Exam 3 Lungs,Heart Flashcards
components of lower respiratory tract
- trachea
- primary bronchi
- lungs
Components of upper respiratory tract
- nasal cavity
- pharynx
- larynx
4 surfaces of the lung
- Apex
- T1
- project 3cm above medial clavicle
- Subclavian A & V pass over apex of lung –>superior thoracic aperture - costal surface: spine to sternum (follows curvature of ribs)
- diaphragmatic surface: follows curvature of diaphragm
- anterior more cranial than posterior
- inferior border @ rest: mid-clavicle = 6th rib; 8th rib = mid-axilla; T10 posteriorly - Medial surface:faces heart
- Hilus:where pulmonary arteries, veins, bronchi enter medial surface
- Root of lung:conduit of pulmonary arteries, veins, bronchi entering hilus
Pleura
- 2 very thin layer of cells
- visceral: surface of lung
- parietal: inner wall of thoracic cavity
- pleural cavity: synovial fluid, lubricant
4 regions of parietal pleura
- costal pleura: lines ant, lateral, post walls of rib cage
- diaphragmatic pleura: cranial surface of diaphragm, floor of pleural cavity
- mediastinal pleura: medial surface of lungs
- continuous c costal/diaphragmatic pleura, copula
- @ root: surrounds pulmonary vessels, bronchi
- inferior to root: fuses c visceral pleura–>2 layered Pulmonary Lig. - Copula (dome): covers apex
- extends into superior thoracic aperture
- superior to posterior surface of mid clavicle, 1st rib
- continuous c costal, mediastinal pleura
pleural recesses
spaces within pleural cavity not filled entirely by lungs
Costodiaphragmatic recess
-formed inferiorly where costal pleura becomes continuous w/ diaphragmatic pleura
costomediastinal recess
- lies anteriorly @ ventral margin of 4th&5th intercostal space
- where costal pleura meets mediastinal pleura
- left recess bigger than right (due to cardiac notch)
Right lung
- 3 lobes: upper, middle, lower
- oblique fissure: runs down/forward, approximates 6th rib; separates middle/lower lobe
- posterior to mid-axillary line: no middle lobe –>oblique fissure separates upper/lower lobes
left lung
- 2 lobes: upper, lower separated by oblique fissure (approximates course of 7th rib)
- cardiac notch: indentation along medial surface of upper lobe
- lingula: tongue like protrusion below cardiac notch
bronchopulmonary segments
- lobes divided into bronchopulmonary segments
- BP segments anterior to oblique fissure differ between upper lobes
- R lung (upper & middle lobe anterior to fissure)
- L lung (only upper lobe anterior to fissure)
- Upper lobe-R lung: apical, ant, post BPS
- Upper lobe-L lung: apical, ant, post BPS
- And superior & inferior lingular segments
bronchial tree (descending order)
- Trachea
- Primary Bronchi
- Right
- Left - Secondary Bronchi (Lobar Bronchi)
- Right (3)
- Left (2) - Tertiary Bronchi (Segmental Bronchi)
- Right (3)
- Left (2) - Each tertiary bronchi goes to one of the BPS (named for that segment it enters)
- terminal bronchioles
- respiratory bronchioles
- alveolar ducts
- alveolar sacs
Describe organization of cartilage as bronchi divide-
-decrease cartilage as bronchi divide
cells found in alveoli
- type I pneumocytes (epithelial)
2. type II (cuboidal):surfactant
Postural drainage
- Helps clear mucoid congestion
- gravity assists
- move mucous from BP segment–>primary bronchus
- tap chest over segment
- coughing: mucous goes from bronchi–>oral cavity for removal
Level of lungs
Inferior border:
- T10 (posterior)
- Rib 8 (mix-axillary line)
- Rib 6 (mid-clavicular)
super mediastinum
border:
- ant: sternal angle (T4,5 disc), top of manubrium
- post: C7/T1 disc, T4,5 disc
- superior: superior thoracic aperture (first ribs)
- lies above heart
- overlaps ant, middle, post mediastinum
planes (ant to post)
- glandular
- venous
- arterial-venous
- visceral
- lymphatic
glandular plane of superior mediastinum
thymus gland
venous plane of superior mediastinum
- 2nd plane (ant–>post)
- L,R brachiocephalic V
- superior vena cava
- arch of Azygos V
arterial-nervous plane of superior mediastinum
- 3rd plane
- Aortic arch & branches: brachiocephalic trunk, L common carotid A, L subclavian A
Nerves:
- L,R vagus
- L,R phrenic
visceral plane of superior mediastinum
- 4th plane
- trachea
- esophagus
- L recurrent laryngeal N
- thoracic duct
pericardium
deep to superficial:
- visceral serous pericardium
- pericardial cavity
- parietal serous pericardium
- fibrous pericardium
Anterior surface of heart
5th-8th thoracic vert Sup/Inf vena cava R auricle ascending aorta aortic arch pulmonary trunk R/L ventricles L auricle
Coronary sulcus
Between atria & ventricles
- circumflex branch of L Coronary A
- Coronary Sinus
- R Coronary A
Lines of reference for lungs
- midline
- lateral sternal line
- midclavicular line
- anterior axillary line
- middle axillary line
- posterior axillary line
Posterior view of heart
- small cardiac v (runs with R coronary A)
- posterior interventricular A (posterior branch of R coronary A)
- middle cardiac v (post interventricular A)
- great cardiac v (ant interventricular A, circumflex A)
- coronary sinus (small, middle, great anastomose)
vessels that enter Right Atrium
- sup vena cava
- inf vena cava
- coronary sinus
Right ventricle
- tricuspid valve (R AV valve)
- chordae tendineae attach to papillary muscles
- pulmonary trunk
- pulmonary valve (semilunar valve)
L Atrium
- most posterior portion of heart
- sup & inf pulmonary veins (4 total)
- biscuspid/mitral valve
- chordae tendineae attach to papillary muscles
L Ventricle
- most muscular
- aortic valve (3 semilunar cusps)
- concave superiorly–>form aortic sinus
- R,L coronary A
- superior to R/L cusps @ level of aortic sinus
- blood pooling in sinus fills coronary arteries when valves close
Ohm’s law
flow:
- directly proportional to pressure difference
- inversely proportional to resistance
METs
THR
Metabolic Equivalent System
- desk work: 1.5-2
- walk 2mph: 2.5
- jog 5mph: 7-8
Target heart rate:
(220-age0.65).65 (lower end range)
(220-age0.65).85 (upper end range)
congestive heart failure
- inability of heart (left ventricle) to eject all blood it receives
- pooling of blood in ventricles reduces amount of blood it can receive from pulm circulation
- ->restriction of blood flow out of lung–>pulm edema
- decreases elasticity of lungs
- pushes fluid into alveoli, decreased respiration
structures that L coronary A supplies
- L atrium
- L ventricle
- interventricular septum
- ant part of R ventricle
- interventricular bundle of His
- branches into Ant Interventricular A & Circumflex A (curves posterior)
- Circumflex A–>L marginal A (supplies L ventricle)
structures that R coronary A supplies
- large part of R atrium, ventricle
- less of L ventricle
- least of L atrium
- interventricular septum
- interatrial septum
- SA,AV nodes
- branches:
- Sinoatrial A : SA node
- R marginal branch
- posterior interventricular A (meets w/ ant IVA @ apex)
- ends by anastomose w/ circumflex A
Coronary Artery Disease
decreased diameter coronary A–>ischemia–>decreased O2 to heart –>chest pain (angina pectoris)
*severe decrease–>myocardial infarction
Cardiac Veins
- venous blood from R,L ventricles & L atrium into coronary sinus
- coronary sinus lies in coronary sulcus
- empties into lower R atrium near inf vena cava
- receives blood from:
- great cardiac v
- middle cardiac v
- L,R marginal v
- small cardiac v
structure of arteries and veins
3 layers:
- intima: simple squamous epithelium i.e. endothelial cells
- middle: “media”, smooth muscle, collagen, elastic fibers
- adventitia: outermost layer, collagen
3 divisions of Arteries
- large elastic (aorta, pulmonary trunk)
- intima: thick, layer of elastic fibers
- media: smooth mm, elastic fibers
- adventitia: thin, collagen - medium size A (muscular A)
- intima: elastic fibers
- media: thick smooth muscle
- adventitia: thick, mostly collagen, some elastic - small A (arterioles)
- few elastic fibers in intima, only few layers of smooth mm in media
- adventitia thin, mostly collagen
structure of veins
- large: thin intima & media, thick advent
- medium size: thin intima & media, distinct advent
- small; thin intima & media
structure of capillaries
- single layer of endothelial cells
- continuous: no pores
- fenestrated:thin porous regions (fenestra)
congenital heart defects
- interventricular septal defect
- hole in IV septum
- more common in superior (membranous)
- loss of pressure in L ventricle during contraction–>decreases flow
- push blood back into R ventricle- increase pulmonary flow, may cause CHF
- tetralogy of fallot
- IV septal defect
- infundibular pulmonary stenosis (narrow opening of pulmonary trunk)
- overriding aorta (receives blood from R & L ventricles due to IV septal defect)
- R ventricular hypertrophy
contents of superior mediastinum
- continuous inferiorly w/ ant, mid, post mediastina
- thymus
- R,L brachiocephalic V, superior vena cava
- arch of aorta
- brachiocephalic trunk: R subclavian A, R common carotid A
- L common carotid A
- L subclavian A
- R,L vagus N (lie in sup, mid, post mediastina)
- run w common carotid A, int jug V
- give off recurrent laryngeal N
- phrenic N (superior and middle mediastina)
- trachea
- esophagus
- thoracic duct
- sympathetic trunks (chains) (neck - sacrum)
- through sup & post mediastina
note:
aortic arch in sup mediastinum
ascending aorta: middle mediastinum
descending aorta: posterior mediastinum
super mediastinum contents (ant–>post)
1.thymus
2.R,L brachiocephalic V, superior vena cava
3.Arch of Aorta
*brachiocephalic trunk: R subclavian A, R common carotid A
*L common carotid A
*L subclavian A
R,L vagus nerves
*run w/ common carotid A and int jug V
*give off branch to recurrent laryngeal N
R,L phrenic N (sup & mid mediastinum)
Sympathetic Trunks
4.Trachea, esophagus
5.thoracic duct
posterior mediastinum contents
- posterior to pericardium, T4-5 disc to vertebral margin of diaphragm
1. thoracic aorta- post intercostal A
- esophageal A
- bronchial A
- subcostal A
- arteries to pericardium, diaphragm
2. esophagus
3. vagus N, ant & post vagal trunks (continuations of R,L vagus N)
4. azygos V
5. hemiazygos V(T12-T9,formed by L subcostal & ascending lumbar V)
6. accessory hemiazygos V (T8-T4, blood from L intercostal V)
7. sympathetic trunks - splanchnic Nerves (3):Greater (T5-9),Lesser(T9-10),Least(T11)
8. thoracic duct - begins @ cisterna chyli (ENLARGED SAC-ventral to T12)
- lymph drainage from abdomen, pelvis, lower extrem
- empties into L brachiocephalic V
Diaphragm apertures (Come Enter Abdomen Please)
Ant –>post:
- vena caval: T8
- esophageal: T10
- Aortic hiatus: T12
- Psoas: T12
posterior mediastinum (4 birds)
- esophaGOOSE (esophagus)
- vaGOOSE (vagus N)
- azyGOOSE (azygos V)
- thoracic DUCK (thoracic duct)
sympathetic trunks
- Neck to sacrum
- superior mediastinum
- posterior mediastinum
- greater splanchnic N (ganglia T5-9)
- lesser (ganglia T9-10)
- least (ganglia T11, sometimes T12)
accessory hemiazygos V
T8-4
blood from L intercostal V
hemiazygos V
T12-9
formed by L subcostal V & ascending lumbar V
R lymphatic duct
drains into R internal jugular V / R brachiocephalic V
