Heart and Lungs - 1 Flashcards
what is in the upper respiratory tract?
nose, nasal cavity, paranasal sinuses
pharynx
larynx
what is in the lower respiratory tract?
trachea
bronchii
lungs
what is contained in the pulmonary cavities?
lungs, pleura, pleural cavity
tracheobronchial tree?
multiple levels of airway branching from trachea to alveoli
18 to 22 divisions
course of trachea?
begins CV6
runs along midline
bifurcates at transverse thoracic plane
structure of trachea?
has C-shaped hyaline cartilage bars
posteriorly filled with trachealis muscle
trachealis
longitudinal smooth muscle on posterior portion of trachea cartilage
carina?
last cartilage ring located at bifurcation of trachea
projects into lumen
identifiable on chest xray
vascular supply for trachea?
bronchial, inferior thyroid vessels
lymphatic supply for trachea?
paratrachea lymph nodes
innervation of trachea?
recurrent laryngeal branches of vagus nerve
bronchial carcinomas?
can cause carina to be distorted
due to spread of metastatic cancer into tracheobronchial lymph nodes
right vs left bronchi?
right - wider, shorter, vertically oriented
**foreign objects more likely in right bronchi
secondary bronchi?
branches of primary
left - 2 branches
right - 3 branches
goes to the lobes of the lung
tertiary bronchi?
aka segmental bronchi
branches of the secondary bronchi
right - 10 segments
left - 8-10 segments
supply bronchopulmonary segments
branching of tertiary bronchi?
branch 18-20 times
bronchioles gives rise to alveolar ducts
alveolar ducts give rise to alveoli
alveoli
thin walled structures which compose parenchyma of lungs are and visualized with microscopy
composition of pleura
simple squamous epithelial cells and thin layer of loose connective tissue
function of pleura
smooth surface for lungs to move
secretions of pleura?
serosal fluid
fills pleural cavity and provides lubrication
visceral pleura
adherent to all external surfaces of lungs
-including fissures
continuous with parietal pleura at hilum of the lung
parietal pleura
lines internal surface of thoracic wall
surfaces of parietal pleura?
costal
diaphragmatic
mediastinal
cervical
mediastinal surface of parietal pleura
line mediastinal surfaces, continuous with visceral pleura at root of the lung
pulmonary ligament
formed by mediastinal surface of parietal pleura and the visceral pleura
inferior extension of pleura which assists in maintaining position of lung in thoracic cavity
cervical surface of parietal pleura
extends superiorly into root of neck reaching its apex slightly superior to neck of first rib
reinforced by suprapleura membrane
lines of reflection of parietal pleura?
vertebral - costal continuous with mediastinal posteriorly
costal - costal continuous with diaphragmatic inferiorly
sternal - costal continuous with mediastinal anteriorly
extent of cervical pleura?
significant because it may be punctured as a result of wound to this region
pleuritis?
pleura become inflamed and can no longer slide easily over each other
parietal pleura receives extensive sensory innervation fro intercostal and phrenic nerves
pain referred to area of thoracic wall or to point of shoulder via phrenic nerve (C345)
visceral pleura sensory nerves?
travel with autonomic fibers of bronchial vessels
important location for pericardiocentesis?
left sternal reflection passes inferiorly in medial plane to level of 4th costal cartilage then turns alterally and inferiorly to level of 6th costal cartilage
creates notch allowing small part of pericardium to be in direct contact with anterior thoracic wall
pleural recess?
area of pleural cavity which lung does not completely occupy during quiet respiration
two layers of parietal pleura come into contact with each other
with deep inspiration - lungs fill medially and inferiorly to the costomediastinal and costodiaphragmatic pleura recess
costomediastinal pleura recess?
where mediastinal pleura contacts costal pleura anteriorly
costodiaphragmatic pleura recess?
where costal pleura contacts diaphragmatic pleura (around periphery of diaphragm)
-can be inadvertently damaged during procedures or injuries to abdomen
pneumothorax?
potential space of pleural cavity becomes a real space
air, blood, or fluid can accumulate in space
tension pneumothorax?
air enters pleural space but cannot leave
results in shift in mediastinal contents to contralateral side because of increased pressure
beck’s triad?
distended neck veins
muffled heart sounds
hypotension (low cardiac output)
signs of tension pneuomthorax**
apex of lungs?
extends to level of neck of first ribs
right lung?
at midclavicular - projects inferior to rib 6
at midaxillary - projects inferior to rib 8
at scapular - projects inferior to rib 10
2 interspaces above the parietal pleura
left lung?
midsternal - projects inferiorly to rib 4, then turns inferolaterally to 6th righ MCL (creates cardiac notch)
midaxillary - projects inferior to rib 8
scapular - projects inferior to rib 10
2 interspaces above the parietal pleura
cupula
apex of lung
surfaces of lung?
costal, mediastinal, diaphragmatic
hilum
area where all structures enter lung and leave lung (on mediastinal surface of lung)
right lung lobes and fissures?
3 lobes - superior, middle, inferior
2 fissures - oblique and horizontal
left lung lobes and fissures?
2 lobes - superior and inferior
1 fissure - oblique
cardiac notch and lingula?
on the left lung
oblique fissures?
begin posteriorly at level of 4th rib, pass anteroinferiorly, crossing 4th and 5th intercostal spaces to 6th rib and costal cartilage anteriorly
**in both lungs
horizontal fissure?
follows course of 4th rib
**in right lung only
root of lung?
all structures that enter or leave lung
pulmonary artery
pulmonary veins (superior and inferior)
primary bronchi (right superior may branch within lung)
bronchial arteries and veins - 1 right / 2 left
pulmonary plexus of nerves
lymphatic vessels and lymph nodes
bronchopulmonary segment
smallest functional unit of lung
area supplied by 1 tertiary bronchus and associated branch of pulmonary artery
separated from adjacent segments by connective tissue septa
pulmonary veins run between bronchopulmonary segments
disease of lung where?
lungs/abscesses often localized to bronchopulmonary segments
can be surgically resected without altering other segments
pneumonectomy
surgical removal of one lung
lobectomy
surgical removal of one lobe of one lung
segmentectomy
surgical removal of a bronchopulmonary segment
pulmonary arteries
carry poorly oxygenated blood from right ventricles to lungs
originate from pulmonary trunk at sternal angle
**branch and course with bronchial airways
pulmonary veins
superior and inferior veins
return oxygenated blood to left atrium
originate from capillary beds around alveoli and course intersegmentally
pulmonary embolism
when blood clot enters a pulmonary artery or one of its branches and blocks blood flow to a portion of lung
-life-threatening because of decreased blood oxygenation and obstruction of pulmonary blood flow
large emboli (block main artery) -can result to death in matter of seconds to minutes
smaller emboli - pulmonary infarction
bronchial arteries
originate from thoracic aorta
two on left, one on right
right often originates from 3rd right posterior intercostal artery
courses with bronchial tree
supply trachea and bronchii
bronchial veins
course with bronchial arteries, terminate in azygous veins
pulmonary nodes?
within substance of lung, along bronchial tree
bronchopulmonary nodes
at hilum of lung
trachobronchial nodes
at tracheal fiburcation
subpleural plexus lymphatic system?
aka superficial
drains visceral pleura and most of lung parenchyma
drains to bronchopulmonary nodes > superior and inferior tracheobronchial nodes > bronchomediastinal trunk
bronchomediastinal trunk
drains into the thoracic duct on the left and to the right lymphatic duct on the right
deep pulmonary plexus
drains larger bronchioles and bronchi
drains to pulmonary nodes > bronchopulmonary nodes > tracheobronchial nodes > bronchomediastinal trunk
lymph from left inferior lobe?
drains to right tracheobronchial nodes
lymph drainage from parietal pleura
to thoracic wall
-mainly intercostal, but also parasternal, diaphragmatic, axillary lymph nodes
innervation of lungs?
both sympathetic and parasympathetic innervation
pulmonary plexuses
located along primary bronchi
continuation of deep cardiac plexus
sympathetic innervation of lungs?
preganglionic T2-T6
postganglionic upper thoracic and cervical portions of sympathetic chain ganglion
postganglionic nerve cells processes from cardiac branches which are called cardiopulmonary splanchnic nerves
efferent: vasoconstriction, bronchodilation, inhibit gland secretion
primary sympathetic innervation of lungs?
cardiopulmonary splanchnic nerves
parasympathetic innervation of lungs?
preganglionic nerve cell bodies in brain stem, processes travel with vagus nerve
in thorax, vagus gives off thoracic cardiac parasympathetic branches
postganglionic nerve cell bodies are in wall of arteries
efferent: vasodilation, bronchoconstriction, gland secretion
innervation of parietal pleura?
via nerves supplying thoraci wall including intercostal and phrenic
pain referred to area of thoracic wall supplied by intercostal nerve or to root of neck/shoulder via phrenic nerve
