Neck Anatomy and Physiology Flashcards
What are the indications for a central line?
Central venous pressure Drug administration Cardiac pacing Blood sampling Fluid resuscitation Haemodialysis IV nutrition
What are the complications of a central line?
Pneumothorax Haematoma Cardiac Tamponade Air embolism Chylothorax False passage Thrombosis Sepsis Line blockage
What is a thyroglossal cyst?
How do you test for one in clinical examination?
What is its management?
Dilation of thyroglossal duct remnant
May become infected
Midline; grows with age
Moves on tongue protrusion
Need ultrasound scan prior to removal to ensure functioning thyroid tissue elsewhere
Excised but chance of recurrence
What are some of the causes of a solitary thyroid nodule?
Cyst: due to local haemorrhage Adenoma: benign follicular tissue Carcinoma Lymphoma Prominent nodule in multi-nodular goitre
What is the epidemiology of solitary thyroid nodule?
F>M
30-40 years
10% malignant in middle-aged,
50% malignant in young
How do you investigate a solitary thyroid nodule?
Investigate by Fine Needle Aspiration Cytology (FNAC) AND ultrasound scan
FNAC CANNOT distinguish between a follicular adenoma and a follicular carcinoma
Therefore tissue required for histological diagnosis
Thyroid lobectomy
What are the different types of thyroid cancer?
Papillary - lymphatic metastasis
Follicular - haematogenous metastasis
Medullary - familial association 10%, arise parafollicular C cells
Anaplastic - aggressive, local spread, very old, poor prognosis
What are some reasons for diffuse thyroid enlargement?
Colloid goitre:
- Due to gland hyperplasia
- Iodine deficiency
- Puberty, pregnancy, lactation
Graves disease
Thyroiditis
What is Grave’s Disease?
F>M
Autoantibodies against thyroid stimulating hormone receptor
This activates the receptor
Hyperthyroidism
What are the sign’s for Grave’s Disease?
Thyroid eye disease
Acropathy/ clubbing
Pre-tibial myxodema
What are the treatments for Grave’s Disease?
Anti-thyroids
beta-blockade
radio-iodine
Surgery
What are the indications for a thyroidectomy?
Airway obstruction Malignancy or suspected malignancy Thyrotoxicosis Cosmetics Retrosternal extension
What are the complications of a thyroidectomy?
Bleeding-primary or secondary Voice hoarseness Thyroid storm Infection Hypoparathyroidism Hypothyroidism Scar (keyloid/hypertrophic)
Explain multi-nodular Goitre
Due to Grave’s disease or toxic goitre
Grave’s: Women, Middle-aged, Overactivity (hyperthyroidism)
Toxic Goitre: Older, No eye sign’s, atrial fibrillation
Thyroid function tests, FNAC, chest x-ray
What are the parathyroid glands?
Usually there are 4
Regulate calcium and phosphate levels
Located posterior to poles of thyroid
Can be injured in neck surgery
What can parathyroid disease cause?
PAINFUL STONES: Renal calculi, polyuria, renal failure
ACHING BONES: pathological fractures, osteoporosis, boan pain
PSYCHIC MOANS: Anxiety, depression, confusion, paranoia
ABDOMINAL GROANS: Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss
What investigations can you carry out for Parathyroid disease?
U+E, Creatinine, Calcium, Phosphate Parathyroid hormone, Bicarbonate Vitamin D USS CT/MRI: look for ectopic glands Isotope scanning: detect disease glands
Surgery for Hyperparathyroidism ONLY
What can hyperparathyroidism cause?
Adenoma: 80% hyperparathyroidism, single or multiple
Hyperplasia: 12 % of hyperparathyroidism
-Common in secondary hyperparathyroidism due to low calcium e.g. renal failure.
Malignancy (rare):
What is the management for hyperparathyroidism?
Management Medical treatment Surgery easier if patient fit Remove single adenomas Remove multiple adenomas too Carcinomas removed with thyroid gland and lymph nodes
What are the indications for tracheostomy?
Airway obstruction
Airway protection
Poor ventilation to reduce dead space
Need suctioning
Need humidification
Need long term care
What is stridor?
Clinical sign of airway obstruction
- Inspiratory = laryngeal
- Expiratory = tracheobronchial
- Biphasic = glottis/subglottic
What is a branchial cyst?
Remnant of fusion failure of brachial arches OR lymph node cystic degeneration
Transilluminates
Anterior to sternocleidosatoid at junction between upper and middle thirds
Becomes infected, enlarged
Excised to prevent further infection
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of the interior constrictor of the pharynx
What are the clinical features of pharyngeal pouch?
Voice hoarseness Dysphagia Aspiration pneumonia Regurgitation Weight loss Neoplasia 1%
How do you deal with pharyngeal pouch?
Barium swallow
Excision (endoscopic or open)
Dilate
What do the parotid glands drain?
Scalp
Face
Parotid galnd
What do the occipital nodes drain?
Scalp
What do the superficial cervical nodes drain?
Breast and solid viscera
What do the deep cervical nodes drain?
Final drainage pathway to thoracic duct
What do the submandibular nodes drain?
Tongue Nose Paranasal sinuses Submandibular gland Oral cavity
What do the submental nodes drain?
Lips
Floor of mouth
What do the supraclavicular nodes drain?
Breast
Oesophagus
Solid viscera
What are the 3 causes of lymphadenopathy?
Infective
Inflammatory
Malignant
What is myxoedema?
Myxedema or myxoedema is a term used synonymously with severe hypothyroidism. It is also used to describe a dermatological change that can occur in hypothyroidism, and some forms of hyperthyroidism
What is pre-tibial myxoedema?
Pretibial myxedema (aka Graves Dermopathy) is an infiltrative dermopathy, resulting as a rare complication of Graves’ disease, with an incidence rate of about 1-5% in patients.
How do you manage stridor?
- Treat with O2
- Nebulised Adrenaline
- IV Dexamethasone
- (Heliox)
- (Definitive) Airway Management
