5. Endo/Pulm/Gastro Flashcards
Thyroid Gland (the largest endocrine gland, produces Thyroid Hormone).
What are its parts?
1. Right lobe of thyroid gland
2. Left lobe of thyroid gland
3. Isthmus of thyroid gland
What are the parathyroid glands?
Four pieces of glandular tissue on the posterior surface of the thyroid gland
Names of 4 parathyroid glands
- Right Superior Parathyroid Gland
- Left Superior Parathyroid Gland
- Right Inferior Parathyroid Gland
- Left Inferior Parathyroid Gland
Which cervical triangle contains the thyroid and parathyroid glands?
Muscular triangle
CN: _______________ can be seen anywhere along the embryonic Thyroglossal Duct (from tongue -> thyroid).
Aberrant thyroid glandular tissue.
Can form a lump. If it is too big, it can interfere with hyoid and affect swallowing/speaking.
Is thyroid gland near thyroid cartilage?
no. it is more inferior.
surrounds pharynx
CN: Thyroglossal Duct Cysts
- Cyst that forms along the thyroglossal duct as the thyroid gland -> to the lower part the Neck.
- Cysts can damage hyoid bone and swallowing and may need to be surgically removed.
What is a accessory thyroid gland?
Remnants of thyroglassal duct that can appear anywhere along embryonic course of development thyroglossal duct.
CN: Pyramidal Lobe of the thyroid gland
Pyramidal lobe of thyroid gland is remnant of thyroglossal duct that formed an accessory thyroid gland.
Branches up from the isthmus of the thyroid gland. It can go all the way up to the hyoid bone and connected by band of CT.
Approximately ____ of Thyroid Glands possess a Pyramidal Lobe varying in size and location.
Can it exist if isthmus of thyroid gland is not present?
50%.
Yes
CN: Thyroid ima artery
What is it?
Why is it clinically important?
- 10% of people, a small, unpaired thyroid ima artery, branching from the brachiocephalic trunk. This small ima artery goes to the anterior surface of the trachea -> isthmus of the thyroid gland, sending branches to both structures.
- CN important bc it must be considered before a tracheotomy or cricothyrotomy
Thyroid ima artery can also branch from what?
- arch of the aorta
- right common carotid A.
- subclavian A.
- internal thoracic As.
Exophthalmic Goiter is produced by _________
and can result in _______________________.
too much TH
eyeballs
CN: Thyroidectomy refers to removal of the Thyroid Gland or an associated tumor or as a potential treatment for Hyperthyroidism. This procedure can be difficult why?
- Rich blood supply
- Presence of laryngeal nerves
- Parathyroid glands, which are typically left in place.
Goiter causes a swelling in the neck that may compress the _________________.
When the gland enlarges, it may do so in what directions?
- trachea, ESO, and recurrent laryngeal nerves
- anteriorly, posteriorly, inferiorly, or laterally. It cannot move superiorly because of the superior attachments of the overlying sternothyroid and sternohyoid muscles.
How to conduct a total thyroidectomy.
- Make a cut 2 fings below laryngeal prominence
- Break pretracheal fascia; DO NOT cut inferior thyroid a.
- Refect sternohyoid and sternothyroid ms.
- Remove thyroid and leave parathyroid glands.
- Cauterize as. or ns.
- Suture
How can we take out thyroid glands w/o leaving a visible scar?
Transoral thyroidectomy: remove from space between teeth and lip.
Risk of injury to what is present during neck surgery?
Recurrent laryngeal nerves: run between thyroid gland and trachea -> larynx
- R recurrent laryngeal nerve runs posteior, anterior or between inferior thyroid artery and its branches. Thus, the inferior thyroid artery is ligated lateral to the thyroid gland, where it is not close to the nerve.
- Danger of damaging L recurrent laryngeal nerve during surgery is not as great
________ is the usual sign of unilateral recurrent nerve injury; however, temporary aphonia or disturbance of phonation (voice production) and laryngeal spasm may occur.
hoarseness
What is your pharynx and where is it located?
- Pharynx (throat) is a space where we send food and liquid and air
- Goes from base of skull -> inferior border of the Cricoid Cartilage
- Located immediately behind the nasal cavity, behind the mouth and above the ESO and larynx.
What are the three parts of the pharynx?
- 1. Nasopharynx- above soft palate; imp for respiration
- 2. Oropharynx- posterior to oral cavity; between soft palate and base of tongue; imp for digestion
- 3. Laryngopharynx: posterior to larynx; from epiglottis -> ESO
What are the parts of the nasopharynx?
- Choanae:
- Torus Tubarius
- Salpoingopharyngeal Fold
- Pharyngeal Opening for the Pharyngotympanic Tube
- Pharyngeal Recess
- Choanae: paired openings from nasal Cavities -> nasopharynx)
- Torus Tubarius- elevation of Pharyngotumpanic Tube
- Salpoingopharyngeal Fold (mucosal layer covering Salpingopharyngeus M.)
- Pharyngeal Opening for the Pharyngotympanic Tube (communication between the Nasopharynx and the Middle Ear)
- Pharyngeal Recess - space between between the salpingopharyngeal Fold and the posterior wall of the Pharynx
Larynx is designed for _________,
connects the ________ to the _______.
Larynx is designed for vocalization,
connects the oropharynx to the trachea.
Our laryngeal cavity is made up of what?
- Laryngeal inlet
- Laryngeal vestibule
- Laryngeal ventricle
- —-4. The glottis—-
- Infraglottic cavity
*
- Infraglottic cavity
Describe the following:
- Laryngeal Vestibule
- Laryngeal Ventricle
- Infraglottic Cavity
- Laryngeal Vestibule-> above the vestibular folds
- Laryngeal Ventricle-> blind-ended opening between vestibular folds and vocal folds
- Infraglottic Cavity-> between vocal folds and the inferior border of the cricoid cartilage
What are our vestibular folds?
False Vocal Cords between the arytenoid Cartilage that have a protective function)
what makes up the glottis?
- Vocal folds (true vocal cords); mucosal fold that overies vocal L.
- Vocal process of arytenoid cartilage
- Rima glottidis- area between vocal folds
Trachea: extends from the _____ to its branch point in the _____.
Trachea: extends from the larynx to its branch point in the thorax)
Aspiration of foreign bodies refers to any foreign body entering an airway through the _________ and can become trapped at the _________.
Aspiration of foreign bodies refers to any foreign body entering an airway through the laryngeal Inlet and can become trapped at the vestibular folds.
Aspiration of Foreign Bodies refers to any foreign body entering an airway through the Laryngeal Inlet and can become trapped at the Vestibular folds. What happens?
- Laryngeal muscles will typically spasm preventing air from reaching the lungs.
- To remove FB: compress the abdomen via heimlech to force air out of lungs.
Where do foreign bodies often get stuck?
- 1. R main bronchus
- 2. L main bronchus
CN: Cricothyrotomy:
An emergency procedure where Intubation is not possible.
A large needle is passed through the cricothyroid membrane (between thyroid cartilage and cricoid cartilage) to permit the entry of air.
CN: Tracheostomy
- Incision through the skin ->
- separate the infrahyoid muscles ->
- removal or retraction of the isthmus of the Thyroid Gland ->
- to insert a tube into the Trachea (2nd or 3rd tracheal rings) to establish an airway.
no larynx =
cant talk
CN: Age changes of the Larynx:
- M/F start off with same size larynx. Grows steadily until around 3, when growth slows.
- Puberty: testosterone causes male Laryngeal cartilages to enlarge and grow anterior.
-
By age 65:
- Laryngeal cartilages also tend to calcify and ossify; c
- ricoarytenoid joints become uneven
- collagen fibers bcome disorganized;
- lamina propria decreases in flexability and elasticity.
Why does voice crack and drop in puberty?
Testosterone makes voice box and voal cords grow larger; muscles in larynx wobble
Why does voice sound weak and breathy in old ppl?
ossification of cartilages nad joints -> increased stiffness in larynx
Cancer of the Larynx is common among individuals who smoke.
What do we do in cases of laryngeal malignancy?
Laryngectomy and Tracheostomy
If one gets larygeal cancer and gets larynx/trachea removed, how can they talk?
- Electrolarynx,
- Tracheoesophageal Prothesis
- Esophageal speech (burp out words)
What part of the larynx is important for digestion?
Oropharynx
- What does the oropharynx carry?
- What does the laryngopharynx carry?
- Mixed: food/drink and air
- Only food and drink
Isthmus of the Facuces
- Passage from the oral cavity -> oropharynx
- Located in between the Epiglottis and Uvula.
What is the soft palate?
Musculomembranous mass extending posteriorly from the Hard Palate.
Ends inferiorly as the Uvula.
Palatoglossal Arch
Palatopharyngeal Arch
- Palatoglossal Arch: anterior pillar of fauces; mucosa covering the Palatoglossus M.
- Palatopharyngeal Arch: posterior pillar of the Fauces, mucosa covering the Palatopharyngeus M.)
Valleculae Epiglottica
Mucosa between anterior surface of epoglottis and root of tongue
Piriform Recess
depression on either side of the Laryngeal Inlet
CN: Branchial Fistula:
- Patency remnant of the 2nd Pharyngeal Pouch and 2nd Pharyngeal Groove that results in a opening between the tonsillar cleft (palatine tonsils) and externally at the side of the neck.
- Saliva can drop -> become infected
CN: Branchial Sinus:
- Embryonic cervical sinus fails to disappear, connecting with the lateral surface of neck via a branchial sinus.
- Communicates externally, but not internally, anywhere along the anterior border of the Sternocleidomastoid M..
CN: Branchial Cyst:
- Similar to a Branchial Sinus. If the embryonic cervical sinus does not communicate externally, it forms a branchial cyst.
- May cause complications bc close to:
- hypoglossal N.
- glossopharyngeal N.
- spinal accessory nerves N
CN: Tracheoesophageal Fistula
!!!!
- the esophagus ends in a blind-ended pouch
- and the stomach communicates with the trachea.
Other forms:
- ESO ends blind-ended pouch with no tracheal communication cannot live with this.
- Comm. between trachea and ESO: can live with for a while, until you keep coughing everytime you eat.
- ESO ends in a blind ended pouch but. communicates with trachea- not good.
SWALLOWING IS CALLED
Deglutination
Deglutination: Three stage process for swallowing:
- Stage 0: smell food.
- Stage 0: eat and chew food
- Stage One (voluntary): push food against the soft palate using your tongue: from mouth -> oropharynx .
- Once you push food to back of tongue, swallowing will happen no matter what.
- Stage Two (involuntary and rapid):
- Soft palate is elevated, sealing off the nasopharynx from the oropharynx, while suprahyoid and anterior longitudinal pharyngeal muscles elevate the Larynx -> pharynx shortens and widens
- Stage Three (involuntary):
- 3 pharyngeal constrictor muscles contract sequentially forcing bolus into Esophagus
- Superior pharyngeal constrictor -> middle -> inferior
- Epiglottis deflects nachos but does not seal off trachea and larynx.
- 3 pharyngeal constrictor muscles contract sequentially forcing bolus into Esophagus
