Cystic fibrosis is an autosomal recessive disorder affecting the function of exocrine glands due to a gene mutation, leading to an abnormally low concentration of chloride in exocrine secretions, rendering them thick and sticky. Thick secretions cause blockage and subsequent damage to the airways, bowel, pancreas, liver, and reproductive tract. In the lungs, thick nonclearing secretions lead to recurrent infections and persistent inflammation, resulting in permanent distortion and dilation of the distal bronchi, a condition known as bronchiectasis. Bronchiectasis can be seen on plain chest radiographs as tubular (tram track like) structures, particularly affecting the upper lobes. Computed tomography can easily demonstrate the extent of airway damage and identify potential pulmonary complications of cystic fibrosis such as lobar collapse, pneumothorax, or enlargement of the pulmonary trunk due to pulmonary hypertension.
The patient was admitted for a course of broad-spectrum intravenous antibiotics and intensive chest physiotherapy and made satisfactory recovery from the acute episode. She was discharged home on oral prophylactic antibiotics with an ongoing physiotherapy program.
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Conceptual Overview • Relationship to Other Regions
Fig. 3.12, cont’d
Fig. 3.26, cont’d
In the clinic—cont’d
Regional Anatomy • Movements of the Thoracic Wall and Diaphragm During Breathing
In the clinic—cont’d
Surface Anatomy • Visualizing Structures at the TIV/V Vertebral Level
Surface Anatomy • Visualizing the Margins of the Heart
Surface Anatomy • Visualizing the Pleural Cavities and Lungs, Pleural Recesses, and Lung Lobes and Fissures
Surface Anatomy • Where to Listen for Lung Sounds
Fig. 3.114, cont’d
The abdomen is a roughly cylindrical chamber extending from the inferior margin of the thorax to the superior margin of the pelvis and the lower limb (Fig. 4.1A).
The inferior thoracic aperture forms the superior opening to the abdomen and is closed by the diaphragm. Inferiorly, the deep abdominal wall is continuous with the pelvic wall at the pelvic inlet. Superficially, the inferior limit of the abdominal wall is the superior margin of the lower limb.
The chamber enclosed by the abdominal wall contains a single large peritoneal cavity, which freely communicates with the pelvic cavity.
Abdominal viscera are either suspended in the peritoneal cavity by mesenteries or positioned between the cavity and the musculoskeletal wall (Fig. 4.1B).
Abdominal viscera include: major elements of the gastrointestinal system—the caudal end of the esophagus, stomach, small and large intestines, liver, pancreas, and gallbladder; the spleen; components of the urinary system—kidneys and ureters; the suprarenal glands; and major neurovascular structures.
The abdomen houses major elements of the gastrointestinal system (Fig. 4.2), the spleen, and parts of the urinary system.
Much of the liver, gallbladder, stomach, and spleen and parts of the colon are under the domes of the diaphragm, which project superiorly above the costal margin of the thoracic wall, and as a result these abdominal viscera are protected by the thoracic wall. The superior poles of the kidneys are deep to the lower ribs.
Viscera not under the domes of the diaphragm are supported and protected predominantly by the muscular walls of the abdomen.
One of the most important roles of the abdominal wall is to assist in breathing: