2. Chapter 22
The Chest and Abdomen

3. 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

4. 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

5. Cavities of the Body
Orbital
Nasal
Buccal/Oral

6. Ribs and Sternum
Manubrium
Sternum
Costal Cartilage
Xiphoid Process

7. 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

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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Animation - Respiration
Click Here to Play Respiration Animation

22. 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

23. 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

24. 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

25. Asthma
Click Here to Play Asthma Animation

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. Chest (Thorax) Injuries (cont’d.)
Pulmonary contusion
Bruise on lung caused by a direct blow causing bleeding in lung tissue
Symptoms: 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

34. 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

35. 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

36. Abdomen

37. 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

38. 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)

39. 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

41. 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

42. 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

43. 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

44. 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

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

46. 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

47. 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

48. 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

49. 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