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Lecture 1 and 2 - Anatomy Flashcards

1
Q

Contents of the upper respiratory tract

A

Nose
Paranasal air sinuses
Pharynx
Larynx - lower border of the cricoid cartilage

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2
Q

How does the respiratory system develop?

A

Develops as a diverticulum from the pharynx from the primitive gut tube

It then branches

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3
Q

What is the purpose of the nasal cavity? (5)

A
  1. Olfaction
  2. Produce turbulent air flow via conchae - slows speed of air entry so it can be warmed and moistened
  3. Warms and moistens inspired air (by transudation of mucous secretions)
  4. Recovers water from expired air
  5. Speech production
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4
Q

What divides the left and right nasal cavities

A

Median nasal septum

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5
Q

Transudation

A

Passage of substance through a membrane due to its hydrostatic pressure gradient

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6
Q

What is each nostril lined by?

A

Course hairs
Mucous secreting goblet cells - trap large particles in inhaled air
Cilia - waft mucous to the oropharynx where it can be swallowed

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7
Q

Which plane is the nasal cavity floor in

A

Horizontal

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8
Q

What does the pharynx and larynx do

A

Ensures food and air enter the oesophagus and trachea respectively

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9
Q

Aspiration

A

Inhalation

Of food particles and liquids which can cause aspiration pneumonia

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10
Q

Why can aspiration occur

A

The trachea and oesophagus crossover

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11
Q

4 Paranasal air sinuses

A

Ethmoidal
Frontal
Maxillary
Sphenoidal

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12
Q

Paranasal air sinuses

A

Air-filled spaces in the head which reduces the weight of the skull

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13
Q

What are paranasal air sinuses lined by?

A

Respiratory epithelium - pseudostratified ciliated columnar epithelium

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14
Q

What are conchae/turbinates?

A

3 bony projections on the lateral wall of the nasal cavity

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15
Q

Larynx

A

Links the pharynx to the trachea
Contains the vocal cords - guards tracheal inlet
Prevents aspiration
Cough reflex

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16
Q

Glottis

A

Vocal cords and aperture between the cords

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17
Q

What happens to the larynx during swallowing?

A
  • Laryngeal inlet narrows
  • Epiglottis folds down over the laryngeal inlet
  • Vocal cords adduct - closing the laryngeal inlet
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18
Q

What adducts the vocal cords?

A

Intrinsic laryngeal muscles

Supplied by the recurrent laryngeal nerve

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19
Q

What can damage the left recurrent laryngeal nerve?

A

Aortic aneurysm
Pancoast tumour

  • Presents with a hoarse voice as the left vocal cord is paralysed
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20
Q

Cough reflex

A

Vocal cords close - increased intrathoracic pressure in early stage of cough reflex

Sudden opening of the vocal cords causes air to be expelled at a high velocity

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21
Q

Conducting airways

A

Do not take part in gas exchange

Trachea
Primary bronchi  - main
Secondary bronchi - lobar
Tertiary bronchi - segmental 
Bronchioles
Terminal bronchioles

1- 16 divisions

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22
Q

Why is the trachea horseshoe shaped?

A

Prevents compression of the oesophagus

Allows the oesophagus to bulge during the passage of a bolus

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23
Q

How many secondary bronchioles does the right and left lung have?

A

Right - 3

Left - 2

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24
Q

What do the ribs articulate with?

A

Anteriorly - costal cartilage

Posteriorly - vertebral column

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25
Sternal angle
Transverse ridge on palpation Between the manubrium and sternal body Indicates 2nd rib
26
What does the tubercle of the rib articulate with?
Transverse process of corresponding vertebrae
27
Describe the head of the ribs T3-9
They have 2 articular facets Articulate with the corresponding and above vertebrae e.g third rib articulates with T2 and T3
28
Bony thorax
Sternum Ribs Thoracic vertebrae Costovertebral joints
29
Describe the structure of a rib
Head with 2 facets articulates with the vertebrae Neck connects head and shaft Tubercle articulates with the transverse process of vertebrae Shaft - external surface The internal surface contains a costal groove Costal cartilage
30
Describe the thoracic vertebrae
``` Superior articular facets (2) Inferior articular facets (2) Superior costal facet (2) [demifacet] Inferior costal facet (2) [demifacet] Transvere costal facet (2) ``` Heart shaped vertebral body Inferiorly slanted spinous processes
31
Mediastinum
Midline structure that separates the lungs The sternal angle T4/ T5 separates the superior and inferior mediastinum
32
What nerve innervates the intercostal muscles
Intercostal nerve
33
External intercostal muscle
Most superficial 30% of chest expansion during quiet inspiration Contraction elevates the ribs in a bucket handle type motion Increases thoracic volume and decreases pressure
34
Internal intercostal muscles
Muscle fibres are perpendicular to the external intercostal muscles Pulls ribs down from chest expansion during FORCED expiration
35
Quiet expiration
Passive process | Due to the elastic recoil of the alveoli
36
Innermost intercostal muscles
Less well developed | Support inner intercostal muscles
37
The costotransverse ligament
Connects the anterior surface of the transverse ligament to the neck of the rib Lateral costotransverse ligament connects the tip of the transverse process to the tubercle of the rib
38
Movement of chest wall during inspiration
RIbs move laterally up and out | Sternum moves forward due to rib elevation
39
Diaphragm
70% of chest expansion during quiet inspiration Dome shape Bulges into the thorax Origin: lower margin of thoracic cavity Insertion: Central tendon Innervation: C3,4,5 Action: Contract moving the diaphragm down to decrease pressure in the thoracic cavity Relaxation on exhalation moves the diaphragm up by 2 intercostal spaces
40
Damage to phrenic nerves
C3,4,5, Paralysis of the diaphragm on the affected side Elevated hemidiaphragm on CXR - Breathless
41
Openings to the diaphragm
Vena cava T8 Oesophagus T10 Aortic hiatus T12
42
Which diaphragmatic dome is higher?
Right due to the liver (5th rib) | Left dome - lower at the 5th intercostal muscle
43
How does the movement of the ribs cause movement of air into the lungs?
The ribs move up and out, increasing intrathoracic volume. Decreases intrathoracic pressure creating negative pressure. Air is drawn in
44
Where are the major neurovascular bundles located in the thorax?
Just below the rib at the inferior margin | Therefore when inserting tubes, go superior to the rib
45
Accessory muscles of inspiration
SCM Pectoralis major when arms are fixed Serratous anterior Scalene muscles
46
Accessory muscles of expiration:
Internal intercostal muscles Innermost intercostal muscles Abdominal muscles - Rectus abdominis + EO + IO
47
Sternum
Manubrium Sternal angle Sternal body Xiphisternum
48
Neurovasculature of the thorax
Intercostal artery, vein and nerve Supply and drain the: - Intercostal muscles - Parietal pleura - Overlying skin The intercostal arteries are posterior and the internal thoracic arteries are anterior
49
Specialised draining system of the thorax
Azygous veins - unpaired (no associated artery) Right - azygous veins - required for intercostal muscles at the level of the heart and drain into the IVC Left - Accessory hemiazygous vein
50
Referred pain to shoulder in pericardium defect
The pericardium is supplied by C3, 4 and 5 Therefore pain in the shoulder due to irritation of the pericardium will be referred to the C3,4, 5 dermatome
51
Liver biopsy
Needle introduced below the 5th intercostal space
52
Trachea
Commences at the lower margin of the cricoid cartilage of the larynx and terminates by dividing into primary bronchi at the sternal angle
53
Carina
Angle between the right and left bronchi
54
Bronchopulmonary segment
Area of the lung supplied by a segmental (tertiary) bronchiole and the accompanying segmental branch of the pulmonary artery. Drained by a segmental pulmonary vein. Segments are pyramid-shaped with the apex facing towards the segmental branches and base towards the lung face Can be isolated and removed with limited bleeding and air leakage during surgery
55
Why is food more likely to lodge in the right bronchus
Shorter Wider More vertical
56
Respiratory zone
7 divisons 16 - 23 Where gas exchange occurs Respiratory bronchioles alveolar sacs alveolar ducts
57
Alveoli
3 million SA = 70m^2 Surrounded by a network of pulmonary capillaries Thin membrane
58
Right lung
3 lobes: upper, middle and lower Horizontal - separates lower lobe from middle Oblique fissure - seperates upper lobe from middle Bases- rests on the right hemidiaphragm Rib 6 MCL Rib 8 MAL Rib 10 Scapula line Apex - extends above the 1st rib level
59
Horizontal fissure
In the midaxillary line | anterior along 4th rib to edge of lung
60
Oblique fissure
From spinous process of T2 posteriorly to 6th intercostal cartilage anteriorly Follows medial border of the scapula
61
Mediastinal surface of the lungs
Contains the hilum: - Main bronchi - lymphatics - pulmonary veins x 2 - pulmonary artery branches - pulmonary plexus
62
What is the right lung adjacent to?
``` Superior vena cava Azygous veins Right atrium Oesophagus Phrenic nerve Vagus nerve Sympathetic trunk ```
63
What is the left lung adjacent to?
``` Heart Aortic arch Descending aorta Left recurrent laryngeal nerve Phrenic nerve Vagus nerve Sympathetic trunk ```
64
Lung pathologies affecting mediastinal surfaces
Phrenic nerve - paralysis of the diaphragm - breathlessness Left recurrent laryngeal nerve - paralysis of the intrinsic laryngeal muscles - hoarse voice Superior vena cava - Obstruction - peripheral oedema
65
Pleural layers
Visceral | Parietal
66
Visceral pleura
Lines the outside of lungs Extends into the fissures Supplied by the pulmonary plexus - sensitive to distention only
67
Parietal pleura
Lines the inside of the hemi thorax Continous with the visceral pleura at the hilum of the lungs Supplied by the phrenic and intercostal nerves - sensitive to pain, pressure and temperature
68
Pleural cavity
Potential space between the visceral and parietal pleura which contains a small amount of pleural fluid
69
Pleural fluid
Surface tension of pleural fluid creates a seal so when the thorax expands the lungs do too.
70
Costodiaphragmatic angle
Space in which only the parietal pleura extends around the outer edge of the diaphragm Allows room for expansion Rib 8 MCL Rib 10 MAL Rib 12 Scapular line
71
Blood supply to the lungs
Dual blood supply: Pulmonary arteries - Supplies alveoli with deoxygenated blood for gas exchange Bronchial arteries - supplies parenchyma of lung and visceral pleura with oxygenated blood Most blood drains via the pulmonary veins Some blood drains to the azygous vein to SVC
72
Lymphatic drainage
``` Hilar node (bronchopulmonary) Efferent lymph nodes - tracheobronchial nodes - enlarged tracheobronchial nodes can widen the carina angle ```
73
Nerve supply of the lungs
Right and left vagus nerve PS efferents - motor to smooth muscle (bronchoconstriction) and secretomotor to mucous glands afferent - cough reflex and pain Sympathetic trunk - efferent - bronchodilation - afferent - vasoconstriction

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