Org Ana: Large Vessels and Clinical Notes Flashcards
what are the structures founded at the superior mediastinum
thymus
R and L brachiocephalic veins
L superior intercostal vein
SVC
arch of aorta w 3 large branches
trachea
esophagus
vagus
phrenic
left recurrent laryngeal nerve
thoracic duct
other small nerves, bv and lymphatics
describe the anterior mediastinum
only on the left side where the left pleura diverges from the mid-sternal line
what are the boundaries of the anterior mediastinum
front - sternum
behind - pericardium
lat - pleura
sup - transverse plane passing sternal angle
inf - diaphragm
what are the structures inside the anterior mediastinum
loose areolar tissue
lymphatic vessels which ascend from the convex surface of liver
2 or 3 anterior mediastinal lymph glands
small mediastinal branches of the internal mammary artery
portion of thymus
describe middle mediastinum
broadest part of inf mediastinum
located in pericardial cavity
what does the middle mediastinum contain
ascending aorta
lower half of the SVC w azygos vein opening into it
bifurcation of the trachea and the 2 bronchi
pulmonary artery and its branches
phrenic nerves
some bronchial lymph gland
what are the contents of the posterior mediastinum
thoracic part of ascending aorta
azygos and 2 hemiazygos veins
vagus and splanchnic nerves
sympathetic trunk
thoracic duct
lymph glands
esophagus and associated nerve plexus
describe the aorta
main arterial trunk that delivers O2 rich blood from LV to the rest of the body
4 parts: ascending, arch, descending, abdominal
describe the ascending aorta
from base of LV; has 3 bulges and the sinuses of the aorta
branches: R and L coronary arteries
what are the branches of the aortic arch
brachiocephalic
- right common carotid
internal > brain tissues; circle of willis
external > face, neck, scalp
- right subclavian > UE
left subclavian
left common carotid
where is the descending aorta found
found in the posterior mediastinum
what are the branches of the descending aorta
bronchial
mediastinal
oesophageal
posterior intercostal
pericardial
superior phrenic
subcostal
what does the pulmonary trunk do
convey O2 poor blood from the RV to lungs
what are the branches of the pulmonary trunk
R pulmonary artery - behind ascending aorta and SVC to enter right lung
L pulmonary - in front of descending aorta to enter left lung
ligamentum arteriosum - fibrous band connecting the bifurcation of pulmonary trunk to arch aorta
what is the brachiocephalic vein
R and L from root of neck recieves blood from subclavian and internal jugular vein
describe the SVC and IVC
SVC - combi of 2 brachiocephalic; head, neck and UE
IVC - from LE
describe the pulmonary vein
2 from in each; carries O2 rich blood
compare the different azygos veins
main - inter something lumbar
inf - lower intercostal, subcostal, lumbar C
sup - upper intercostal
what is the function of the azygos veins
drains blood from posterior parts of intercostal space, posterior abdominal wall, pericardium, diaphragm, bronchi and esophagus
describe the lymphatic drainage in the thoracic wall
skin of anterior thoracic - anterior axillary > internal thoracic
posterior thoracic - posterior axillary
deep - posterior intercostal
mediastinal structures - bronchomediastinal trunk
describe the thoracic duct
it starts from below abdomen as cisterna chyli and ascend through the aortic opening of diaphragm right of the descending aorta
recieves lymph from left jugular, subclavian, bronchomediastinal
what are the structures founded anterior to esophagus
trachea
left recurrent laryngeal
left principal bronchus
pericardium
what are the structures founded posterior to esophagus
body of thoracic vertebrae
thoracic duct
azygos vein
right posterior intercostal artery
descending thoracic aorta
what are strucutres found at R and L of esophagus
R - mediastinal pleura and terminal azygos
L - left subclavian, aortic arch, thoracic duct, mediastinal pleura
what is the arterial supply of esophagus
upper - inferior thyroid
middle - esophageal branch of descending aorta
lower - left gastric
what is the venous drainage of the espohagus
upper - inferior thyroid
middle - azygos
lower - left gastric vein
what is the nerve and lymph supply of the esophagus
parasymph and symph fibers via vagus ant symph trunks
lymp:
upper - deep cervical
middle - sup and inf mediastinal
lower - left gastric and celiac
describe the thymus
in ant mediastinum; reaches sup media in new born
site for development of T-lymphocytes
what is bronchitis
inflammation of lining of the tracheobronchial tree
acute - infection, virus and less often bacteria
chronic - cigarettes and inhaling dust/chemicals
what are the symptoms and treatment of bronchitis
inflammation and swelling
inc mucus production = hoarseness, cough and fever
antibiotics, water, mucolytic
what is the emphysema
loss of elasticity of lungs = unable to recoil adequately causing incomplete expi
type of COPD involving damage to alveoli = dec O2 diffusion
what are the causes and treatment of emphysema
smoking
inhalers, O2 medications, surgery
what is asthma
bronchi narrows, coughing, wheezing and shortness of breath
caused by airway hyperresponsiveness - bronchodilators
what is bronchogenic carcinoma
highly malignant primary lung tumor
- accounts for most cases of lung cancer
- vv poor prognosis
- 2nd most common cancer in men
- 3rd most common in women
- 45-70
what are the causes of bronchogenic carcinoma
smoking, second hand smoke, occupational agents, poison gas
what are the symptoms and treatment of bronchogenic carcinoma
persistent cough
blood tinged sputum or hemoptysis
fatigue and weakness
chest pain, shortness of breath
weight loss or bone pain of
pneumonectomy (late) or lobectomy (early)
what is tubercolosis
chronic bacterial infection from myobacterium tubercolosis
develop after inhale droplets from infected person
what are the symptoms of tuberculosis
cough w thick and cloudy and bloody mucus for > 2wks
rapid heartbeat
swollen neck - lymph
fever, chills, night sweats
fatigue and muscle weakness
loss of appetite and weight loss
shortness of breath and cheast pain
what is postural drainage
patient is positioned to let gravity assist in drainage of excessive bronchial secretions sa lobes
describe valvular heart disease
inflammation in valve that causes valves to stick and fibrous thickening; loss of flexibility and shrinkage
narrowing - stenosis = hypertrophy
regurgitation - incompetence = babalik
RHD - mitral
when are heart murmurs heard
stenosis - before closure of AV valves
regurgitation - ventric systole
what is coronary heart disease
block in coronary artery that causes necrosis/myocardial infarc
due to arteriosclerosis
ischemia > angina pectoris - aggravated by exertion and relieved by rest or vasodilators
what are the causes and symptoms of cardiac pain
O2 deficiency and accumulation of metabolites; myocardial infarc
pain
- mild discomfort
- severe crushing
- referred to skin supplied by upper 4 intercostal
what is differential diagnosis from cardiac pain
GERD - acid reflux; relieved by sit patient or sleep w a higher pillow, antacid
describe conducting system problem
arrhythmia caused by arteriosclerosis of coronary artery diminishes blood supply to conducting system
what are the conducting system problems in the atria
tachycardia - inc in cardiac rate; > 100 bpm
atrial flutter - tachycardia > arrhythmia; usually regular
atrial fibrillation - more chaotic atrial arrhythmia; fast and irregular ventricular rate
what is the causes right sided heart failure
as a result of left sided heart failure
COPD and pulmonary fibrosis
what is the causes left sided heart failure
LV loses its ability to contract normally = cant pump w enough force to push blood into circulation
LV loses ability to relax = cant fill up during resting period
describe congestive heart failure
as blood flows out of heart:
- it slows
- blood returning to heart through veins back up = congestion in body tissues
swelling - edema
fluid collects in lungs
- dyspnea
- easily fatigue
- shortness of breath when laying down - orthopnea
what is v-tach
rapid heartbeat from ventricles; keeps heart from adequately filling
what is v-fib
erratic disorganized firing of impulse from ventricles
what is tetralogy of fallot
4 anatomic abnormalities:
- stenosed pulmonary trunk
- large ventricular septal defect
- overriding of aorta
- hypertrophy of RV
what is atrial septal defect
small opening at foramen ovale causing mixture of O2 rich blood from LA
what is ventricular septal defect
most common congenital heart malformation
closes in growth - no surgery
blood shift from left to right > RV enlarges
what is patent ductus arteriosus
distal aortic arch connects w left pulmonary artery
high psi in pulmonary artery = pulmonary hypertension and hypertrophy of RV
what is the coarctation of aorta
dilatation or aneurysm of aorta showing as pulsalite swelling in suprasternal notch
narrowing of aorta = decrease pulse in femoral artery
collaterals to compensate develops
what is CABG
coronary artery bypass graft
used to treat CAD by bypassing the blocked portion of coronary artery
sources of graft:
- internal thoracic artery
- radial artery
- saphenous vein
