Anatomy of the Cardiovascular, Respiratory, and · PDF file1 Anatomy of the Cardiovascular...
Transcript of Anatomy of the Cardiovascular, Respiratory, and · PDF file1 Anatomy of the Cardiovascular...
1
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
2
Cardiovascular System Overview
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
3
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
4
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
5
Opening the pericardial sac
Great vessels1. Superior vena cava2. Inferior vena cava3. Pulmonary veins (n=4)4. Ascending aorta5. Pulmonary trunk
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
6
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.
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
7
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
8
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
9
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
10
(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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
11
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
12
Right common carotid
(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 common carotid
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
13
(d) Anterior view of branches of arch of aorta
Right common carotid
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
14
(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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
15
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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
16
(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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
17
(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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
18
(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 artery
Left pulmonary veins
Left lung
Diaphragm
Abdominal aorta
Pulmonary System
(b) Scheme of pulmonary circulation
Left atrium
Right pulmonaryveins
Left pulmonary veins
Left pulmonary artery
Right pulmonaryartery
Air sacs(alveoli)of right lung
Pulmonarytrunk
Air sacs(alveoli)of left lung
Rightventricle
Respiratory System
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
19
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:
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
20
(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 primary bronchus
Left secondary bronchi
Left tertiary bronchi
Bronchioles
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
21
Larynx
(a) Anterior view
Trachea
Left lung
Location of carina
Left secondary bronchus
Left tertiary bronchus
Left primary 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
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
22
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.
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
23
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.
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD
24
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.
Anatomy of the Cardiovascular System, Respiratory System, & Lymphatic System September 23, 2017
Coding Fiesta 2017 Kyle E. Rarey, PhD