Anatomy of the Cardiovascular, Respiratory, and · PDF file1 Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System Kyle E. Rarey, Ph.D. Professor & Director

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Anatomy of the Cardiovascular System, Respiratory System, &

Lymphatic System

Kyle E. Rarey, Ph.D.

Professor & Director of the Center for Anatomical Sciences Education

Department of Anatomy & Cell Biology

University of Florida College of Medicine

Outline of Presentation

• Cardiovascular System• Heart

• Vessels

• Respiratory System

• Lymphatic System

Anatomy associated with the 30,000 Series CPT

Cardiovascular System

Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017

Coding Fiesta 2017 Kyle E. Rarey, PhD

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Cardiovascular System Overview



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Right atrium

Right ventricle

Left ventricleLeft atrium

C‐525

Left brachiocephalic veinRight brachiocephalic vein

Arch of aorta

Pulmonary trunk

Ascending aorta

Left ventricle

SVC

Right atrium



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Mediastinum: Divisions

Mediastinum: The space between the right and left pleural cavities in the midline.

Divisions of the mediastinum:

Superior mediastinum

Inferior mediastinum

Anterior mediastinum

Middle mediastinum

Posterior mediastinum

S

M PA



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Opening the pericardial sac

Great vessels1. Superior vena cava2. Inferior vena cava3. Pulmonary veins (n=4)4. Ascending aorta5. Pulmonary trunk



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Pericardial Tamponande

An example:Blood has completely filled the pericardial cavity

Image: Klatt, Web Internet Pathology

Clinical Considerations

Pericarditis

Fibrinous pericarditisEvidence of fibrinous exudate can be seen attaching to the visceral and parietal serous pericardium

Image: Klatt, Web Internet Pathology

Purulent pericarditisPurulent fluid can be seen within the pericardial cavity

Pericardiocentesis - ApproachesParasternal approachSubcostal approach

Parasternal Approach:Needle inserted at intercostal space 5 or 6 to left of sternum.

Needle would pass through :skin, superficial fascia, pectoralis major, external intercostal muscle, internal intercostal muscle, thrasversus thoracusmuscle, fibrous pericardium, parietal layer of serous pericardium

Subcostal approach: Nneedle inserted at a superior angle at the left infrasternal angle

Needle would pass through: skin, superficial fascia, anterior rectus sheath and muscle, transverse abdominis muscle, fibrous pericarium, parietal layer of serous pericardium.



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There are two types of the valves in the heart

Atrioventricular valves

• Located between atria and ventricles :

• It has 3 cusps (tricuspid)

• It has 2 cusps (bicuspid or mitral)

Semilunar valves

• Located at the base of the ascending aorta ( aortic valve) and

• Located at the base of the pulmonary trunk (pulmonary vale)

Anterior cusp

Posterior cuspMitral

Anterior cuspSeptal cuspPosterior cusp

TRICUSP

Aortic valvePosterior cusp Right cuspLeft cusp

RL

Pulmonic valveAnterior cuspRight cuspLeft cusp

cusp

Papillary muscle

Chordae tendineae



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Semilunar cusp of aortic valve

(g) Superior view of aortic valve

A (aortic) detected at the second intercostal space, right sternal border.

P (pulmonary) heard at left sternal border in second intercostal space.

M (mitral) heard at apex in fifth intercostal space.

T (tricuspid) heard at the lower left aspect of the sternal border.

SITES OF HEART VALVE AUSCULTATION

A P

TM

A

P

M

T



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PV

AV

PV

AV

“DUB” heard with closing of pulmonary & aortic valves

“LUB” heard with closing of AV valves

Valves replacement • Regurgitation (or leakage of the valve).

This means the valve doesn't close completely, causing the blood to flow backward through the valve.

• Stenosis (or narrowing of the valve). With stenosis, the valve opening is narrowed and the valve doesn't open properly, inhibiting the ability of the heart to pump blood across the narrowed valve due to the increased force required to pump blood through the stiff (stenotic) valve(s).

• Atresia. This means the valve opening doesn't develop at all, preventing blood from passing from an atria to a ventricle, or from a ventricle to the pulmonary artery or aorta. Blood must find an alternate route, usually through another existing congenital (present at birth) defect, such as an atrial septal defect or a ventricular septal defect.

• When heart valves fail to open and close properly, the implications for the heart can be serious, possibly hampering the heart's ability to pump blood adequately through the body.Secctra Table

S067 Recording

HEART VALVEREPLACEMENT

PACEMAKER



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(c) Anterior view

Arch of aorta

INFERIOR

SUPERIOR

Left pulmonary artery

Pulmonary trunk

Left auricle

GREAT CARDIAC VEIN

LEFT CORONARY ARTERY

CIRCUMFLEX BRANCH

LEFT MARGINAL BRANCH

Left ventricle

TRIBUTARY TO GREAT CARDIAC VEIN

Ascending aorta

Right auricle

RIGHT CORONARY ARTERY

ANTERIOR CARDIAC VEIN

Right ventricle

MARGINAL BRANCH

ANTERIOR INTERVENTRICULAR BRANCH



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Vessels

Arterial System

Right common carotid

(b) Detailed anterior view of the principal branches of the aorta

Right vertebral

Right subclavian

Brachiocephalic trunk

ASCENDING AORTA

Bronchials

Esophageals

Right posterior intercostal

Diaphragm

Right inferior phrenic

Common hepatic

Celiac trunk

Right middle suprarenal (adrenal)

Right renal

Right gonadal (testicular or ovarian)

Right lumbars

Inguinal ligament

Left common carotid

Left vertebral

Left subclavian

ARCH OF AORTA

Axillary

THORACIC AORTA

Mediastinals

Left brachial

Pericardials

Left superior phrenic

Left inferior phrenic

Left gastric

Splenic

Left middle suprarenal (adrenal)

Left renal

Superior mesenteric

Left gonadal (testicular or ovarian)

ABDOMINAL AORTA

Inferior mesenteric

Left common iliac

Left internal iliac

Left external iliac

Median sacral

Left deep artery of the thigh (deep femoral)

Left femoral



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(c) Anterior view of the principal branches of the aorta

Brachiocephalic trunk

ASCENDING AORTA

Celiac trunk

Left common carotid

Left vertebral

Left subclavian

ARCH OF AORTA

THORACIC AORTA

Splenic

Left renal

ABDOMINAL AORTA

INFERIOR

SUPERIOR

Trachea

Esophagus

Inferior vena cava

Common hepatic

Superior mesenteric

Right common iliac

Right ureter

Larynx

Left primary bronchus

Diaphragm

Left adrenal (suprarenal) gland

Left kidney

Inferior mesenteric

Psoas major muscle

Sigmoid colon (cut)

(e) Anterior view of arteries of shoulder and brachium


Right subclavian

Pectoralis major (cut and reflected)

Right axillary

Right subscapular

Right deep brachial

Right brachial

Left subclavian

Left common carotid

Brachiocephalic

Right internal thoracic (mammary)

Arch of aorta

Vagus nerve (recurrent laryngeal branch)

Pulmonary trunk

Heart

Major arteries of the arm, forearm, and hand



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(d) Anterior view of branches of arch of aorta


Right subclavian

Trachea

Brachiocephalic

Right internal thoracic (mammary)

Arch of aorta

Left subclavian

Clavicle (cut)

First rib (cut)

Left axillary

Left common carotid

Vagus nerve (recurrent laryngeal branch)

Phrenic nerve

Left lung

Pulmonary trunk

Heart

(d) Anterior view of arteries of abdomen and pelvis

Diaphragm

Inferior vena cava

Right adrenal (suprarenal) gland

Right kidney

Superior mesenteric

Right common iliac

Right internal iliac

Right external iliac

Hepatic veins

Esophageal hiatus

Common hepatic

Splenic

Celiac trunk

Abdominal aorta

Inferior mesenteric

Ureter

Right renal

(e) Anterior view of celiac trunk and its branches

Liver (cut)

Right gastroepiploic

Right gastric

Common hepatic

Proper hepatic

Gastroduodenal

Superior pancreaticoduodenal

Diaphragm

Stomach (turned upward)

Left gastroepiploic

Spleen

Left gastric

Splenic

Pancreas

Celiac trunk



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(f) Anterior view of superior mesenteric artery and its branches

Middle colic

Ascending colon

Cecum

Ileocolic

Ileum (cut and reflected downward)

Diaphragm

Transverse colon(turned upward)

Descending colon

Superior mesenteric

Right colic

Jejunals

Ileals

Sigmoid colon

(g) Anterior view of inferior mesenteric artery and its branches

Ascending colon

Inferior mesenteric

Cecum

Ileum (cut andreflected downward)

Diaphragm

Transverse colon(turned upward)

Descending colon

Left colic

Sigmoid

Sigmoid colon

Superior rectal

(c) Anterior view of arteries of pelvis and thigh

Inguinal ligament

Femoral vein

Femoral artery

Abdominal aorta

Common iliac artery

Internal iliac artery

External iliac artery

Sartorius muscle

Deep artery of the thigh (deep femoral)

Adductor longus muscle



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Venous System

Caval Venous SystemHepatic portal hepatic SystemPulmonary Circulation

(b) Anterior view of superior vena cava and its tributaries

Right internal jugular

Right subclavian

Right brachiocephalic

Superior vena cava

Right atrium (cut)

Inferior vena cava

External jugular

Trachea

Left brachiocephalic

First rib (cut)

Aorta

Diaphragm

(b) Anterior view

Left internal jugular

INFERIOR

SUPERIOR

Left brachiocephalic

Internal thoracic

Heart

Left subclavian

Left axillary

Left brachial

Left basilic



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(d) Anteromedial view of superficial veins of arm and forearm

Biceps brachii muscle

Basilic

Median antebrachial

Brachial

Median cubital

Cephalic

(c) Anterior view

Diaphragm

INFERIOR

SUPERIOR

Right kidney (internal view)

Right renal artery

Right renal vein

Abdominal aorta

Right lateral femoralcutaneous nerve

Right ureter

Right external iliac vein

Inferior vena cava

Left kidney (external view)

Left renal vein

Left gonadal (ovarian) vein

Left ureter

Right internal iliac vein

Rectum (cut)

(c) Anteromedial view of thigh

Femoral artery

Femoral nerves

Fascia lata

Tributary to greatsaphenous vein

Accessory saphenous vein

Great saphenous vein

Inguinal ligament

Femoral vein



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(a) Anterior view of veins draining into the hepatic portal vein

HEPATIC PORTAL

Liver

Cystic

Gallbladder

Duodenum

Pancreas

Transverse colon

Ascending colon

Cecum

Appendix

Drain into superior mesenteric vein

Drain into splenic vein

Drain into inferior mesenteric vein

Hepatic Inferior vena cava Stomach

Spleen

Short gastric

Left gastric

Pancreas (behind stomach)

Pancreatic

Left gastroepiploic

Right gastric

SPLENIC

Right gastroepiploic

Left colic

Inferior mesenteric

Descending colon

Sigmoidal

Sigmoid colon

Superior rectal

Rectum

SUPERIORMESENTERIC

Middle colic

Jejunaland ilealJejunal

and ileal

Ileum

Pancreaticoduodenal

Ileocolic

Right colic

Portal Venous System

Inferior vena cava

Hepatic veins

Liver

Heart

Abdominal aorta

Proper hepatic artery

Hepatic portal vein

Splenicvein

Superiormesentericvein

Tributaries from portions of stomach, pancreas, and portions of large intestine

Tributaries from small intestine and portions of large intestine, stomach, and pancreas

(b) Scheme of principal blood vessels of hepatic portal circulation and arterial supply and venous drainage of liver

Blood from superior mesenteric vein

Blood from splenic, gastric, inferior mesenteric veins

Mixture of above two2

2

4

4

4

4

4

44

4

4

4

1

1

3

Esophageal veins

Left gastric veinRight gastric vein

Portal vein

Portocaval anastomoses:1 Esophageal2 Paraumbilical3 Rectal4 Retroperitoneal

Pancreaticoduodenalveins

SMV

Short gastric veins

Left gastro‐omental vein

Splenic vein

Middle colic vein

Ileocolic vein

Right colic vein

Cecal vein

Appendicular vein

IMV

Left colic vein

Sigmoid veins

Superior rectal vein

Middle rectal vein

Inferior rectal veinAnterior view

Jejunal‐ileal veins

Portal

Venous System

http://medpics.ucsd.edu/images/path_640/gi3/path_gi3_019_00.jpg

Portal Hypertension



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(a) Anterior view

Superior vena cava

Right pulmonary artery

Pulmonary trunk

Right pulmonary veins

Right lung

Inferior vena cava

Arch of aorta

Ascending aorta


Left pulmonary veins

Left lung

Diaphragm

Abdominal aorta

Pulmonary System

(b) Scheme of pulmonary circulation

Left atrium

Right pulmonaryveins

Left pulmonary veins


Right pulmonaryartery

Air sacs(alveoli)of right lung

Pulmonarytrunk

Air sacs(alveoli)of left lung

Rightventricle

Respiratory System



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Nose

Nasal cavity

Larynx

Trachea

Pharynx

Right primarybronchus

Lungs

(a) Anterior view showing organs of respiration

(c) Parasagittal section

Trachea

Esophagus

Laryngopharynx

Epiglottis

Maxilla

Palatine bone

Hard palate:

Soft palate

Nasopharynx

Opening of auditory tube

Internal nares

Inferior

MiddleSuperior

Nasal meatuses:

Sphenoidal sinus

Ethmoidal cells

Brain

Oropharynx

Tongue

Lower lip

Oral cavity

Upper lip

Nasal vestibule

InferiorMiddleSuperior

Nasal conchae:Olfactory bulb

Nasal bone

Frontal sinus

Frontal bone

Mandible

Larynx

Periorbital fat

EyeballEthmoidal cell

Superior nasal concha

Middle nasal concha

Inferior nasal concha

Maxillary sinus

Perpendicularplate of ethmoid

Vomer

Hard palate

Frontal plane

View

(d) Frontal section showing conchae

Nasal septum:



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(b) Anterior view of bronchial tree in lungs

Cricoid cartilage of larynx

Right lung

Right primary bronchus

Right secondary bronchi

Right tertiary bronchus

Right bronchiole

Right pulmonary vein

Inferior vena cava

Ventricular fold (false vocal cord)

Vocal fold(true vocal cord)

Common carotid artery

Left lateral lobeof thyroid gland

Trachea

Aorta (cut)

Left lung

Left pulmonary vein

Esophagus

Diaphragm

(c) Anterior view of larynx and bronchial tree

Epiglottis

(d) Posterior view of larynx and bronchial tree

Thyroid cartilage

Arytenoid cartilage

Cricoid cartilage

Trachea


Left secondary bronchi

Left tertiary bronchi

Bronchioles



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Larynx

(a) Anterior view

Trachea

Left lung

Location of carina

Left secondary bronchus

Left tertiary bronchus


Left bronchiole

Left terminal bronchiole

Diaphragm

Right lung

Visceral pleura

Parietal pleura

Pleural cavity

Right primarybronchus

Right secondarybronchus

Right tertiarybronchus

Right bronchiole

Right terminalbronchiole

Cardiac notch

BRANCHING OFBRONCHIAL TREE

Trachea

Primary bronchi

Secondary bronchi

Tertiary bronchi

Bronchioles

Terminal bronchioles

Right lung

Apex

Superior lobe

Horizontalfissure

Cardiac notch

Middle lobe

Base

Oblique fissure

Inferior lobe

POSTERIORLeft lung

Oblique fissure

Inferior lobe

POSTERIOR

(f) Lateral views

ANTERIOR

SUPERIOR SUPERIOR

Costal (rib)impressions



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Apex

Superior lobe

Hilum and itscontents (root)

Cardiac notch

Base

Oblique fissure

ANTERIOR

Oblique fissure

Inferior lobe

ANTERIOR

Right lung Left lung

(g) Medial views

POSTERIOR

Horizontal fissure

SUPERIOR SUPERIOR

BronchopulmonarySegments

A bronchopulmonary segment is a division of the lung.

A bronchopulmonary segment is a portion of lung supplied by a specific tertiary bronchus (also called a segmental bronchus) and arteries. These arteries branch from the pulmonary and bronchial arteries, and run together through the center of the segment.



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Pseudoglandular 12 weeks Cannicular 16 weeks

Cannalicular 24 weeks Terminal Sac 26‐27 weeksAlveolar near term 38 weeks

18, 20, and 26 weeks

Lymphatic System

“Loosely” organized small caliber vessels drain “tissue fluid” from peripheral to central. Lymph filtered by lymph nodes along the way.



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Lymphatic System

The spleen, located in the upper left part of the abdomen under the ribcage, works as part of the lymphatic system to protect the body, clearing worn-out red blood cells and other foreign bodies from the bloodstream to help fight off infection.



Documents

Anatomy of the Cardiovascular, Respiratory, and · PDF file1 Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System Kyle E. Rarey, Ph.D. Professor & Director