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Anatomy > Mediastinum and Great Vessels > Flashcards

Mediastinum and Great Vessels Flashcards

1
Q

Where does the arch of the aorta begin?

A

Posterior to R 2nd sternocostal joint at sternal angle

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2
Q

What are the branches of the aorta?

A

Brachiocephalic
Common carotid
Subclavian

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3
Q

What does the brachiocephalic artery branch into?

A

Right common carotid

Right subclavian artery

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4
Q

What is the position of the descending aorta?

A

T4-T12

slightly left of midline

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5
Q

What are the branches of the descending aorta?

A 
Pericardial
bronchial
oesophageal
mediastinal
POSTERIOR INTERCOSTAL
SUPERIOR PHRENIC 
SUBCOSTAL
Perfect bananas open marvellously by pulling skin smoothly
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6
Q

Relate the parts of the aorta to their position in the mediastinum

A

Ascending arch = middle mediastinum
Aortic arch = superior mediastinum
Descending aorta = posterior mediastinum

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7
Q

Ligamentum arteriosus

A

remnant of ductus arteriosus, which shunts blood away from lungs in fetal circulation as they collapsed in utero
connects aorta and pulm artery-when becomes ligamentum arteriosus, prevents O2 and deO2 blood mixing

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8
Q

Coarctation of aorta

A

congenital condition where the aorta narrows (stenosis) in the area where the ductus arteriosus inserts

  • often distal to left subclavian –> decreases BP at legs, but increases BP at upper limbs-more blood going to common carotid and subclavian arteries
  • lower pressure distal to narrowing, higher pressure proximal to narrowing
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9
Q

From which veins is the SVC made from?

A

L+R brachioceohalic at cc1

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10
Q

What is the brachiocephalic vein made from?

A

subclavian and internal jugular veins behind sternoclavicular joint

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11
Q

Which brachiocephalic vein is longer and why?

A

left is twice as long as right as courses from left to right side, passing ant to root of branches of arch of aorta.
-shunts blood from the head, neck and upper limb to RA

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12
Q

Where does the SVC enter the heart?

A

RA behind r cc3

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13
Q

Where does the SVC return blood from back to the heart?

A

all structures superior to the diaphragm, not inc heart and lungs

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14
Q

Where does the SVC lie in the mediastinum?

A

Superior mediastinum, anterolateral to the trachea and posterolateral to the aascending aorta
-terminal half of SVC is in the middle mediastinum, adj to the asc aorta and forms posterior border of the transverse pericardial sinus

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15
Q

Route of the Right Azgos Vein

A

Originates from L1-L2
Ascends through aortic hiatus T12
Ascends through thoracic wall lateral to thoracic duct
Joins SVC at T4

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16
Q

Route of the Left Hemi-Azygos Vein

A

Originates from L1-L2
Ascends through aortic hiatus T12
Ascends to T9 and crosses vertebral column
Joins Azygos vein at T9

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17
Q

Route of Left Accessory Hemi-Azygos Vein

A

Originates from superior posterior mediastinum
Descends to T8 and crosses vertebral column
Joins azygos vein at T8

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18
Q

At what spinal level do the vena cava and right phrenic nerve pierce the diaphragm?

A

T8

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19
Q

At what spinal level does the oesophagus and vagus nerve pierce the diaphragm?

A

T10

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20
Q

At what spinal level does the aortic hiatus, thoracic duct and azygos system pierce the diaphragm?

A

T12

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21
Q

What pierces the diaphragm at T8?

A

Vena cava

R phrenic nerve

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22
Q

What pierces the diaphragm at T10?

A

Oesophagus

Vagus nerve

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23
Q

What pierces the diaphragm at T12?

A

aortic hiatus
thoracic duct
azygos system

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24
Q

What sort of pain can irritation of the phrenic nerve cause?

A

Referred pain to shoulder - C3-C5 innervate dermatomes around shoulders

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25
Motor and sensory innervation of the phrenic nerves?
Motor: breathing (diaphragm) Sensory: parietal pleura, pericardium and peritoneum, central area of the diaphragm
26
Where does the right phrenic nerve run?
lateral to RA and SVC
27
Where does the left phrenic nerve run?
runs over L side of heart and L surface of aortic arch
28
Route of the R phrenic nerve
Originates C3-5 Enters sup mediastinum lateral to R vagus and descends posterior to R brachiocephalic Continues to descend along R side of pericardial sac anterior to hilum of R lung Pierces diaphragm at T8
29
Route of L phrenic nerve
Originates C3-5 Enters sup mediastinum lateral to L vagus and descends posterior to L brachiocephalic vein Continues to descend along R side of pericardium anterior to hilum of L lung Pierces diaphragm near apex of heart
30
Are vagus nerve sympathetic or parasympathetic?
Parasympathetic
31
Where do the vagus nerves enter the mediastinum?
Posterior to brachiocephalic veins
32
Route of the right vagus nerve
Enters thorax anterior to R subclavian arteries Gives off R recurrent laryngeal that hooks around subclavian arteries Runs on R side of trachea Posterior to root of R lung
33
Route of left vagus nerve
Enters thorax anterior to L subclavian and common carotid arteries Gives off L recurrent laryngeal that hooks around arch of aorta Separated from left phrenic by left superior intercostal vein Posterior to root of L lung
34
Function of recurrent laryngeal nerves
Supply muscles of larynx | Voice production
35
Where do the recurrent laryngeal nerve originate from?
Vagus nerve
36
What do the left and right recurrent laryngeal nerves loop around?
Right: loops around subclavian artery Left: loops around arch of aorta and ascends in tracheal-oesophageal groove
37
Where do thoracic splanchnic nerves synapse?
not at the sympathetic trunk, but at peripheral ganglia | sympathetic
38
Types of thoracic splanchnic nerves
GREATER=T5-T9 spinal nerves to celiac ganglion to supply foregut LESSER = T10+11 spinal nerves to superior mesenteric ganglion to supply midgut LEAST = T12 spinal nerve to superior mesenteric ganglion to supply midgut
39
Sympathetic trunk
2 chords with 11-12 ganglia provides sympathetic innervation connects white rami communicates to grey rami communicates
40
Where does the sympathetic trunk enter the abdomen?
Median arcuate ligament
41
Cardiac plexus
Origin: cervical and cardiac branches of vagus Goes from arch of aorta and post surface of the heart, along coronary arteries and to SAN parasympathetic fibres slow heart rate and force of contraction and constrict coronary arterties sympathetic fibres increase heart rate and force of contraction and dilate coronay arteries.
42
Mediastinum
covered by mediastinal pleura extends from superior thoracic aperture to the diaphragm and from the sternum and cc anteriorly to the bodies of the thoracic vertebrae posteriorly highly mobile region-accommodates movement and volume and pressure changes. Ct here becomes more fibrous and rigid with age - structures in mediastinum become less mobile
43
superior mediastinum
small compared to the inferior mediastinum | from superior thoracic aperture to transverse thoracic plane that passes through the sternal angle (T4/5)
44
Boundaries of the superior mediastinum
``` Anterior = manubrium Posterior = T1-T4 vertebrae Superior = plane of the jugular notch/thoracic inlet Inferior = plane of the sternal angle Lateral = mediastinal pleura (mediastinal part of the parietal pleura) ```
45
Contents of the superior mediastinum
``` Thymus Brachiocephalic vein Arch of aorta and its branches Vagus and phrenic nerves Left recurrent laryngeal nerve Trachea Oesophagus Thoracic duct ```
46
Inferior mediastinum
separated from superior mediastinum at T4/5 | Split into anterior, middle and posterior
47
Boundaries of the anterior mediastinum
``` Superior: thoracic plane T4/5 Inferior: diaphragm Anterior: Body of sternum Posterior: Pericardium and medial mediastinum Lateral: mediastinal pleura ```
48
Contents of the anterior mediastinum
Internal thoracic arteries and veins Inferior thymus Lymph nodes Sternopericardial ligaments (pericardium --> sternum)
49
Boundaries of middle mediastinum
``` Superior: Thoracic plane T4/5 Inferior: diaphragm Anterior: anterior mediastinum Posterior: posterior mediastinum Lateral: mediastinal pleura ```
50
Contents of middle mediastinum
Pericardium Heart Ascending aorta, pulm trunk, arch of azygos vein, main bronchi Phrenic nerve
51
Boundaries of posterior mediastinum
``` Superior: thoracic plane T4/5 Inferior: diaphragm Anterior: middle mediastinum Posterior: T5-12 Lateral: mediastinal pleura ```
52
Contents of posterior mediastinum
``` DATES Descending aorta Azygos system Thoracic duct oEsophagus Sympathetic trunks lymph nodes thoracic splanchnic nerves Vagus nerve ```
53
Thoracic duct
L2 to root of neck returns lymph to the venous system empties into venous system at left venous angle
54
What is the left venous angle?
union of left internal jugular and subclavian veins which forms the brachiocephalic vein
55
Which vessels drain into the thoracic duct?
Left jugular trunk Left subclavian trunk Left bronchomediastinal trunk
56
Which vessels drain into the right lymphatic duct?
Right jugular trunk Right subclavian trunk Right bronchomediastinal trunk
57
Route of thoracic duct
``` Originates from the cisterna chyli Enters via aortic hiatus in diaphragm Ascends right of midline At T4-6 vertebra moves left of midline into sup mediastinum Drains into left venous angle ```
58
Thymus
Located in lower part of neck, posterior to mediastinum and extends into anterior mediastinum lymphoid organ - site of T cell maturation After puberty shrinks and is replaced by fat
59
Which arteries supply the thymus?
anterior, intercostal and mediastinal branches of the internal thoracic arteries
60
Where do veins of the thymus end?
L brachiocephalic Internal thoracic veins Inferior thyroid veins
61
Lymph vessels of the thymus end?
Parasternal brachiocephalic tracheobronchial lymph nodes
62
Trachea
Continuation of larynx at lower border of cricoid cartilage Travels in superior mediastinum bifurcates at sternal angle anterior to oesophagus c-shaped cartilage lined by psuedostratified columnar epithelium
63
What is the innervation of the trachea
recurrent laryngeal nerve
64
Arterial supply of the trachea
Inferior thyroid artery
65
Venous drainage of the trachea
Brachiocephalic, azygos and accessory hemi-azygos veins
66
What are the components of the bronchial tree?
Trachea Primary bronchi Lobar bronchi Tertiary/segmental (provides air to a bronchopulmonary segment) Conducting Terminal Respiratory (provides 2-11 alveolar ducts) Alveolar ducts (gives rise to 5-6 alveolar sacs) Alveolar sacs
67
How many bronchopulmonary segments are there in each lung?
10 in right lung-3 in superior lobe, 2 in middle, 5 in inferior 8-9 in left lung -
68
Innervation of the bronchi
Vagus nerve
69
Arterial and venous supply of the bronchi
Bronchial arteries and veins
70
Oesophagus
25cm, divided into thoracic and abdominal parts Transports food from pharynx (inf border of cricoid cartilage C6) to stomach (T11) by peristalsis Thoracic duct to the left and aortic arch deep External longitudinal (where SkM->SM) and internal circular muscular layers
71
Course of the oesophagus
Originates in the neck, at inf border of cricoid cartilage, C6, continous with laryngopharynx Descends into sup mediastinum, running between trachea and vertebral bodies Enters abdomen by piercing oesophageal hiatus at T10 Approx 10cm further along it terminates by joining the stomach at T11
72
What is the phrenicoesophageal ligament?
connects oesophagus to border of oesophageal hiatus and permits independent movement of the oesophagus and diaphragm during respiration and swallowing
73
Narrowings of the oesophagus
Upper sphincter (superior cricopharyngeal) Where it is compressed by the aortic arch and left main bronchus Where it pierces the diaphragm at T10, oesophageal hiatus Lower sphincter (gastro-oesophageal) opening of stomach
74
Upper sphincter
Prevents entry of air located at junction of pharynx and oesophagus, located behind the cricoid cartilage SkM-cricopharyngeus muscle
75
Lower sphincter
Prevents reflux of gastric contents gastro-oesophageal junction, left of T11 relaxed in peristalsis dysfunction leads to reflux-damages mucosa and make it more prone to cancer -Barrett's Oesophagus
76
Innervation of the oesophagus
``` Sympthetic trunk Vagus nerve (parasym) ```
77
Oesophageal plexus
Origin: vagus nerve, sym ganglia, greater splanchnic nerve | distal to tracheal bifurcation
78
Borders of the thoracic part of the oesophagus
Anterior: Trachea, L recurrent laryngeal nerve, pericardium Posterior: thoracic vertebrae, thoracic duct, azygos veins, descending aorta Right: pleura, terminal part of azygos veins Left: subclavian artery, aortic arch, thoracic duct, pleura
79
Borders of abdominal part of the oesophagus
Anterior: L vagus nerve, post surface of liver Posterior: R vagus nerve, left crus of the diaphragm
80
Blood supply to thoracic oesophagus
Thoracic aorta, inferior thyroid artery | Drains into azygos system and inferior thyroid vein
81
Blood supply to abdominal oesophagus
Left gastric artery and left gastric veins and azygos vein
82
Carina
Cartilagenous ridge running antero-posterior between two primary broncho at site of bifurcation Carina ridge most sensitive for triggering cough reflex Widening and distortion of carina can indicate cancer of the lymph nodes where the trachea divides
83
Chylothorax
Chyle=fluid containing lymph and chylomicrons | -a type of pleural efflusion resulting from chyle entering the pleural cavity e.g. accidentally during surgery

Anatomy (7 decks)

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