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Phase 1 - Anatomy > Anatomy - The Mediastinum and Sympathetic Chain > Flashcards

Anatomy - The Mediastinum and Sympathetic Chain Flashcards

1
Q

What is the ligamentum arteriosum a remnant of and what was its function in the foetus?

A

Remnant of the ductus arteriosum. It’s function was to shunt blood between the pulmonary trunk and the aorta in order to bypass the non-functioning lungs.

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2
Q

What branch does the left vagus nerve give off as it crosses the arch of the aorta?

A

The left recurrent laryngeal nerve.

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3
Q

Briefly describe the anatomical course of the right phrenic nerve.

A

Lies on large veins (brachiocephalic, SVC etc) and along the right side of the heart. Crosses in front of root of the lung.

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4
Q

Briefly describe the anatomical course of the left phrenic nerve.

A

Crosses the arch of the aorta and descends in front of the root of the lung.

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5
Q

What spinal roots is the phrenic nerve derived?

A

C3, 4 and 5 (cervical plexus).

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6
Q

What does the phrenic nerve supply?

A

Motor innervation to the diaphragm. Sensory innervation to the pleura, peritoneum and pericardium.

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7
Q

Briefly describe the anatomical course of the left vagus nerve.

A

Crosses the aorta and behind the root of the lung. Breaks up into branches on the oesophagus (oesophageal plexus) and leaves the thorax as the anterior gastric nerve.

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8
Q

Briefly describe the anatomical course of the right vagus nerve.

A

Lies on the trachea and crosses behind the root of the lung. Breaks up into branches on the oesophagus and leaves the thorax as the posterior gastric nerve.

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9
Q

Does the phrenic nerve enter the diaphragm? If so where?

A

Yes. It pierces the central tendon of the diaphragm alongside the IVC on the right (T8).

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10
Q

Does the vagus nerve enter the diaphragm? If so where?

A

Yes. Through the oesophageal hiatus (T10).

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11
Q

Describe the path of the phrenic nerves?

A
  • under the mediastinal pleura
  • downwards anterior to the hilum of the lung
  • pierces the dome of the diaphragm T8
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12
Q

Describe how the path of the left and right phrenic nerves differ?

A
  • right - runs adjacent to the right brachiocephalic vein and superior vena cave
  • left - over the arch of the aorta along lateral side of the pericardium
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13
Q

What do the phrenic nerves innervate?

A
  • diaphragm
  • sensory and motor fibres
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14
Q

Name the 2nd nerve that passes more posteriorly than the phrenic nerves?

A

Vagus nerve

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15
Q

Describe the pathway the left vagus nerve?

A

Behind the route of the lung to join the oesophagus which flows down into the abdomen

T10 - oesophageal hiatus

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16
Q

Where does the vagus nerve divide and what is its importance?

A
  • As it passes over the aortic arch gives off the recurrent laryngeal nerve
  • the recurrent laryngeal nerve passes over the ligament arteriosus
  • and back into the neck in the group between the trachea anteriorly and the oesophagus behind
  • supplying the muscles of the larynx
  • Cancerous tumours putting pressure on the laryngeal nerve results in a hoarse voice
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17
Q

What are the functions of the left and right brachiocephalic veins?

A

Drain blood from the head and neck and upper limbs combining to form the superior vena cava that enters the pericardium

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18
Q

What two vessels does the brachiocephalic trunk divided into?

A
  • The right common carotid
  • subclavian vessels
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19
Q

What 2 vessels are on the left and supply the upper half of the body?

A
  • left common carotid
  • left subclavian arteries
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20
Q

Describe the two layers of the pericardium and their function?

A
  • parietal pericardium- Covers the fibrous pericardium
  • visceral pericardium - Covers blood vessels and heart
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21
Q

Define the surfaces of the heart?

A
  • diaphragmatic - inferior
  • Sterno-costal - Anterior
  • base - posterior
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22
Q

Where does the phrenic nerve originate from?

A
  • C3, C4, C5 nerve roots
  • pain is felt on the third fourth and fifth Dermatomes
  • i.e. the neck and shoulders, shoulder tip
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23
Q

What is the developmental significance of the ligamentum arteriosum?

A
  • Valve between Left pulmonary artery And descending aorta
  • used in fetal circulation to prevent blood going through the lungs
  • Closes within three weeks of birth
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24
Q

Describe how the mediastinum is divided into two parts?

A
  • Imaginary line divided at the sternal angle (2nd costal cartilage) to the T4 vertebrae
    • Superior mediastinum - extends upwards terminating at the superior thoracic aperture
    • inferior mediastinum - extends downwards terminating at the diaphragm
      • subdivided into anterior, middle and posterior mediastinum
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25
Q

Describe the thoracic structure borders of the mediastinum?

A
  • Superior - thoracic inlet
  • Inferior - continuous with superior mediastinum at the level of the sternal angle
  • anterior - Manubrium of the sternum
  • Posterior - vertebrae bodies of T1-4
  • lateral - pleurae of the lungs
26
Q

What are the three main branches of the aortic arch arising within the superior mediastinum?

A
  • brachiocephalic artery - supplying right-sided head and neck in the right upper limb
  • left common carotid artery - to supply the left side had an
  • left subclavian artery - to the left upper limb
27
Q

What are the four main tributaries to the superior vena cava located within the superior mediastinum?

A
  • Brachiocephalic vein - drains blood from upper body
    • left superior intercostal vein - collect blood from the second and third intercostal vein, drains into left brachiocephalic Vein
    • supreme intercostal vein - Drains the vein from the first intercostal space directly into the brachiocephalic veins
  • Azygos vein - receives blood from my posterior intercostal vein, then accessory veins, before joining azygos vein around T7-T9
28
Q

Describe two distinct parts of the vagus nerve and Laryngeal nerve in the superior mediastinum?

A
  • Right vagus nerve - runs parallel to the trachea passes posteriorly to the superior vena cava and the right primary bronchus
    • Passes through the diaphragm behind the oesophagus with the left vagus nerve In front
  • Left vagus nerve - enters between the left common carotid and left subclavian arteries, Descends anteriorly to the aortic arch before travelling posterior to the left bronchus.
    • Joins oesophagus at the level of the leave of the lungs
    • pass through the Oesophageal hiatus into the diaphragm
  • Left recurrent laryngeal nerve - arises from left vagus nerve as it passes the aortic arch, loops under the arch to the left of the ligamentum arteriosum Before continuing to the larynx
29
Q

Describe other phrenic nerve passes through the superior mediastinum?

A
  • from the anterior surface of the anterior scalene muscle, the phrenic nerve (roots C3,4, and 5) enters the superior mediastinum lateral to the great vessels
  • then descends anteriorly into the middle mediastinum, passing anteriorly to the helium of the lungs
30
Q

What cervical nerves can be found in the superior mediastinum?

A
  • Originating from the superior (C1 to C4), middle (C5 to C6) and inferior (C7 to T1) cervical ganglion
  • Forms superficial and deep cervical plexuses
    • superior plexus sits between aortic arch and right pulmonary artery
    • Deep plexus lies on the surface of the trachea at the point of bifurcation
31
Q

Where does a sympathetic trunk lie?

A

bilaterally to the vertebral bodies along the entire length of the vertebral column

32
Q

Describe the location of the oesophagus?

A
  • Behind the tracha
  • runs alongside the descending aorta and thoracic vertebrae
  • passes through the diaphragm and enters the abdomen at T10
33
Q

What is the thoracic duct?

A
  • drains all the lymph from the lower half of the body and bow back into the bloodstream
  • drains into the confluence of the left subclavian vein and internal jugular vein on the left side of the neck
34
Q

Describe the intercostal vessels?

A
  • arteries and veins running horizontally over the vertebral bodies
  • veins on the right are called the azygous system
  • veins on the left are called hemi-azygous system
  • at least one connecting vein between them
  • draining the thoracic wall and upper lumbar region
35
Q

How many ganglia are there within the thorax?

A
  • 12, one for each vertebrae
    • three in the neck
    • one per abdominal vertebrae
    • one per pelvic vertebrae
36
Q

What forms the three splanchnic nerves? What are they?

A
  • 5- 12 thoracic Ganglia nerves, pain supply in the upper abdomen
  • Supply the bowel
    • greater splanchnic nerve arises from T5 to T9 to supply the foregut
    • Lesser splanchnic nerve arises from T10 to T11 and supplies the midgut
    • least splanchnic nerve arises from T12 and supplies the hindgut.
37
Q

Why do more foreign objects get stuck in the right lung?

A

because the right main bronchus is more vertical and wider than the left

38
Q

What is a TOE and what its function?

A
  • trans-oesophageal Echo
  • placed in the oesophagus and provides exceptional images and measurements of the function of the mitral valve
  • i.e. the mitral valve disease
39
Q

What is Horner’s syndrome? Why does it clinically occur?

A
  • All sympathetic nerve supply to the head and neck travels to the thoracic one ganglia of the sympathetic chain
  • damage to this ganglia causes loss of sympathetic innovation to the face and eyes
  • results in facial sweating, drooping of the eyelid, constricted pupils, and eyes slightly drawn in
40
Q

Describe the journey of the Thoracic descending aorta through the thorax?

A
  • Beginning at the lower edge of the T4 vertebrae
  • descend through the posterior mediastinum to the left of the vertebrae becoming more medial as it moves
  • at the inferior border of T12, the thoracic aorta becomes the abdominal aorta and passes through the aortic hiatus of the diaphragm
41
Q

Describe the pattern of arising branches from the thoracic aorta?

A
  • unpaired branches to the viscera extend anteriorly
  • paired branches to the viscera extends laterally
  • paired segmental parietal branches extend mostly posterolateral
42
Q

Describe the posterior intercostal arteries?

A
  • paired parietal branches
  • nine pairs branch from the posterior aspect of the aorta
  • supplies intercostal space ( except the first two)
  • Pass posteriorly and Laterally, in parallel with the ribs
43
Q

Describe bronchial arteries?

A
  • paired visceral branches, usually one or two
  • left bronchial arteries always arise directly from the thoracic aorta
  • Right brachial artery usually branches indirectly from the right posterior intercostal artery
  • go on to supply the tracheobronchial tree
44
Q

Describe the oesophageal arteries?

A
  • Unpaired visceral branches
  • arises from the anterior aspect of the aorta
  • in most of individuals, there are two but can be up to 5
  • supply the oesophagus
45
Q

Describe the superior phrenic arteries?

A
  • arise from the anterior aspect of the thoracic aorta at the aortic hiatus (T12)
  • varying number
  • supply the superior aspect of the diaphragm
46
Q

Described the journey of the oesophagus through the thorax?

A
  • passes into the posterior mediastinum from the superior mediastinum
  • descending posteriolaterally to the arch of the aorta in the heart
  • initially positioned to the right, it deviates the left as it moves downwards
  • Leaves the mediastinum via the oesophageal hiatus (T10) of the diaphragm
47
Q

What supplies the oesophagus?

A
  • the oesophageal plexus
  • surrounds the oesophagus as it descends
  • comprises a branch of the left and right vagus nerve
  • above the diaphragm, the plexus converge to form an anterior Vagal trunk and posterior Vagal trunk
    • travels along the surface of the oesophagus as it exits the thorax
48
Q

what is the function of the thoracic duct?

A
  • largest lymphatic vessel in the body
  • returns lymph from most of the body into the venous system
    • All except the right superior quadrant
  • Receives lymphatic drainage from the intercostal spaces and neighbouring structures while in the thorax
49
Q

Describe the journey of the thoracic duct through the thorax?

A
  • originates from the cisterna chyli (L1) in the abdomen
  • enters the mediastinum through the aortic hiatus ((T12)
  • Ascends to lie directly anterior to T6-T12 vertebrae
  • Deviates left as it ascends into the superior mediastinum
50
Q

Describes the three major veins in the Azygos system of veins?

A
  • Azygos vein - on the right, enters the mediastinum by the aortic hiatus (T12) and drains into the superior vena cava
  • hemiazygous vein - on the left, at T8 It turns ascends combines with the azygous vein
  • accessory hemiazygous vein - on the right, drains into the azygos vein at T7
51
Q

What is the sympathetic trunk Formed of? What is their function?

A
  • Paired bundles of nerves that extend from the base of the skull to the coccyx
  • in the thoracic region they are known as the thoracic synthetic trunk, lying within the posterior mediastinum
  • the lower thoracic splenic nerves arise from them
    • continue inferiorly to supply the viscera of the abdomen
52
Q

What vertebral level is the tracha bifurcation?

A

T4.

53
Q

What is the function of the thoracic duct?

A

It drains all the lymph from the lower half of the body and bowel back into the blood stream.

54
Q

Where does the thoracic duct drain into?

A

The confluence between the left jugular vein and left subclavian vein. (C7) (then into superior vena cava)

55
Q

Where does the azygous vein drain into?

A

The superior vena cava.

56
Q

What are the names of the three splanchnic nerves?

A

The greater (T5-9), the lesser (T10-11) and the least (T12).

57
Q

What is the function of the splanchnic nerves?

A

They provide sympathetic innervation to the foregut, midgut and hindgut.

58
Q

Occlusion of which vessel is most likely to result in a fatal heart attack?

A

The left main coronary artery.

59
Q

Which artery provides the main blood supply to the left ventricle?

A

The left anterior descending artery.

60
Q

Which vessel is most likely to become occluded without producing any symptoms?

A

Right marginal artery.

61
Q

What is stenosis?

A

Narrowing.

62
Q

Which artery most frequently supplies the AVN?

A

The right main coronary artery.

Phase 1 - Anatomy (29 decks)

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