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Y1 - Anatomy of the Thorax > Lecture 3 - Bronchi, pleura, lungs and the diaphragm > Flashcards

Lecture 3 - Bronchi, pleura, lungs and the diaphragm Flashcards

1
Q

What vertebral levels does the trachea span?

A

From C6 to T4/5

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2
Q

Describe the structure of the trachea.

A
  • Held open by cartilaginous (hyaline) C-shaped rings that face posteriorly, allowing for the oesophagus to expand when food passes through it
  • Lowest cartilaginous ring has a hook on it, called the carina (looks like the bow of a ship when passing an endoscope down the trachea)
  • Posterior wall is composed of mainly smooth muscle
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3
Q

At what level does the trachea bifurcate?

A

T4/5

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4
Q

Describe the structure of the primary bronchi.

A
  • Known as the right and left bronchus
  • Right is wider and more vertical than the left
  • Enters and passes through the hilum of the lung
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5
Q

In which bronchus are obstructions more common?

A

The right bronchus as it is almost a direct pathway from the trachea (more vertical) and therefore foreign objects are more likely to enter into this bronchus.

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6
Q

What do the main bronchi branch into?

A

Lobar bronchi (secondary), forming in the lungs and supplying the lobes of the lungs.

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7
Q

How many lobar bronchi are there on each side?

A

2 on the left and 3 on the right

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8
Q

What follows the lobar bronchi and what do they do?

A 
Segmental bronchi (tertiary) which supply the bronchopulmonary segments
- 10 segments in each lung
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9
Q

How are segmental bronchi held open?

A

Discontinuous elongated plates of cartilage that is not present in the bronchioles.

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10
Q

What is the clinical significance of the segmental bronchi?

A

They are the smallest functionally-independent regions in the lung that can be isolated and removed without affecting other regions.

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11
Q

What are the attachments of the lungs?

A

Attached to the heart via the pulmonary blood vessels and the to the trachea via the lung root.

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12
Q

How many lobes are in each lung and what are their individual names?

A

Right lung - 3 lobes (superior, inferior and middle lobes)

Left lung -2 lobes (superior and inferior lobes)

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13
Q

How are the lobes visibly separated in the lungs?

A

Right - horizontal and oblique fissures

Left - oblique fissure (level T4)

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14
Q

Which lung is larger?

A

Right

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15
Q

How do the oblique fissures differ in each lung?

A

The oblique fissure on the left lung runs slightly more obliquely than the right oblique fissure.

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16
Q

Describe the shape and boundaries of the lungs.

A
  • Conical in shape
  • Apex rises 3-4cm above first costal cartilage
  • Base is concave and rests on the convex surface of the diaphragm
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17
Q

What does the diaphragm separate the lungs from?

A

Right - right lobe of the liver

Left - left lobe of the liver, stomach and spleen

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18
Q

Describe the mediastinal surfaces of the lungs?

A

Anterior - deeply concave to accommodate mediastinum/heart. Indent on the left is larger than the right due to increased cardiac muscle.
Posterior - in contact with thoracic vertebrae (T1-12)
Superior and posterior to cardiac impression - hilum of the lung

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19
Q

What is the hilum of the lung?

A

The lung root which connects the mediastinal surface to the heart and trachea and is formed by structures that enter and leave the hilum.

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20
Q

What are the contents of the hilum?

A
  • Principal bronchi (right or left)
  • Pulmonary artery
  • 2 pulmonary veins
  • Bronchial arteries
  • Pulmonary nerve plexus
  • Lymph vessels and nodes
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21
Q

What is the pulmonary ligament?

A

Thin, blade-like fold of pleura that projects inferiorly from the hilum to the mediastinum.

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22
Q

What is the function of the pulmonary ligament?

A

It stabilises the position of the inferior lobe and accommodates translocation of structures in the hilum during breathing.

23
Q

What is the pleura?

A

A thin layer of flattened cells that are supported by connective tissue, lining each pleural cavity and covering the exterior of the lungs. Can be divided into parietal and visceral pleura.

24
Q

What is the visceral pleura?

A

Covers the surface of the lungs and lines the fissures.

25
Q

What is the parietal pleura?

A

Lines the inner surface of the chest walls.

26
Q

How does the parietal pleura come about covering the lungs?

A

The lung bud grew into the parietal pleura.

27
Q

When is the costa-diaphragmatic recess of pleura not seen?

A

Maximal inspiration where the entire pleural cavity is filled with air and expanding lung tissue.

28
Q

What is the diaphragm?

A

A thin musculotendinous structure that fills the inferior thoracic aperture and separates the thoracic cavity from the abdominal cavity.

29
Q

What is the role of the diaphragm during breathing?

A
  • Contraction causes normal dome shape to flatten (during inspiration), increasing thoracic cavity volume and decreased intra-thoracic pressure.
  • During contraction, it presses on the abdominal viscera which initially descend due to the relaxation of the abdominal wall during inspiration
  • Abdominal viscera begin to resist suppression so costal margin moves superiorly
30
Q

What arteries supply the diaphragm?

A
  • Superior phrenic arteries (arising from inferior region of thoracic aorta)
  • Intercostal arteries
  • Inferior phrenic arteries (largest supplier)
31
Q

Where does the inferior phrenic artery branch from?

A

Abdominal aorta

32
Q

What is the venous drainage system for the diaphragm?

A
  • Brachiocephalic veins in the neck
  • Azygos vein
  • Abdominal veins (left suprarenal and inferior vena cava)
33
Q

Which nerves innervate the diaphragm?

A

C3-5 (right and left phrenic nerves - motor only)

34
Q

How are the central and peripheral diaphragm supplied by nerves?

A

Central - S3-5

Peripheral - lower six intercostal nerves

35
Q

At what level does the vena cava pierce the diaphragm?

36
Q

At what level does the oesophagus pierce the diaphragm?

37
Q

At what level does the descending aorta pierce the diaphragm?

38
Q

At what level does the vagus nerve pierce the diaphragm?

A

T10 (with the oesophagus)

39
Q

At what level does the thoracic duct pierce the diaphragm?

A

T12 (with the descending aorta)

40
Q

Where do the azygos vein and hemiazygos veins pass through the diaphragm?

A

Aortic hiatus

41
Q

What muscles are used in expiration?

A

No muscles - it is a passive process. It depends on elastic recoil that is stored in the elastic tissue of the lungs and the rib cage.
- In deep/forced expiration, the abdominal muscles help

42
Q

Which mucous glands are present in the different levels of the airway?

A 
Trachea - goblet cells
Bronchi - goblet cells 
Bronchioles - none (surfactant)
Respiratory bronchioles - club/clara cells
Alveoli - none
43
Q

What muscle is present at different levels of the airway?

A 
Trachea - SM
Bronchi - SM
Bronchioles - SM
Respiratory bronchioles - some (transition)
Alveoli - none
44
Q

What cell type is present at different levels of the airway?

A

Trachea - pseudostratified ciliated columnar
Bronchi - pseudostratified ciliated columnar
Bronchioles - pseudostratified ciliated columnar
Respiratory bronchioles - cuboidal cells
Alveoli - simple squamous (T1/2 pneumocytes)

45
Q

Where is cartilage present at the different levels of the airway?

A 
Trachea - C-shaped
Bronchi - complete (main) and crescent shaped (lobar/segmental)
Bronchioles - none
Respiratory bronchioles - none
Alveoli - none
46
Q

What is the pleural cavity?

A

A potential space between the visceral and parietal pleura containing a thing layer of serous fluid allowing the lungs to glide during expansion.

47
Q

What is different about where the IVC and the oesophagus/aorta pierce the diaphragm?

A

The IVC is compressible to pierces the tendinous part of the diaphragm so it does not collapse. The oesophagus is muscle and the aorta is thicker so they can pierce the muscular part of the diaphragm.

48
Q

What is the bronchial circulation responsible for?

A

Provides the lung tissue with oxygenated blood to meet its metabolic demands. It forms the part of the systemic circulation.

49
Q

What is the pathway for the bronchial circulation?

A

left ventricle - descending aorta - bronchial arteries - capillaries - bronchial veins - azygos vein - superior vena cava

50
Q

What does parasympathetic innervation of the lungs result in?

A

Increased secretions and contraction of smooth muscle.

51
Q

What does sympathetic innervation of the lungs result in?

A

Decreased secretions and relaxation of smooth muscle.

52
Q

What are the surface landmarks for the lung fissures?

A

Oblique - starts at T4, crosses 4th and 5th ICS moving laterally and inferiorly, ending at 6th rib
Horizontal - follows contour of 4th rib and CC on the right to meet oblique fissure at MAL

53
Q

What are the surface landmarks for the lungs?

A
  • 2-3cm about medial 3rd of clavicle
  • Sternoclavicular joint
  • 2nd CC at sternal angle
  • 6th CC at sternal border
  • MCL at 8th rib
  • MCL at 10th rib
  • Scapular line at 12th rib

Y1 - Anatomy of the Thorax (9 decks)

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