DINDING

THORAX
Smstr 7
22 Nov. 2017
 Thorax
Boundaries
• Superior - jugular notch,
sternoclavicular joint,
superior border of
clavicle, acromion,
spinous processes of C7
• Inferior - xiphoid process,
costal arch, 12th and
11th ribs, vertebra T12
Regions
• Thoracic wall
• Thoracic cavity
PEMERIKSAAN FISIK
- INSPEKSI
- PALPASI
- PERKUSI
- AUSKULTASI
PEMERIKSAAN TAMBAHAN :
X FOTO
Kiphosis
Scoliosis
Gibbus
• JUGULAR NOTCH corresponds
with Landmarks
– The 2th thoracic vertebra in
male, the 3th thoracic
vertebra in female
• STERNAL ANGLE connects 2nd
costal cartilage laterally
corresponds with
– The lower border of 4th
thoracic vertebra
– The bifurcation of trachea in
the adult
– The beginning of aortic arch
which ends posteriorly at the
same level
– The esophagus is crossed by
the left main bronchus
 Inervasi segmental pada Truncus anterior
• T2－Angulus Sterni
• T4－Papilla Mammae
• T6－Processus Xyphoideus
• T8－Arcus Costarum
• T10－Umbilicus
• T12－Pertengahan
Umbilicus dan Symphysis
Pubis
BARREL
CHEST
PECTUS
EXCAVATUM
 PECTUS
CARINATUM
Apa fungsi Thorax?
 3 kelompok musculi inspirasi
1. Diaphragma:
– Kontraksinya mengisap udara menuju Pulmo
– 75% dari udara yang diinhalasi
2. Mm Intercostales Externa:
– Membantu inspirasi
– Memenuhi 25%
3. Musculi tambahan untuk elevasi costa:
– sternocleidomastoideus
– serratus anterior
– pectoralis minor
– scaleni
 Musculi dalam expirasi
1. Intercostalis Interna transversus
thoracis :
– depress Costae
2. Musculi dari Abdomen
– Menekan Abdomen
– Mendorong Diafragma ke
cranial
 Diafragma
Intercostalis
externa
Transv.thor.

Deep/accessory
Sternocleido
Scaleni
Serratus ant
Pect.minor
Pect.major

Muscles for expiration

Intercostalis interna
Rectus abdominis
Muscles for inspiration Oblig.abdominis externa
Oblig abdominis internus
Transversus abdominis
Quadratus lumborum
Sensoriknya berasal dari Nn. Intercostales
dan menginervasi periferi dari Diafragma.
Apa yang terjadi bila N.Phrenicus cedera?
Laesi yang timbul dapat memberi iritasi
dan menimbulkan kontraksi tidak dengan
sengaja (involuntary constractions),
akibatnya terjadi “hiccups”
Bila hanya satu yang terjadi laesi, maka
terjadi paralysis pada daerah yang
diinervasinya, terjadi gerakan paradoxal
separo dari Diafragma. Bagian tersebut
tidak dapat descensus/ turun saat inspirasi,
malah tertekan ke superior oleh tekanan
yang ada di Abdomen.
 Diaphragmatic Rupture
• A tear in the Diaphragm that allows
the abdominal organs enter the
chest cavity
• More common on Left side due to
liver helps protect the right side of
diaphragm
• Associated with multipile injury
patients
 S/S of Diaphragmatic Rupture
• Abdominal Pain
• Shortness of Air
• Decreased Breath Sounds on side of rupture
• Bowel Sounds heard in chest cavity
 Thoracic trauma
• - 1 out of 4 death
• - blunt < 10 % require operation
• - penetrating 15%-30% require operation
• - majority require simple procedures
 Main Causes of Chest Trauma
• Blunt Trauma- Blunt force to chest.

• Penetrating Trauma- Projectile that enters

chest causing small or large hole.

• Compression Injury- Chest is caught between

two objects and chest is compressed.
Chest Injuries are common and often
life threatening in trauma patients.
So, Rapid identification and treatment
of these patients is paramount to
patient survival. Airway management
is very important and aggressive
management is sometimes needed for
proper management of most chest
injuries.
Flail Chest

 The breaking of 2
or more ribs in 2
or more places
 COSTA CUTIS

SUBCUTIS
V.A.N. INTERCOSTALIS
Cavum Thoracis
The Mediastinum
 Subdivisions of mediastinum
• Superior mediastinum
• Inferior mediastinum
– Anterior
mediastinum
– Middle mediastinum
– Posterior
mediastinum
Thoracic duct
• Begins in front of L1 as a dilated sac,
the cisterna chyli, which formed by
joining of left and right lumbar trunks
and intestinal trunk
• Enter thoracic cavity by passing
through the aortic hiatus of the
diaphragm and ascends along on the
front of the vertebral column, between
thoracic aorta and azygos vein
• Travels upward, veering to the left at
the level of T5
• At the roof of the neck, it turns laterally
and arches forwards and descends to
enter the left venous angle
• Just before termination, it receives
the left jugular, subclavian and
bronchomediastinal trunks
• Drains lymph from lower limbs,
pelvic cavity, abdominal cavity, left
side of thorax, and left side of the
head, neck and left upper limb
Right lymphatic duct
• Formed by union of right jugular,
subclavian, and bronchomediastinal
trunks
• Ends by entering the right venous
angle
• Receives lymph from right half of
head, neck, thorax and right upper
limb
V. AZYGOS
Kanan Azygos ki Hemiazygos
Ditengah Hemiazygos berhu-
bungan dengan Azygos
Tempat muara vv. Intercostales
+Bronchialis
Ditengah-tengahnya trdpt Ao+
Esophagus+ Dct. Thoracicus
Berasal dari Abdomen
Bermuara ke V. Cava superior
DUCTUS THORACICUS
N. Splanchnicus major
medius
minimus
SEMOGA
SUCCESS