratnya sekitar 1/43BB.
• Berat jenis paru-paru sebelum bernapas : 1.062 - 1.068, dan sesudah bernapas : 0.342.
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BAGIAN PARU-PARU
• Apex pulmonum• Basis pulmonum (facies
diaphragmatica)• Facies costalis • Facies mediastinalis
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SEGMENT PARU
• Adalah bagian dari lobus paru yang mempunyai : – ARTERI SENDIRI– VENA SENDIRI– BRONCHUS SENDIRI– CAPSULA PLEURA SENDIRI
• Bronchus segmentalis = Bronchus orde 1 = Bronchus tertius
• Bronchus orde 23 bronchiolus• Bronchus orde 24-25 bronchiolus terminalis yang
disebut juga bronchiolus intralobularis
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BRONCHO PULMONARY SEGMENT
APICAL
POSTERIOR
ANTERIOR
LATERAL
MEDIALSUPERIOR/
APICAL
MEDIOBASAL
ANTEROBASAL
LATEROBASAL
POSTEROBASAL
APICOPOST
ANTERIOR
SUPERIOR
INFERIOR
ANTEROMEDIO
BASAL
LATERAL
POSTERIOR BASAL
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CATATAN
1. Bronchus lobaris superior dan medius pulmo sinister seolah-olah jadi satu.
2. Bronchus segmentalis apicalis dan posterior sinister jadi satu.
3. Bronchus segmentalis basalis anterior dan bronchus segmentalis basalis medialis pulmo sinister menjadi satu
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PERCABANGAN SEGMENT PARU
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ORGAN Cartilago Otot Polo
s
Jar. elastis
Kelenjar submucos
a
Epithel propria
TRACHEABRONCHUS EXTRAPULMONALEBRONCHUS INTRAPULMONALEBRONCHIOLUSBRONCHIOLUS TERMINALISBRONCHIOLUS RESPIRATORIUSDUCTUS ALVEOLARIS + ATRIASACCUS ALVEOLARISALVEOLUS
CC
LempengLempeng
-----
++++++---
+++++++++
++++-----
SilindrisSilindrisSilindrisSilindrisKubisPipihPipihPipihPipih
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VASCULARISASI PARU
• FUNGSIONAL : VASA PULMONALIS
• NUTRITIONAL: VASA BRONCHIALIS
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ARTERI PULMONALIS.
DEXTRA :
- TRUNCUS ANTRERIOR- TRUNCUS INTERLOBARISSINISTRA:
- TRUNCUS INTERLOBARIS.
PERCABANGAN ARTERI MENURUT PERCABANGAN
BRONCHUS SEGMENTALIS
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A.PULMONALIS SIN.
BRONCHUS
V.PULMONALIS
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VENA PUMONALIS.
• VENA TIDAK MENGIKUTI PERCABANGAN BRONCHUS.
Dari permukaan alveolus
Superficial Profundus
Septa inter lobuler Intra lobuler
vena lobularis mengikuti bronchus hilus pulmonum vena pulmonalis
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A. BRONCHIALIS.
• KIRI BERASAL DARI AORTA THORACALIS JUMLAH :2
• KANAN. BERASAL DARI A.INTERCOSTALIS III.• CATATAN:• A. BRONCHIALIS- MENGIKUTI PERCABANGAN BRONCHUS - MASUK ADVENTITIA. - BERAKHIR DI BRONCHIOLUS
RESPIRATORIUS
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VENA
• V. bronchialis :• Terdapat dua sistem vv.bronchiales yaitu :
• 1. Vena bronchialis profunda.
Berasal dari plexus pada bronchiolus respiratorius yang dibentuk dari a. bronchialis dan a. pulmonalis. Vena azygos
• 2. Vena bronchialis superficialis.
Mengalirkan darah vena dari dinding bronchus diluar paru-paru dan pleura visceralis.
Vena intercostalis V. Hemi azygos
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INNERVASI
• SYMPHATIS. PRE GANGLIONER V.TH I-IV POST GANGLIONER GANGLION
CERVICALIS SUP/MED/INF• PARA SYMPHATIS. N. VAGUS.
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ALIRAN LYMPHE
• SUPERFICIAL. SUBPLEURAL• PROFUNDUS. DIMULAI DARI Lnn
PADA BRONCHUS ORDE 3-4.• (lnn.pulmonalis)
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Ductus thoracicus
Lnn. paratrachealis sinistra
Ductus lymphaticus
Lnn. paratrachealis dextra
Lnn.pulmonalis
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Mediastinum
Terletak diantara pulmo dext/sin, sternum dan collumna vertebralis
Dibagi menjadi :o Mediastinum superioro Mediastinum inferior :
• Mediastinum anterior
• Mediastinum medius• Mediastinum posterior
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BATAS MEDIASTINUM SUPERIOR
Mediastinum superior :Batas-batas :ventral : manubrium sterni.
dorsal : vertebra thoracal I thoracal IIIcaudal : bidang horizontal melalui
angulus Ludovici dan ertebra thoracalis IV.
lateral : pleura mediastinalis.cranial - apertura thoracis
cranialis.
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ISI MEDIASTINUM SUPERIOR
• Mediastinum superior berisi organ-organ antara lain :• - arcus aorta dengan tiga cabang besarnya• - v. innominata dan v. cava cranialis• - trachea dan oesophagus• - ductus thoracicus• - n. phrenicus • - n. vagus• - n. recurrens• - thymus• - kelenjar-kelenjar lymphe
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BATAS MEDIASTINUM ANTERIOR
• Mediastinum anterior :• Batas-batas : • ventral : corpus sterni• dorsal : pericardium• caudal : diaphragma• lateral : pleura mediastinalis• cranial : bidang horizontal yang
melalui• angulus Ludovici dan vertebra
thoracalis IV.• ISI :Lymphonoduli dan rr.mediastinalis aa. mammaria
interna.
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ISI MEDISATINUM MEDIUS
Mediastinum medius berisi :- Jantung dengan pericardiumnya.- Aorta ascendens- n. phrenicus- a. pericardiacophrenica- truncus pulmonalis
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MEDIASTINUM POSTERIOR
• Batas-batas :- ventral : bagian dorsal dari pericardium- dorsal : vertebra thoracal IV-XII- cranial : bidang horizontal yang melalui
angulus Ludovici dan vertebra thoracalis IV
- caudal : diaphragma - lateral : pleura mediastinalis
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ISI MEDIASTINUM POSTERIOR
• aorta descendens• bifurcatio trachei dan bronchus
principalis• oesophagus• ductus thoracicus• v. azygos dan v. hemiazygos• n. splanchnicus major dan minor
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PERICARDIUM
MERUPAKAN KANTONG PEMBUNGKUS JANTUNG DAN PEMBULUH DARAH
BESAR
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LAPISAN PERICARDIUM
• PERICARDIUM FIBROSA• PERICARDIUM SEROSA
- LAMINA PARIETALIS CAVUM PERICARDII
- LAMINA VISCERALIS ( EPICARDIUM)
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BAGIAN PERICARDII
• PERICARDII MEDIASTINALIS• PERICARDII STERNOCOSTALIS• PERICARDII DIAPHRAGMATICA• PERICARDII DORSALIS• CUPULA PERICARDII
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PORTA ARTERIOSUMBAGIAN DARI PERICARDIUM TEMPAT KELUARNYA :
- AORTA
- A.PULMONALIS
PORTA VENOSUMBAGIAN DARI PERICARDIUM TEMPAT MUARA :
- VENA PULMONALIS
- VENA CAVA
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RUANGAN JANTUNG
• ATRIUM DEXTRA• VENTRICLE DEXTRA • ATRIUM SINISTRA• VENTRICLE SINISTRA
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LETAK DAN BATAS JANTUNG
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BATAS JANTUNG ABSOLUT
BATAS JANTUNG RELATIVE
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STRUKTUR BAGIAN LUAR JANTUNG
• SULCUS CORONARIUS
• SULCUS LONGITUDINALIS
ANTERIOR
POSTERIOR
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BAGIAN LUAR JANTUNG
• Apex : Ictus cordis• Basis : terdiri terutama dari atrium kiri, sebagian atrium kanan, bagian-bagian proximal pembuluh darah besar.
• Facies sternocostalis : dibentuk oleh atrium kanan, ventriculus kanan dan sebagian kecil ventriculus kiri.
• Facies diaphragmatica : dibentuk oleh kedua ventriculus terutama ventriculus kiri.
• Margo dexter : dibentuk oleh atrium dexter. ventriculus dexter. Karena bentuknya yang tipis dan tajam dinamakan juga margo acutus.
• Margo sinister : dibentuk olehventriculus kiri dan sebagian kecil oleh atrium kiri. Margo sinister dinamakan juga margo obtusus.
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• SINUS TRANSVERSUS
ADALAH suatu celah diantara PORTA ARTERIOSUM dan PORTA VENOSUM
• SINUS OBLIQUUM
ADALAH peralihan PERICARDIUM menjadi EPICARDIUM di SINUS VENOSUS
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STRUKTUR PERMUKAAN LUAR
• SULCUS CORONARIUS.
• SULCUS LONGITUDINALIS.
ANTERIOR
POSTERIOR
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BAGIAN LUAR JANTUNG
• Pada permukaan jantung dikenal :– Apex – Basis – Facies sternocostalis :– Facies diaphragmatica : dibentuk oleh kedua ventriculus terutama ventriculus kiri
– Margo dexter : dinamakan juga margo acutus
– Margo sinister : dinamakan juga margo obtusus
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STRUKTUR LAPISAN TENGAH
• EPICARDIUM
• MYOCARDIUM
• ENDOCARDIUM.
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KERANGKA JANTUNG
• ANNULUS FIBROSUS• TRIGONUM FIBROSUS
• TENDON INFUNDIBULUM
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ATRIUM DEXTER.
• BAGIAN LUAR.– SINUS TERMINALIS
– SINOATRIAL NODE
• BAGIAN DALAM– M.PECTINATI
– VALVULA VENA CAVA INFERIOR
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VENA YANG BERMUARA KE ATRIUM DEXTER
Pada atrium dexter bermuara • v. cava superior • v. cava inferior
• sinus coronarius • v. cordis anterior• v. cordis minima
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ATRIUM SINISTRA
• Ruangannya lebih sempit, tapi dindingnya lebih tebal dari atrium dexter.
• Pada dinding dalam terdapat - m. pectinati - muara
• v. pulmonalis sinister (2)
• v. pulmonalis dexter (2).
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VENTRICULUS SINISTER.
• OSTIUM ATRIO VENTRICULARIS
• VALVULA BICUSPIDALIS (MITRALIS)
• CHORDA TENDINEA
• M.PAPILLARIS
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VALVULA SEMILUNARIS DEXTRA A.PULM
VALVULA SEMILUNARIS DEXTRA AORTAE
VALVULA SEMILUNARIS POST. A. PULM
ANT MED POST
ANT
POST
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VENTRICULUS DEXTER
• OSTIUM ATRIOVENTRICULARIS DEXTER
• VALVULA TRICUSPIDALIS
• M. PAPILLARIS
• TRABECULAER CARNEAE
• VALVULA SEMILUNARIS PULMONALIS
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BUNYI KATUB JANTUNG
PAMT
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VASCULARISASI JANTUNG
• A.CORONARIA SINISTRA
• A.CORONARIA DEXTRA
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CABANG CABANG ARTERI CORONARIA SINISTRA
• R. descendens anterior berjalan di sulcus longitudinalis anterior beranastomose dengan r. descendens posterior di apex cordis
• R. circumflexa berjalan di sulcus coronarius ke facies diaphragma (m. obtusus) beranastomose dengan r. transversus a. coronaria dextra
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CABANG ARTERI CORONARIA DEXTRA
• R. descendens posterior terletak di sulcus longitudinalis posterior
• R. transversus di sulcus coronarius, beranastomose dengan r. circumflexa a. coronaria sinister
• R. marginalisberjalan disepanjang tepi ventriculus dexter
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ALIRAN DARAH VENA JANTUNG
1. V. cordis magna2. V. cordis parva3. V. cordis media4. V. cordis anterior5. V. cordis minimi Thebesii 6. V. posterior ventriculi sinistri7. V. obliqua atrii sinistri Marshalli
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AORTA THORACICA
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VANA CAVA SUPERIOR
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PENYEMPITAN OESOPHAGUS PARS THORACICA
1. Pada permulaan oesophagus setinggi cartilago cricoid (vertebra cervicalis VI)
2. Pada penyilangan dengan arcus aortae3. Pada penyilangan dengan bronchus
primarius sinister4. Pada cardia