Anatomy And Pattern Recogniton Of The Upper Respiratory System And Neck Flashcards

1
Q

Summary of respiratory system

A

• Our cells need O2 to produce ATP. It is vital to life
• We also need to eliminate the toxic bi-product of
the cellular processes – CO2
• Our respiratory and cardiovascular system work
in collaboration to exchange and transport gases
• Failure of this process due to pathology will lead
to rapid cell death and a build-up of toxins
• Secondary functions of the respiratory system
include:
• Helps to regulate PH alongside the kidneys
• Smell receptors
• Filters and moistens inspired air
• Sound production
• Release of heat and some water

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2
Q

What is respiratory system divided into

A

Divided into:
• Upper:
• Nose (nasal cavity and paranasal sinuses)
• Pharynx
• Lower:
• Larynx
• Trachea
• Bronchi
• Lungs
• Conducting system:
• Transport of air: filter, warm, moisten
• Respiratory portion:
• Gas exchange between air and blood

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3
Q

Nose

A

• Has 3 main functions
• Warming, moistening and filtering inhaled air
• Detecting smell
• Modifying speech and sounds through resonance
• It is the only part of the respiratory system that is externally visible
• Is often divided into
• External – nose
• Internal – nasal cavity

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4
Q

External nose

A

• Muscle and skin supported by bone/ hyaline cartilage framework
• Lined internally with mucous membrane
• External opening – nares
• Bones:
- Paired nasal bones (bridge)
- Frontal bone (root)
- Maxilla
• Hyaline cartilage:
- Septal cartilage (midline)
- Lateral processes of septal cartilage
- Alar cartilages (form flared rim of nares)
• Shape of nose dependent on cartilage structure

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5
Q

What is Nasal cavity

A
  • Paired spaces either side of midline
  • Upper part of respiratory tract between external nares and nasopharynx thought the choanae
  • Wedge-shaped (apex anteriorly)
  • Formed by complex bone and cartilage framework
  • Have floor, roof, and medial/lateral walls
  • Separated;
    • From each other by nasal septum
    • From oral cavity by hard palate
    • From the cranial cavity by the frontal, ethmoid, and sphenoid bone
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6
Q

3 regions of nasal cavity

A

3 regions:
Vestibule:
• Within nares/external nose
• Lined with skin
• Coarse hairs filter large particles
Respiratory:
• Largest
• Very neurovascular (capillaries warm air)
• Respiratory epithelium
Olfactory:
• Contains olfactory (smell receptors)
• Lined with olfactory epithelium

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7
Q

Nasal cavity

A

Respiratory epithelium
Secretes (1litre per day):
• Mucous
• Watery-fluid containing lysozyme (antibacterial enzyme)
• Defensins (natural antibiotics)
Cilia propel mucous and ‘foreign particles’ towards throat; swallowed and digested

. Medial wall/division between cavities called nasal septum
• Anteriorly formed by septal cartilage
• Posteriorly formed by vomer bone and perpendicular plate of ethmoid bone

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8
Q

Nasal cavity – lateral walls

A

. Three ‘shelves / scroll-like’ bony protuberances from each wall; nasal conchae (sometimes called turbinates)
• Groove inferior to each called nasal meatus
• Mucous covered
• Increase surface area and cause air turbulence meaning particles more likely to become trapped in mucous
• Also extract moisture and heat on exhaling so not lost

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9
Q

Paranasal sinuses

A

Extensions of nasal cavity; drain into lateral walls
Develop in adolescence
Four pairs named after bone in which they are found:
• Ethmoid air cells
• Sphenoid sinuses
• Maxillary sinuses (largest)
• Frontal sinuses (variable in size)
• Lined with respiratory mucosa
Help lighten skull and resonate voice
Nasal-lacimal duct also drains into lateral wall of nasal cavity

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10
Q

Pharynx

A
  • Funnel shaped tube between the nasal cavity
    (base of skull) and the oesophagus / larynx (C6)
  • Approximately 13cm long
  • Composed of skeletal muscle
  • Functions as
    • Common pathway for food / air before splitting into the respiratory / digestive systems
    • Helps form sounds as a resonating chamber
    • Contains the tonsils as part of the immune system
  • Is subdivided into 3 regions
    • Nasopharynx – at the level of the choanae in the
    nasal cavity
    • Oropharynx – at the level of the oral cavity and
    mouth
    • Laryngopharynx (or hypopharynx) – at the opening for the larynx: laryngeal inlet
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11
Q

Nasopharynx

A

. Superior to soft palate; passage of air only
• Swallowing elevates the soft palate to close the nasopharynx
• Continuous with epithelial layer of respiratory region of nasal cavity; similar role
• Pharyngeal tonsil on posterior wall; pathogens in air
• Pharyngotympanic (Eustachian) tubes open into lateral wall
• Adjacent ridge of tubular tonsils; prevent spread of infection into middle ear

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12
Q

Oropharynx

A

. Continuous with nasopharynx above at the level
of the soft palate; passage of air and food
• Continues inferiorly to level of epiglottis / hyoid bone
• Stratified squamous epithelium; protection
• Opening with oral cavity called oropharyngeal isthmus
• Closed when chewing; can still breath through nose
• Surrounded by arches called palatoglossal folds
• Inferior to this, anterior wall is formed by posterior part of tongue
• More tonsils on posterior tongue and lateral walls of oropharynx

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13
Q

Laryngophalynx

A

• Continuous with oropharynx above at the level of the hyoid bone passage of air and food
• Continues inferiorly to level of cricoid cartilage (C6) and start of oesophagus and larynx
• Continuous with oesophagus
• Stratified squamous epithelium; protection

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14
Q

The tonsils

A

. They are collections of lymphoid tissue within the nasal and oral cavities and pharynx as part of the body’s defence against disease
• The largest of these form distinct areas called tonsils
• They form a ring around the pharynx and there are 4 main areas
• Pharyngeal tonsil
• Palatine tonsil
• Lingual tonsil
• Tubal tonsil

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15
Q

Pharyngeal Musculature

A

. Arranged in two groups separated by fascia (allows passage of other structures)
• Constrictors:
- circular around cavity
- Superior, middle, and inferior
. Longitudinal:
- Vertically orientated

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16
Q

Larynx

A

• Main function of the larynx are
Breathing
Speaking making noise
Forced closure (val salva)
swallowing
• 5cm long between the laryngopharynx and trachea
• Anterior to 4-6th cervical vertebrae
• Suspended from hyoid bone superiorly
• Inferiorly linked to trachea via ligaments
• Is a framework of 9 cartilages supported and connected by fibrous membrane and intrinsic muscles
• Innervated by branches of the vagus nerve
• Mucosal lined
• Start of the lower respiratory tract, functions as:
- A sphincter to close off the lower respiratory tract; guide passage of food
- Maintain a patent airway
- To produce sound ‘Voice box’

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17
Q

Epiglottis

A

• Spoon/leaf-shaped elastic cartilage
• Anchored anteriorly on thyroid cartilage
• Projects postero-superiorly into the pharynx posterior to the tongue
• Covered in mucosal epithelium containing tastebuds
• Normally open at laryngeal inlet
• On swallowing, larynx is elevated and epiglottis occludes trachea

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18
Q

So how do we swallow

A

• Aim to close off lower respiratory tract completely
• Adduction of both vocal and vestibular folds
• Rima glottides, vestibule, and vestibule closed
• Extrinsic muscles elevate the larynx which
causes the epiglottis to close the laryngeal inlet
• Simultaneously causes the oesophagus, posteriorly, to open (attached to cricoid cartilage)

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19
Q

The neck

A

• Extends from
Anteriorly
• Inferior border of the mandible to the manubrium
Posteriorly
• Posterior occipital protuberance to C7/T1 disc space
• It is often divided into 4 compartments
Visceral;
• Anterior
• Contains parts of digestive and respiratory systems
• Also contains several endocrine glands
Vertebral;
• Posterior
• Contains vertebrae and related muscles
• Also contains spinal cord and nerves
Left / right Vascular;
• Lateral
• Contains major vessels and vagus nerve (CN X)
Separated by surrounding layers of cervical fascia

20
Q

Surface anatomy

A

• C3 / C4:
Superior border of thyroid cartilage (palpable)
Bifurcation of common carotid artery
• C5 / C6
Indentation of cricoid cartilage / first tracheal ring (palpable)
Inferior border of pharynx / larynx
Superior limit of trachea / oesophagus

21
Q
A

• Lies anteriorly in the midline of the neck
• There are 2 lobes and in total is approximately 5cm long.
• It is part of the endocrine system and is key to several metabolic functions including:
- Production of thyroxine, calcitonin and tri-idothyronine
- Assists in protein, fat and carbohydrate production, heat
production and calcium regulation

22
Q

Parathyroid glands

A

• These are bilateral glands (4) in the posterior aspect of the thyroid gland
• Secrete parathyroid hormones. This increases blood calcium levels.
Calcium is needed for
• Muscle contraction
• Transmission of nerve impulses
• Blood clotting
• Normal enzyme actions

23
Q

Acute sinusitis description

A

• Acute inflammation of any of the paranasal sinus mucosa that lasts less than 4 weeks. If the nasal cavity is also involved its called rhinosinusitis

24
Q

Acute sinusitis causes and symptoms

A

Causes
• Normally follows an upper respiratory tract infection.
Symptoms
• Fever, headache, postnasal discharge, abnormal sense of smell

25
Q

Treatment acute sinusitis

A

• Antibiotics. If it becomes chronic, FESS (functional endoscopic sinus surgery) may be carried out

26
Q

Cystic fibrosis description

A

Genetic disease affecting the lungs, liver, pancreas, small bowel and urogenital system

27
Q

Cystic fibrosis causes and symptoms

A

Causes
• Most common genetic disease affecting 1:2000/3500 live births
Symptoms
• Lung and upper respiratory system manifestations
• Repeated bacterial infections, chronic sinusitis, nasal polyps

28
Q

Treatment for cystic fibrosis

A

For respiratory complications
• Physiotherapy for airway clearance
• Anti-inflammatory therapy
• Antibiotics
• Lung transplant

29
Q

Nasal polyps Description

A

• Multiple benign polyps in the nasal cavity and paranasal sinuses

30
Q

Causes and symptoms Nasal polyps

A

Causes
- Most commonly seen in adults. Rare in children.
• May be associated with cystic fibrosis, asthma,
rhinosinusitis
Symptoms
• Patient has a feeling of nasal obstruction, facial pain,headache, loss of smell. May also have symptoms of sinusitis

31
Q

Treatment nasal polyps

A
  • steroid
  • surgery if advanced
32
Q

Retropharyngeal abscess description

A

Life threatening infection involving the retropharyngeal space. Needs immediate diagnosis

33
Q

Retropharyngeal abscess description

A

Life threatening infection involving the retropharyngeal space. Needs immediate diagnosis

34
Q

Retropharyngeal abscess causes and symptoms

A

Causes
• Most commonly seen in young children (<5yrs)
• Commonly a complication of a primary infection
elsewhere in the sinuses, ear or nasopharynx.
• These areas drain lymph to the retropharyngeal
lymph nodes which become infected and
develop into an abscess
Symptoms
• Nonspecific symptoms of infection
• May have stridor and neck swelling

35
Q

Retropharyngeal abscess for treatment

A

Surgical drainage
IV antibiotics
If treatment is timely 100% of patient recover fully

36
Q

Pharyngeal diverticulum

A

. Also known as a pharyngeal pouch
• Posterior outpouching of the hypopharynx through a weakness in the muscle

37
Q

Pharyngeal diverticulum causes and symptoms

A

Causes
- Advancing age
Symptoms
- Food and liquid become trapped leading to a sensation of trapped food, dysphagia, regurgitation, chronic cough, aspiration pneumonia

38
Q

Treatment of Pharyngeal diverticulum

A

Endoscopic surgery to resect it

39
Q

Foreign bodies

A

In America foreign body aspiration is the 4th leading
cause of death in younger children

40
Q

Tonsillitis and complications description

A

Inflammation of any of the tonsils

41
Q

Tonsillitis and complications causes and symptoms

A

Causes
- Bacterial infection, commonly Strep A
Symptoms
- Pain, dysphagia, fever

42
Q

Treatment of tonsillitis and complications

A

Antibiotics. Oral if uncomplicated, IV if there is concern for quinsy

43
Q

Underactive thyroid (hypothyroidism)

A

Description
- The thyroid does not produce enough thyroid hormone resulting in decreased cellular metabolism.
Causes
- Autoimmune diseases such as Hashimoto’s is the most common cause.
Symptoms
- Affects nearly every system in the body
- SOB
- Muscle / joint pain
- Weight gain, cold intolerance
Treatment
Drugs to replace the thyroid hormone - levothyroxine

44
Q

overactive thyroid (hyperthyroidism)

A

Description
• The thyroid produces too much thyroid hormone
Causes
• Graves disease, radiation or drug induced, tumours
Symptoms
• Heart arrythmias most commonly
• Goitre
• Weight loss
Treatment
. Drugs, radioactive iodine treatment, surgery

45
Q

Thyroid cancer causes symptoms and treatment

A

Causes
. Head and neck radiotherapy
• Family history
• There are many different types
Symptoms
• Usually a palpable mass
Treatment
. Surgery and radioactive iodine treatment

46
Q

Enlarged lymph nodes

A

. Description
Enlarged lymph nodes
• Causes
Infection
Neoplastic (due to cancer)
Due to certain drugs
• Symptoms
Depends in cause but can cause pain and
difficulty in movement
• Diagnosis
Can be seen and measured on CT and MRI.
PET will show intense F-FDG uptake