Exam 2: Mediastinum Flashcards
Mediastinum
Space between pleural cavities
Imaginary plane that separates superior and inferior mediastinum
From sternal angle to T4-T5
Sternal angle indicates level of
- Superior and inferior mediastinum
- Articulation of 2nd rib w/ sternum
- Aortic arch
- Bifurcation of trachea
- Upper border of pulmonary trunk
Blood vessels within superior mediastinum
Superior vena cava
Brachiocephalic veins
Arch of aorta and branches
Structures located within superior mediastinum
Thoracic duct
Trachea
Esophagus
Thymus
Nerve located within superior mediastinum
Vagus
Left recurrent laryngeal
Phrenic
3 compartments of inferior mediastinum
Anterior
Middle
Posterior
Anterior mediastinum location
Anterior to pericardial sac
Posterior to sternum
Contents of anterior mediastinum
Thymus
Lymph nodes
Sternopericardial ligaments
Middle mediastinum bounded by
Pericardial sac
Contents of middle mediastinum
Heart
Pericardium
Roots of great vessels
Main bronchi
Posterior mediastinum location
Posterior to pericardial sac
Anterior to T5-12
Structures located in posterior mediastinum
Esophagus
Thoracic duct
Blood vessels located within posterior mediastinum
Thoracic aorta
Azygos vein
Hemiazygos vein
Nerves located within posterior mediastinum
Vagus nerve
Splanchnic nerves
Contents of BOTH superior and inferior mediastinum
Vagus nerve Phrenic nerve Thymus Thoracic duct Esophagus
Trachea begins at
Inferior border of cricoid cartilage (C6)
Trachea consists of
15-20 C-shaped cartilaginous rings
Rings of trachea function
Prevent trachea form collapsing
Trachea bifurcates into _____ at the level of _____
Right and left main bronchi; sternal angle (IVD T4/5)
Carina location
Within trachea, at bifurcation
Carina separates
Openings of right and left main bronchi
Trachea lies anterior to ______ and posterior to ____
Anterior to esophagus
Posterior to arch of aorta
Trachea deviates to
Right
To accommodate aorta
Right main bronchus is ____________ than left main bronchus
Shorter, wider, more vertical
Right main bronchus gives off ______ BEFORE entering hilum
Superior lobar bronchus
Right main bronchus divides into ____________ WITHIN hilum
Middle and inferior lobar bronchi
The 3 lobar bronchi of right lung then divide into
10 segmental bronchi
Left main bronchus is ______ than right main bronchus
Longer, narrower, more horizontal
Left main bronchus divides into
Superior and inferior lobar bronchi (within hilum)
The 2 lobar bronchi of left lung divide into
10 segmental bronchi
Foreign objects during aspiration usually enter
Right main bronchus
Lowest point in tracheobronchial tree where cough reflex stimulated
Carina
Once object passes carina
Coughing stops
Blood supply to trachea
Inferior thyroid artery
Bronchial arteries
Innervation of trachea
Vagus nerve
Sympathetic trunk
Surfaces of each lung
Costa
Mediastinal
Diaphragmatic
Hilum is on what surface of lung
Mediastinal
What structures pass through hilum
Vessels, nerves, bronchi
Structures that form root of lung
- Bronchi
- Pulmonary vessels
- Bronchial vessels
- Nerves
- Lymphatics
Root of lung covered with
Pleura
Pleura that is prolonged downward as double layered membrane called
Pulmonary ligament
Fissures on right lung
Oblique fissure
Horizontal fissure
Right lung has how many lobes
3: superior, middle, inferior
Features of right lung
Grooves for azygos vein, esophagus, superior vena cava, R brachiocephalic vein and the cardiac impression
Left lung fissures
Oblique fissure
Left lung has how many lobes
2: superior and inferior
Features of left lung
- Lingula
- Cardiac notch
- Cardiac impression
- Groove for aorta
- Groove for left subclavian A
Functional units of the lung
Bronchopulmonary segments
Each bronchopulmonary segment consists of
- Segmental bronchus
- Branch of pulmonary artery
- Lung tissue
- Septum
Bronchopulmonary segments are clinically important
Can be surgically removed without affecting function adjacent segments
Trachea primary tissue
Cartilage rings
Main bronchi primary tissue
Cartilage rings
Lobar bronchi primary tissue
Cartilage plates
Segmental bronchi primary tissue
Smooth muscle
Bronchioles primary tissue
Smooth muscle
Alveoli primary tissue
Membrane
Inflammation of segmental bronchi
Bronchitis
Inflammation of bronchioles
Bronchiolitis
Inflammation of alveoli
Pneumonia
Divisions of trachea
Trachea—main bronchi—lobar bronchi—segmental bronchi—bronchioles—alveoli
Innervation of lungs
Vagus — parasympathetic and sensory
Sympathetic trunk — sympathetic and sensory
Sympathetic activation produces
Bronchial dilation, vasoconstriction, decreases glandular secretion
Parasympathetic activation produces
Bronchial constriction, vasodilation, increases glandular secretion
Asthma caused by
Spasms of smooth muscle in segmental bronchi and bronchioles
Extrinsic asthma
Triggered by allergens
Intrinsic asthma
Triggered by stress, cold, exercise
Lungs and tracheobronchial tree are rich in lymphatics to
Fight infection — lungs are interface w/ environment
Bronchogenic carcinoma
Primary tumor of bronchus
Bronchogenic carcinoma directly related to
Cigarette smoking and air pollution
Bronchogenic carcinoma often causes enlargement of
Sentinel node
Diaphragm separates
Thorax from abdomen
Diaphragm is a fibromuscular dome-shaped structure with
Right and left domes
Which dome of diaphragm is higher and why
Right because it overlies the liver
2 parts of diaphragm
Muscular part and central tendon
3 points of origin of diaphragm
Sternal
Costal
Lumbar
Openings in diaphragm
Caval opening
Esophageal hiatus
Aortic hiatus
Caval opening located at
T8
Caval opening transmits
Inferior vena cava and right phrenic nerve
The inferior vena cava firmly attached around caval opening in order to
Facilitate venous return
Esophageal hiatus located at
T10
Esophageal hiatus transmits
Esophagus and anterior and posterior vagal trunks
Aortic hiatus located at
T12
Aortic hiatus transmits
Aorta, thoracic duct, azygos vein
Innervation to diaphragm
Phrenic nerve
Intercostal nerves
Hiatal hernia
Upper part of stomach protrudes into esophageal hiatus
Major cause of GERD
Upon inspiration what happens to volume and pressure
Volume increases
Pressure decreases
Upon expiration what happens to volume and pressure
Volume decreases
Pressure increases
During piston movement what contracts
Diaphragm; pulls domes inferiorly
Piston movement causes increase in
Vertical diameter
During bucket handle movement what elevates
Lower ribs (7-10th)
Bucket handle movement causes increase in
Transverse diameter
During pump handle movement what elevates
Upper ribs (2-6)
Pump handle movement causes increase in
Antero-posterior diameter
Elevation of ribs in bucket and pump handle movements due to
Contraction of external intercostals
In NORMAL expiration
Diaphragm and external intercostal muscles relax
In FORCED expiration
Internal intercostals, innermost intercostals and anterior ab muscles contract
Forced expiration includes
Coughing, sneezing, clearing airway
Contraction of diaphragm has opposite effect on abdomen than thorax—
Abdominal volume decreased while intra-abdominal pressure increased
Hiccups are result of
Spasmodic contraction of diaphragm
Irritation of phrenic nerve