Chapter 22 The Chest and Abdomen

Objectives Upon completion of this chapter, you should be able to: Describe the anatomy of the thoracic cavity Describe the structures and functions of the organs of respiration Explain the breathing and respiratory process

Objectives (cont’d.) Upon completion of this chapter, you should be able to (cont’d.): Discuss the significance of chest and abdominal injuries List and describe the various injuries associated with the thoracic cavity List and describe the various injuries associated with the abdominal cavity

Cavities of the Body Orbital Nasal Buccal/Oral

Ribs and Sternum Manubrium Sternum Costal Cartilage Xiphoid Process

Ribs and Sternum Sternum True Ribs – first 7 pairs Manubrium, body, xiphoid process True Ribs – first 7 pairs False Ribs – 3 pairs Costal cartilage attaches to 7th rib instead of sternum Floating Ribs – 2 Pairs Not connected to costal cartilage or the sternum

Lungs Apex Trachea Right Superior Lobe Left Superior Lobe Right Middle Lobe Left Inferior Lobe Right Inferior Lobe Base

The Respiratory System Obtains oxygen for use by body cells Eliminates carbon dioxide produced in cellular respiration Responsible for production of sound Larynx contains vocal cords Need constant supply of O2 in order to survive

The Respiratory System (cont’d.) Air moves into the lungs through passageways: Nasal cavity Pharynx Larynx Trachea Bronchi Bronchioles Alveoli

The Nasal Cavity Nasal Septum- separates the two nasal cavities Turbinates in cavity increase surface area causing turbulence Forces air to move in different directions Cilia- dust and particles filtered and swept away Hairs entrap and prevent entry of larger dirt particles Olfactory nerves- sense of smell Sinuses Frontal, Maxillary, Sphenoid, Ethmoid Air leaves nasal cavity and enters pharynx

The Pharynx Passageway for air and food Divided: Nasopharynx- lies above and behind soft palate Oropharynx – extends soft palate, behind mouth, to above hyoid bone Laryngopharynx – below oropharynx, above larynx Air travels down to lungs, food travels to stomach Epiglottis- flap of cartilage in front of entrance to larynx At rest allows air to pass through; closes when swallowing to prevent food in trachea

The Larynx Voice box; triangular chamber in pharynx Composed of 9 cartilaginous plates Largest called Adam’s Apple Vocal cords lie within larynx Glottis- the space within the vocal cords

The Trachea Windpipe; extends from larynx, in front of esophagus, and forms 2 bronchi for each lung Can be obstructed by food, tumorous growths, or inflamed lymph nodes in neck Lined with mucous membrane Purpose is to entrap inhaled dust particles Cilia sweeps up to pharynx Coughing and expectoration dislodges and eliminates from pharynx

The Bronchi and Bronchioles Trachea separates in to right and left bronchus Right is shorter, wider and more vertically positioned Subdivide into bronchial tubes and smaller bronchioles in lungs Alveolar Sacs (Alveoli)- at end of bronchioles Air sacs in the lung

The Alveoli Alveolar sacs have many alveoli Adult lung- about 500 million 3x amount necessary to sustain life Surfactant- stabilizes and prevents their collapse Encases by blood capillaries Rapid exchange of carbon dioxide and oxygen occurs here

The Lungs Separated by mediastinum and heart Lung tissue is porous and spongy because of alveoli and air Left lung is smaller, narrower and longer Divided into 2 lobes Right lung is larger and broader because heart inclines to left Shorter because of diaphragm’s upward displacement Divided by fissures into 3 lobes

The Pleura Thin, moist, slippery membrane of tough endothelial cells Pulmonary (Visceral) – covers lungs Parietal Pleura – lines thoracic cavity and upper surface of diaphragm Pleural cavity- separates and filled with fluid to prevent friction during breathing Pleurisy- inflammation of the lining of the lungs Increased fluid can cause lung to collapse Thoracentesis- insert hollow, tube-like instrument to drain

The Mediastinum Intrapleural space separating sternum and vertebral column Contains thoracic viscera: Thymus Gland - Thoracic Heart Duct Aorta and its branches - Lymph Nodes Pulmonary Arteries and Veins - Vessels Superior and Inferior Vena Cavae Esophagus Trachea

Respiration Process by which body supplies cells and tissues with oxygen for metabolism and relieves them of carbon dioxide External respiration Exchange of oxygen and carbon dioxide between lungs and outside environment Internal respiration Exchange of carbon dioxide and oxygen between cells and lymph, plus oxidative process of energy in cells (cellular respiration) Cellular respiration (oxidation) The use of oxygen to release energy from the cell

Animation - Respiration Click Here to Play Respiration Animation

Control of Breathing Rate of breathing is controlled by neural (nervous) and chemical factors Same goal but function independently Chemical control of respiration depends on carbon dioxide level in the blood Chemoreceptors in carotid arteries and aorta are sensitive to blood oxygen levels As blood circulates through respiratory center, the increased carbon dioxide in the blood is recognized and respiratory rate is increased (ie during exercise) Can be affected by drugs

Lung Capacity and Volume Factors: Tidal volume – amount of air in/out with each breath Inspiratory reserve volume – amount of air can force person to take in over and above tidal volume Expiratory reserve volume – amount of air can force person to exhale over and above tidal volume Vital lung capacity – total amount of air involved with first 3 Residual volume – amount of air cannot be voluntarily expelled from lungs; maintains continuous gas exchange Functional residual capacity- ERV + residual volume Total lung capacity – tidal volume, IRV, ERV, and residual air

Disorders of the Respiratory System Asthma Muscles around airways tighten and airway lining swells and gets clogged with thick mucus Exercise-induced asthma Symptoms: coughing, wheezing, dyspnea (difficulty in breathing), and chest tightness Treatment: varies Carry quick-acting inhaler to relieve symptoms

Asthma Click Here to Play Asthma Animation

Chest (Thorax) Injuries Rib contusions Caused by a forceful blow to the ribcage that bruises intercostal muscle Symptoms: point tender, sharp pain with breathing Treatment: remove from activity, ice, monitor for more serious injury, pad for protection Rib fractures Break in bony structure of thorax Most often the result of a direct blow to the ribcage Symptoms: point tender, severe pain, crepitus Treatment: Immediate medical attention Intercostals – lie between ribs and aid in breathing - Flail Chest – fx of 3+ ribs on same side of chest FX can be serious and casue damage to organs they normally protect

Chest (Thorax) Injuries (cont’d.) Chest contusions Bruising over central area of chest Results from a compressive, forceful blow to the body Symptoms: point tender, swelling; if severe, consider heart contusion and seek medical tx Treatment: ice, compression, monitor - Myocardial contusion- rare; blow from bsb, sb, barbell dropped on chest

Chest (Thorax) Injuries (cont’d.) Myocardial contusion and aortic rupture Occurs if force applied to sternum is great enough to compress the heart against the spin Symptoms: immediate, severe pain, rapid onset of shock, possible cardiac temponade, abnormal heartbeat, congestive heart failure, damage to heart valves, weakening or death of heart muscle Treatment: Activate EMS, CPR if needed; cleared by physician before returning

Chest (Thorax) Injuries (cont’d.) Sudden death syndrome Usually caused by some form of heart disease Symptoms: chest pain, discomfort during exercise, heart palpitations, shortness of breath, profuse sweating, LOC from inadequate supply of oxygen to brain Occurs in individuals who are apparently healthy and show no signs prior to its onset Treatment: CPR until EMS arrives -Most common heart diseases: hypertrophic cardiomyophathy (thickening of cardiac muscle), coronary artery abnormalities, Marfan’s (abnormality of connective tissue that weakens aorta and cardiac vlaves), and congenital heart disease - noncardiac- alcohol, cocaine/illegal drugs, cerebral aneurysm, head trauma

Chest (Thorax) Injuries (cont’d.) Pneumothorax Occurs when air enters thoracic cavity between the chest wall and lung causing lung to collapse Sucking chest wound- open wound allowing air to enter and be trapped in pleural space Tx: Seal on 3 sides with occlusive dressing; allows air to exit as they breathe Spontaneous pneumothorax- rupture of weakened area of lung, allowing air into pleural space Tension pneumothorax- air entrapped in pleural space puts pressure on the lung and heart Death can result if not treated quickly - Foreign object or fx rib penetrate skin creating open wound or intense impact tears the lung itself

Chest (Thorax) Injuries (cont’d.) Pneumothorax (cont’d.) Symptoms: severe chest pain, difficulty breathing, cyanosis, unequal expansion of right and left side of lungs, absence of breathing sounds Treatment: EMS, occlusive dressing(keeps from enlarging and air to enter), reassure athlete, treat for shock, monitor vitals Additional padding required esp. in contact sports once recovered. Cyanosis- bluish discoloration of skin

Chest (Thorax) Injuries (cont’d.) Hemopneumothorax Can occur with both open and closed chest injuries Often accompanies a pneumothorax Blood accumulates in pleural space between chest wall and lung Symptoms: similar to pneumothorax Tx: EMS, treat for shock, monitor vitals; Physician’s orders for type and intensity of future contact sports, additional padding

Chest (Thorax) Injuries (cont’d.) Pulmonary contusion Bruise on lung caused by a direct blow causing bleeding in lung tissue Symptoms: 24-48 hours- shortness of breath, chest pain, coughing, hemoptysis, and rales Tx: Transport to hospital immediately, monitor for shock Hemoptysis- coughing up blood Rales- crackling sound to the breathing

Chest (Thorax) Injuries (cont’d.) Blows to the solar plexus- “Having the wind knocked out” S/S: anxious, but usually only short duration Tx: reassure, loosen constrictive clothing Hyperventilation- Breathing at a rate faster than required for proper exchange of oxygen and carbon dioxide S/S: chest pain, dizziness, numb lips, fingers, toes, LOC Tx: reassure and relax, get them to talk, if LOC call EMS Side stitches- Occur during vigorous exercises, Usually with novice exercisers S/S: pain under ribs typically while running Tx: stretch, relax, walk briskly, gradually increase running -solar plexus- if no recovery w/in minutes, suspect intra-abdominal injury and take to hospital - Side stitch causes: unconditioned diaphragm, food allergies, intestinal gas, eating before running

Injury Prevention for the Chest Begins with proper equipment and education Good, well-maintained, equipment that fits properly will reduce chance of injury At risk athletes should wear additional protection Education and use of proper techniques can also minimize risk of trauma

Abdomen

The Abdominopelvic Cavity One large cavity, with no separation between the abdomen and pelvis Abdominal cavity contains: stomach, liver, gallbladder, pancreas, spleen, small intestine, appendix, and part of the large intestines Kidneys are close to but behind abdominal cavity Pelvic cavity contains: urinary bladder, reproductive organs, rectum, remainder of large intestine, and appendix

Protection of the Abdominal Organs Abdominal area is vulnerable to injury Muscular abdominal wall is most commonly involved Injury to contents of abdominal cavity are infrequent Musculature of abdominal wall provides adequate protection from most injuries Serious injuries to the intra-abdominal contents occur and can be life threatening Most associated with serious injury: kidneys, spleen, and liver (all rich blood supplies)

Organs of the Abdominopelvic Cavity Include: Stomach Small intestine Pancreas Liver Gallbladder Urinary bladder Large intestine Cecum and Appendix Ascending, transverse, and descending colon Kidneys Medulla and cortex Nephron Ureters

Organs of the Abdominopelvic Cavity Stomach Organ of digestion located in upper left quadrant Size: depends on amount of food, digestion stage, position of body, and pressure from intestines below Small Intestine Final prep of food to be absorbed 3 sections: Duodenum, Jejunum, and Ileum Digested food passes through villi into blood and body cells; indigestible portion to large intestine

Organs of the Abdominopelvic Cavity Pancreas Feather-shaped organ behind stomach Functions as exocrine (duct carries away secretions) and endocrine (ductless and secretions emptied directly into bloodstream) glands Liver Largest organ in body Manufactures bile (necessary for fat digestion); produce and store glucose as glycogen; detoxify alcohol, drugs, and other harmful substance; manufacture blood proteins for clotting, fluid balance and immunity; prepare urea (waste product); Store vitamins A, D, and B complex; breakdown non-useful hormones; remove worn-out red blood cells and recycle their iron content

Organs of the Abdominopelvic Cavity Gallbladder Small, green organ Stores bile unneeded by body Releases bile when food high in fat enters duodenum Large Intestine 5 ft long and 2 in diameter Cecum and Appendix Ascending, Transverse, and Descending Colon Sigmoid Colon (s-shape) and Rectum

Organs of the Abdominopelvic Cavity Kidneys Only portion of nephron is used; if one fails or removed, more nephrons open up to take over work of that kidney Medulla and Cortex Nephron- functional unit of kidney Ureters One in each kidney Carry urine to urinary bladder

Organs of the Abdominopelvic Cavity Urinary Bladder Hollow, acts like a reservoir Stores urine until ~1 pint accumulated then it is emptied

Abdominal Injuries Kidney contusion - Uncommon in athletics Occurs with a violent blow to upper posterior abdominal wall S/S: pn in abdomen, shock, nausea, vomiting, rigid back muscles, hematuria Liver contusion- Uncommon but life-threatening injury Occurs with a hard blow to right side of ribcage S/S: severe bleeding and shock; referred pain right scapula, shoulder Tx: Immediate Surgery Hematuria- blood in urine

Abdominal Injuries (cont’d.) Spleen injuries- Treat as medical emergency Results from a blow to the left upper quadrant, lower left ribcage, or left side of the back S/S: pain upper left quadrant, referred pn left shoulder (Kehr’s sign), shock, low BP Hernias Protrusion of abdominal tissue through a portion of the abdominal wall S/S: bulge, sharp or dull pain that worsens w/ bowel mvmt, urination, or lifting Spleen- most commonly injured; responsible for many deaths/year -----don’t play if have Mono! Hernia- most eventually require surgery, see physician ASAP

Conclusion The chest and abdomen contain the body’s vital organs Organs in the chest are protected by the ribcage Chest contains the heart and lungs Abdomen contains kidneys, liver, spleen, stomach, urinary bladder, intestines, among others

Conclusion (cont’d.) Chest and abdominal injuries are uncommon in athletics, but do occur Most internal organs are very vascular and can bleed profusely if injured Proper recognition and treatment of these injuries are vital to the health and well-being of the athlete