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Respiratory block > Lower respiratory tract > Flashcards

Lower respiratory tract Flashcards

1
Q

What is the trachea?

A

Windpipe that is 11 cm long and 2.5cm wide.
Extends from cricoid (C6) to T5.
Lies in a visceral compartment of the neck, surrounded by a pre-treacheal layer of fascia.

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2
Q

What is an anatomical fascia?

A

A sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscles and other internal organs.

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3
Q

What is the pretracheal layer of fascia?

A

Extends medially in front of the carotid vessels and assists in forming the carotid sheath.
Continued behind the depressor muscles of the hyoid bone.
Envelopes the thyroid gland and the trachea.

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4
Q

Where does the trachea bifurcate?

A

At T5 into the right and left primary bronchi.

The carina is a cartilage situated at the point where the trachea (windpipe) divides into the two bronchi.

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5
Q

What is the carotid sheath?

A

Connective tissue that covers the carotid structures in the neck.

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6
Q

What are the 3 layers of the tracheal wall from deep to superficial?

A

1) mucosa 2) Submucosa 3) Hyaline Cartilage 4) Adventia (composed of aerolar connective tissue).

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7
Q

What is in the carotid sheath?

A

Internal jugular vein, artery and vagus nerve.

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8
Q

Where is the position of the trachea in the thoracic cavity?

A

Enters superior thoracic aperture, connecting the root of the neck with the thorax.
Lies in an oblique plane, tilted anterosuperiorly.

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9
Q

Which structures enter the thorax more vertically?

A

Those from the head and neck region rather than the upper limbs, which will have to bend over the superior ribs.

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10
Q

What is the progression of the trachea?

A

Trachea enters superior mediastinum.
Sternal angle- progression of superior to inferior mediastinum (T4/T5.)
The trachea bifurcates as soon as it enters the posterior mediastinum.

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11
Q

What is the structure of the trachea?

A

Mobile cartilaginous tube with membranes connecting the different cartilage.
Divides into left and right principle (main) bronchi at the level of the sternal angle.
Fibroelastic tube kept patent by U-shaped bars (rings- missing posteriorly) of hyaline cartilage.
Posterior free ends connected by smooth muscle called trachealis (allows esophagus to expand)

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12
Q

What are the layers of the trachea?

A

1) Mucosa (pseudostraified ciliated columnar epithelium) with goblet cells (secret mucin)
2) Submucosa (connective tissue with seromucus glands)
3) Fibrocartilage (16-20 in number)
4) Adventia- binds trachea to adjacent structures in the neck and mediastinum.

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13
Q

Why is mucus needed?

A

Secretions of mucosa and serous glands moistoins the air, which protects the alveoli from desiccation(drying out)

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14
Q

Which bronchi is bigger?

A 
The left main bronchus is narrower, longer and
more horizontal (5cm length)
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15
Q

What is the right main bronchi like?

A

Right main bronchus is wider and shorter

2.5cm length

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16
Q

Which bronchi are foreign material more likely to pass into?

A

Inhalation of foreign bodies – more likely to enter right bronchus, passing into middle or lower lobe bronchi

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17
Q

What is a bronchoscopy?

A

Bronchoscopy: enables examination of
trachea to carina:
Experience permits view of lobar and even segmental bronchi.
Can be used for biopsy of mucous membrane and removal of inhaled foreign bodies
Tracheostomy may be required in severe cases to re-establish an airway

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18
Q

Describe the bronchial tree

A

1) Bifurcation of trachea into right and left principle bronchi.
2) Secondary bronchus(lobar) to tertiary bronchus(segmental).
3) Bronchi divide dichotomously, giving rise to several million terminal bronchioles that terminate in one or more respiratory bronchioles.
4) Each respiratory bronchiole divides into 2- 11 alveolar ducts that enter alveolar sacs

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19
Q

What cells are the primary bronchi made from?

A

Incomplete rings of cartilage and are lined by pseudostratifed ciliated columnar epithelium.

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20
Q

What is the carina?

A

An internal ridge made by the posterior and somewhat inferior projection of the last tracheal cartilage.

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21
Q

What is the most sensitive region?

A

The mucous membrane of the carina is one of the most sensitive areas of the larynx and trachea in triggering a cough reflex.

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22
Q

How many lobes do the right and left lung have?

A

Seconary (lobar) bronchi lead to 1 lobe. Right lung has 3 lobes and the left lung has 2.

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23
Q

What do the tertiary (segmental bronchi) divide into?

A

Bronchioles

24
Q

What cells do the terminal bronchioles contain?

A

Clara cells- columnar nonciliated cells interspersed amongst epithelial cells.
Function as stem cells and protect against harmful toxins.

25
Q

How does the cartilage change during the bronchial tree?

A

Plates of cartilage eventually replace the incomplete rings of cartilage in primary bronchi, and finally disappear in distal bronchioles.

26
Q

What increases when the cartilage decreases in the bronchial tree?

A

Smooth muscle.
Encircle lumen in spirals and helps maintain patency
But can close of airways during spasms as no supporting cartilage is present

27
Q

What happens during exercise?

A

Sympathetic activity of ANS.
Adrenal medulla releases epinephrine and nephrine.
Cause relaxation of smooth muscle in bronchioles which dilates airways

28
Q

What are the lungs surrounded in?

A

Enclosed and protected in a double layered serous membrane called the pleural membrane.

29
Q

What are the layers of the pleural membrane?

A

The parietal pleura is the superficial layer and lines the thoracic cavity. The visceral pleura lines the lungs themselves.

30
Q

What is the function of the pleural fluid?

A

Reduces friction between the membranes.
Allows them to adhere to one another.
Separates pleural cavities into right and left.

31
Q

What is pleuritis or pleurisy?

A

Inflammation of the pleural membranes, which may cause pain due to friction between membranes.
If inflammation persists, excess fluid may accumulate in the pleural space, which is known as pleural effusion.

32
Q

Where do the lungs lie?

A

Extend from the diaphragm.

Slightly superior to the clavicles.

33
Q

Where is the apex and base of the lungs?

A

The apex is the narrow superior portion of the lungs.

The base s the broad inferior concave portion.

34
Q

What is the costal surface of the lungs?

A

The surface of the lung lying against the ribs, which matches the rounded curvature of the ribs.

35
Q

What is the hilium (or hilus) of the lungs?

A

A region at the mediastinal surface of each lung.
Region where bronchi, pulmonary blood vessels, lymphatic vessels, and nerves enter and exit.
Structures held together by pleura and connective tissue and constitute the root of the lung.

36
Q

What is the cardiac notch?

A

Medially on the left lung where the apex of the heart lies.

Therefore the left lung is 10% smaller than the right.

37
Q

Which lung is shorter?

A

Although the right lung is thicker and broader, it is somewhat shorter because the diaphragm is higher on the right side due to the liver accommodating it.

38
Q

Which area of the lungs can be palpated?

A

The apex of the lungs which lies superior to the medial third of the clavicle.

39
Q

Where does the base of the lung lie? And the pleura?

A

Extends anteriorly from the sixth costal cartilage to the spinous process of the 10th thoracic vertebra posteriorly.
The pleura extends about 5cm below the base from the sixth costal cartilage anteriorly to the 12th rib posteriorly.

40
Q

What is the pulmonary ligament?

A

Pulmonary ligament: fold of pleura that projects inferiorly from root of lung.
Stabilise inferior lobe.
Permit movement during respiration

41
Q

What nerves pass the lungs?

A

Vagus nerves pass immediately posterior to lung root and phrenic nerves immediately anterior

42
Q

What are the fissures of the lung?

A

Both have oblique fissure (between inferior and middle on right lung).
The right lung also has a horizontal fissure/

43
Q

How many bronchus do each lobe get?

A

1 Secondary bronchus.

44
Q

How many tertiary bronchi are in each lung?

A

10.

The segment of lung tissue that each tertiary bronchus supplies is called a bronchopulmonary segment.

45
Q

What are lobules?

A

Each bronchopulmonary segment of the lungs has many small compartments called lobules.
Each lobule is wrapped in elastic connective tissue and contains a lymphatic vessel, an arteriole, a venule and a branch from the terminal bronchiole.

46
Q

How does the epithelial lining of the respiratory bronchioles change?

A

Goes from simple cuboidal to simple squamous.

47
Q

What do respiratory bronchioles divide into?

A

They divide into 2-11 alveolar ducts, which consist of simple squamous epithelium.

48
Q

What is the order of the vessels in the lung root?

A

Pulmonary arteries superior
Pulmonary veins inferior
Bronchi posterior

49
Q

What are differences in the right and left hilia?

A

Right: the lobar bronchus to the superior lobe branches from the main bronchus in the root
Left: branches within the lung itself

50
Q

What is the inferior border of the lung?

A

Separates the costal and mediastinal surfaces of the lungs

51
Q

What is the lingula?

A

Comes off the cardiac notch.

52
Q

What is a bronchopulmonary segment?

A

Each is shaped like an irregular cone with an apex facing the lung root and a base at the pleural surface.
Some of the segments fuse together to make larger segments.

53
Q

What 3 dimensions is the thoracic cavity affected by?

A

Vertical- movement of the diaphragm.
Antero-posteriorly- movement of ribs
Trasnverse

54
Q

What happens to the first rib during respiration?

A

It is fixed into place by accessory muscles which allows the rest of it to move up and out.

55
Q

How are diameters changed during inspiration?

A

1) Anterior and superior movement of the sternum
2. Elevation of the lateral aspect of rib shaft
3. Diaphragm descends

Respiratory block (4 decks)

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