Lungs and Heart Flashcards
What makes up the upper respiratory tract
Nose/nasal cavities/paranasal sinuses
pharynx
larynx
what makes up the lower respiratory tract
trachea
bronchi
lungs
where does the tracheobronchial tree begin and then bifurcate?
begins CV6
bifurcates at the transverse thoracis plane
What is the named sm m in the trachea
trachealis
What is the carina
last cartilage ring before bifurcation of trachea
What supplies the trachea vascularly
bronchial and inferior thyroid vessels
what innervates the trachea
recurrent laryngeal branches of vagus n
metastatic cancer cells in the paratracheal lymph nodes can cause what
carina to be distorted (bronchial carcinomas)
Which bronchus is shorter and more vertically oriented
right
how many secondary bronchi are there on the R and L lungs
R has 3
L has 2
How many tertiary bronchi are there on the R and L lungs
R has 10
L has 8-10
What type of cells make of pleura of lung
simple squamous epithelial cells+ loose CT
what is the function of pleura around lung
smooth surface for lungs to move during respiration
what does the pleura secrete
serosal fluid to lubricate
where is the visceral and parietal pleura continuous
hilum of lung
What are the surfaces of the parietal pleura
costal, diaphragmatic, mediastinal and cervical
what it the pulmonary ligament
formed from parietal and visceral pleura jointing and acts to maintain position of lung in thoracic cavity
what are the lines of reflection of parietal pleura
vertebral (post)
costal(inferior)
sternal (anteriorly)
How far does the cervical portion of parietal pleura extend, why is this important
the root of neck. could be punctured as result of wounds in this region
Why is pain of the pleura produced and where is it referred
lots of sensory innervation and referred to C3 C4 C5 dermatomes because of phrenic
Where do the visceral pleura nn travel
with autonomic fibers of bronchial vessels
What part of the cavity is important for pericardiocentesis
the small notch where pericardium is in direct contact with anterior thoracic wall.
formed because left sternal reflection runs lateral and inferior from 4th to 6th rib
Where is the pleural cavity
between the parietal and visceral pleura
What ribs does the visceral pleura extend along the midclavicular line, mid axillary and scapular
midclavicular- 6th
midaxillary-8th
scapular- 10th
what ribs does the parietal pleura extend along the midclavicular line, mid axillary and scapular
midclavicular -8th
midaxillary- 10th
scapular- 12th
what are pleural recesses
areas of pleural cavity that lungs don;t occupy during quiet respiration- two layers of pareital pleura come in contact
what are the two pleural recesses
costomediastinal- mediastinal pleura contacts costal pleura anteriorly
costodiaphragmatic- costal pleura contacts diaphragmatic around periphery
Which pleural recess can be damaged during abdominal procedures
costodiaphragmatic
What happens in a pneumothorax
potential space (air in pleural cavity) becomes real space
what is a hemothorax and hydrothorax
hemo- blood in the pleural space
hydro- fluid in the pleural space
What is tension pneumothorax
air entering pleural space and unable to exit- one way valve created. so increases intrathoracic pressure
shifts mediastinal contents and compresses venous return to heart
what are signs of a tension pneumothorax
muffled heart sounds, hypotension, and distended neck vv
“Becks triad”
Where are the apex’s of the lungs
first rib
At what levels of ribs do you find the cardiac notch in L lung
rib 4 mid sternal line then lateral to 6th rib at MCL
At scapular lines where do the lungs project to
rib 10
At midaxillary lines where do the lungs project to
rib 8
What is the cupula of the lung
apex
what is the hilum of the lung
area where all structures enter and leave lung
what are the lobes and fissures of the right lung
oblique and horizaontal fissure
superior middle and inferior lobes
what are the lobes and fissures of the L lung
oblique fissure
superior and inferior lobes
What are 2 specific characterizations of the L lung
cardiac notch and the lingula
Where are the oblique fissures located in regards to the ribs
4th rib crossing anterioinferioly to 6th ribs
What structures are located at the hilum
pulmonary artery pulmonary vv primary bronchi bronchial aa and vv pulmonary plexus of nn lymphatic vessels and lymph nodes
What is the smallest functional unit of the lung
bronchopulmonary segment
How many tertiary bronchi supply one bronchopulmonary segment
1
Where are the pulmonary vv in regards to the bronchopulmonary segments? aa?
one artery branch will run within
the plum vv run intersegmental
What is the difference of a pneumonectomy and lobectomy and a segmentectomy?
pneumonectomy- removal of 1 lung
lobectomy- removal of one lobe
segmentectomy- removal of one bronchopulmonary segment
How many bronchial aa do we have
2 on left 1 on right
Where do the bronchial vv terminate
azygos vv
Where are the pulmonary nodes
within substance of lung along bronchial tree
Where are the bronchopulmonary nodes
hilum of lung
where are the tracheobronchial nodes
tracheal bifurcation
where do the superficial pulmonary lymph drain
bronchopulmonary nodes–>superior and inferior tracheobronchial nodes–> bronchomediastinal trunk
What do the deep pulmonary plexus of lymph drain
larger bronchioles and bronchi
Where does lymph of the left inferior lobe drain
right tracheobronchial nodes
Do the lungs recive PANS or ANS inn
both
Describe the sympathetic inn for lungs
preganglionic nerve cell bodies in T2-T6 segments thru sympathetic chain
Where are the post ganglionic cell bodies located
upper thoracic and cervical
what do the cell processes of the postganglionic cell bodies of lungs become?
cardiopulmonary splanchnic nn
What is the efferent role of the sympathetic inn to lungs
vasoconstriction, bronchodilation, inhibit gland secretion
what is the afferent role of the sympathetic inn to lungs
acute pain
where are the cell bodies of the preganglionic fibers of parasympathetics to lung
brain stem, processes travel with vagus
where are the PANS postganglionic nerve cell bodies for lungs
in the wall of the airways
What is the role of PANS efferents of lungs
vasodilation, bronchoconstriction, gland secretion
What inn the parietal pleura
nn supplying the thoracic wall including intercostal and phrenic nn.
Where is phrenic pain seen on the body
neck/shoulder
Boundaries of middle mediastinum
superior- transverse thoracis plane inferior- diaphragm lateral- mediastinal pleura of lungs anterior- anterior border pericardium posterior- posterior border of pericardium
what are the contents of the middle mediastinum
pericardium, herat, pulm trunk, ascending aorta, pulm vv
phrenic n and pericardiophrenic vessesls
Where are the surface projections of the heart
superior- 2nd L costal cartilage to 3rd right costal cartilage
right- 3rd right costal carilate to 6th R costal cartilage
inferior- 6th R costal cartilage to L 5th intercostal space at MCL
left- left 5th intercostal space MCL to 2nd L costal cartilage
Where does the fibrous pericardium attach
sternum via sternopericardial ligaments
posteriorly to fascia of esophagus
inferiorly to central tendon of diaphragm via pericardiacophrenic log
superiorly with the adventitia of great vessels
What makes up the serous pericardium
visceral and parietal layers
What is the function of the serous pericardium
allows the heart to move during contraction without friction
What cell type make up parietal pericardium
simple squamous epithelial cells and thin layer of loose CT
What cell type make up visceral pericardium
simple squamous epithelial cells and thin layer of loose Ct
What part of the pericardium forms epicardium
visceral pericardium
What causes cardiac tamponade
if pericardial space is filled with fluid, heart can’t fill to capacity
What is pericardiocentesis
procedure to remove excess fluid, typically a needle is inserted through bare area of the heart(left of sternum 5th or 6th intercostal space)
What are the pericardial sinuses
separate atrial and venouse ends of embryonic tubular heart and turn into transverse and oblique pericardial sinuses
What are the anterior and posterior borders of transverse pericardial sinus
anterior- aorta and pulm trunk
posterior- SVC and pulm vv
why is the transverse pericardial sinus important surgically
allows surgeons to pass a surgical clamp around the major aa and vv and insert tubes allowing blood to be diverted to a cardiac bypass pump during coronary artery surgery
what are the boundaries for the oblique pericardial sinus
pulmonary vv and IVC
Where do the paericardiacophrenic aa and vv arise from
internal thoracic aa and vv
What provides sensory inn to fibrous and parietal pericardium
phrenic n
what inn the visceral pericardium
cardiac plexus
Where is pericardial pain referred
shoulder/neck because phrenic C345
Why is pericarditis painful
because of pain fibers in the fibrous and parietal pleura
Which part of the heart is more posterior
left
what are the external sulci of the heart
atrioventricular sulcus (coronary) interventricular sulci (anterior and posterior)
What portion of the heart makes up the apex
left ventricle
Where is the apex located on the surface of thorax
posterior to L 5th intercostal space MCL
What portion of the heart makes up the base
left atrium
What are the functions of the heart’s fibrous skeleton
support for heart valves, preventing distention of heart and provides for attachment of cardiac m and for valve leaflets
insulates against impuls conduction to prevent aberrant spread of impulses
provide tunnel for passage of A/V bundle of His
Where are the fibrous rings of the heart
around orifices of 4 heart valves
what are the fibrous trigones of the heart
connections between fibrous rings
L between aortic and mitral
R between aortic mitral and tricuspid
What lines the auricles
pectinate mm
What is the crista terminalis of the heart
dividing line between sinus venarum and embryonic atrium
demarcated externally by sulcus terminalis
Where is the SA node relatively located
right atrium nead junction of sulcus terminalis and SVC
where is the AV node relatively located
near opening of coronary sinus of right atrium
Where is the septomarginal band in the heart
interventricular septum to anteiror papillary in R ventricle
where is the conus arteriosus in R ventricle
smooth wall part leading to plum artery
how many cusps and what are they in the R AV valve
- anterior posterior and septal
what are the 2 parts of the interventricular septum
membranous and muscular
how many cusps does the pulmonary semilunar valve have and names?
3 anterior left and right
what are the components of a cusp in semilunar valves
nodule and lunule at thickened parts
are there more trabecular carnae in R or L ventricles
L, finer but more abundant
What is the aortic vestibule
smooth wall portion L ventricle leading to aorta
How many cusps are there in the L AV valvae
2 anterior and posterior
How many cusps are there in the aortic semilunar valve
3 posterior left and right
which cusps of the aortic semilunar valve have the openings for the coronary aa
left and right
Where can you listen for murmurs at the tricuspid and bicuspid valves
tircuspid at 4th ICS left of sternum
bicuspid at 5th ICS left MCL
What does the R coronary a supplu
right atrium, SA and AV nodes
most of right ventricle
some inferior portion l ventricl and posterior 1/3 IV septum
What does the L coronary a supply
left atrium
most of left ventricle
some anterior part of right ventricl and anterior 2/3 interventricular septum
What v runs with anterior interventricular a
great cardiac v
what v runs with posterior interventricular a
middle cardiac v
what v runs with the right marginal a
small cardiac v
what vv enter chambers of heart directly
anterior cardiac vv and venae cordis minimae and coronary sinus
Where does most lymph drain from heart
subepicardial lymphatic plexus
Where do lymph following RCA terminate
anteiror mediastinal nodes to the left bronchomediastinal trunk
Where do lymph following LCA terminate
inferior tracheobronchial nodes to the right bronchomediastinal trunk
SA sets HR at what speed
60-100bpm
What inn the heart
cardiac plexus, sympathetics and parasympathetics
what type of info do the cardiac plexuses carrry
postganglionic SANs and preganglionic PANS
how does the cardiac plexus distribute
via coronary aa
where are the superficial and deep cardiac plexuses found
superficial- inferior to aortic arch
deep- posterior to arch of aorta, anterior to tracheal bifurcation
Where are the sympathetics to heart found
preganglionic in T1-T4 segments
Postganglionic in upper thoracic and cervical sympathetic ganglia
the postganglionic fibers form cardiopulmonary splanchnic nn
What are the functions of sympathtetics to heart
increase HR, vasodilation, also carry visceral afferents(acute pain fibers)
where are the nerve cell bodies of the pain fibers of the heart
dorsal root ganglia
Where are the postganglionic nerve cell bodies for the vagus n
within wall of the heart
what are the functions of the PANS to heart
decrease HR, vasoconstriction, stretch receptors too so maybe some visceral afferents
