Chapter 27 The Thorax and Abdomen

Chapter 27

Extended Lecture Outline

  • Anatomy of The Thorax (Figure 27-2)
  • Ribs, Costal Cartilage, and Sternum
  • 12 pairs of ribs
  • Upper 7 ribs are the true ribs (sternal ribs) – each is joined to the sternum by a separate costal cartilage
  • Eighth, ninth and tenth ribs (false ribs) have a common cartilage that joins the seventh rib before attaching to the sternum
  • Eleventh and twelfth ribs (floating ribs) remain unattached to the sternum but have muscle attachments
  • Thoracic Muscles (Figure 27-3 and Table 27-1)
  • Lungs (Figure 27-4)
  • Respiratory Muscles
  • Diaphragm is large dome-shaped muscle – separates the thoracic cavity from the abdominal cavity
  • Diaphragm contracts- inspiration results
  • Diaphragm relaxes – expiration occurs
  • Blood Supply
  • Heart (Figure 27-5 and 27-6)
  • Adult heart lies under the sternum, slightly to the left, between the lungs and front of vertebral column
  • Extends from first rib to the space between 5th and 6th ribs
  • Four Chambers: right and left atria, right and left ventricles
  • Deoxygenated blood returns to right atrium-> tricuspid valve to right ventricle->right ventricle pumps blood through pulmonary valve to pulmonary artery into the lungs where it is oxygenated->blood returns to left atrium through pulmonary vein->passes through mitral valve into the left ventricle->blood is ejected past aortic valve into aorta-> supplies the body
  • Contraction of chambers is called systole, and relaxation diastole
  • Blood Supply: right and left coronary arteries branching from the aorta. Cardiac veins drain into the right atrium
  • Thymus (Figure 27-7)
  • Function is to produce lymphocytes which migrate to other lymphatic tissues to respond to foreign substances
  • Anatomy of the Abdomen
  • Abdominal Muscles (Figure 27-8 and Table 27-2)
  • Abdominal Viscera
  • Solid organs: kidneys, spleen, liver, pancreas, and adrenal gland
  • Hollow organs: vessels, tubes and receptacles such as the stomach, intestines, gallbladder, and urinary bladder
  • Urinary System Organs
  • Kidneys
  • Located on each side of the spine in center of the back
  • Right kidney is usually slightly lower due to pressure of the liver
  • Primary function is to filter metabolic wastes, ions, or drugs from the blood and expel them from the body via urination
  • Adrenal Glands
  • Part of the endocrine system rather than the urinary system
  • Located on top of kidneys – also called the suprarenal glands
  • Secrete epinephrine, norepinephrine, cortisol, estrogen, aldosterone, and androgen
  • Ureters and Urinary Bladder
  • Ureters are small tubes that extend inferiorly from the kidney to the urinary bladder, which stores the urine
  • Digestive System Organs
  • Liver
  • Largest internal organ, lies in the upper right quadrant of the body
  • Consists of right and left lobes
  • Performs digestive and excretory functions; absorbs and stores excessive glucose; processes nutrients; and detoxifies harmful chemicals
  • Secretes bile – essential for neutralizing and diluting stomach acid and for digesting fat in the small intestine during digestion
  • Cirrhosis is a progressive liver disease most often associated with chronic alcoholism
  • Gallbladder
  • Located on the inferior surface of the liver
  • Storage reservoir for bile secreted from the liver
  • Pancreas
  • Located between the small intestine and the spleen
  • Secretes pancreatic juice, critical for digestion of fats, CHO, and proteins
  • Produces insulin and glucagon, controls the amount of glucose and amino acids in the blood
  • Stomach
  • Upper left quadrant between the esophagus and the small intestine – functions mainly as storage and mixing chamber for food that has been ingested
  • Small Intestines
  • Three portions: Duodenum, jejunum, and ileum
  • Secretions from liver and pancreas mix with secretions from small intestine to digest and absorb food
  • Large Intestines
  • Extends from small intestine to anus; three divisions: cecum, the colon, and the rectum
  • Colon changes chyme to feces
  • Lymphatic System Organs
  • Spleen
  • Largest lymphatic organ in the body, lies under the diaphragm on the left side behind the ninth, tenth and eleventh ribs
  • Main functions: to serve as a reservoir of red blood cells; to regulate the number of red blood cells in the general circulation; to destroy ineffective red cells; to produce antibodies and to produce lymphocytes
  • Reproductive System Organs
  • Female Reproductive Organs: (Ovaries, uterus, uterine tubes/fallopian tubes and vagina)
  • Male Reproductive Organs: (Seminal vesicles, prostate gland, testes, vas deferens, epididymis, urethra, and penis)
  • Prevention of Injuries to the Thorax and Abdomen
  • Wear protective equipment in collision sports
  • Strengthen the abdominal muscles (core stabilization)
  • Empty hollow organs (stomach and bladder) prior to competition
  • Meals should be eaten at least 3-4 hours before competition to allow foods to clear the stomach
  • Urinate immediately before stepping onto the playing surface to protect the bladder from injury
  • Assessment of the Thorax and Abdomen
  • History
  • Observation (Figure 27-12)
  • Palpation
  • Thorax (Figure 27-13, 27-14A, 27-14B)
  • Abdomen (Figure 13-3, Figure 27-15)
  • Rebound tenderness: pain that is felt after the hand is removed from the area
  • Referred Pain (Figure 27-16)
  • Special Tests
  • Auscultation
  • Heart Sounds (Figure 27-17A)
  • Normal cardiac cycle includes two sounds – lubb-dupp- caused by turbulence of the blood as the valves close
  • Murmur: abnormal periodic sound
  • Breath Sounds: (Table 27-3)
  • Cheyne-Stokes: rate speeds up and then slows down over a one-to-three minutes period
  • Biot’s breathing: series of breaths at the normal rate are followed by complete cessation of breathing
  • Apneustic breathing: pauses in the respiratory cycle at full inspiration
  • Thoracic breathing: occurs without diaphragmatic breathing
  • Abnormal sounds: wheezes or rhonchi, crackling, and bubbling sounds (rales)
  • Bowel Sounds
  • Diminished bowel sounds may mean paralytic ileus or peritonitis, high pitched sounds may be associated with intestinal obstructions
  • Percussion (Figure 27-17B)
  • Solid organ will produce a dull sound and a hollow organ will produce a tympanic or resonant sound
  • Recognition and Management of Specific Injuries and Conditions of the Thoracic Region
  • Rib Contusions
  • Rib Fractures (Figure 27-18)
  • Flail chest: fracture of three or more consecutive ribs on the same side
  • Direct fracture: external force fractures and displaces the ribs inwardly
  • Indirect fracture: causes the rib to spring and fracture outward
  • Stress fracture of the 1st rib
  • Costochondral Separation and Dislocation (Figure 27-20)
  • Rib Tip Syndrome
  • Sternum Fracture
  • Muscle Injuries
  • Breast Injury
  • Breast Cancer
  • Injuries to the Lungs
  • Pneumothorax: Pleural cavity becomes filled with air that has entered through an opening in the chest (Figure 27-21A)
  • Tension Pneumothorax: Pleural sac on one side fills with air and displaces the lung and the heart toward the opposite side, compressing the opposite lung (Figure 27-21B)
  • Hemothorax: Presence of blood within the pleural cavity (Figure 27-21C)
  • Traumatic Asphyxia: Result of violent blow to or a compression of the rib cage that causes a cessation of breathing
  • Hyperventilation
  • Sudden Cardiac Death Syndrome in Athletes
  • Heart Murmur
  • Athletic Heart Syndrome
  • Commotio Cordis
  • Heart Contusion
  • Recognition and Management of Specific Injuries and Conditions of the Abdomen
  • Injuries and Conditions Related to the Urinary System
  • Kidney Contusions
  • Kidney Stones
  • Contusion of the Ureters, Bladder and Urethra
  • Cystitis and Urinary tract infections
  • Urethritis
  • Injuries and Conditions Related to the Digestive System
  • Gastrointestinal Bleeding
  • Liver Contusion
  • Pancreatitis
  • Indigestion (Dyspepsia)
  • Vomiting
  • Food Poisoning (Gastroenteritis)
  • Peptic Ulcer
  • Gastroesophageal Reflux
  • Diarrhea (“Travelers” Diarrhea)
  • Constipation
  • Irritable Bowel Syndrome
  • Appendicitis
  • Hemorrhoids (Piles)
  • Injuries and Conditions Related to the Reproductive Organs
  • Scrotal Contusion
  • Spermatic Cord Torsion
  • Traumatic Hydrocele of the Tunica Vaginalis
  • Testicular Cancer
  • Vaginitis
  • Contusion of the Female Genitalia
  • Injury to Lymphatic Organs
  • Injury of the Spleen
  • Injuries to the Abdominal Wall
  • Abdominal Muscle Strains
  • Contusions of the Abdominal Wall
  • Hernia (Figure 27-24A, Figure 27-24B)
  • Blow to the Solar Plexus
  • Stitch in the Side

Prentice, Principles of Athletic Training , 15e LO-27 | 1