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Lungs > Gross Anatomy of Lungs > Flashcards

Gross Anatomy of Lungs Flashcards

1
Q

Thorax definition

A

superior component of the trunk, connecting the neck with the abdomen

an irregular cylinder with an opening at each end

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2
Q

what are the openings of the thorax called + what communicates?

A

superior thoracic aperture- thoracic inlet formed by the first thoracic vertebra, the first pair of ribs and the superior surface of the manubrium of the sternum- neck and upper limb

inferior thoracic aperture- thoracic outlet- twelfth thoracic vertebra, eleventh and twelfth pair of ribs and the inferior costal cartilages

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3
Q

what separates the thorax and the abdomen?

A

muscular sheet of diaphragm

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4
Q

thoracic wall definition

A

the boundary of the thoracic cavity

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5
Q

what forms the thoracic wall?

A

bony skeletal part- rib cage- thoracic cage comprised of the sternum, thoracic vertebrae, ribs and costal cartilages

the rest- intercostal muscle, skin and fasciae

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6
Q

function or thoracic wall

A

protection of thoracic viscera

dynamic generator of change in intrathoracic pressure to drive ventilation

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7
Q

What two things must the thoracic wall be + how is this achieved?

A

rigid- bony components

mobile- various parts of articulation between the bones

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8
Q

How does the upper limb articulate with the thorax?

A

clavicle and scapula, which form the pectoral girdle, are closely associated with the thoracic wall

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9
Q

Three parts of the sternum + any important regions

A

manubrium, body of sternum and cartilaginous xiphoid process- level T9/10

suprasternal notch- jugular notch- level of T2

sternal angle- manubriosternal joint at level of lower T4 vertebrae- secondary cartilaginous joint- palpable landmark

sternal plane at T4/T5- level of bifurcation at carina

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10
Q

Origin of sternum

A

developmentally forms from a series of smaller bones called sternebrae, fusion of which creates the body of the sternum

more superior sternebrae form the manubrium

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11
Q

costal cartilage definition

A

bars of hyaline cartilage that serve to prolong the rib forward and contribute to the elasticity of the walls of the thorax

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12
Q

where is costal cartilage found?

A

only found at the anterior ends of the ribs, providing medial extension

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13
Q

Where do the first two pairs of costal cartilages articulate?

A

manubrium of the sternum

joint between the manubrium and the body of sternum

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14
Q

how many pairs of ribs?

A

12

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15
Q

What may also be the case with the number of ribs + significance?

A

extra or absent ribs in some individuals

clinically significant if there is a pair of cervical ribs at the superior thoracic aperture, which may compress neurovascular structures transversing the narrow space

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16
Q

joint name between sternum and costal cartilage

A

sternocostal joints

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17
Q

what are the posterior joints called?

A

costovertebral joints with the ribs articulating with the twelve thoracic vertebrae

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18
Q

Which rib articulates with which vertebrae?

A

head of rib articulates with the vertebral body at the same level and that of the vertebra above

first, eleventh and twelfth ribs articulate only with respective thoracic vertebra T1, T11 and T12

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19
Q

rib structure

A

anterior portion contain a piece of costal cartilage

curved body

angle

neck

tubercle- a small bump on the neck articulates with the vertebral transverse process at the same level

head with two articular facets

first rib is particularly flattened

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20
Q

What are the different ribs referred to as?

A

true ribs- upper seven, articulate directly via their costal cartilages with the sternum

false ribs- rib pair 8 -10 articulate with the costal cartilage of the ribs above

floating ribs- 11-12 have no anterior articulation

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21
Q

Diaphragm definition

A

domed musculotendinous sheet, being fibrous in its central part called the central tandon

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22
Q

diaphragm structure

A

both the left and right dome are associated with the lobe above it

muscular part is attached to the xiphoid process and the 11th and 12th rib, lower costal cartilages and the first to third lumbar vertebrae

veretbral attachments are via muscular slopes called crura

right crus originates from L1-L3 and left from L1-L2 vertebral bodies

costophrenic angle- peripheral edge of diaphragm with the thoracic wall

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23
Q

What happens to the costophrenic angle upon inspriration?

A

diaphragm flattens angle decreases

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24
Q

Where does innervation of the diaphragm originate?

A

sensory and motor innervation from right and left phrenic nerves originating from C3, C4 and C5

C3,4,5 keep the diaphragm alive

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25
Q

structures that transverse the diaphragm

A

inferior vena cava at T8- through opening on the right of central tendon

oesophagus and vagus nerves passes through fibres of the left crus at T10

Aorta and thoracic duct of the lymphatic system- pass between crura at the T1 level

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26
Q

Where do the sympathetic chains pass?

A

along the posterior thoracic wall and pass behind the diaphragm at a level similar to the aorta

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27
Q

Where do the phrenic nerves pass?

A

descend through the thorax on either side of the mediastinum to reach the diaphragm where they penetrate its substance to innervate it.

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28
Q

Other innervation of diaphragm

A

peripheral edge of diaphragm receives some sensory innervation from intercostal nerves

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29
Q

What is referred pain?

A

Pain perceived at a location other than the site of the painful stimulus.

It is a result of a network of interconnecting sensory nerves that supplies many different tissues

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30
Q

Where may the diaphragm pain be referred to?

A

right shoulder region or right hypochondrium, due to the distal origin of these diaphragmatic nerves C3,4,5

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31
Q

condition affecting the lung + cause

A

hemidiaphragmatic palsy

paralysis during neck surgery may damage C3,4,5 which prevents motor innervation, so one half of the diaphragm doesn’t move during inspiration

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32
Q

how many layers of intercostal muscle + names?

A

external and internal intercostal muscles- most developed and fill the spaces between the adjacent ribs

innermost intercostal muscles

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33
Q

Which are the most well developed muscles?

A

external and internal intercostal

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34
Q

what are the 3 layers continuous with ?

A

counterparts to the three layers that make up the anterolateral walls of the abdomen

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35
Q

what may the innermost intercostal muscles form?

A

some anatomically recognised muscle groups such as transversus thoracic and subcostales

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36
Q

Explain the fibres of the external intercostal muscles

A

rub forwards and downwards rom the tubercles of the ribs

become membranous close to the sternum

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37
Q

explain fibres of the internal intercostal muscles

A

thickest closest to the sternum

fibres run at right angles to those of the external intercostals and become membranous at the angles of the ribs

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38
Q

what achieves changes in thoracic volume?

A

diaphragm and intercostal muscles, latter driving the movement of the ribs

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39
Q

What drives ventilation at rest?

A

contraction and relaxation of the diaphragm

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40
Q

accessory muscles of breathing

A

sternocleidomastoid, scalenes and quadratus lumborum

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41
Q

What happens during inspiration?

A
  1. external intercostal muscles contract, pulling ribs outwards and upwards, which increases the transverse and anteroposterior diameters of the thorax
  2. diaphragm contracts, increasing the vertical dimension of the thoracic cage
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42
Q

How do the ribs differ + what this causes during inspiration?

A

different shape and dimension of different ribs results in a slightly different range of movements for each rib

sternal ends of the ribs are lower than their vertebral ends and elevation of the ribs at their costovertebral joints results in a lifting of the sternum upwards and outwards in a ‘pump handle’ movement

the most lateral part of the rib is inferior to its vertebral attachment, resulting in the rib also being moved outwards as it is elevated in a ‘bucket handle’ movement

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43
Q

Where is the pump handle movement most pronounced? + what it causes

A

second to sixth ribs

increases anteroposterior diameter of thorax

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44
Q

where is the bucket handle movement most pronounced? + what it causes

A

lower ribs

increases the transverse diameter of the thoracic cage

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45
Q

When are accessory muscles utilised?

A

during deep or forced inspiration

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46
Q

explain actions of accessory muscles

A
  1. neck muscles, sternocleidomastoid and the scalenes pull upon the first rib, lifting the sternum- further increasing the anteroposterior and vertical dimension

quadratus lumborum aids the contraction of the diaphragm by pulling upon the twelfth rib

47
Q

explain expiration

A

predominantly passive process, driven by the relaxation of the diaphragm and external intercostal muscles and recoil of the elastic lung tissue itself

forced expiration depends upon the contraction of the inner intercostal and innermost intercostal muscles, which depress the ribs

48
Q

accessory muscles that aid expiration + function

A

abdominal muscles- external oblique and rectus abdominis

further depress the thoracic cage while increasing intra abdominal pressure which pushes the diaphragm superiorly

49
Q

what are the intercostal spaces?

A

eleven anatomical spaces present between the typically 12 pairs of ribs

contain the intercostal muscle, nerves, arteries and veins, along with the associated lymph vessels and nodes

50
Q

organisation of the main neurovascular bundle

A

superior to inferior

vein - artery - nerve

51
Q

What are the intercostal nerves?

A

ventral rami of the T2-T11 spinal nerves

ventral ramus of the first thoracic spinal nerve contributes to a large branch called the brachial plexus

a smaller branch passes into the first intercostal space as the first intercostal nerve

52
Q

What is the ventral ramus of the 12th thoracic spinal nerve called?

A

subcostal nerve- innervates the lower part of the abdominal wall

53
Q

function and structure of the intercostal nerves

A

innervate the intercostal muscles and provide branches to the parietal pleura and their respective dermatomes

lateral cutaneous branch pierces the intercostal muscle and provides sensation to the skin of the lateral thoracic wall

anterior cutaneous branch provides sensation to the anterior thorax and abdomen skin

54
Q

how can the segmental innervation be viewed clinically?

A

shingles- reactivation or varicella zoster virus lying dormant in a dorsal root ganglion from an earlier chicken pox infection forms a rash following the dermatomes

55
Q

Where is a chest drain inserted? + why?

A

lower part of of the intercostal space, to avoid damage to main neurovascular bundle

56
Q

What are the main arteries in the lungs+ what do they form?

A

anterior and posterior intercostal arteries which form an anastomosis

57
Q

Where are the intercostal arteries derived from?

A

anterior- segmental vessels from the internal thoracic branches of the subclavian arteries- which run deep to the thoracic wall 1cm lateral to the sternum

posterior- segmental branches of the descending thoracic aorta

most superior two posterior are usually branches of a superior intercostal artery, derived from the costocervical trunk o the subclavian arteries

58
Q

What are the internal thoracic arteries usually used for?

A

coronary artery bypass graft- CABG

59
Q

aortic coarctation definition

A

congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus inserts

60
Q

What can be used to visualise a coarctation?

A

cardiac magnetic resonance angiograph

61
Q

main veins in lungs + where they drain

A

anterior and posterior intercostal veins

superior two veins drain into brachiocephalic veins

most others drain into the azygos venous system present on the posterior thoracic wall

intercostal veins on the right side join onto the azygos vein which drains into the superior vena cava

intercostal veins on the left are drained by accessory hemiazygos vein andlower hemiazygos vein

62
Q

Where do the hemiazygos veins cross to join the azygos vein?

A

the midline

63
Q

Where are the lymph nodes located?

A

alongside the internal thoracic arteries within the posterior intercostal spaces, where lymphatic vessels lie alongside the intercostal vessels

64
Q

What are the lymph nodes in that position called?

A

Parasternal nodes

65
Q

Important note in regards to breast tissue and drainage

A

lymphatic vessels from the medial portions of each breast drain to parasternal nodes

metastases from a breast tumour may drain to the contralateral thoracic wall and breast

66
Q

Where do the lymph nodes drain?

A

thoracic duct carries lymph from all body regions except for the right side of the thorax, head, neck and right upper limb

67
Q

What does the thoracic duct form and where?

A

thoracic duct forms within the abdomen as the cisterna chyli at the level of the first lumbar vertebra and ascends anterior to the thoracic vertebrae, inferior lying to the right side of the aorta

crosses to the left, where it receives lymphatic vessels from the left posterior intercostal spaces

reaches anterior to join and drain the venous angle between the left internal jugular and subclavian veins

the right lymphatic duct drains into the venous angle between the right internal jugular and subclavian veins

68
Q

chylothorax definition

A

wall of thoracic duct is damaged, lymphatic fluid may leak into pleural cavitites

69
Q

What is Horner’s syndrome?

A

compression of the sympathetic chains as they transverse the posterior thoracic wall, typically close to the superior thoracic aperture, by a tumour in the Apex of a Lung and causes drooping of the eyelid- partial ptosis, pupillary constriction- miosis and lack of sweating- anhydrosis

70
Q

What is a tumour in the apex of the lung called?

A

Pancoast’s tumour

71
Q

what type of epithelium are the pleura?

A

mesothelium

72
Q

What does the mesothelium produce + function?

A

small amounts of pleural fluid that allows pleural layers to slide past each other without producing friction

73
Q

two types of pleura

A

visceral- covers the lungs including fissures, which is continuous with parietal at hilum

parietal pleura - lines the walls of the pleural cavity- cervical, mediastinal, diaphragmatic and costal

74
Q

explain innervation of pleura

A

phrenic nerves- innervate diaphragmatic mediastinal pleura

intercostal nerves- costal pleura

75
Q

What causes the pleura to be kept close together?

A

normal surface tension, holds both layers close together to form a very small space called the pleural cavity

76
Q

what may go wrong with the pleural cavity?

A

air- pneumothorax, fluid (blood- haemothorax)

excessive pleural fluid- pleural effusion/ lymph- chylothorax

all in pleural cavity may compress the lung and compromise respiratory function

77
Q

4 parts of parietal pleura

A

cervical, costal, mediastinal and diaphragmatic

78
Q

what is the costodiaphragmatic recess?

A

spaces formed by the parietal pleura between the thoracic wall and diaphragm

lung expands into this during deep inspiration

79
Q

where may the recess extend below?

A

12TH RIB

80
Q

what can cause a pneumothorax?

A

trauma or interventional procedures that may damage the parietal pleura which results in an ingress of air into the space

trauma- stab injury, rib fracture

underlying lung disease

spontaneous

81
Q

tension pnemothorax definition

A

a progressive increase in air within the pleural cavity with each breath- the air being unable to escape upon expiration

leads to a rapid deterioration in respiratory function and is a medical emergency

can cause tachypnoea, tachycardia, hypotension

mediastinal shift, tracheal deviation- shift away from affected side

unilateral hyperinflation, hyperresonance and absent breath sounds on affected side

82
Q

Trachea definition

A

Prominent midline structure, which is palpable in the neck where it lies anterior to the oesophagus

83
Q

What structure is above the trachea + where does it change?

A

continuous with the larynx

the inferior border of which lies at the fifth/sixth cervical vertebrae

84
Q

trachea structure + function

A

formed partly by approximately 15 incomplete hyaline cartilage rings which are deficient posteriorly permitting expansion of the oesophagus as swallowed food passes down its length

incomplete part of the C shaped rings of cartilage also provide a site of attachment for the trachealis muscle

85
Q

trachealis muscle function

A

contract to narrows the airway during coughing to increase the velocity of airflow to help expel any objects irritating the tracheal lining

86
Q

Where does the trachea birfurcate?

A

at the sternal plane- C5/C6 at the carina

87
Q

where do the bronchi enter the lungs?

A

Enter the hilum approximately at the T5/T6 level

88
Q

Structure of right bronchus

A

wider and more vertically orientated

divides into three secondary bronchi- correlating with the number of lobes in each lung

right primary bronchus is shorter, and divides before it enters the lung

89
Q

structure of left bronchus

A

narrower and more horizontal

divides into two secondary bronchi

secondary bronchi then divide into tertiary/segmental bronchi which serves the bronchopulmonary segments of each lobe

90
Q

How can the tracheobronchil tree be examined?

A

by bronchoscopy

91
Q

Where are aspirated objects more likely to become lodged?

A

right bronchus, as wider and more vertical orientation

92
Q

lung margins

A

apex, reaches the neck region above the clavicle- suprapleural fossa and is palpable here

apex separated from neurovascular structures passing through the neck by a sheet of connective tissue- suprapleural membrane

lateral surface of lung in contact with the thoracic wall is the costal surface

inferior diaphragmatic surface of each lung is called the base

medially each lung presents a surface in contact with the mediastinum, called the mediastinal surface

mediastinal surface has a root/hilum where the bronchi, blood vessels, nerves and lymphatic vessels enter and leave the lung

93
Q

lung structure

A

left lung has two lobes

right lung has three lobes

both lungs divided into upper and lower lobes by the oblique fissure which passes through the entire depth

right lung has an additional horizontal fissure, separating the middle lobe from the upper lobe

upper lobe of left lung demonstrates a cardiac notch, inferior extension of which is called the lingula, which is a developmental homologue of the middle lobe of the right lung

94
Q

what can each lobe be divided into?

A

bronchopulmonary segments, each associated with the terminal bronchi

95
Q

How many segments in each lung?

A

10 in right

8-10 in left, as some segments duse

96
Q

Explain structures of segments

A

each segment is separated by sheets of connective tissue

blood supply is segmental, with each segment receiving a branch from the pulmonary artery

97
Q

clinical relevance of bronchopulmonary segments

A

knowledge of the anatomical arrangement is of importance in facilitating postural drainage of fluid or lung secretions

in supine patients the fluid will drain into the superior apical segments of the lower lobe

98
Q

where do the bronchi lie relative to the arteries?

A

lie posterior to the pulmonary arteries of the right lung and inferior to the pulmonary arteries of the left lung at their entry point in the hilum

99
Q

describe vasculature of hymen

A

Two pulmonary arteries- one right and one left

4 pulmonary veins- one superior and inferior leaving the hilum of each lung. Return oxygenated blood to the left atrium. Normally lie anterior and inferior to the pulmonary arteries and main bronchus

100
Q

What is the pulmonary ligament and where does it lie?

A

fold of pleural membrane reflected at the junction between parietal and visceral pleura

101
Q

Where do the lung tissue receive their blood supply from?

A

bronchial arteries originating from the aorta

small in comparison to pulmonary vessels and lie posterior to the main bronchi at the hilum

102
Q

What is a pulmonary embolism?

A

venous thromboses can enter the lung circulation via a pulmonary artery and cause a blockage

103
Q

explain lymphatic drainage of the lungs

A

lymphatic vessels surround the bronchial tree to form a deep lymphatic plexus

nodes surrounding the periphery of the lungs deep to the visceral pleura form the superficial lymphatic plexus

lymph from the superficial plexus drains into the bronchopulmonary lymph nodes situated at the hilum of the lung

lymph from the deep plexus drains first to pulmonary lymph nodes surrounding the secondary bronchi and then the bronchopulmonary nodes

bronchopulmonary nodes drain to tracheobronchial lymph nodes surrounding the tracheal birfucation at the carina

then drains to paratracheal nodes

lymphatic drainage from right lung is received by the right lymphatic trunk, as is lymphatic drainage from the lower lobe of the left lung

lymph from superior lobe of left lung drains to the thoracic duct at the left venous angle

104
Q

Where is the apex located?

A

2cm above the medial clavicle

105
Q

what is MAL?

A

Mid axillary line- found at the 4th costoclavicular cartilage

106
Q

what is MCV?

A

mid clavicular line-

107
Q

what is flail chest?

A

when a rib fracture results in a region of the rib cage becoming disconnected from the chest well.

the segment will then move with the lungs upon inspiration and expiration, not the ribcage

108
Q

what is percussion of the chest?

A

an assessment technique which produces sounds by the examiner tapping on the patient’s chest wall

109
Q

different sounds + what they mean

A

normal- no problem

dull- abnormal lung density, tumour pleural effusion

hyperresonant - too much air present in lung tissue, emphysema or pneumothorax

110
Q

dullness due to?

A

heart/ liver

111
Q

auscultation definition

A

listening to the internal sounds of the body, using a stethoscope

112
Q

different areas of auscultation

A

heart, breathe sounds over trachea, lung fields

113
Q

lung field definition

A

region of the body containing a lung

Lungs (10 decks)

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