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Anatomy > Lungs > Flashcards

Lungs Flashcards

1
Q

What makes up the bony thorax?

A

-Sternum
-12 thoracic vertebrae
-12 pairs of ribs

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2
Q

How many bones make up sternum?

A

3 = manubrium, body, xiphoid process

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3
Q

What does costo mean?

A

Rib

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4
Q

What does chondro mean?

A

Cartilage

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5
Q

What does a typical rib articulate with?

A

-Body of its own vertebra
-Transverse process of its own vertebra
-Body of vertebra above

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6
Q

What types of joints are the costotransverse & costovertebral?

A

Synovial

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7
Q

What is a synovial joint?

A

-Connection between 2 bones consisting of a cartilage lined cavity filled w/ fluid
-Most flexible type of joint between bones, as bones = not physically connected & can move more freely in relation to each other

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8
Q

What are some key surface landmarks of the chest?

A

-Spinous process of vertebra
-Jugular notch
-Sternal angle
-Xiphoid process
-Ribs

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9
Q

What is surface tension?

A

Exists between visceral pleura (adheres to lungs) & parietal (adhering to chest wall) pleura
- so when chest wall moves in a certain direction, the lungs will do the same (as pleural layers = stuck w/ small pleural cavity

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10
Q

What is pleura?

A

-Serous mesothelial memb
-Double layered
-Thin
-Layer of simple squamous ep cells - supported by CT
-Simple squam layer = mesothelium
-Surrounds & adheres to lungs

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11
Q

What is visceral pleura?

A

Covers/adheres to (outer surface of) lungs - extends into interlobular fissures

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12
Q

What is parietal pleura?

A

-Covers/adheres to chest wall
-Thicker than visceral pleura
-4 types

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13
Q

What are the 4 types of parietal pleura?

A

-Mediastinal
-Cervical
-Costal
-Diaphragmatic

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14
Q

What is between the pleurae?

A

= Pleural cavity
–> a potential space
-Contains SMALL vol of serous/pleural fluid (so pleura x2 stuck together w/ small amount of pleural fluid)
-Has 2 functions

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15
Q

What are the 2 functions of the serous fluid in the pleural cavity?

A

-Lubrication - of pleural surfaces - so slide over each other - no friction
-Produces surface tension - pulls parietal & visceral pleura together - so when thorax expands so does lung - so can fill with air (= inhalation)

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16
Q

What is it called when there is air in the pleural cavity, & why is this a problem?

A

Pneumothorax
–> reduces surface tension between 2 layers of pleura

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17
Q

How is pleura named?

A

Depends on where is:
-Diaphragmatic
-Costal
-Cervical
-Mediastinal

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18
Q

What is a pneumothorax?

A

Air in pleural cavity

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19
Q

What is pleural effusion?

A

= Abnormal collection of fluid in pleural cavity- e.g.:
-Haemothorax:Blood in cavity
-Empyema:Pus in cavity
-Chylothorax:Lymph in cavity

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20
Q

What is quiet respiration?

A

Resting breathing - not forced

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21
Q

Is quiet inhalation active or passive & why?

A

Active = as requires contraction of muscles which requires energy from ATP

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22
Q

What happens during quiet inhalation?

A

-Contraction of diaphragm & ext intercostals = ribs move sup & lat
= sternum moves ant & sup
–> Surface tension causes vol expansion/inc in 3D (height, width, depth) of thoracic cavity
–> Pressure in thoracic cavity decreased
–> air moves down pressure gradient into lungs
-Rhythmic contraction of thoracic cavity allows for regular air replacement

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23
Q

What is the bucket handle analogy in terms of inhalation & ribs?

A

Ribs move sup & lat (up & out) in inhalation - like how a bucket handle moves

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24
Q

What is the pump handle analogy in terms of inhalation & the sternum?

A

Sternum moves ant & sup (forwards & up) - like how a pump handle moves

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25
Q

Is quiet exhalation active or passive, & why?

A

Passive = as doesn’t require any contraction of muscles (so no energy from ATP needed)

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26
Q

What happens during quiet exhalation?

A

-Relaxing of diaphragm & ext intercostals
= ribs move inf & med
= sternum moves post & inf
–> surface tension causes vol decrease in 3D (height, width, depth) of thoracic cavity
–> pressure in thoracic cavity increased
–> air down pressure gradient out lungs

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27
Q

What is forced respiration?

A

Forced breathing - when exercising or if have respiratory disease
-Active form of breathing - uses additional accessory muscles - more often in respiratory diseases

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28
Q

Is forced inhalation active or passive & why?

A

Active = as requires contraction of muscles which requires energy from ATP

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29
Q

What happens during forced inhalation?

A

-Contraction of diaphragm & ext intercostals + sternocleidomastoid, scalenes & pectoralis minor –> helping ext intercostals & diaphragm
=ribs move sup & lat
= sternum moves ant & sup
–> surface tension causes vol expansion/inc in 3D (height, width, depth) of thoracic cavity
–> pressure in thoracic cavity decreased
–> air down pressure gradient into lungs

*Sternocleidomastoid = elevates sternum
*Scalene (ant, middle, post) = elevates ribs 1,2
*Pectoralis minor = elevates ribs 3,4,5

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30
Q

What accessory muscles are involved in forced inhalation & what do they do?

A

-Sternocleidomastoid = elevates sternum
-Scalene (ant, middle, post) = elevates ribs 1,2
-Pectoralis minor = elevates ribs 3,4,5

*Sternocleidomastoid & scalenes = neck muscles

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31
Q

Is forced exhalation active or passive & why?

A

Active = as requires contraction of muscles which requires energy from ATP - BUT will still have passive muscles involved

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32
Q

What happens during forced exhalation?

A

-Relaxation of diaphragm & ext intercostals (passive) + contraction of internal intercostals, abd muscles (ext oblique, int oblique, transversus abdominus, rectus abdominus) - active
*Abd muscles = move inf ribs down & compress abd viscera
= forces diaphragm sup, & int

*Int intercostals = pull ribs inf & med, sternum ant & sup - also compresses abd viscera forces diaphragm sup

–> surface tension = vol decrease in 3D (height, width, depth) of thoracic cavity
–> pressure in thoracic cavity increased
–> air down pressure gradient out lungs

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33
Q

What accessory muscles are involved in forced exhalation?

A

-Int intercostal?

*Abdominal muscles
-Ext oblique
-Int oblique
-Transversus abdominus
-Rectus abdominus

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34
Q

Summarise quiet & forced respiration.

A
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35
Q

Label these muscles of respiration.

A
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36
Q

What are the muscles of the internal chest wall?

A

Intercostals)
-External intercostals
-Internal intercostals
-Innermost intercostals
(+ subcostals, transversus thoracis)

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37
Q

External intercostals - number of, where found, role?

A

-11 pairs
-In intercostal space between pairs of ribs
-Elevates ribs & keeps intercostal space rigid

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38
Q

Internal intercostals - number of, where found, role?

A

-11 pairs
-In intercostal space (@ lateral edge of costal groove to rib below)
-Depresses ribs & keeps intercostal space rigid

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39
Q

Innermost intercostals - number of, where found, role?

A

-11 pairs
-In medial edge of costal groove to rib below

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40
Q

Which of these is each if the 3 intercostal muscles?

A
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41
Q

What is the overall action of the intercostals?

A

Keep intercostal space rigid - prevents spaces being blown “out” during expiration or “in” during inspiration

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42
Q

Why do intercostal muscles give us a high capacity for aerobic metabolism & endurance (keep on going - i.e., keep breathing even when tired)?

A

As have 60% slow twitch fibres in intercostal muscles

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43
Q

What gives the arterial supply to the intercostal muscles?

A

*Posterior intercostal arteries - from 2 arteries:
1+2: Supreme intercostal artery
3-11: Thoracic aorta (direct)
From spine around ribs (around back)

*Anterior intercostal arteries: Internal thoracic artery
1-6: Direct branches - ICA
7-11: Musculophrenic artery
From sternum around ant ribcage –>

anastomose w/ post intercostal arteries

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44
Q

What is the venous drainage of the intercostal muscles?

A

Parallels arterial supply- intercostal veins
= drain into Azygous vein (most post veins) & internal thoracic veins (ant veins)

45
Q

What gives innervation to the intercostal muscles?

A

-Intercostal nerves T1-T11
-Subcostal nerve T12

46
Q

How are chest drains conducted?

A

-Insert above rib (to avoid damage to neurovascular bundle)
-Usually put between ant axillary & mid axillary line - in 4th/5th intercostal space

47
Q

How does veinous drainage into azygous vein occur - to drain all blood from posterior chest wall?

A

Numbers = posterior intercostal veins - contribute to azygous vein directly or to sup or inf hemizygous veins
-On left = drain into sup/inf hemiazygos
-On right = drain into azygous vein directly

–> both then drain into azygous vein (if not already) then into superior vena cava

48
Q

Structure of the diaphragm & what attaches to & forms?

A

-Dome shaped - 2 domes (right & left) - right is higher than left
-Skeletal muscle
-3 arcuate ligaments come off diaphragm to attach to post abd wall

49
Q

What is diaphragm form superiorly & what does this attach to?

A

Muscle fibres merge superiorly = central tendon - not attached to bones sup (heart sits on top of central tendon - pericardium stuck to)

50
Q

What does diaphragm attach to inferiorly?

A

*Bony points
-Xiphoid process (ant)
-Costal margin & ribs 11 & 12 (post)
-Post abd wall (via 3 arcuate ligaments) (post)
-Lumbar vertebrae (post)

–> seals off the thoracic cavity from abdominal cavity (for movement)

51
Q

What are the 3 arcuate ligaments that the diaphragm attaches to the posterior abdominal wall by?

A

-Median (goes over aorta)
-Medial (goes over psoas major muscle)
-Lateral (attached to & goes over quadratus lumborum muscle)

52
Q

How does diaphragm attach to the lumbar vertebrae?

A

By crura - left & right crus
-Right crus attaches from L1 - L3
-Left crus attaches from L1 - L2

53
Q

What is the respiratory function of the diaphragm?

A

Contracts = flattens as single unit = inc thoracic volume - draws air into lungs

54
Q

What is the non-respiratory function of the diaphragm?

A

-Separates thoracic & abd cavities
-Increases intra-abdominal pressure (helps expel vomit, faeces, & urine)
-Prevents acid reflux - exerts pressure on oes as it passes through oesophageal hiatus

55
Q

What is the oesophageal hiatus?

A

Oes passes through diaphragm - helps pinch off oes - acts as sphincter junction to prevent reflux

56
Q

Why is the diaphragm resistant to fatigue?

A

Is 60% slow twitch fibres - higher oxidative capacity & larger blood-flow than limb muscles

57
Q

What are the 3 diaphragmatic openings?

A

-Caval opening - for inf vena cava & right phrenic nerve to enter
-Oesophageal hiatus - for vagal trunks & oesophageal blood vs to enter
-Aortic hiatus - for aorta, thoracic duct & azygous vein to enter

58
Q

What vertebral level is the caval opening of diaphragm at?

A

T8 - as VENA CAVA has 8 letters

59
Q

What vertebral level is the oesophageal hiatus opening of diaphragm at?

A

T10 - as OESOPHAGUS has 10 letters

60
Q

What vertebral level is the aortic hiatus opening of diaphragm at?

A

T12 - as AORTIC HIATUS has 12 letters

61
Q

What is what we need to know the azygous vein drains blood from?

A

Azygous vein drains venous blood from thoracic cavity

62
Q

What innervates the diaphragm?

A

-Phrenic nerves - C3,4,5 (“keep the diaphragm alive”) = all motor
–> right phrenic nerve enters via caval opening
–> left phrenic nerve enters directly through diaphragm
-Marginal part of diaphragm = spinal (T6-T12) sensory nerves inn
-Crura inn by spinal sensory nerves from T12

63
Q

How can respiratory system be structurally divided?

A

-Upper respiratory system
-Lower respiratory system

64
Q

What is involved in the upper respiratory system & where is this region located?

A

= all above sternal angle (so above T4/5)
-Nose/nostrils
-Mouth
-Pharynx - throat
-Larynx - voice box??

65
Q

What is involved in the lower respiratory system & where is it located?

A

= mostly below sternal angle (so below T4/5)
-Larynx (below vocal folds)
-Trachea
-Bronchi
-Lungs

66
Q

What vertebral level is the sternal angle at?

A

T4/5

67
Q

What does the vertebral level T4/5 demarcate?

A

-Sternal angle
-Trachea bifurcates
-Initial portion of aortic arch
-Important in dividing mediastinum up

68
Q

How can respiratory system be functionally divided?

A

-Conducting airway
-Respiratory airway

69
Q

What is makes up the conducting airway, & what happens here?

A

-Nose –> terminal bronchioles
-Filters, warms & moistens air

70
Q

What makes up the respiratory airway, & what happens here?

A

-Respiratory bronchioles –> alveoli
-Where gas exchange occurs between air & blood (across blood-air barrier)

71
Q

What vertebral level does the trachea start at?

A

C6

72
Q

Structure of trachea?

A

-C-shaped cartilage rings in walls
-Open part of C faces post
-Post wall part = mostly smooth muscle (trachealis muscle)
-Bifurcates @ T4/5 = left & right bronchi (primary)

73
Q

What is the role of cartilage in walls of trachea?

A

To maintain integrity so sides of trachea not closed when inhale

74
Q

What is the bronchial tree structure?

A

-Primary/main bronchi (from bifurcation of trachea = L&R bronchi)
-Secondary/lobar bronchi
-Tertiary/segmental bronchi
-Terminal bronchioles
-Respiratory bronchioles
(each prior one divides into the subsequent one)

75
Q

Why is the right primary bronchus more likely to gain foreign particles?

A

Is wider & has steeper angle - so inhaled ps more likely to lodge here

76
Q

Which bronchi enters lung & where does this happen?

A

Primary bronchi enters lung at hilum - at root of lung

77
Q

What is a hilum?

A

Gateway/doorway for structures to enter an organ

78
Q

How many lobes are there in the right lung, & so how many secondary/lobar bronchioles?

A

3 lobes (sup, middle, inf) so 3 lobar bronchi

79
Q

How many lobes are there in the left lung, & so how many secondary/lobar bronchi?

A

2 lobes (sup & inf) so 2 lobar bronchi

80
Q

What do tertiary/segmental bronchi supply?

A

Bronchopulmonary segments

81
Q

How many divisions are there roughly of bronchioles?

A

Around13

82
Q

What happens to walls of bronchi with each division?

A

Amount of cartilage reduces & amount of smooth muscle increases

83
Q

Features of terminal bronchioles?

A

-No cartilage
-High in smooth muscle
-Fewer goblet cells (produce mucus)
-Clara cells - distally

84
Q

When do bronchi form bronchioles?

A

From tertiary/segmental bronchi to terminal bronchioles

85
Q

Describe the division from secondary/lobar to tertiary/segmental bronchi in terms of what they supply?

A

-Primary/main bronchi divide to give the same number of secondary/lobar bronchi as there are lobes of that particular lung (right lung = 3 left lung = 2)
-Secondary/lobar bronchi supply 1 lobe of lungs each
-Secondary/lobar bronchi divide = tertiary/segmental bronchi
-Each tertiary/segmental bronchi supply a bronchopulmonary segment
-Each segmental bronchi divide = bronchioles (terminal)

86
Q

What are bronchopulmonary segments (what each tertiary/segmental bronchi supply)?

A

= Portion of lung tissue supplied by its own specific segmental bronchi & its own associated vasculature
-About 10 in right lung
-About 8/9 in left lung
–> each of the segments are separated by bands of CT - so each bronchopulmonary segments are functionally separate (are no superficial anatomical markings on lungs to demarcate the separate segments)

87
Q

How many lobes are there in the left lung?

A

2 = sup & inf

88
Q

What separates the 2 lobes of the left lung?

A

Oblique fissure

89
Q

How many bronchial arteries are there for the left lung?

A

2

90
Q

How many lobes are there in the right lung?

A

3 = sup, middle, inf

91
Q

What separates the 3 lobes of the right lung?

A

Horizontal fissure = separates sup & middle
Oblique fissure = separates middle & inf

92
Q

How many bronchial arteries are there for the right lung?

A

1

93
Q

Why is left lung slightly smaller than right?

A

Due to heart - forms lingula (shows what is front of left lung) = cardiac impression - cardiac notch

94
Q

What is the lingula of the left lung?

A

Tongue shaped projection from lower part of upper lobe of left lung - inf to cardiac notch

95
Q

What impressions do you get on the lungs?

A

Right lung
-Cardiac (lesser)
-Oesophagus
-Azygous vein

Left lung
-Cardiac (greater)
-Oesophagus
-Aorta

96
Q

What are the 3 surfaces of the lungs?

A

-Mediastinal (post)
-Diaphragmatic (diaphragm - inf)
-Costal (ribs - ant) - where see ridges on lungs where ribs are
-Cervical

97
Q

What is the costodiaphragmatic recess?

A

A potential space between bottom of ribs & diaphragm
-Lungs only fill if breathing v. forcefully - where have inc heartrate & resp rate
-Not often need to expand this far down - so will be a potential space so:
-@ bottom of thoracic cavity - likely fluid & infection can accumulate here

98
Q

Where are the base and apex of the lungs?

A

-Base = bottom - diaphragmatic surface
-Apex = top - extends to neck

99
Q

RALS?

A

Right Anterior
Left superior

100
Q

What is the position of the pulmonary artery in relation to the main/primary bronchi entering the hilum of the right lung?

A

Anterior

101
Q

What is the position of the pulmonary artery in relation to the main/primary bronchi entering the hilum of the left lung?

A

Superior

102
Q

What is found at hilum of right lung?

A

-Bronchi (primary/main)
-Pulmonary artery
-Pulmonary veins x2
-Bronchial arteries x1 = can’t see - v. small
-Bronchial veins = can’t see - v. small
(Pulmonary veins usually inf & arteries sup - to each other - veins like plughole at bottom)

103
Q

What is found at hilum of left lung?

A

-Bronchi (primary/main)
-Pulmonary artery
-Pulmonary veins x2
-Bronchial arteries x2 = can’t see - v. small
-Bronchial veins = can’t see - v. small
(Pulmonary veins usually inf & arteries sup - to each other - veins like plughole at bottom)

104
Q

Why are pulmonary arteries blue & pulmonary veins red in diagrams?

A

-Pulmonary arteries bring deoxygenated blood to lungs to be re-oxygenated
-Pulmonary veins take oxygenated blood away from lungs to deliver to heart then to body tissues

105
Q

What supplies lungs with oxygen - arterial supply?

A

Bronchial arteries - supply:
-Bronchi
-Lung roots
-Visceral pleura
-Lung tissue

106
Q

What provides veinous drainage from lungs?

A

Bronchial veins - drains to azygous vein (from right side) & into hemizygous vein (from left side)

107
Q

How to tell bronchi & pulmonary artery & veins apart physically?

A

Bronchi = catilage = rigid
Arteries = muscular walls = keep structure
Veins = no muscle in walls = will not keep structure

108
Q

What is found at bottom of hilum of lungs?

A

Pulmonary ligament

109
Q

What surface anatomy is vital when referencing the chest & lungs?

A

Anatomy (21 decks)

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