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Respiratory Diseases > Anatomy of lower respiratory tract > Flashcards

Anatomy of lower respiratory tract Flashcards

1
Q

What does the respiratory portion of the respiratory system consist of?

A
  • Respiratory bronchioles
  • Alveolar ducts
  • Alveolar sacs
  • Alveoli
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2
Q

What is the conducting portion of the LRT?

A
  • Carina - a ridge of cartilage at the base of the trachea, usually at T4/T5 vertebral level
  • Separates the openings of the left and right main bronchi
  • Mucous membrane of the carina = serious radiological sign, usually indicated carcinoma of the lymph nodes around the region where the trachea divides
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3
Q

What is the respiratory portion?

A
  • Extends from the branching of the respiratory bronchioles to the alveolar ducts and the alveolar sacs
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4
Q

Describe the trachea

A
  • starts at the cricoid cartilage
  • It is palpable at the suprasternal notch
  • 15-20 C shaped cartilaginous incomplete rings keep airway open
  • Bifurcates at the sternal angle (T4/T5 verterbrall level) into two main bronchi (Carina)
  • Right bronchus - makes an anfle of 25 degrees. letft - 45 degrees
  • Left main bronchus passes under aortic arch
  • Carina - very sensitive area of the trachea, hook shaped process projecting backwards from the lowest tracheal ring
  • Bronchoscopy - visualising the interior of the bronchi through a bronchoscope passed through the mouth and the trachea
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5
Q

What are the divisions of the bronchial tree?

A
  • Main bronchi
  • Lobar bronchi
  • Segmental bronchi
  • Terminal , Respiratory Bronchioles
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6
Q

What are the Broncho-pulmonary segments?

A
  • Lung is divided into segments based on the arborisation of the bronchi
  • BP segments are the largest functional divisions of the lung lobes: each receiving their own air and blood supply
  • Each bronchopulmonary segment is sevred bt the tertiary/segmental bronchus of the bronchial treem along with their own arterial supply
  • The venous and lymphatic vessels of the BP segments pass through the intervening septae separating adjacent segments from each other
  • Each BP segment is functionally separate from the adjacent segments
  • Damaged segments can be resected without affecting adjacent segments
  • The infection of any BP segment usually remains restricted to it, TB and bronchogenic CA may spread from one segment to another
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7
Q

What are the BP segments of the lungs?

A
  • Right = 10 segments , Left =9
  • Superior lobe segments - Apical (1), posterior (2), anterior (3)
  • No middle lobe in left lung ; lingula present instead
  • BP Segments :
    1. Superior lingular
    2. Infeior lingular
    3. Lateral segments
    4. Medial sefments - 3 and 4 present in middle lohe of R luing (if apical and posterior segments are combined = APICO-posterior segment
    5. Inferior lobe segments - APICAL, Medial basal, anterior basal, lateral basal and posterior basal
    6. Medial basal segment may be absent or small in left lung, shares its bronchus with the anterior basal segment
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7
Q

What are the features of the lungs>

A
  • Each lung characterised by an apex, base, costal, medial and diaphragmatic surfaces
  • Have 3 borders - anterior, posrerior, inferior
  • Roughly conical in shape and are divided by fissures inro lobes.
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8
Q

Compare the left and right lungs

A

Left lung = 2 lobes and one fissure
Right lung = 3 lobes and 2 fissures

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9
Q

What do the mediastinal surfaces form on the lungs?

A
  • Mediastinal surfaces of the lungs and hila form lareral walls of the mediastinum
  • M structures form impressions of lungs
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10
Q

What is the difference of the mediastinal relations between the left and right lungs?

A

RIGHT LUNG :
- Brachiocephalic veins, Superior VC, IVC, Diaphragm, Oesophagus, Azygos vein

LEFT LUNG:
- Subclavian artery, Brachiocephalic vein, Oesophagus, Aortic arch, Descending Aorta, Diagphragm, Cardiac impression

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11
Q

Explain the importance of the hilum of the lungs

A
  • connects lungs to mediastinal structures
    Contains:
  • principal bronchus, bronchial arteries and veins
  • Connective tissue
  • Broncho-pulmonary lymph nodes
  • Pulmonary artery
  • Pulmonary veins x2
  • Pulmonary plexusof nerves / sympathetoc plexus formed by CN X
  • Main bronchi & pulmonary vessels from the root of the lungs
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12
Q

What is the lung vasculature?

A
  • Lungs are supplied with deoxygenated blood by 2 pulmonary arteries, arising from pulmonary trunk from the right ventircile.
  • Oxygenated blood reaches left atrium of heart via four pulmonary veins
  • Bronchi, lung roots, and visceral pleura are also supplied by the bronchial arteries, arising from the descending thoracic aorta
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13
Q

What is the role of somatic nerves in the lungs?

A

Supplies the URT via the cranial berves.
Chest wall supllied by the intercosatal nerves
Diaphragm- phrenic nerve

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14
Q

What is the role of the ANS in the lungs?

A
  • Innervates bronchi and lungs via pulmonary plexus, located in the thorax
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15
Q

How is the lung innervated?

A
  • Derived from pulmonary plexus
  • consists of sympathetic, parasympathetic, visceral afferents
16
Q

What is the parasympathetic innervation of the lungs?

A

-Derived from the vagus nerve
-Stimulates secretion from the bronchial glands, contractioon of the bronchial smooth muscle, and vasodilation of the pulmonary vessels

17
Q

What is the sympathetic innervation of the lungs?

A
  • Derived from the sympathetic trunks
  • Stimuate relaxation of the bronchial smooth muscle and vasoconstriction of the pulmonary vessels
18
Q

What is the role of the visceral afferent to the lungs?

A
  • conduct pain impulses to the sensory ganglion of the Vagus nerve (CN X)
19
Q

What is the role of lung lymphatic vessels ?

A
  • Have 2 plexuses:
  • Superficial : Drains lung parenchyma
  • Deep : drains the structures of lungroot
    Both lymphatic plexuses drain into the tracheobronchial lymph nodes, which are located at the tracheal bifurcation
20
Q

What is the diaphragm?

A
  • Primary muscle of respiration
  • Undergoes contraction and relaxation, alters vertical diameter of the thoracic cavity anf the lungs, producing inspiration and expiration
21
Q

What are the peripheral attachments of the diaphragm?

A
  • Lumbar vertebrae and IV discs
  • L1-L3 - right and left cura
  • Costal cartilages (7-10)
  • Xiphoid process of the sternum
  • Skeletal muscles insert to form a central tendon that ascends to fuse with the ineferior surface of the fibrous pericardium
22
Q

What are the openings of the diaphragm?

A
  • Allow structures to travel to/ from the abdomen
  • Caval hiatus (T8) - IVC and the right phrenic nerve
  • Oesophageal hiatus (T10)- Oesophagus, right and left vagus nerves
  • Aortic hiatus (T12)- Aorta, Thoracic duct and Azygous vein
  • Diaphragm receives motor innervation from phrenic nerve, spinal roots C3- C5 (cervical plexus)
  • Majority of arterial supply of the diaphragm is delivered via inferior phrenic arteries.
23
Q

What are the intercostal muscles and what are they innervated by?

A

Internal, external, innermost intercostal muscles
- innervated by the intercostal nerves, suipplied by intercostal arteries, drained by intercostal veins
- Neurovascular bundle present in the costal groove

24
Q

What is the function of the external intercostal muscles?

A
  • To elevate the ribs during forced inspiration
25
Q

What is the function of the internal intercostal muscles?

A

Depress the ribs during forced expiration

26
Q

What is the function of the innermost intercostal muscles?

A

To assist in the depression of the ribs during forced expiration

27
Q

What is the action of the ribs and muscles on the thoracic cage during breathing?

A
  • Pump handle movement increases the anteroposterior diameter of the thorax during elevation
    -Results in raising and lowering the sternal end of ribs
  • Lower rib movements result in raising and lowering the middle of the rib, Bucket- handle movement. Increases the transverse diameter of the thorax during elevation of the lower ribns
28
Q

What are the accessory inspirtatory and expiratory muscles?

A

-Stemocleidomastoid, scalenus anterior and posterior, pectoralis major, minor , serratus aneterior and latissimus dorsi
- Accessory expiratory muscles - abdominal muscles, rectus abdominis, external oblique, internal oblique and transverse abdominis

29
Q

What is the pleura?

A

protects lungs from friction against chest wall, formed of simple squamous epithelial layer
Visceral = covers lunfs
parietal pluera- covers internal surfaces of thoracic cage (costal), mediastinium ( mediastinal) and cervical (Apical) region, diaphragm (diaphragmatic)
- Pleural cavity - contains a thin film of serous fluid

30
Q

What nerves innervate the pleurae?

A
  • Phrenic nerves = mediastinal and diaphragmatic pleurae
  • Intercostal nerves = apical and costal pleurae
  • ## Autonomic innervation = pulmonary plexus for parietal p
31
Q

What is the blood supply of the pleura?

A
  • derived from the intercostal arteries (parietal p) and from bronchial arterues (visceral pleura)
32
Q

What is pnuemothorax?

A

Air/ fluid that enters the pleural cavity and compresses the lungs, causing it to collapse.
- occurs when gas/ air is present within the pleural space, which removes serous tension of the serous fluid in pleural cavity, reducing lung extension
- Sponatneous or traumatic (from blunt/ penetrating chest trauma)

33
Q

What is tension pneumothorax?

A
  • Can result from traumatic pneumothorax, air continues to enter into pleural cavity
  • trachea deviates towards contralateral side and can form a valve
  • prevents air entering the unaffected lung
34
Q

What is pleural effusion?

A
  • fluid collection in the plueral cavity due to infection/inflammation associated with the lungs/ pleura
35
Q

What is a heamothorax?

A

The presence of blood in the pleural cavity

36
Q

What is a chylothorax?

A
  • the presence of chyle (lymph) in the pleural cavity
37
Q

What is empyema?

A

a collection of pus in the pleural cavity caused by microorganisms, usually bacteria

38
Q

How is a pneumothorax/ pleural effusion treated?

A
  • Chest drain usually inserted in the mid-axillary line at the 5th/6th intercostal space, abopve the rib
  • Pneumothorax- drain should point upwards
  • Pleural effusion - drain point downwards

Respiratory Diseases (17 decks)

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