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
What can cause an inguinal hernia?
Chronic cough or constipation
Occupational heavy lifting
Athletic effort
Where is the inguinal canal?
Between deep ring and superficial ring
Where is the inguinal region?
between anterior superior iliac spine and pubic tubercle
What guides the testicle from its origin point in the abdomen down through the abdominal wall into the scrotum?
The gubernaculum
How does the testicle descend from the abdomen to the scrotum?
Testicle starts to push into transversalis fascia (drags some with its) > bypasses transverse abdominus > crosses internal oblique (drags some with) > passes through superficial ring of pubic tubercle > passes through superficial fascia (drags some with)
What does the layer of transversals fascia become known as when covering the testis?
Internal spermatic fascia
What does superficial fascia become known as later on when it covers the testis?
External spermatic fascia (covering of external oblique aponeurosis)
What does the internal oblique become known as later on when it covers the testis?
Cremasteric fascia
The structures that the testes dragged with it become known as the ____
spermatic cord
Small part of peritoneum remained in scrotum after descending of testis becomes known as the ______
tunica vaginalis
The point between the deep & superficial is the _____
inguinal canal
The deep ring is where the the testes pushed into the ________
transversals fascia
The superficial rings is where the testes pushed into the _______ of the scrotum
superficial fascia
What does the spermatic cord contain?
Vas deferens
Tsticular artery
Pampiniform plexus
What is the function of the venous pampiniform plexus in the testes?
Venous drainage
What is the function of the testicular vein?
Testicular perfusion
What is the function of the vas deferens?
Transports sperm
What are the boundaries of the femoral canal?
Anterior = inguinal ligament Medial = lacunar ligament Lateral = femoral vein Posterior = pectinate ligament
