Consequences of chronic coughing (ANATOMY) Flashcards
What is a pneumothorax?
Air in the pleural cavity
How can dynamic airway compression in asthma lead to a pneumothorax?
Expiration is difficult and the build-up of air trapped in alveoli can lead to rupture of lung & visceral pleura
By which mechanism is a pneumothorax developed?
Penetrating injury to parietal pleura or rupture of visceral pleura > loss of vacuum > elastic recoil of lungs towards lung root > pneumothorax
What classifies a small pneumothorax?
<2 cm between lungs and parietal pleura
What classifies a large pneumothorax?
> 2 cm between lungs and parietal pleura
How is a pneumothorax diagnosed by examination?
Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper-resonance on percussion
How can a pneumothorax be diagnosed by investigation via a CXR?
Absent lung markings peripherally
Visible lung edge
How does a tension pneumothorax develop?
Torn pleura creating a one-way valve allowing air to enter pleural cavity on inspiration but not expiration
What consequence can follow a tension pneumothorax?
Mediastinal shift
How can mediastinal shift, and therefore a tension pneumothorax, be diagnosed?
Deviation of the trachea - palpable on jugular notch
What is the consequence of mediastinal shift?
SVC compression reduces venous return to the heart causing hypotension
How is a large pneumothorax managed (2)?
Needle aspiration (thoracentesis) Siting of chest drain
Where should the needle enter to relieve a large pneumothorax?
4th or 5th intercostal space in the mid-axilliary line
Why do you have to perform a thoracentesis absolutely centred in the intercostal space?
To avoid intercostal neuromuscular bundle
What are the borders of the SAFE TRIANGLE for a thoracentesis?
Anterior border of latissimus doors
Posterior border of pectoralis major
Axial line superior to nipple
How would you emergency manage a tension pneumothorax?
Insert large gauge cannula into pleural cavity via 2nd or 3rd intercostal space in the mid-clavicular line on the side of the tension pneumothorax
What is a hernia?
Any structure passing through another (i.e. ending up in the wrong place)
What is required for a hernia to develop?
Weakness of one structure (normal/congenital/surgical scar) + increased pressure on one side of that part of the wall
Why can a chronic cough cause a hernia?
Regular increase in intra-abdonimal pressure on diaphragm, anterolateral abdominal walls (including inguinal region + femoral triangle)
Where do diaphragmatic hernia tend to develop?
Xiphoid attachment
Posterior attachments
Oesophageal hiatus
What distinguishes a paraoesophagheal hiatus hernia?
herniated pert of stomach passes through oesophageal hiatus to become parallel to the oesophagus in the chest - Gastro-oesophageal junction doesn’t move
What distinguishes a sliding hiatus hernia?
Herniated part of the stomach slides through oesophageal hiatus into the chest with the gastro-oesophageal junction
Where do inguinal hernias occur?
Uni-/bilateral
Medial halves of inguinal region
What weakness and which pressure cause inguinal hernias?
Weakness = presence of inguinal canal Pressure = intra-abdominal
