1- anatomy of breathing 2 Flashcards
at what point does upper respiratory tract turn to lower respiratory tract?
C6 vertebra
- larynx turns to trachea
- pharynx turns to oesophagus
where can trachea be palpated?
at jugular notch of manubrium - if place finger just above jugular notch, can feel rings of trachea
what is the isthmus and where is it?
connecting part of of thyroid gland - it’s anterior to tracheal cartilages 2-4
what is the thorax?
area between neck & abdomen where lungs are
- has 2 parts; chest wall & chest cavity
what makes up chest wall?
consist of skeletal structure (ribs, vertebrae, scapulae, clavicles) and overlying soft tissue (skeletal muscles, fascia & skin)
*also breast tissue in females stick to ribs and are important for lactation
what are the 2 types of pleura and what are pleura?
pleura = lining
there is visceral pleura that lines organs and parietal organs (that lines body wall)
how does lungs develop with pleura?
- chest filled with 2 pleural cavities (think like balloon)
- lung develops and pushes into pleural cavity but will never enter pleura cavity (displaces pleural cavity around itself)
- any part of pleural cavity that becomes in contact with lung is known as visceral pleura
- lung grows in size until visceral pleura pretty much touch parietal pleura and in between, small pleura cavity with tiny amount of pleural fluid
what is function of pleural fluid?
it brings surface tension that causes visceral pleura to stick to parietal pleura - this surface tension important in respiratory mechanics
what are the fissures of lung lobes?
- fissures = separate lung lobes
- both have oblique fissures that go diagonally down separating superior & inferior lobe
- only right lung has horizontal fissure separating superior & middle lobe
what are the intercostal muscles?
3 layers of skeletal muscles within intercostal spaces:
- external intercostal muscles
- internal intercostal muscle
- innermost intercostal muscle
= pull adjacent ribs up & out in breathing
what is the primary muscle of respiration?
diaphragm
how many intercostal spaces do we have?
11
what makes up intercostal neurovascular bundle and where is it found?
neurovascular bundle = vein, artery, nerve (VAN)
- groove on lower border of rib
what is intercostal nerve?
anterior ramus of thoracic spinal nerve that supplies anterolateral spinal nerve
where does intercostal artery arise from?
- arises from aorta if posterior
- arises from internal thoracic artery
the posterior & anterior intercostal arteries then anastomose at midpoint
where do intercostal veins drain to?
- posteriorly drains into azygous vein
- anteriorly drains into internal thoracic vein
what is the diaphragm?
- internal part of body wall (parietal structure) that forms floor of chest cavity and roof of abdominal cavity (separates thorax & abdomen)
- from superior view= a number of openings can be seen e.g. inferior vena cava, oesophagus, aorta
- diaphragm has unusual central tendon (one of the holes (for inferior vena cava) passes through central tendon)
what is the difference in right & left domes of diaphragm?
right dome significantly higher than left as lever sits below right dome and pushes diaphragm up (left hand side has stomach & spleen which are much smaller attachments)
what do the muscular parts of diaphragm attach to?
- attach peripherally to sternum.
- lower 6 ribs and costal cartilages are also attached
- posteriorly attached to L1-3 vertebral bodies
what nerve supplies the diaphragm?
phrenic nerve = formed by anterior rami of spinal nerves C3,4,5
what is the route of phrenic nerves?
- passes through muscle in neck, sits on muscle called scalenus anterior muscle (on R&L)
- descends into thorax, passes on lateral aspects of heart - over surface of pericardium (passes anterior to root of lung)
- supplies somatic sensory and sympathetic axons to the diaphragm & fibrous pericardium
- supplies somatic motor axons to the diaphragm
what is the pneumonic about the phrenic nerves and diagram?
phrenic nerves C3,4,5 keeps diaphragm alive
- causes diaphragm to move (somatic motor) and relays sensory information from body wall (somatic sensory)
what are the axillary lines - surface anatomy?
underneath the arm divisions - the axilla
there is anterior, middle & posterior axillary lines
what is the female breast anatomy?
= can be divided into quadrants referred to as:
- superomedial quadrant (upper inner)
- superolateral quadrant (upper outer)
- inferolateral quadrant (lower outer)
- inferomedial quadrant (lower inner)
also axillary tail (associated with upper outer quadrant - where breast goes up to arm)
what is involved in complete examinations of breast?
all 4 quadrants, nipple, areola, axillary tail & regional lymphatics
what arteries & veins predominantly supply the breast?
subclavian and internal thoracic artery (branch of subclavian)
subclavian and internal thoracic vein (internal thoracic drains to subclavian)
where do lateral quadrants of breast lymphatics drain to?
lateral quadrants (upper outer and lower outer) will drain unilaterally to axillary lymph nodes
where do medial quadrants of breast lymphatics drain to?
medial quadrants (upper inner and lower inner) will drain bilaterally to parasternal nodes (drain to both r&l parasternal nodes)
what are the layers of chest from superficial to deep?
skin →superficial fascia (layer of fat) →deep fascia (grey fibrous, tough) →skeletal muscles (pectoralis major, deltoid, serratus anterior)
what is serratus anterior nerve?
nerve found on superficial surface (long thoracic nerve) of serratus anterior muscle that anchors scapula to ribs (unusual as usually nerve runs deep)
what is problem with serratus anterior nerve over serratus anterior muscle?
it runs superficial so is vulnerable to injury and means that if not working then scapula no longer anchored to thoracic wall (winged scapula surface anatomy look)
- viewed by asking patient to push on wall
what does subclavian artery/vein turn into?
as progress laterally they undergo name change once past rib 1 to axillary artery & vein
where are internal thoracic artery & veins found and what do they do?
they run either side of sternum on anterior chest wall (deep)
- the intercostal artery& veins come to and from intercostal vessels and supply & drain breast tissue
what is the only part of lungs that is connected?
the hilum (root)
what are the different parietal pleura?
cervical parietal pleura, costal parietal pleura, mediastinal parietal pleura, diaphragmatic parietal pleura
what is the costodiaphragmatic recess?
inferior space = most dependant part of thoracic cavity when someone standing upright (deepest part of pleural cavity so any abnormal fluid collects there which ends at costophrenic angle)
- located between the diaphragmatic parietal pleura and the costal parietal pleura
*sits below position of the lung tissue itself, left base descends into it during full inspiration
what does costodiaphragmatic recess look like on radiograph if abnormal fluid in pleural cavity?
has blunting appearance (not as good angle)
what structures are within root (hilum) of lung?
- primary bronchus
- pulmonary artery
- 2 pulmonary veins
- visceral afferents (sensory nerves to lungs)
- sympathetic nerves
- parasympathetic nerves
- pulmonary lymph nodes
what is lingula?
unique ro superior lobe of left lung = tongue of lung tissue
what is arrangement of lung root?
most posterior structure = airway (primary bronchus)
most superior = pulmonary artery
most inferior = pulmonary veins
*pulmonary lymph nodes usually interspersed amongst all these structures at hilum
what do normal breathing sounds sound like?
rustling in nature
what areas of lung do you auscultate?
all 5 lung lobes, the apices & the bases
where are each of the lobes in relation to surface anatomy?
above rib 4 = superior lobe
right rib 4-6 = middle lobe
where are the fissures of lungs related to in surface anatomy?
horizontal fissure (splitting superior & middle) = rib 4 so above rib 4 is superior, below rib 4 is middle lobe
oblique fissure = anterior at rib 6 and arises posteriorly at T3 vertebrae
where is apex of lung on surface anatomy?
superior to medial 1/3rd of clavicle
what can be used as landmark to auscultate lower lobe posteriorly?
scapular line = vertically passing inferior angle of scapula
auscultate lung base at T11 vertebral level
