neck anatomy, physiology and pathology Flashcards
what are the some of the gross anatomical structures within the neck?
arteries veins nerves lymph nodes lymphatic channels thyroid and parathyroid glands muscles trachea
what is the superior boundary of the neck?
mandible
what is the inferior boundary of the neck?
clavicle
what is the anterior boundary of the neck?
anterior midline
what is the posterior boundary of the neck?
trapezius
what are the boundaries of the anterior triangle?
anterior: midline of neck
posterior: anterior border of sternocleidomastoid (SCM)
what are the boundaries of the posterior triangle?
anterior: posterior border of sternocleidomastoid
posterior: anterior border of trapezius
name the 4 arteries, 2 veins, 2 groups of lymph nodes and 5 nerve groups contained in the anterior triangle of the neck
common carotid artery external carotid artery internal carotid artery internal jugular vein facial artery facial vein hypoglossal nerves accessory nerves vagus nerves laryngeal nerves glossopharyngeal nerves submandibular and submental lymph nodes
name the 5 contents of the posterior triangle
accessory nerve occipital artery lymph nodes cervical nerve plexus external jugular vein
where does the common carotid artery bifurcate?
vertebral level C4
what makes the common carotid artery unique within the neck?
only artery with branches in the neck
name 8 branches of the Common carotid artery
superior thyroid ascending pharyngeal lingual occipital facial posterior auricular maxillary superficial temporal
what are some uses of a central line?
measuring central venous pressure drug administration cardiac pacing blood sampling fluid resuscitation haemodialysis IV nutrition
what are some complications that may result from insertion of a central line?
pneumothorax haematoma cardiac tamponade air embolism chylothorax false passage thrombosis sepsis line blockage
where do the lymph nodes in the head and neck drain to BEFORE the thoracic duct?
cisterna chyli
what are the different groups of lymph glands in the head and neck?
occipital cervical supraclavicular submandibular submental parotid -there are others
where do the parotid nodes drain from?
scalp, face and parotid gland
where do the occipital nodes drain from?
scalp
where do the superficial cervical nodes drain from?
breast and solid viscera
what is the function of the deep cervical nodes?
final drainage pathway to the thoracic duct
where do the submandibular nodes drain from?
tongue nose paranasal sinuses submandibular gland oral cavity
where do the submental nodes drain from?
lips
floor of mouth
where do the supraclavicular nodes drain from?
breast
oesophagus
solid viscera
what are 3 broad categories that my cause lymphadenopathy?
infection
inflammation
malignancy
what kind of gland is the thyroid?
endocrine
what is the structure of the thyroid gland?
2 lobes joined by the isthmus
what does the thyroid produce?
thyroid hormone
calcitonin
what is the function of calcitonin?
lowers calcium and raises phosphate levels
what is a thyroglossal cyst?
dilatation of thyroglossal duct remnant - may become infected
what are some causes of thyroid masses?
solitary nodules
diffuse enlargement
multi nodular goitre
what are some causes of solitary thyroid nodules?
cyst adenoma carcinoma lymphoma prominent nodule in multi nodular goitre
what causes thyroid cysts?
localised haemorrhage
what would be appropriate investigations in the case of a solitary thyroid nodule?
fine needle aspiration cytology (FNAC)
ultrasound scanning
what can FNAC NOT distinguish between?
follicular adenoma and follicular carcinoma - tissue required for a histological diagnosis
what are 4 classifications of thyroid cancer?
papillary
follicular
medullary
anaplastic
what causes papillary thyroid cancer?
lymphatic metastasis
what causes follicular thyroid cancer?
haematogenous metastasis
what causes medullary thyroid cancer?
familial association (10%), arise from parafollicular C cells
what are some characteristics of anaplastic thyroid cancer?
aggressive
local spread
old patients
poor prognosis
what are some causes of diffuse thyroid enlargement?
colloid goitre
grave’s disease
thyroiditis
what can cause colloid goitre?
gland hyperplasia iodine deficiency puberty pregnancy lactation
what is the pathology of graves disease?
auto antibodies against thyroid stimulating hormone receptor stimulate the receptor, resulting in hyperthyroidism
what is the treatment for graves disease?
anti thyroids, beta blockade, radio iodine and surgery
what are indications for a thyroidectomy?
airway obstruction malignancy or suspected malignancy thyrotoxicosis cosmesis retrosternal extension
what are possible complications of a thyroidectomy?
bleeding - primary or secondary voice hoarseness thyroid storm infection hypoparathyroidism hypothyroidism scarring (keloid/hypertrophic)
what are causes of multi nodular goitre?
graves disease or toxic goitre
what kind of patient would you expect to see in a toxic goitre case?
older
no eye signs
atrial fibrillation
what kind of patient would you expect to see where the cause of multi nodular goitre is graves disease?
woman
middle aged
over active thyroid (hyperthyroidism)
what tests would you perform if you suspected multi nodular goitre?
thyroid function tests
FNAC
CXR
how many parathyroid glands are there usually?
4
what is the function of the parathyroid glands?
regulate calcium and phosphate levels
where are the parathyroid glands located?
posterior to the poles of the thyroid
what are some renal signs of parathyroid disease?
renal calculi
polyuria
renal failure
what are some alimentary signs of parathyroid disease?
abdominal pain constipation peptic ulceration pancreatitis weight loss
what are some bony (awful name sorry) signs of parathyroid disease?
pathological fractures
osteoporosis
bone pain
what are some psychological signs of parathyroid disease?
anxiety
depression
confusion
paranoia
what tests would you run (exluding imaging tests) to try and diagnose parathyroid disease?
U & Es creatinine calcium and phosphate levels parathyroid hormone levels bicarbonate levels vitamin D
what IMAGING tests would you run to try and diagnose parathyroid disease?
ultrasound scan
CT/MRI - identify ectopic glands
Isotope scanning - detect diseased glands
when would surgery be indicated in parathyroid disease?
hyperparathyroidism ONLY
what are some causes of hyperparathyroidism?
adenoma
hyperplasia
malignancy in rare cases
what accounts for the majority of hyperparathyroidism?
adenomas account for 80%
what percentage of hyperparathyroidism does hyperplasia account for?
12% - common in secondary hyperparathyroidism due to low calcium
how is hyperparathyroidism managed?
can be treated medically
surgery easier if patient is fit
remove single and multiple adenomas
remove 3 or 3.5 hyperplastic glands through neck exploration
carcinomas removed along with the thyroid gland and lymph nodes
what are the 4 fascial layers of the neck?
pre-tracheal
pre-vertebral
deep cervical
carotid sheath
what is a tracheostomy?
A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help the patient breathe
what are some indications for a tracheostomy?
airway obstruction
airway protection
poor ventilation to reduce dead space
what would be a sign of laryngeal stridor?
inspiratory stridor
what would be a sign of tracheobronchial stridor?
expiratory stridor
what would be a sign of glottic/subglottic stridor?
biphasic stridor
what causes a branchial cyst?
remnant of fusion failure of branchial arches
lymph node cystic degeneration
where are branchial cysts located?
anterior to the SCM at the junction between the upper and middle thirds
how are branchial cysts managed?
excised to prevent further infection
what is a “pharyngeal pouch”?
herniation of the pharyngeal mucosa between the thyropharyngeus and cricopharyngeus muscles of the inferior constrictor of the pharynx
what are some signs of a pharyngeal pouch?
voice hoarseness dysphagia aspiration pneumonia regurgitation weight loss neoplasia (1%)
how is a pharyngeal pouch diagnosed?
barium swallow
what is the treatment for a pharyngeal pouch?
excision
dilatation
