1. Pulmonary and Lower Respiratory Anatomy Flashcards
The gross anatomy of the upper respiratory tract, including:
• ____
• Nasal cavity
• ____
• Larynx
was discussed in detail
and dissected in your first year of study
nose
pharynx
TRACHEA
• ____ form the skeleton of the trachea and prevent collapse of the lumen
• A membrane with ____ bands of smooth muscle (____) connects the ends of the rings ____
c-shaped cartilaginous rings
transverse
trachealis
Trachealis is in a ____ of contraction, relaxing as the oxygen needs of the body increase to dilate the trachea
The elastic membrane between the rings ensures ____ air flow thru the respiratory tract even as
the flexible ____
moves in multiple directions
steady state
constant
cervical spine
The superior thoracic aperture transmits the trachea between the ____ and ____
deep neck
superior mediastinum
The plane of the
STERNAL ANGLE
marks the plane of the
bifurcation of the ____ as well as the boundary between the ____
trachea
superior and inferior mediastinum
CARINA
The carina, a wedge shaped cartilage marks the bifurcation of the trachea into ____
As the carina lies slightly to the ____ of the bifurcation, it tends to divert inhaled foreign objects to the ____ bronchus
left and right primary bronchi
left
right
The right main bronchus is • \_\_\_\_ • wider • more \_\_\_\_ than the left main bronchus...
Thus ____ are more likely to enter and obstruct the right bronchus
Consequently, both ____ and pneumonia caused by ____ are more common in the right lung!
shorter vertical aspirated foreign objects lung abscesses microbial infection
Repeated branchings of the ____ and the associated
____ form the substance of the lungs
bronchi
blood vessels
- The tracheobronchial tree develops initially as a ventral ____ of the embryonic ____
- The developing tree elongates and undergoes repeated buddings bilaterally, yielding just over 20 generations of ____ tubes contributing to the ____ of the respiratory system
respiratory diverticulum
foregut
endodermal
conducting zone
____ and ____ are both features of the first five generations of bronchi
Bronchioles have no ____ and are surrounded instead by ____ under autonomic control
hyaline cartilage
elastic tissue
cartilage
smooth muscle
The ____, the ____, provide for intimate contact between inspired atmospheric air and pulmonary vasculature as features of the the respiratory zone of the tract
terminal bronchioles branching
alveoli
Proliferation of alveoli increases through the first decade of postnatal life until age ____
Ultimately…
the two mature lungs contain approximately ____ km.
of airways and ____ million alveoli
Gas exchange takes place as oxygen diffuses through the walls of the alveoli into the developing ____
8 or 9
2,400
300 to 500
capillaries
The ____ are found on either side of the mediastinum
in the thorax
Each cavity is filled with a ____ surrounding a lung and lining the pulmonary cavity
pulmonary cavities
fibroserous pleural sac
The two pleural sacs are ____ of each other, though they converge upon each other deep to the sternum in the ____
HOWEVER…
independent
anterior mediastinum
Along the body wall, each pulmonary cavity is lined by ____ whereas each developing lung assumes a covering of ____
As the lung buds develop from the ____ endoderm, they essentially “punch” into the ____ (or body cavity) around the lungs, which is thereafter called the ____.
parietal pleura visceral pleura foregut intraembryonic coelom pulmonary cavity
Along the body wall, each pulmonary cavity is lined by ____ whereas each developing lung assumes a covering of ____
As the lung buds develop from the ____ endoderm, they essentially “punch” into the ____ (or body cavity) around the lungs, which is thereafter called the ____.
parietal pleura visceral pleura foregut intraembryonic coelom pulmonary cavity
So the parietal and visceral layers of pleura are continuous with each other at the ____ (root of the lung) forming the ____
pulmonary hilum
pulmonary ligament
Between the PARIETAL and VISCERAL layers of PLEURA lies the ____, containing a capillary-thin layer of serous fluid
• Lubricates the adjacent pleural surfaces - ____
— However, a condition known as pleural friction rub will result if there is some interruption of the ____ of the lubricating fluid in the pleural cavity. Sounds like 2 pieces of leather rubbing together. Sound can result from inadequacy of ____, and can be heard after pathologies that produce ____ between visceral and parietal membranes.
• Facilitates movement of the ____
• Maintains ____ that is crucial for respiration, ensuring coincident movement of ____ pleural layers with changes in ____ and pressure
pleural cavity pleural friction rub flow pleural fluid adhesions
lungs
surface tension
BOTH
thoracic volume
Parietal pleura receives ____ innervation
Visceral pleura does ____!
Thus pulmonary pathology (e.g. a lung tumor) will ____ include sharp, localizable pain as part of its symptomatology until…
… the pathological process erodes the ____ of the lung and its covering of visceral pleura and impinges upon the ____
somatosensory not NOT surface parietal pleura
Top:
NO PAIN
May have ____ issues: coughing up black sputum and ____
Bottom:
PAIN
Contacting the ____ pleura lining the pulmonary cavity - stimulated ____ and producing sharp localized pain
respiratory
blood
parietal
somatic afferents
Discrete portions of the
____ PLEURA lining each pulmonary cavity may be defined
\_\_\_\_ \_\_\_\_ \_\_\_\_ \_\_\_\_ Lungs are not exclusively thoracic organs, also have some \_\_\_\_ origin
parietal costal diaphragmatic mediastinal cervical cervical
The ____ of each lung and the pleural membranes that surround it extend superiorly through the ____ into the root of the neck
Thus a penetrating wound to the ____ may actually violate the pleural cavity… causing a ____ as well as injure the ____ of the lung itself
The cervical pleura is also referred to as the pleura of the ____
apex superior thoracic aperture root of the neck pneumothorax apex cupola
PNEUMOTHORAX
lResults from introduction of air into the ____ as the result of penetrating chest trauma or a ____
l____ lung collapses as intrapleural pressure rises and increases with each breath lMediastinum shifts ____, leading to
lCompression of the ____ lung
lAs pressure builds, mediastinal and tracheal shifts are augmented, the diaphragm is ____ and venous return to the ____ is impeded
pleural cavity ruptured lung cyst ipsilateral contralaterally contralateral depressed right atrium
SUPERIOR THORACIC APERTURE
INFERIOR THORACIC APERTURE is largely filled by the ____, the primary muscle of ____
diaphragm
respiration
Diaphragm
Right hemidiaphragm is always ____ than the left because of the liver
higher
The dome-shaped DIAPHRAGM forms both the ____
of the thoracic
cavity and the ____ of the abdominopelvic
cavity
floor
roof
The CENTRAL TENDON of the diaphragm receives the insertion of fibers
arising from the
circumference of
the ____ and the ____
thorax
upper lumbar spine
COSTAL part of diaphragm \_\_\_\_ ribs (\_\_\_\_ surface; lower margin of \_\_\_\_)
LUMBAR part of diaphragm
____ part: ____ vertebral vodies, intervertebral disk, and ____ as right and left crura
STERNAL part of diaphragm
____ (____ surface)
ALL INSERT ON THE ____
7th-12th
inner
costal arch
medial
L1-L3
anterior longitudinal ligament
xiphoid process
posterior
central tendon
There are three important apertures in the diaphragm, transmitting structures between the thoracic and abdominal cavities
CAVAL FORAMEN
____ ascends into thorax from abdomen via the caval foramen; ____ enhances flow of blood to the heart
ESOPHAGEAL HIATUS
____, vagal fibers, and vasculature supplying and draining the inferior aspect of the ____ travel through here
AORTIC HIATUS
Point of transition of ____ from thoracic to abdominal
I ATE(8) 10 EGGS AT 12
IVC
diaphragmatic contraction
esophagus
esophagus
descending aorta
Recall that the fibrous pericardial sac, containing the ____, is fused to the cranial (____) surface of the
____
fibrous pericardial sac
superior
central tendon
Recall that the heart
falls and rises as the diaphragm contracts and relaxes during respiration…
…as the position of the ____ changes by about ____ vertebral levels in quiet breathing
Diaphragmatic contraction also produces ____ of the base and marked distension of the ____ of each lung in inspiration
central tendon
two
descent
inferior lobe
Diaphragmatic contraction ____ the volume of each ____, while ____ between the parietal and visceral pleurae causes adherence that
produces associated ____ of the lung…
increases
pulmonary cavity
surface tension
expansion
Inspiration occurs when the thorax is ____ and both pleural and alveolar pressures become increasingly ____… causing air to flow into the ____.
Expiration occurs when the thorax ____ in size and alveolar pressures exceed ____ pressure… causing air to be forced out of the ____.
expanded
subatmospheric
lungs
diminishes
atmospheric
lungs
With the ____ of the diaphragm in inspiration, the lungs ____ and ____ elements of the bronchial tree are physically ____ and elongated
Their ____ will contribute significantly to expiration
depression expand elastic stretched recoil
L & R PHRENIC
NERVES
descend between ____ ____ to the root of each lung
____ keep the diaphragm alive!
• A high cervical spinal cord injury, above the C4 cord segment ○ Producing \_\_\_\_ and \_\_\_\_ paralysis reducing vital capacity and requiring a \_\_\_\_
pleura pericardium C3, 4, 5 quadriplegia diaphragmatic ventilator
The lungs and pleural cavities are ____ in quiet respiration
There is roughly a 2-rib disparity in the ____, ____ and ____ lines
asymmetric
mid-clavicular
midaxillary
scapular
The costomediastinal and costodiaphragmatic recesses are formed by the acute ____ of the parietal pleura onto the ____ and ____ respectively
reflection
fibrous pericardial sac
diaphragm
Pleural recesses
the areas of the pleural space into which the lungs do not ____ in quiet respiration
They are crucial for ____ the pleural cavity without injuring the lungs… as in ____ to drain a ____
When inserting the tube, you will have the patient ____
extend accessing thoracentesis pleural effusion expiring
TO SUMMARIZE:
• Diaphragmatic
____ increases the volume of the pleural cavity
• ____ between parietal and visceral pleurae causes adherence that produces associated expansion of the lung…
… including expansion into the ____ at full inspiration
contraction
surface tension
pleural recesses
The ____ SURFACE of the embalmed lung preserves the impressions of the adjacent ribs in addition to demonstrating the ____ separating the ____
costal
fissures
lobes
LEFT LUNG
* \_\_\_\_ lobes * \_\_\_\_ (oblique) fissure
Each conical lung presents with three surfaces:
• ____
• ____
• ____
____ overlies apex of heart during life and is unique to the ____ lung
two one costal mediastinal diaphragmatic lingula left
RIGHT LUNG
• \_\_\_\_ lobes • Two fissures: ○ \_\_\_\_ ○ \_\_\_\_
In the depths of the fissures,
____ covers the
____ surfaces
two
oblique
horizontal
visceral pleura
interlobar
The ____ surface of each lung preserves impressions of adjacent features of the ____
LEFT:
- ____ impression
- ____ impression
- ____ impression
RIGHT:
- ____ impression
- ____ impression
- ____ impression
mediastinal
middle and posterior mediastinum
aortic arch
aortic
cardiac
cardiac
azygos arch
esophageal
With the ____ and its contents removed, the structures effectively suspending each lung from the mediastinum may be observed
pericardial sac
____ and ____ enter each lung at the ____ or ROOT on the MEDIASTINAL SURFACE
pulmonary vessels
primary bronchi
hilum
LEFT HILUM
- branches of ____.
- ____ bronchi
- branches of ____
- ____
left pulmonary a.
superior and inferior lobar
left pulmonary vv.
pulmonary ligament
RIGHT HILUM
- ____
- branches ____
- ____(common origin)
- branches of ____
- pulmonary ligament
The superior lobar (eparterial) bronchus branches off the ____ prior to its passage through the hilum of the lung
The bronchus intermedius (interlobar bronchus) gives rise to the ____
superior lobar bronchus
right pulmonary a.
inferior and middle lobar bronchi
right pulmonary vv.
main bronchus
middle and inferior lobar bronchi
CARDIOPULMONARY CIRCULATION
The functional segmentation of each lung is reflected in the branching of the ____ and the formation of the paired ____ draining each organ
left and right pulmonary arteries
pulmonary veins
Pulmonary arterioles are continuous with a \_\_\_\_ in intimate contact with the alveoli that is in turned drained by tributaries of the \_\_\_\_
capillary network
pulmonary veins
“RALS”
LEFT HILUM RIGHT HILUM Note too: • \_\_\_\_ • \_\_\_\_
bronchial vessels
bronchopulmonary (hilar) lymph nodes
Bronchial Arteries
provide an oxygenated blood supply to the ____ of the lung, ramifying along the ____
parenchymal
bronchial tree
85% of the blood the ____ deliver to the lungs leaves those organs with the newly oxygenated blood in the ____
bronchial arteries
pulmonary veins
The remainder returns via ____ to the
____
Responsible for draining the remaining 15%: small bronchial veins that drain the lung into Azygos system (venous system), which is responsible for draining posterior thoracic wall and posterior mediastinal viscera like esophagus.
bronchial veins
azygos sytem
Broncho-pulmonary (Hilar) lymph nodes
…drain to ____
… Which in turn drain to ____
tracheobronchial (carinal) nodes
paratracheal nodes
Pulmonary lymphatic drainage is ultimately returned to the ____ in the root
of the neck…
Enlargement of
supraclavicular (inferior deep cervical) nodes may indicate ____ pulmonary pathology
including but not limited to ____
venous sytem
ipsilateral
metastatic lung cancer
The BRONCHIAL TREE
Each lung features ____
functional segments - each segment is supplied by a ____ and accompanying branch of the ____
ten
tertiary broncus
PA
The bronchopulmonary segments are, in fact, the ____
units of each lung
anatomical bronchovascular
LEFT LUNG
Clinical assessment of the lungs relies upon techniques of ____ and ____ of the chest wall overlying specific segments in order to determine ____
auscultation
percussion
air vs. fluid content
RIGHT LUNG
In the supine, bed-ridden patient, aspirated material is most likely to enter ____ via the ____, which branches posteriorly off either ____ or the ____
Aspiration of oropharyngeal contents and bacteria may lead to ____
segment VI superior segmental bronchus bronchus intermedius inferior lobar bronchus aspiration pneumonia
The segmentation of the lungs means that pulmonary pathology may be isolated to either a ____
Surgeons exploit the anatomical subdivision of the organ into lobes and segments when excising damaged tissue via ____
segment or a lobe
segmental or lobar resections
PULMONARY PLEXUS
Target: bronchial muscles
Sympathetic: ____
Parasymp: ____
Target: pulmonary vessels
Sympathetic: ____
Parasymp: ____
Target: secretory cells of alveoli
Sympathetic: ____
Parasymp: ____
inhibitory (bronchodilation)
motor (bronchoconstriction)
motor (vasoconstriction)
inhibitory (bronchodilation)
secretomotor
inhibitory
Sympathetic inputs to pulmonary plexus produce ____…
… as well as secretion of ____ by alveolar cells
bronchodilation
pulmonary surfactant
Parasympathetic Vagal inputs:
• facilitate ____ of smooth muscle that ____ the bronchial tubes
• stimulate bronchial secretion by ____ and goblet cells
—part of the ____ defense system protecting the airways against inhaled irritants soot, ____, microbes
contracting constricts mucous glands innate dust
Deep breathing requires ____ as well as ____ movement
thoracic
diaphragmatic
COSTOVERTEBRAL JOINTS
The ____ of each rib articulates with the body of at least one ____ (and often an IV disc) at a ____ of the head of the rib
The ____ articulates with
the ____ process of a single thoracic vertebra at a
____ joint
head
thoracic vertebra
joint
tubercle
transverse
costotransverse
These COSTOVERTEBRAL JOINTS are ____ joints …
… that permit movements of the ribs necessary for ____
plane synovial
deep breathing
Note the ____ course that each rib takes from its vertebral articulations to the ____ aspect of the body…
As a consequence, note that the ____ ends of both
the ____ ribs are ____ to the vertebral ends
oblique ventral sternal true and false inferior
Elevation of the rib cage, further increasing the vertical diameter of the thorax, also contributes to expansion of
the thorax in both…
• \_\_\_\_ (in the \_\_\_\_ plane) • \_\_\_\_ (in the \_\_\_\_ plane) Both crucial for \_\_\_\_ into and out of the lungs
width coronal depth sagittal maximum airflow
When the ____ ribs are elevated, the ____ dimension of the thorax is increased
This is known as the ____
upper
anteroposterior
pump handle effect
When the angles of
the ____ ribs are elevated, they move ____, increasing the ____ DIMENSION
The ____
lower
laterally
transverse
bucket-handle effect
These movements combine with the increase in the ____ dimension of the thorax resulting from the contraction of the DIAPHRAGM to facilitate ____
vertical
deep or forced inspiration
These expanded diameters will be reduced in \_\_\_\_ by the following factors (in addition to the \_\_\_\_ of the elements of the bronchial tree): • \_\_\_\_ • \_\_\_\_ of the costal cartilages • \_\_\_\_ of abdominal viscera • If necessary, contraction of \_\_\_\_
expiration gravity elastic recoil elastic rebound abdominal musculature
