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MD3001resp > diaphragm, mechanism of respiration, surface projections > Flashcards

diaphragm, mechanism of respiration, surface projections Flashcards

1
Q

describe the stricture of the thoracic diaphragm?

A

musculotendinous sheet separating thoracic and abdominal cavity
- central tendon, surrounded by muscle
- inverted J
- domed structure (right is 1cm higher than the left)

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2
Q

when maximally expired, what will the right and left dome reach to?

A

right dome reaches rib 5 level
left = 5th intercostal space

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3
Q

what are the attachments of the diagram?
sternal attachments?
costal attachment?

A

attaches to the inferior thoracic aperture:

sternal part = diploid process (T8/9 vertebral levels)

costal part= costal cartilages 7-10, ribs 11 and 12

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4
Q

what are the 4 lumbar attachments of the diaphragm?

A
  • right and left crura
  • median arcuate ligaments
  • medial acute ligaments
  • lateral arcuate ligaments
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5
Q

what are the right and left crura attachments?

what are the median arcuate ligaments made from?

A

1- left L1 to L2, right L1 to L3 bodies, anterior longitudinal ligament and IV discs

2- median arcuate ligaments will be formed by the crura

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6
Q

what are the medial arcuate ligaments made from?

what are the lateral arcuate ligaments made from?

A

medial arcuate ligaments = thickened poses major fascia spanning L1 vertebral body and transverse process

lateral arcuate ligaments = thickened quadrates lumborum fascia

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7
Q

what are the diaphragmatic attachments?
what is it continuous with?
what level is this attachment at?

A
  • insertion to central tendon
  • continuous with fibrous pericardium
  • central tendon at level of Xiphosternal synchondrosis
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8
Q

what are the 3 major openings in the diaphragm?

A

1- caval opening
2- oesophageal hiatus
3- aortic hiatus

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9
Q

what level is the naval opening at?

what structures pass through it?

what are the IVC connections?

A

1- level of T8, through central tendon

2- IVC and right phrenic nerve

3- IVC is connected to the margins so diameter changes during action of diaphragm (widens during contraction)

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10
Q

at what level is oesophageal hiatus?

what travels through it?

A

1- level T10, within fibres of right crus 9which have sphincter function)

2- oeopghagus, right and left vagal trunks, oesophageal branches of left gastric vessels.

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11
Q

at what level is the aortic hiatus?

what passes through here?

is the aorta effected by the actions of the diaphragm?

A

1- level T12, posterior to the median arcuate ligaments

2- aorta, thoracic ducts
- sometimes azygous and hemiazygous veins

(if they don’t pass through here, they will pass through the crura)

aorta is not effected by the actions of the diagram.

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12
Q

what 6 smaller structures will also cross the diaphragm?

A

1- left phrenic nerve

2- sympathetic trunks (posterior to medial arcuate ligaments)

3- greater, lesser and least splanchnic nerve through crura

4- intercostal nerves

5- superior epigastric vessels

6- musculophrenic vessels

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13
Q

arterial supply of diaphragm:

superior surface?

inferior surface?

A

superior surface:
1- superior phrenic from thoracic aorta
2- musculophrenic from internal thoracic

inferior surface:
1- inferior phrenic from abdominal aorta

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14
Q

describe the venous drainage of the diaphragm?
right side?
posterior superior surface veins will drain where?
where will the left phrenic vein drain?

A

essentially minor arteries

  • superior phrenic vein on the right
  • some of the posterior superior surface veins will drain to azygos/hemiazygous system
  • left phrenic will drain to suprarenal then renal vein
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15
Q

innervation of the diaphragm?

where is the additional peripheral sensory innervation from?

A

1- phrenic nerve (C3, C4, C5)
Motor, sensory to central diaphragm (and partial pleura and pericardium)

2- additional peripheral sensory innervation from intercostals (T5-T11) and subcostals (T12) nerves

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16
Q

overview of breathing

A

1- at rest, inspiration is mostly driven by the thoracic diaphragm (external intercostal contribute)

2- diaghragm contraction increases thoracic volume, drawing air into lungs

3- gases exchange occurs

4- diaghragm relaxes, thoracic volume falls and air is inhaled

5- exhaling at rest is passive (elastic recoil)

6- higher demand for O2/ CO2 removal can involve accessory muscles

7- smooth movement is aided by the pleurae

17
Q

inspiration?

A
  • peripheral muscle of diaphragm contracts
  • domes descend
  • external intercostals act to move ribs superiorly and laterally
  • thoracic volume increases and air is drawn in to compensate for the volume change
18
Q

forced inspiration?

A

1- diaghram can aid in creasing thoracic volume by raising ribs when anchored via pericardium

2- minimises costodiaphragmatic recess

3- accessory muscles can increase force/speed of inspiration but not alter the volume of air inspired

19
Q

what 4 actions are involved in forced expiration and what are the 4 muscles involved?

A

fixing ribes = SCM, scalenes, trapezius

inspiration = pectorales major and minor

inspiration and expiration = lat dorsi

expiration = abdominal wall muscles

20
Q

surface anatomy of the lungs and pleura?

A
  • apex = 3cm superior to the mid clavicle
  • at middle from 2nd to 6th CC on the right
  • deviation laterally between 4th to 6th CC on the left
21
Q

surface anatomy of the lungs?

A
  • midclavicular line - 6th rib
  • midaxillary line - 8th rib
  • scapular line and midline (posteriorly) - 10th rib
22
Q

surface anatomy of pleurae?

A

add 2 ribs to the level of the lungs
- midclavicular line - 8th rib
- midaxillary line - 10th rib
scapular line and midline (posteriorly) -12th rib

23
Q

surface anatomy - oblique fissures

posteriorly=
laterally=
anteriorly=

A

posteriorly = level T3/T4
laterally = midaxillary line (5th intercostal space)
anteriorly = rib 6

24
Q

surface anatomy of the horizontal fissure?

where will the horizontal and oblique fissure merge?

A

moving lateral from sternum, 4th rib/intercostal space

merges with oblique fissure at 5th rib

25
Q

surface anatomy- 4 anterior auscultation sites?

A

1- apex of right lung
2- superior lobe of right lung
3- middle lobe of right lung
4- inferior lobe of right lung

26
Q

surface anatomy- 3 posterior auscultation sites?

A

1- apex of lung
2- superior long of left lung
3- inferior lobe of left lung

27
Q

what are the 2 lungs recesses?

A

costodiaphragmatic
costomediastinal

28
Q

costodiapghragmatic recess:
where is it?
what is it?
what is it a site of?
how do you treat this?

A

1- it is in the space below lungs around periphery of diagram

2- it is a double fold of parietal pleural

3- it is a site of fluid collection

4- needle angled upwards at 9th intercostal space on mid axillary line during expiration can remove the fluid

29
Q

costomediastinal recess:
where is it?
what is it?
where is it more pronounced?

A

1- behind manubrium

2- is It made of costal and mediastinal pleura

3- it is more pronounced on the left

  • lingual partly occupies during breathing
30
Q

pneumothorax:
what is it?
how are the lungs still held in place?
what can they be?

A
  • lungs tend to a collapse state due to their elasticity
    (air enters pleural space)
  • they are held in place against thoracic wall by surface tension of pleural fluid between the visceral and parietal pleura
  • can be traumatic or spontaneous
31
Q

chest drain:
does what?
inserted where?

A

1- used to evacuate air or fluid from pleural space

2- safety triangle

32
Q

what are the borders of the safety triangle?
lateral?
anterior?
apex?
base?

A

lateral border = pectorals major
anterior border = latissimus dorsi
apex = towards axilla
base = nipple/5th intercostal space

33
Q

what can an incorrect placement of chest drain cause?

A

risk perforating the pericardium, part or liver

34
Q

what is flail chest?
when does it occur?

A
  • it is paroxical chest wall motion, loose section of the thoracic wall is drawn inwards upon inspiration
  • occurs after severe trauma (fracture > 3ribs)
35
Q

In a traverse section of the thorax, what will you find at:
T12
T9
T5
T2

A

T12 = transverse colon
duodenum
pancreas
costodiaphragmatic recess
liver
spleen

T9=
- liver
- lungs
- aorta
- oesophagus
- IVC
- left ventricle
- right ventricle

T5=
- SCV
- ascending aorta
- carina
- pulmonary trunk
- descending aorta
- oesophagus
- azygous vein

T2=
- left lung apex
- rib 1
- trachea
- manubrium
- clavicle

MD3001resp (41 decks)

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