Anatomy of Respiratory System Flashcards
what structures form the upper respiratory tract
the right & left nasal cavities
or the oral cavity
the naso- oro- & laryngo- pharynx
larynx
what structures form the lower respiratory tract
trachea right & left main bronchi lobar bronchi segmental bronchi bronchioles alveoli
where does the larynx become the trachea and they pharynx become the oesophagus
at C6 vertebra
cricoid cartilage
where is the trachea palpated
he jugular notch of the manubrium can feel cart igneous right
where is the isthmus of the thyroid gland located
anterior to tracheal cartilages 2-4
what is the only bone that doesn’t articulate with any other bone in the body
hyoid
bones in neck from superior to inferior
hyoid
thyoid
cricoid cartilage
where does the thyroid gland sit
anterior to trachea
where is the thorax located
between neck and abdomen
what structures make up the thorax
chest walls - rib cage
chest cavity - contains viscera, major vessels, nerves, mediastinum, left & right pleural cavities
list the chest wall layers from superficial to deep
skin fascia (superficial -> deep) skeletal muscle bone (ribs) parietal pleura
role of the chest wall
protect lungs and heart
movement of breathing
breast tissues - lactation
what does the mediastinum contain
heart and great vessels
located between pleural cavity
role of the pleural cavity
to protect lungs
define lung lobe
are of lung that each of the lobar bronchi supply with air
what lobes does the right lung have
superior, middle, inferior lobe
what are the lung lobes separated by
oblique fissures
what lobes does the left lung have
superior and inferior
how does the left lung differ from the right
the right lung has a horizontal fissure separating the superior and middle lobes, left lung does not have a middle lobe
what lung is higher, why
right lung, due to the liver
what is lingual
appendage of tissue only non left lung as there is no middle lobe on the left lung due to position of heart
describe the segments of the lung
10 segments can be isolated during surgery, each segment has its own blood/lymph/air/venous supply
what is the thoracic skeleton made up of
12 rib pairs intercostal spaces 12 thoracic vertebrae clavicle, scapula sternum costal margin
what are ribs 1-7 called
true ribs, costal cartilage attaches to sternum
what are ribs 8-10 called
false ribs as the costal cartilage above to the sternum
what are ribs 11 & 12 called
floating ribs
no sternum attachment
what is the sternum made up of
manubrium
body
xiphoid
sternal angle
what is the mesosternum
sternum process
how does the rib attach to the sternum
via costal cartilage
what does the head of the rib articulate with
body of vertebra of the same number thoracic vertebrae but also partly with the vertebrae superiorly
what does the rib tubercle articulate with
transverse process of the vertebra of the same number
what joint type are the sternocostal joints
synovial
what joints in the thoracic skeleton have limited movements
costovertebral
what are the costal margins
cartilage edge of the false ribs
what type of joint is costovertebral joints
hyaline cartilaginous joints
no movement
3 layers of skeletal muscle located between ribs and within the intercostal spaces
external intercostal internal intercostal innermost intercostal (each layer attach between adjacent ribs)
how do the intercostals move the ribs during breathing
expand chest wall pulling adjacent ribs up and out
how many pairs of intercostals is there
11
what does each intercostal space between innermost intercostal and internal intercostal carry
neuro-vascular bundle:
artery, vein and nerve
what is the nerve supply of the intercostals
anterior rams of spinal nerve
intercostal nerve
what is the posterior atrial supply to the intercostals
thoracic aorta
posterior venous drainage of intercostals
azygous vein
anterior atrial supply to intercostals
internal thoracic artery
anterior Venous drainage to intercostals
internal thoracic vein
what skeletal muscle forms the floor of the chest cavity and the roof of the abdominal cavity
diaphragm - skeletal muscle with a central tendon
why does the diaphragm have opening
allows structures to pass through connecting abdominal and chest cavities
why is the right dome higher than left dome of the diaphragm
presence of the liver inferiorly
what does the diaphragm attach peripherally to
sternum
lower 6 ribs + costal cartilages
L1-L3 vertebral bodies
what nerves supply the diaphragm
phrenic nerves C3,4,5
anteripr rami
the diaphragm is supplied by the autonomous/somatic nervous system
somatic
where are the phrenic nerves found
neck: anterior surface of scalenus anterior muscle
chest: depend over lateral aspects of heart
what does the phrenic nerves supply
somatic sensory & sympathetic axons to diaphragm and fibrous pericardium
somatic motor axons to diaphragm
what is the pleural cavity
vacuum containing pleural fluid
difference between parietal and visceral pleura
visceral pleura in contact with lungs
when the lungs expand how does air move into the lungs
under negative pressure
when the intercostals contract how are the ribs elevated
increases A-P and laterally
what happens during expiration
elastic recoil so air pushed out
where is the trachea palpated
jugular notch of manubrium
where is the sternal angle located
rib 2
T4
what is adipose tissues function
insulation
function of deep fascia
fibrous tough
protection
what vein is located in the delta-percoral groove
cephalic vein, drains upper limb
what is superficial fascia
fat, adipose tissue
what causes a winged scapula
paralysis of serrates anterior
dure to injury eg compression of long thoracic nerve which supplies serratus anterior
thoracic wall no longer attached to scapula so sticks out
function of the serratus anterior
anchors scapula to thoracic wall
muscles of anterolateral chest wall
pectorals major
serratus anterior
ltissimus dorsi
were are the subclavian vessels located
lateral to the lateral border of the first rib
they become axillary vessels then brachia vessels
what is the fibrous pericardium covered bilaterally with
parietal pleura
what is the only connection of the lungs to the mediastinum
the lung roots
areas of the parietal pleura
cervical pleura costal pleura visceral pleura diaphragmatic pleura = in contact with parietal mediastinal parietal pleura
what is the most dependant part of the pleural cavity (most inferior)
costodiaphragmatic recess
where does abnormal fluid in the pleural cavity drain eg pleural effusions/hemothroax
costodiaphragmatic recess - causes blunting of angles
angles not clear on CXR
what is located between diaphragmatic parietal pleura and costal pleura
costodirphragmatic recess
what is laterally the most inferior region of the lungs
costophrenic angle
what are the structures of the root of lung
1 main bronchus 1 pulmonary artery 2 pulmonary veins lymphatics viscera afferents sympathetic + parasympathetic nerves
what is the root of the lung called
the hilum
4 features of the hilum
main bronchi (hyalin cartilage in walls)
pulmonary arteries
pulmonary lymph nodes (back)
pulmonary veins
on the left lung arteries are located superior/inferior whereas veins are located antrosuperior/antroinferior
arteries = superior veins = antroinferior
what do normal breathing sounds, sound like
rustling
what must be auscultated in the lungs
5 lung lobes
apices (at top of lungs)
bases
what do pleurae secrete
pleural fluid into pleural cavity
what is the role of pleural fluid
a lubricate
provides surface tension
how do lungs in embryo differ from lungs in adult
lung bud (balloon) in embryo pushes out from the mediastinum into pleural cavity but is not in the cavity whereas in adults theres a vacuum filled with pleural fluid so lung is in the pleural cavity
what 4 structures of the resp. have sensory receptors in the mucosa
oropharynx
laryngopharyx
larynx
respiratory tree (trachea to bronchioles)
what sensory receptors of nerves are stimulated in sneezing
CN V or CN IX
what sensory receptors of nerves are stimulated in coughing
CN IX (glossopharyngeal) - on surface of carotid sheath or CN X (vagus) in carotid sheath
what does the carotid sheath contain
vagus nerve
internal carotid artery
common carotid artery
internal jugular vein
what is there carotid sheath
bilateral, protective tubes of cervical (neck) deep fascia
attaches superiorly to the bones of the base of the skull and blends inferiorly with the fascia of the mediastinum
how do nerves initiate cough reflex
send sensory impulses to the CNS via carotid sheath
how do visceral pleura and respiratory trees visceral afferents (sensory nerve) connect with CNS
via the pulmonary plexus
sympathetic trunk
vagus nerve CNX in the carotid sheath
pulmonary visceral afferents travel from visceral pleura and resp tree to the plexus then follows vagus nerve to the medulla of brain stem
what does the pulmonary plexus contain
sympathetic axons
parasympathetic axons
visceral afferens
what is the role of motor axons travelling from tracheal bifurcation to branches of the resp tree
supply all mucus glands and all bronchiolar smooth muscle
how is a negative pressure in the lungs created
diaphragm contacts + descends
intercostal muscles elevate ribs (increased AP/lateral dimension)
chest wall pull parietal pleura creating vacuum and pulls visceral pleura (lungs)
main muscle of quiet inspiration
diaphragm
what nerves supply the diaphragm
anterior rami of C3, 4, 5
where is the phrenic nerves found in the neck
anterior surface fo scalenus anterior muscle
where is the phrenic nerve located in the chest (thorax)
descends over lateral aspects of the fibrous pericardium ANTERIOR TO HYLEM (lung root)
role of the phrenic nerve
supplies somatic sensory and sympathetic axons to diaphragm and fibrous pericardium and somatic motor axons to diaphragm
INNERVATES DIAPHRAGM
role of phrenic nerve in deep/forced inspiration
greater outflow of action potential of longer duration of phrenic nerve causing diaphragm to flatten + maximally descend
what are the intercostal nerves
anterior rami of spinal nerves T1 - T11
what does the posterior rami of the nerve supply only supply
the back
role of intercostals in deep/forced inspiration
muscle contracts forcefully, raises ribs maximally
3 intercostal muscles
external
internal
innermost
what are the accessory muscles of deep/forced inspiration
pectoralis major
pectoralis minor
strnocleidomastoid
scalenus anterior, medius + posterior
what is recruitment of the accessory muscles a clinical sign of
dyspnoea - breathing difficulty
role of pectorals major in deep/forced breathing
if fixed upper limb position ie. hold onto arms of a chair or thigh (hunch over) pectorals major pulls the ribs up and out expanding thoracic cave
where does the pectorals major attach between
sternum/ribs + humerus
adduce and medially rotates humerus
role of pectoralis amino in deep inspiration
pulls ribs 3-5 superiorly shards coracoid process of scapula
attachments of sternocleidomastoid muscle
sternum/clavicle + mastoid press of temporal bone
it is the big muscle in neck that can lift thoracic cave superiorly
attachment of silenus anterior, medium and posterior
between cervical vertebrae and ribs 1+2
where is the sternal angle located
rib 2
during cough reflex what is closed to prevent air escaping the lungs
rima glottidis
where are the vocal cords found
midline, close the rims glottidis
what are the intrinsic muscles of the larynx
all skeletal (voluntary) muscles
attach between cartilages
move the cartilages resulting in vocal cords
what are the intrinsic muscles of the larynx supplied by
somatic motor branches of CNX
role of intrinsic muscles of the larynx during cough reflex
adduct vocal cords
what are the 3 laryngeal cartilages
thyroid cartilage (large cartilage superior) cricoid cartilage aretanoid cartilage (posterior 2 little cartilages)
what separates the upper and lower resp trac
rima glottidis
what nerve are the vocal cords supplied by
vagus nerve
where do the vocal cords sit
C6
where does the right and left mixed cranial nerves connect with the CNS
at medulla (obligate) of brainstem
how does the vagus nerve enter brain
at base of skull via jugular foramen with internal jugular vein
how does the vagus nerve descend from brain to neck
within carotid sheath
where does the vagus nerve descend over in the chest
POSTERIOR TO HYLEM (lung root)
what does CNX supply to the chest organs inc. pulmonary plexus
parasympathetic axons
how does CNX pass through the diaphragm
on the oesophagus
on surface of stomach divide into parasympathetic branches fro foregut + midgut organs
what is the function of the vagus nerve in cough reflex
supplies sensory axons to the mucosa lining larynx
supplies motor axons to intrinsic muscles of larynx
how is air pushed out during expiration
diaphragm relaxes and rises
intercostals lower ribs
elastic tissue of lungs recoils
what are the accessory muscles of deep (forced) inspiration
right/left anterolateral abdominal wall muscles contract increasing abdominal pressure, forces diaphragm up increasing intra-thoracic pressure
what are the anterolateral abdominal wall muscles
right/left transverses abdominus
right/left internal oblique
right/left external oblique
right/left rectus abdominis (6 pack muscles)
where does the aponeurosis of the right and left external oblique meet
midline - linea alba
why are abdominal muscles unique
50/50 muscle/tendon (aponeurosis)
what forms the transition between muscle and aponeurosis
linea semilunaris (right and left)
where does the right external oblique attach
superiorly: lower ribs
inferiorly: anterior iliac crest and pubic tubercle
what is the attachments of the internal oblique muscles (deep to external oblique)
superior: inferior border of lower ribs
inferior: ileac crew and thoracolumbar fascia of lower back
muscle fibre direction of external oblique
anterior downwards
muscle fibre direction of internal oblique
posterior downwards
where is the transverses abdominus located
deep to internal oblique
direction of fibres of transverses abdominus
posterior to anterior
horizontal
attachments of transverse abdominus
superiorly: deep aspects of the lower ribs
inferiorly: iliac crest + thoracolumbar fascia of lower back
what nerves (somatic motor, sensory and sympathetic fibres) supply the abdomen muscles
thoracoabdominal nerves:
7TH-11TH Intercostal travel anteriorly to plane between internal oblique & transverses abdominus
subcostal nerve T12 anterior ramus
iliohypogastic nerve half L1 anterior rami
ilioinguinal nerve other half L1
function of the 4 abdominal muscles
maintain posture suport vertebral column movements of spine guarding (protect) abdominal viscera contract to increase intra-abdominal pressure + forced expiration
in the cough reflex the CNS responds rapidly to coordinate what responses
1) deep inspiration: diaphragm (phrenic nerves), intercostal muscles (intercostal nerves) & accessory muscles
2) adduction vocal cords, close rima glottidis (vagus)
3) anterolateral abdominal wall muscles contract (intercostal nerves) builds intra-abdominal pressure (vocal cords closed)
4) vocal cords suddenly abduct opening rims glottides
5) soft palate tenses (CNV) and elevates (vagus) closes nasopharynx and directs stream of air (100mph) through oral cavity as cough
what is the main nerve of the diaphragm
phrenic nerve
what nerve adducts then abducts vocal cords closing rim glottidis
vagus nerve
what nerves cause contraction of the anterolateral abdominal wall muscles
intercostal nerves
what causes the soft palate to tense
CNV (trigeminal nerve)
what causes soft palate to elevate
vagus nerve
4 parts of the mediastinum
middle mediastinum
anterior mediastinum
superior mediastinum
posterior mediastinum
what does the middle mediastinum contain
the heart and commencement of great vessels
what does the anterior mediastinum contain
adults - fat
children - thymus gland for immune response, produces mature T cells
what does the posterior mediastinum contain
thoracic aorta
thoracic duct
azygous vein (drains intercostals)
what does the superior mediastinum contain
aorta and veins draining from head + neck
what is the level of the sternal angle
T4
rib 2
what is the level of the mid mediastinum
T7
what is the consequences of a mediastinal shift
tracheal deviation away from the side of a unilateral tension pneumothorax - palpated in jugular notch
SVC compression - reduces venous return to heart = hypotension (low arterial bp)
where does the aorta, thoracic duct and azygous vein perforate the diaphragm
T12
where does the trachea bifurcate
carina
T5, rib 2
where can the sternal angle be palpated
Rib 2
where is the right middle lob located
between ribs 4-6
mid clavicular and midaxillary lines
where is the horizontal fissure
right rib 4
where can the base of the lungs be auscultated
T12
where are the oblique fissures
Rib 6 (rising to T3)
