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Anatomy: Respiratory > Consequences of Chronic Cough > Flashcards

Consequences of Chronic Cough Flashcards

1
Q

What is dynamic airway compression?

A

When during expiration the intrapleural pressure rises above alveolar pressure which compresses the airways

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2
Q

Why is expiration more difficult than inspiration?

A

In expiration, the intrapleural pressure rises which compresses the airways narrowing them, making expiration more difficult

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3
Q

What can the build up of air in the alveoli due to dynamic airway compression lead to?

A

A rupture of the visceral pleura

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4
Q

What is the consequence of a rupture of the visceral pleura?

A

Air can enter the pleural cavity and the transmural pressure gradient is lost

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5
Q

What is a pneumothorax?

A

Air in the pleural space which results in the loss of the connection between the lung and the body wall

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6
Q

What defines a small pneumothorax?

A

Less than a 2cm gap between the lung and the parietal pleura

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7
Q

What defines a large pneumothorax?

A

Greater than 2cm between the lung and parietal pleura

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8
Q

What can cause a pneumothorax?

A

Penetrating injury to the parietal pleura

Rupture of the visceral pleura

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9
Q

What would be seen on examination of a patient with a pneumothorax?

A

Ipsilateral reduced chest expansion and breath sounds

Hyper-resonant percussion

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10
Q

What is a tension pneumothorax?

A

A pneumothorax where the torn pleura forms a one way valve which allows air into the pleural cavity on inspiration but prevents it leaving on expiration

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11
Q

What can a tension pneumothorax cause?

A

Mediastinal shift due to the increased pressure on one side of the thorax with each inspiration

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12
Q

What are the regions of the mediastinum?

A

Superior mediatstinum

Inferior mediastinum, made up of

  • anterior mediastinum
  • middle mediatstinum
  • posterior mediastinum
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13
Q

What level divides the superior and inferior mediatstinum?

A

Level of the sternal angle

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14
Q

Which region of the mediatstinum is the heart located in?

A

Middle mediastinum

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15
Q

What divides the anterior, middle and posterior mediatstinum?

A

The heart forms the middle mediastinum which puts anything anterior to the heart in the anterior mediastinum and anything posterior to the heart in the posterior mediastinum

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16
Q

What are the consequences of a tension pneumothorax?

A

Tracheal deviation

SVC compression can reduce venous return to the heart

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17
Q

What direction does the trachea deviate to in a unilateral tension pneumothorax?

A

Away from the side of the pneumothorax

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18
Q

What structure can be compressed in a tension pneumothorax which reduces venous return to the heart

A
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19
Q

What is the management of a large pneumothorax?

A

Thoracentesis (needle aspiration)

or

Chest drain

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20
Q

What is the purpose of thoracentesis/chest drain in the management of a large pneumothorax?

A

To remove the excess air from the pleural cavity

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21
Q

4th or 5th intercostal space in the midaxillary line

In the ‘safe triangle’

  • anterior border of lattismus dorsi
  • posterior border of pectoralis major
  • axial line superior to nipple
A
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22
Q

What are the borders of the ‘safe triangle’ in drainage of a large pneumothorax?

A

Anterior border of lattismus dorsi

Posterior border of pectoralis major

Axial line superior to nipple

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23
Q

From superficial to deep, which layers are penetrated in the drainage of a large pneumothorax?

A

Skin (superficial)

Superficial fascia

Deep fascia

External intercostal muscles

Internal intercostal muscles

Innermost intercostal muscles

Parietal pleura (deep)

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24
Q

What is the management of a tension pneumothorax?

A

Insertion of large bore cannula into the pleurl cavity via the 2nd or 3rd intercostal spaces in the midclavicular line on the side of the tension pneumothorax

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25
Q

Where is the large bore cannula inserted in the management of a tension pneumothorax?

A

2nd or 3rd intercostal space, midclavicular line

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26
Q

What is used in the emergency management of a tension pneumothorax?

A

Large bore cannula

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27
Q

From superficial to deep, which layers must the large bore cannula penetrate in the treatment of a tension pneumothorax?

A

Skin

Superficial fascia

Deep fascia

External intercostal muscle

Internal intercostal muscle

Innermost intercostal muscle

Parietal pleura

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28
Q

What is a hernia?

A

The protusion of a structure outside the compartment meant to contain it

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29
Q

Which two factors are normally required for the development of a hernia?

A

Weakness of part of the wall containing a structure

Increased pressure on one side of that wall

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30
Q

Which parts of the body wall have a normal anatomical weakness and what are the herniae which can arise from this?

A

Diaphragm - diaphragmatic hernia

Umbilicus - umbilical hernia

Inguinal canal - inguinal hernia

Femoral canal - femoral hernia

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31
Q

Name a congenital hernia

A

Congenital diaphragmatic hernia

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32
Q

What is the name of the hernia which results from the weakness of the body wall due to surgical scars?

A

Incisional hernia

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33
Q

What can weaken the body wall?

A

Congenital abnormalities

Surgical scars

Some parts of the body have a natural anatomical weakness

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34
Q

What can cause an increase the pressure leading to herniae?

A

Cough

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35
Q

How can chronic cough cause herniae?

A

Coughing increases the pressure exerted on the anterolateral abdominal wall, diaphragm and inguinal/femoral regions which can push structures through any weak spots

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36
Q

What is the most common diaphragmatic hernia?

A

Hiatus herniae

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37
Q

What is a hiatus hernia?

A

Where part of the stomach pushes up into the thoracic cavity

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38
Q

Where are the natural weak spots in the diaphragm?

A

Oesophageal hiatus

At the attachments to the xiphoid process

Aortic hiatus

Caval opening

Posterior attachments

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39
Q

What are the two classes of hiatus hernia?

A

Paraoesophageal hiatus hernia

  • part of stomach passes into chest and is parallel to the oesophagus

Sliding hiatus hernia

  • part of stomach passes into chest with the gasto-oesophageal junction
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40
Q

What kind of hernia is this?

A

Paraoesophageal hiatus hernia

41
Q

What kind of hernia is this?

A

Sliding hiatus hernia

42
Q

Where do the inguinal ligaments attach?

A

On the anterior superior iliac spine (ASIS) and the pubic tubercle

43
Q

What is the oesophageal hiatus?

A

Hole in the diaphragm which the oesophagus passes through

44
Q

What is the aortic hiatus?

A

Hole in the diaphragm which the aorta passes through

45
Q

What is the caval opening?

A

Hole in the diaphragm which the inferior vena cava passes through

46
Q

What is the iguinal canal?

A

A 4cm passageway through the anterior abdominal wall in the inguinal region

47
Q

What is the anterior superior iliac spine?

A

Bony projection of the iliac bone

48
Q

Name the numbered boney prominences

A
  1. Anterior superior iliac spine
  2. Pubic tubercle
49
Q

What is the pubic tubercle?

A

Bony projection of the iliac bone

50
Q

What forms the floor of the inguinal canal?

A

The medial half of the inguinal ligaments

51
Q

What are the inguinal ligaments?

A

Inferior border of the external oblique aponeuroses

52
Q

What are the entrance and exit to the inguinal canal called?

A

Deep ring (entrance)

Superficial ring (exit)

53
Q

What is the superficial ring?

A

A v-shaped defect in the external oblique aponeurosis

54
Q

Where is the superficial ring located?

A

Immediately superolateral to the tubic tubercle

55
Q

Where is the deep ring?

A

Superior to the midpoint of the inguinal ligament

56
Q

What is an inguinal herniae?

A

Protusion of the contents of the abdominal cavity through the inguinal canal

57
Q

Where do inguinal herniae form?

A

In the medial half of the inguinal region

58
Q

What causes the weakness of the body wall in the development of inguinal herniae?

A

Presence of the inguinal canal

59
Q

When is the inguinal canal formed?

A

Formed embryologically during the passage of the testes/round ligament of the uterus into the perineum

60
Q

What does the inguinal canal contain in adults?

A

Spermatic cord (men)

Round ligament of the uterus (women)

61
Q

Name the numbered structures

A
  1. Ureter
  2. Rectus abdominus
  3. Inguinal canal
  4. Testes
  5. Parietal peritoneum
  6. Kidneys
62
Q

Where do the testes descend from during their development?

A

Abdomen into the scrotum

63
Q

Which layers of the anterolateral abdominal wall do the testes pass through during their developent?

A

Transversalis fascia

Internal oblique muscle

V-shaped defect of external oblique aponeurosis

(pass into but don’t penetrate) Superficial fascia

64
Q

What forms the inguinal canal?

A

Descent of the spermatic cord/round ligament of the uterus through the anterolateral abdominal wall during embryonic development

65
Q

What layer of tissue forms the deep ring?

A

Transversalis fascia

66
Q

What layer of the spermatic cord does the internal oblique muscle become when the spermatic cord passes through it?

A

Cremasteric fascia

67
Q

What layer of the spermatic cord does the transversalis fascia become when the spermatic cord passes through it?

A

Internal spermatic fascia

68
Q

What layer of the spermatic cord does the external oblique aponeurosis become when the spermatic cord passes through it?

A

External spermatic fascia

69
Q

From deep to superficial, what are the 3 layers of the spermatic cord and what tissue are they formes from?

A

Internal spermatic fascia - transversalis fascia (deep)

Cremasteric fascia - internal oblique muscle

External spermatic fascia - external oblique aponeurosis (superficial)

70
Q

Name the numbered structures

A
  1. Testiular artery
  2. Testicular vein
  3. Visceral peritoneum
  4. Parietal peritoneum
  5. Tranversalis fascia
  6. Transversus abdominus
  7. Internal oblique muscle
  8. Inguinal ligament/external oblique aponeurosis
  9. Deep fascia
  10. Superficial fascia
  11. Skin
  12. Anterior superior iliac spine
  13. Pubic tubercle
  14. Peritoneal cavity
  15. Testes
  16. Abdominal organs
  17. Vas deferens
71
Q

Name the numbered structures

A
  1. Testicular artery
  2. Testicular vein
  3. Parietal peritoneum
  4. Transversus fascia
  5. Transversalis abdominus
  6. Internal oblique muscle
  7. Inguinal ligament/external oblique aponeurosis
  8. Deep fascia
  9. Superficial fascia
  10. Tunica vaginalis
  11. Skin
  12. Anterior superior iliac spine
  13. Pubic tubercle
  14. Deep ring of the inguinal canal
  15. Spermatic cord
  16. Superficial ring of the inguinal canal
72
Q

What is the processus vaginalis?

A

Embryonic outpouching of parietal peritoneum

73
Q

What is the tunica vaginalis?

A

Pouch of serous membrane which covers the testes

74
Q

What embryonic structure is the tunica vaginalis derived from?

A

Processus vaginalis

75
Q

What does the spermatic cord consist of?

A

3 layers developed as it passes through the inguinal canal

  • external spermatic fascia (from external oblique aponeurosis)
  • cremasteric fascia (from internal oblique muscle)
  • internal spermatic fascia (from transversalis fascia)

Structures within it

  • testicular artery
  • vas deferens
  • pampiniform plexus
76
Q

What layer of the abdominal wall is the internal spermatic fascia derived from?

A

Transversalis fascia

77
Q

What layer of the abdominal wall is the cremasteric fascia derived from?

A

Internal oblique muscle

78
Q

What layer of the abdominal wall is the external spermatic fascia derived from?

A

Aponeurosis of the external oblique muscle

79
Q

What structures run within the spermatic cord?

A

Testicular artery

Vas deferens

Pampiniform plexus

Autonomic nerves

Genitofemoral nerve

Lymphatics

80
Q

From superficial to deep, what are the three layers of the spermatic cord and what skin tissues are they derived from?

A

External spermatic fascia - aponeurosis of external oblique (superficial)

Cremesteric fascia - internal oblique muscle

Internal spermatic fascia - transversalis fascia (deep)

81
Q

Name the numbered structures

A
  1. Transversus abdominus
  2. Internal oblique
  3. External oblique
  4. Ilioinguinal nerve
  5. Inguinal ligament
  6. Superficial ring
  7. Internal spermatic fascia (transversalis fascia)
  8. Cremasteric fascia
  9. External spermatic fascia (aponeurosis of external oblique)
  10. Visceral peritoneum
  11. Parietal peritoneum
  12. Transversalis fascia
  13. Peritoneal cavity
  14. Abdominal organs
  15. Deep ring
  16. Rectus abdominus
  17. Conjoint tendon
82
Q

What is the conjoint tendon?

A

Medial end of the combined aponeuroses of the internal oblique and transversus abdominus which anchours those muscles to the pubic bone

83
Q

What is the function of the conjoint tendon?

A

Anchors the internal oblique and transversus abdominus to the pubic bone

84
Q

Name the numbered structures

A
  1. Spermatic cord
  2. Vas deferens
  3. Testicular artery
  4. Pampiniform plexus
85
Q

Name the numbered nerves

A
  1. Iliohypogastric nerve
  2. Ilioinguinal nerve
86
Q

What anterior ramus is the iliohypogastric nerve from?

A

Half of L1 (other half from ilioinguinal nerve)

87
Q

What anterior ramus is the ilioinguinal nerve from?

A

Half of L1 (other half for iliohypogastric nerve)

88
Q

Name the numbered structures

A
  1. Inguinal ligament (cut)
  2. Cremasteric fascia
  3. Spermatic cord (severed)
  4. Ilioinguinal nerve
89
Q

Name the numbered structures

A
  1. Inguinal canal
  2. Spermatic cord
  3. Superficial ring
  4. Ilioinguinal nerve
90
Q

Where does the ilioinguinal nerve lie in the inguinal canal?

A

Within inguinal canal but external to spermatic cord

91
Q

Name the numbered structures

A
  1. Vas deferens
  2. Testicular artery
  3. Pampiniform plexus
92
Q

Which sex more commonly develop inguinal hernias and why?

A

Males

Larger inguinal canal

93
Q

What passes through the inguinal canal in females?

A

Round ligament of the uterus

94
Q

What are the two classes of inguinal herniae and what is the difference?

A

Direct (structure directly pushes out of superficial ring)

Indirect (structure passes through both deep and superficial rings)

95
Q

How can you distinguish between direct and indirect herniae?

A

Reduce the hernia

Occlude the deep ring with finger

Ask patient to cough

If direct hernia, lump will reappear

If indirect hernia, lump won’t reappear

96
Q

What is a direct hernia?

A

One which directly protudes out the superficial ring without passing through deep ring

97
Q

What is an indirect hernia?

A

One which passes through both the deep and superficial rings

98
Q

If you reduce a direct hernia, occlude the deep ring and ask the patient to cough, what would be seen?

A

The hernia would reappear

99
Q

If you reduce an indirect hernia, occlude the deep ring and ask the patient to cough, what would be seen?

A

The hernia would not reappear

Anatomy: Respiratory (3 decks)

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