Anatomy 3 - Consequences of a Chronic Cough Flashcards
What lobe of what lung do foreign bodies tend to be inhaled into in the upright patient?
The inferior lobe of the right lung (right bronchus has a larger diameter, more vertical orientation and a shorter length)
What is the name of the internal aspect of the tracheal birfurcation?
Carina
What is a pneumothorax?
The presence of air in the pleural cavity causing the lung to collapse
What are 3 types of pneumothoraxes with explanation?
Spontaneous = no apparent cause (in an otherwise healthy person)Traumatic = result of an injury Tension = breach in the lung surface acts as a one way valve allowing air to move into the pleural cavity during inhalation but preventing it from moving out during exhalation
What is a bulla?
A thin-walled air-filled space within the lung, arising congenitally or in emphysema
What size is a small pneumothorax?
Less than 2cm
What happens when a small amount of air enters the pleural cavity (either due to a penetrating injury to the parietal pleura or due to rupture of the visceral pleura) leading to the lung collapsing?
The vacuum is lost and the elastic lung tissue recoils towards the lung root (if only a small pneumothorax there will only be a
Examination findings when a pneumothorax is present? (3)
Reduced ipsilateral chest expansion and breath soundsHyper-resonance on percussion
What are the 2 features of a pneumothorax on a chest x-ray?
Absent lung markings peripherally and lung edge invisible
What does the build up of air in the pleural cavity eventually lead to in a tension pneumothorax?
Pleural cavity applies pressure (tension) to the mediastinal structures eventually causing mediastinal shift compressing the heart and left lung
What happens to the trachea in a tension pneumothorax?
Tracheal deviation away from he side of a unilateral tension pneumothorax
Why does a tension pneumothorax lead to hypotension?
SVC compression reduces venous return to the heart leading to hypotension
What is the treatment of a large pneumothorax?
Needle aspiration (thoracentesis)sitting of a chest drain
Why is the a chest drain inserted in the 4th or 5th intercostal space midaxillary line?
This is the “safe traingle” - anterior border of latissimus dorsi and the posterior border of the pectoralis major
When carrying out thoracentesis, where should you aim to place the needle?
Just above the rib below in order to keep away from the NVB
Emergency management of a tension pneumothorax?
Insert a large gauge cannula (grey/orange) into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax
What is the most likely consequence of a chronic cough?
Herniae
What are the 2 factors usually required for the development of a hernia?
Weakness of one structure (usually a part of the body wall)Increased pressure on one side of the part of the wall (e.g. chronic cough)
What are 4 examples of the body wall which have a normal anatomical weakness?
DiaphragmUmbilicusInguinal canalFemoral canal
Apart from normal anatomical weakness, what other 2 factors can cause weakness of a structure?
Congenital abnormalities e.g. congenital diaphragmatic weaknessSurgical scars = incisional hernias
What are 3 normal anatomical weaknesses in the diaphragm? (common arrestor hernia)
Attachements to xiphoid processOesophageal hiatusAt posterior attachments
2 type of hiatus hernia?
Paraoesophageal hiatus hernia (herniated part of stomach passes through hiatus to become parallel to the oesophagus int he chest)Sliding hiatus hernia (herniated part of stomach slides through hiatus into chest with gastro-oesophageal junction
Where in the inguinal canal do inguinal herniae tend to form?
In the medial half of the inguinal region
When is the inguinal canal formed?
During embryology due to the passage of the testes or the round ligament of the uterus into the perinuem
What does the inguinal canal contain in the adult?
The spermatic cord or the round ligament of the uterus
What can add increased pressure in the inguinal canal (intra-abdominal) leading to the formation of an inguinal hernia?
Chronic coughChronic constipationOccupational lifting of heavy weightsAthletic effort
Where is the inguinal (groin) region?
The region between the anterior superior iliac spine and the pubic tubercle
Where do the inguinal ligaments attach between?
The ASIS and the pubic tubercle
What does the medial halves of the inguinal ligaments form in terms of the inguinal canals?
Forms the floors of the inguinal canals
How are the inguinal ligaments related to the external oblique aponeuroses?
Inguinal ligaments are the inferior borders of the external oblique aponeuroses
What are the inguinal canals?
approx. 4 cm long passageways through the anterior abdominal wall in the inguinal regions
What are the entrance and exit to the inguinal canals called?
Entrance = deep in (superior to the midpoint of the inguinal ligament)Exit = Superficial ring (“V” shaped defect in the external oblique aponeurosis that lies superolateral to the pubic tubercle)
What causes the weakness in inguinal hernia?
The presence of the inguinal canal in the inguinal part of the anterolateral abdominal wall
What are the layers of the anterolateral abdominal wall of the inguinal canal in men?
Scrotal skinSuperficial fascia of the scrotumDeep fasciaInguinal ligamentLower border of internal obliqueLower border of transverses abdomensTransversalis fasciaTesticular vein (tributary of IVC or left renal vein)Testicular artery (branch of AA)Peritoneum(the vas deference is attached inferiorly in the pelvis in the region of the developing prostate gland)
What is the name of the out pouching of parietal peritoneum that forms as the testicle begins to descend?
Processus vaginalis
What is the name of the covering transversals fascia that covers the testicle as it descends through the transversalis fascia?
Internal spermatic fascia
What is the name of the covering of skeletal muscle fibres from the internal oblique that cover the testicle as it descends?
Cremasteric fascia
What is the name of the covering of external oblique aponeurosis that covers the testicle as it descends?
External spermatic fascia
What is the name of the remains of the processes vaginalis?
Tunica vaginalis
What forms the deep ring of the inguinal canal?
Where the testis pushed into the transversalis fascia
What passes through the inguinal canal with the testis?
The spermatic cord
What is the spermatic cord
The 3 layers of “coverings” gained as the testis passes through the inguinal canal and the structures contain within (vas deferent, testicular artery and pampiniform plexus)
What passes through the inguinal canals and females?Where do these go to?What are these?
Round ligaments of the uterus Labium majusFibrous embryological remnants in the adult female
2 types of inguinal hernia?
Direct inguinal herniaAn indirect inguinal hernia
How is a direct inguinal hernia formed?
A “finger” of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum
How is an indirect inguinal hernia formed?
A “finger” of peritoneum is first forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum
How can you clinically differentiate between a direct and indirect hernia? (not a perfect test)
Reduce the herniaOcclude the deep ring with fingertip pressureAsk the patient to coughIf it is a direct hernia, the lump will reappear whereas if it is an indirect hernia the lump will not appear
