Doctors academy - Thorax COPY Flashcards
What is the blood supply to the oesophagus?
Upper 1/3 - Inferior thyroid
Middle 1/3 - Descending thoracic aorta
Lower 1/3 - Left gastric
What is the venous drainage of the oesophagus?
Upper 1/3 - Inferior thyroid
Middle 1/3 - Azygous
Lower 1/3 - Left gastric
What is the lymphatic drainage of the oesophagus?
Upper 1/3 - Deep Cervical
Middle 1/3 - Para trachial
Lower 1/3 - caeliac
What surgical treatment can be done for oesophageal cancer
Proximal 1/3 - McKewan Procedure
Middle and Distal - Ivor Lewis
All generally have neoadjuvant chemotherapy
What histological changes occur in barrats oesophagus?
- There is metaplasia from squamous to columnar
- There would then be dysplasia of these cells for them to become cancerous
There are two types of metaplasia in barrats oesophagus, what surveillance is required for each?
- Gastric metaplasia - surveillance every 3-5 years
- Intestine metaplasia - surveillance every 2-3 years
what structure would be damaged 1cm lateral and 1cm deep to the sternum?
the internal mammary artery
what is the blood supply and venous drainage of the anterior and posterior chest wall?
Anteriorally: Internal mammary arteries and internal mammary veins
posteriorly: decending thoracic aorta and azygous vein (accessory hemi azygous and hemiazygous drain the left side and then drain in to azygous)
where are the intercostal neurovascular bundles found?
they are found blow the corresponding rib between the internal intercostal and the innermost intercostal muscles
what are the boarders of the safe triangle for chest drain insertion
Roof: Base of the axilla
Floor: 6th Intercostal Space
Lateral: Lateral edge of lat dorsi
Medial: lateral edge of pec major
What layers do you pass through when inserting a chest drain
skin
subcutaneous fat / fascia
external intercostal
internal intercostal
innermost intercostal
endothoracic fascia
pariatal pleura of the lung
what are the treatment options for achalasia?
either botox or hellers myotomy
what disease is associated with achalasia
chagas disease
what are the treatment options for oesophageal spasms/ dysmotility?
Nitrates
Calcium Channel blockers
phosphodiesterase inhibitors
what are the features of plummer Vincent syndrome?
- iron deficient anemia
- post cricoid web
- macroglositis / angular stomatas
- beefy red tongue
- chelitis
What is the inferior most structure in both lung hilum
the pulmonary veins
what is the posterior most structure in both lung hilum
the bronchus
what is the position of structures in the right lung hilum
Anterior - Pulmonary artery
Inferior - Pulmonary vein
Posterior - Bronchus
What is the position of structures in the left lung hilum
Anterior (and inferior) - pulmonary Veins
Superior - Pulmonary artery
Posterior - Bronchus
where do the phrenic and vagus nerves lie in the lung hilum
phrenic nerve runs in front of the hilum
vagus nerve runs behind the hilum
What are the 4 different types of lung cancer
- Small Cell
- Large cell
- Adeno carcinoma
- Squamous cell carcinoma
what is the most common type of lung cancer in adults and children
Adults - adenocarcinoma
Children - bronchiocarcinoma
where are the 4 different lung cancers found within the lung?
Adnocarcinma - Peripheral (Away from centre)
Large cell - Peripheral
SCC - Central
Small Cell - Central
what histological features are seen in small cell lung cancer
Salt and pepper appearance of nuclei
nuclear chromatin
scanty cytoplasm
round cells
which lung cancer is associated with paraneoplastic syndrome?
Small cell lung cancer - It is associated with SIADH and carcinoid syndrome
what is pancost syndrome and what are some of the common presenting symptoms?
Pancosts tumours are at the apex of the lungs, they cause compression of surrounding structures.
Symptoms:
- Compression of sympathetic nerves = horners syndrome (miosis, ptosis and anhydrosis)
- Compression of branchial plexus trunks, particularly ulnar nerve - weakness and atrophy of muscles of the hand
- SVC compression - SOB and Swelling of the arm
- Recurrent laryngeal nerve compression - hoarse voice
What are the branches of the Subclavian Artery
Mnemoic: VIT C&D
Part 1:
- Vertibral artery
- Internal Thoracic
- Thyrocervical Trunk
Part 2:
- Dorsal Scapular
- Costocervical Trunk
part 3:
No branches
What are the branches of the Axillary Artery
Mnemonic: Some Time Life Seems A Pain
Part 1:
- Superior Thoracic
Part 2:
- Thoracoacromial
- Lateral Thoracic
Part 3:
- Subscapular
- Anterior circumflex
- Posterior Circumflex
At what level does the SCA become the Axillary Artery
The level of the first rib
What happens at the angle of Louis? (T4/T5)
RAT PLANT
* R: rib 2
* A: aortic arch
* T: tracheal bifurcation
* P: pulmonary trunk
* L: ligamentum arteriosum
* A: azygos vein drains into SVC
* N: nerves
* loop of recurrent laryngeal nerve
* parasympathetic: contributions to the cardiopulmonary plexuses
* sympathetic: branches of the cardiopulmonary splanchnic nerves
* T: right-to-left movement of the thoracic duct
What muscular structures are found in the Right Atrium?
- Crista Terminalis (junction between sinus venous and the heart)
- Pectinate Muscles (Ridges of the walls of the atrium)
What muscular structures are found in the ventricles of the heart
- Papillary muscles
- Chordae Tendinae
- Trabeculae carnae (meaty ridges on surface of ventricles)
Extra:
- Vestibule
- Infundibuloventricular crest
what is the nerve supply to the heart including the SAN and AVN
the vagus nerve
what is the cardiac sinus composed of?
- great cardiac veins
- middle cardiac veins
- small cardiac veins
- oblique veins
where do the thesbian veins drain and where do they drain in to?
these drain the anterior surface of the heart and drain directly in to the right atrium
What are the abnormalities in tetralogy of fallot?
- Overriding aorta
- VSD
- Pulmonary stenosis
- Right ventricular hytertrophy
What ECG findings do you get in hyperkalaemia?
- Flat P wavs
- Wide QRS
- increased PR
- Peaked T Waves
What ECG findings do you get in hypokalaemia?
- Tall P waves
- U waves
- Increased PR
- Increased QT
What ECG findings do you get in hypercalcemia?
- decreased QT
- Decreased ST
- Osborns waves (J waves) If severe
What ECG findings do you get in hypocalcemia ?
- Increased QT
- Increased ST
What ECG findings do you get in hypothermia?
J waves
What are the contents of the superior mediastinum?
- Thymus
- Oesophagus
- Trachea
- Brachiocephalic veins
- Thoracic duct
- Arch of Aorta
- Vagus Nerve
- Left recurrent laryngeal nerve
- Phrenic nerve
What are the structures in the anterior mediastinum?
- lymph nodes and fat
What structures are found in the middle mediastinum?
- Heart
- Aortic root
- arch of azygos vein
- main bronchi
- phrenic nerve
what structures are in the posterior mediastinum?
- Thoacic aorta
- Azygos vein
- thoracic duct
- vagus nerve
- sympathetic nerve trunks
- splancnic nerves
Where is the thoracic duct positioned in relation to the oesophagus?
The thoracic duct lies posterior to the oesophagus
Where does the thoracic duct drain in to?
The left subclavian vein which drains in to the left brachiocephalic vein which drains to the SVC
What are the branches of the coeliac trunk
Left gastric
splenic
common hepatic
What are the branches of the common hepatic artery
- Right gastric
- Gastroduodenal (becomes right gastroepiploic)
- proper hepatic (left and right hepatic)
What are the branches of the splenic artery
- Short gastric
- left gastroepoploic
During the median sternotomy which structure would routinely require division?
Interclavicular ligament
What is the nerve supply of the pectoralis major and minor
Pectoralis Major - Medial and lateral pectoral nerves
Pectoralis Minor - Medial pectoral nerves
How many collateral circulations exist as alternative pathways of venous return if the SVC was obstructed?
4 alternative systems
- Azygous system
- Internal mammary venous pathway
- Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
at what anatomical level does the descending aorta begin
T4/T5
What is the blood supply to the ribs T1-T3
Costocervical arteries which become the superior intercostal arteries
At what level does the Azygus vein drain in to the SVC
T4
What is the venous drainage of the chest wall above T4
- The supreme intercostal veins OR
- the intercostal veins
Both of these drain straight in to the brachiocephalic vein
What is the pathophysiology of achalasia
The myenteric plexus of orbach is not developed and so you get no peristalsis
What is the treatment for a pancosts tumour
Radiotherapy + chemotherapy + surgical removal
Which structure is responsible for the coordination of the contraction of the papillary muscles
Moderator band
what is the Mackler triad for borhaeves?
vommiting
throacic pain
subcutaneous emphasyma
