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CPR 1 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

What is the mediastinum

A

The thoracic (Ab-Neck region) compartment between the pleural sac

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2
Q

What is the Plane of Ludwig and what structures does it contain?

A

-Horizontal plane across thorax

Contains:

1) Superior vena cava
2) Aorta
3) Trachea bifurcation
4) Pulmonary trunk bifurcation

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3
Q

Boundaries of superior mediastum

A

Superior:

  • 1st rib
  • T1
  • Jugular notch

Inferior:
-Transthoracic plane

Posterior
-T1-4 Vertebrae

Anterior:
-Manubrium

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4
Q

Contents of the superior mediastinum

A

Structures:

1) Esophagus
2) Thoracic duct
3) Thymus
4) Trachea
5) Aortic arch and major vessels
6) Left and right brachiocephalic veins
7) Superior vena cava
8) Pulmonary arteries

Nerves:

1) Vagus
2) Recurrent laryngeal
3) Phrenic

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5
Q

Thymus

A

Function:

  • Immune function
  • Secretes hormones (puberty)

Blood supply:
-Internal thoracic and anterior intercostal

Venous drainage:
-Brachiocephalic, internal thoracic, and inferior thyroid veins

Lymph drainage:
-Into parasternal, brachiocephalic, and tracheobronchial lymph nodes

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6
Q

Trachea

A
  • Continuation of the larynx at C6
  • Terminates at transthoracic olane (Bifurcates into right and left bronchi)
  • Crossed over by the arches of the aorta and azygos vein
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7
Q

Aortic Arch and Branches

A

Branches

1) Brachiocephalic trunk
- Right subclavian
- Right common carotid

2) Left common carotid
3) Left subclavian

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8
Q

Brachiocephalic veins

A

-Formed by the union of the subclavian and internal jugular

Posterior to sternoclavicular joints

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9
Q

Subclavian Artery

A

• Divided into 3 parts by the anterior
scalene muscle

1st part (VIT)
• Vertebral A.
• Internal thoracic A.
• Thyrocervical trunk

2nd part (C)
• Costocervical trunk

3rd part

    • Dorsal scapular
  • Becomes the axillary artery at the lateral border of rib 1
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10
Q

Nerves of the mediastinum

Vagus

A

1) Vagus nerve
- Travels along common cartoid artery

-Path:
Esophagus (Esophageal plexus) –> down abs (Anterior vagal trunk-left vagus nerve) and (Posterior vagal trunk-right vagus nerve)

-Carries parasympathetic and visceral afferent to thoracic vertebrae

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11
Q

Nerves of the mediastinum

Recurrent laryngeal nerves

A

-Branch of vagus nerves on either side

  • Left associated with arch of aorta
  • Right associated with right subclavian artery
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12
Q

Nerves of the mediastinum

Phrenic nerve

A

• Enters sup. mediastinum
between the subclavian
artery and the root of the
brachiocephalic vein

• Courses along the
pericardium, pierces through
the diaphragm (innervates both)

• Sensory and motor
innervation to the diaphragm (C3, 4 , 5)

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13
Q

Inferior Mediastinum Boundaries, divisions, contents

A

Boundaries:

1) Superior = Transthoracic plane (Plane of ludwig)
2) Inferior = diaphragm
3) Anterior = Body of sternum
4) Posterior = T5-T12

Divisions-made up of all

1) Anterior
2) Middle
3) Posterior

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14
Q

Middle Mediastinum Boundaries and contents

A

-Fibrous/parietal layers of serous pericardium bind it

Contents:

1) Heart
- Ascending aorta
- Intrapericardial SVC
- Pulmonary trunk

2) Main bronchi

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15
Q

Posterior Mediastinum Boundaries and contents

A

Boundaries:

1) Anterior = Pericardium
2) Posterior = Vertebrae T5-12

Contents:

1) Sympathetic chain
2) Esophagus
3) Esophageal plexus
4) Azygos venous system
5) Descending thoracic aorta
6) Thoracic Duct

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16
Q

Sympathetic chain and

Splanchnic nerves

A

• Sympathetic chains are located laterally to the vertebral column
-Contain interconnected sympathetic ganglia

•3 distinct splanchnic nerves

1) Greater
- T5-9 with some variation
- Joins the celiac ganglion

2) Lesser
- T10-11
- Joins aortico-renal ganglion

Least

  • T12 but not always present
  • Joins the renal plexus
17
Q

Esophagus Constriction/path of contriction points

A
  • Junctions w pharnx at C6
  • Enters the thorax through the superior thoracic aperture

Crossed by left main bronchus (T4/5)

  • Pass diaphragm at es. hiatus T10
  • Ends at cardiac sphincter
18
Q

Anterior mediastinum

A

Divisions:

1) Anterior = Sternum
2) Posterior = Pericardium

Contents:

1) Thymus
2) Lymph node
3) Connective tissue

19
Q

Esophagus Blood supply, innervation, venous, lymph drainage

Thoracic Portion

A

Thoracic portion:
• Arterial supply:
-thoracic aortic
-bronchial arteries

• Innervation:

  • esophageal plexus,
  • sympathetic trunks

• Venous drainage:

  • azygos,
  • hemiazygos veins

• Lymphatic drainage:

  • thoracic duct,
  • posterior mediastinal nodes
20
Q

Esophagus Blood supply, innervation, venous, lymph drainage

Abdominal Portion

A

Abdominal portion:
• Innervation:
-vagal trunks,
-greater splanchnic nerves

• Arterial supply:

  • left gastric artery,
  • left inferior phrenic

• Venous drainage:
-left gastric vein

• Lymphatic drainage:
-left gastric
nodes

21
Q

Azygos system

of veins

A
  • Form a collateral drainage pathway between the IVC and SVC.
  • Drain the back, thoracoabdominal wall, and mediastinal viscera

Right side: (Azygos)
Ascending lumbar and subcostal meet up, ascend through and arch over into SVC

Left side: (Hemiazygos)
Ascending lumbar vein and subcostal meet, cross over T5-8 level and meet up with azygos and SVC

Upper left: (Azygos accessory)
-Runs 4-8 intercostal veins/bronchial veins, crosses over T5-8 and reaches azygos and SVC

22
Q

Descending thoracic aorta

A 
Branches
• Posterior intercostal arteries
• 1 or 2 bronchial arteries
• Pericardial and mediastinal branches
• Esophageal branches
• Superior phrenic artery
• Subcostal artery
Trajectory
• Continuation from aortic arch (T4/5)
• Travels along the left side of the
esophagus in its entire length down
the thorax
• Pierces aortic hiatus at T12 level to
becomes the abdominal aorta
23
Q

Diaphram hiatus’s

A 
T8 = inferior vena cava (Right
T10 = Esophagus (left)
T12 = Aorta (Midline)

I 8 10 eggs @ 12

24
Q

Thoracic Duct Path

A

-Lymphatic vessel

Path:
Cisterna chyli –> Right side –> Diaphragm aortic hiatus –> azygos vein –> T5 crosses to left side –> Enters neck –> drains into junction of Left subclavian and Left internal jugular veins

25
Q

Where does the Thoracic Duct receive lymph from?

A

Everything drains inter left thoracic duct except

1) Jugular trunk
2) subclav trunk
3) bronciomedistinal nodes
4) upper intercostal nodes

26
Q

Thoracic outlet syndrome

Causes
Effects
Symptoms

A 
Thoracic outlet syndrome
Cause:
1) Extra rib attaching to the 7th Cervical vertebra and rib 1
2) Muscular abnormalities
3) Trauma, tumor

Leads to compression of axillary inlet components:
• Subclavian artery/vein: thrombosis/embolization
• Nerves (C8-T1): sensory deficit, muscle wasting

Symptoms
1) Neurological: pain, paresthesia, paresis/paralysis
2) Vascular: pallor, pulselessness, poikilothermia (cold),
edema (venous compression)

CPR 1 (32 decks)

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