Lungs & Diaphragm Flashcards
What lines of separation does the right lung possess?
Oblique fissure and horizontal fissure
What is the location of the superior lobe of the right lung?
Above the horizontal fissure
What is the location of the middle lobe of the right lung?
Between the horizontal and oblique fissures
What is the location of the inferior lobe of the right lung?
Below the oblique fissure
Why are the grooves and impressions of the lungs not typically present in the living?
Due to the perfusion/inflation of the lungs
What are the grooves/impressions found in the right lung?
Grooves for the azygos vein, esophagus, superior vena cava, and right brachiocephalic vein, as well as the cardia impression (shallow)
What are the lines of separation found with the left lung?
Only the oblique fissure
What is the location of the superior lobe of the left lung?
Above the oblique fissure
What is the location of the inferior lobe of the left lung?
Below the oblique fissure
What are characteristic features of the left lung?
Lingula, grooves for the aorta and left subclavian artery, cardiac notch, and a deep cardiac impression
What is significant about the cardiac notch of the left lung?
Important for auscultation of the heart
Why does the esophagus typically not lie against the left lung?
It rests on the aorta
What are the functional units of the lung?
Bronchopulmonary segments
Each bronchopulmonary segment consists of what four things?
Segmental bronchus, branch of the pulmonary artery, segment of lung tissue, and surrounding septum
Why are bronchopulmonary segments clinically important?
Can be surgically removed without affecting the functioning of adjacent segments
What is the blood supply of the lungs?
Bronchial arteries and bronchial veins
From where do the bronchial arteries arise?
Thoracic aorta
Where do the bronchial veins drain?
Azygos and accessory hemiazygos veins
What is the primary tissue of the trachea, main bronchi, and lobar bronchi?
Cartilaginous rings
What is the primary tissue of segmental bronchi?
Smooth muscle
What is the primary tissue of bronchioles?
Smooth muscle
What is the primary tissue of alveoli?
Membrane
What is bronchitis?
Inflammation of the segmental bronchi
What is bronchiolitis?
Inflammation of the bronchioles
What is pneumonia?
Inflammation of the alveoli
What fibers form the anterior and posterior pulmonary plexuses?
Vagus and sympathetic trunk
The sympathetic trunk is made up from which cord levels?
T2-T5
What effect does sympathetic activation have on the lungs?
Bronchial dilation, vasoconstriction, and decreased glandular secretion
What effect does parasympathetic activation have on the lungs?
Bronchial constriction, vasodilation, and increased glandular secretion
What is asthma?
An obstructive airway disease characterized by coughing, wheezing, and difficulty breathing
What causes asthma?
Spasms of the smooth muscle which lies in the segmental bronchi and bronchioles
What also tends to accompany asthma?
Excessive secretion of mucus
What triggers extrinsic asthma?
Allergies
What triggers intrinsic asthma?
Stimuli such as stress, cold, or exercise
Subluxation of what area tend to accompany asthma?
Upper thoracic region
What part of the autonomic nervous system would dominate in asthma if there was a subluxation in the upper thoracics (T2-T5)?
Parasympathetics
What effect does the release of epinephrine have on the lungs that is released from the adrenal medulla that is supplied by the lower thoracics (T9-T11)?
Bronchodilation
What is the pathway of lymph drainage in the lungs?
Lungs to pulmonary and bronchopulmonary nodes in hilum to tracheobronchial nodes
Are the lungs rich or poor in lymphatics?
Rich
Why do the lungs have so many lymphatics?
Breathing accumulates toxins and pathogens and the lungs are an interface with the external world
What is a bronchogenic carcinoma?
Primary tumor of the bronchus
What is a bronchogenic carcinoma directly related to?
Cigarette smoking and air pollution
How does a bronchogenic carcinoma quickly spread to lymph nodes and the bloodstream?
By eroding a venue and traveling via the pulmonary veins to the heart and systemic circulation
<p>A bronchogenic carcinoma often causes an enlargement of which type of lymph node?</p>
<p>Sentinel</p>
How may a bronchogenic carcinoma result in paralysis of half of the diaphragm?
Damage to phrenic nerve
How may a bronchogenic carcinoma result in paralysis of half of the larynx?
Damage to recurrent laryngeal nerve
Where can referred pain be found with a bronchogenic carcinoma?
Upper or middle thoracic cord segments
Which innervation of the lungs contain sensory fibers?
BOTH the vagal and sympathetic fibers
What two things does the diaphragm separate?
Thorax from abdomen
Why is the right dome of the diaphragm slightly higher than the left?
It overlies the liver
What are the two parts of the diaphragm?
Muscular part and central tendon
What is the origin of the sternal part of the diaphragm?
Xiphoid process
What is the origin of the costal part of the diaphragm?
Lower 6 costal cartilages
What is the origin of the lumbar part of the diaphragm?
Lumber vertebrae 1-3 and the medial and lateral arcuate ligaments
At which vertebral level is the caval opening of the diaphragm located?
T8
What does the caval opening of the diaphragm transmit?
Inferior vena cava and right phrenic nerve
At which vertebral level is the esophageal hiatus of the diaphragm located?
T10
What does the esophageal hiatus of the diaphragm transmit?
Esophagus and the anterior and posterior vagal trunks
What is significant about the placement of the esophagus?
It is not firmly attached meaning it can slide
At which vertebral level is the aortic hiatus of the diaphragm located?
T12
What does the aortic hiatus of the diaphragm transmit?
Aorta, thoracic duct, and azygos vein
What is the blood supply of the muscular part of the diaphragm?
Musculophrenic artery
What is the blood supply of the central tendon of the diaphragm?
Pericardiacophrenic artery
What is the blood supply of the upper surface of the diaphragm?
Superior phrenic artery
What is the blood supply of the lower surfaces of the diaphragm?
Inferior phrenic artery
From where do the superior and inferior phrenic arteries arise?
Aorta
From where do the musculophrenic and pericardiacophrenic arteries arise?
Internal thoracic artery
What nerve is motor to the diaphragm and sensory to its central part?
Phrenic nerve (C3-C5)
What nerves are sensory to the peripheral part of the diaphragm?
Intercostal nerves
Why does the inferior vena cava attach to the caval opening?
To facilitate greater venous return
What is a hiatal hernia?
When the upper part of the stomach slides up into the thoracic cavity through the opening
What is the cause of a hiatal hernia?
Weakness in the diaphragmatic wall around the esophageal hiatus
A hiatal hernia typically occurs at what age?
After 50 years old
What technique is specifically effective for a hiatal hernia?
S.O.T.
Hiatal hernias are a major cause of what GI tract disease?
Gastroesophageal reflux
What are the three movements of respiration that result in an increase in intrathoracic volume and a decrease in intrathoracic pressure?
Piston, bucket handle, and pump hande movements
What is the piston movement of respiration?
Diaphragm contracts, pulling the domes inferiorly into the abdomen
What is the bucket handle movement of respiration?
Elevation of the lower ribs (7th-10th) about an anteroposterior axis
What is the pump handle movement of respiration?
Elevation of the upper ribs (2nd-6th) about a transverse axis
The piston movement of respiration results in an increase in what diameter of the thorax?
Vertical
The bucket handle movement of respiration results in an increase in what diameter of the thorax?
Transverse
The pump handle movement of respiration results in an increase in what diameter of the thorax?
Antero-posterior
Which movement of respiration is best seen from the side view as the chest rises?
Pump handle movement
What muscles are responsible for both the bucket handle and pump handle movements of respiration?
External intercostal
What is the second most important muscle of respiration?
External intercostal
What muscles contract during forced expiration?
Internal intercostals, innermost intercostals, and the anterior abdominal wall muscles
Which muscles are important for coughing, sneezing, and general clearing of the airway?
Internal intercostals
During inspiration, what happens to the intrathoracic volume and pressure?
Increase, decrease
During expiration, what happens to the intrathoracic volume and pressure?
Decrease, increase
When abdominal volume is decreased, what happens to the intra-abdominal pressure?
Increased
What are hiccups?
Results of spasmodic contractions of the diaphragm
What are the distinguishing factors of serious hiccups that could be signs of pericarditis, pleuritic, or peritonitis?
Painful abdomen, fever, or hiccups lasting more than two days.
