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CRRAB Week 4 > Posterior, Superior Mediastinum > Flashcards

Posterior, Superior Mediastinum Flashcards

1
Q

What does the mediastinum contain?

A

Esophagus, heart, trachea, great vessels, etc.

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2
Q

What covers the mediastinum?

A

Mediastinal pleura

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3
Q

What way are you looking from when viewing CT of abdomen?

A

Up bottom (so the right is on your left)

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4
Q

What are the upper and lower limits of the mediastinum?

A

Thoracic inlet and diaphragm

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5
Q

What divides superior and inferior mediastina?

A

Transverse plane at the level of the sternal angle and the T4-T5 intervertebral disc

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6
Q

How is the inferior mediastinum divided?

A

Into anterior, middle and posterior. The middle mediastinum is the pericardial sac and its contents.

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7
Q

What type of muscle is the esophagus made of?

A
  • Inner circular and outer longitudinal layers.
  • Upper third is striated muscle under voluntary control, inferior third is smooth muscle and middle third is combination of both
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8
Q

Where does the esophagus travel?

A

Extends from C6 (pharynx) to T10 where it pierces the diaphragm to enter the stomach.
Lies posterior to the stomach.

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9
Q

What are the upper and lower esophageal sphincters?

A

UES - Cricopharyngeus

LES - Esophageal hiatus

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10
Q

What happens during swallowing?

A

Suprahyoid muscles elevate hyoid bone which elevates the laryngeal cartilages (allowing epiglottis to cover airway), elevating the esophagus

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11
Q

What three constrictions are in the esophagus?

A
  1. Cricopharyngeus muscle (UES) - relaxes during swallow
  2. Aortobronchial (aortic arch and left bronchus)
  3. Esophageal hiatus
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12
Q

What is important to know about these constrictions?

A

They are where foreign objects lodge, perforations are possible and carcinomas are more likely

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13
Q

What is a barium esophagram used for?

A

Initial diagnostic test for: Barett’s esophagus, dysphagia (difficulty swallowing), complications: stricture, obstruction, narrowing, ulcers and tumors

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14
Q

What is the disadvantage to a barium esophagram?

A
  • Can miss small ulcers and tumors

- Not effective for diagnosing gastroesophageal reflux associated with GERD

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15
Q

What do individuals with a prominent cricopharyngeus or spasm of muscle complain of?

A
  • Difficulty swallowing or having “lump in the throat”

- Some with prominent cricopharyngeus are asymptomatic

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16
Q

What can cause Cricopharyngeal achalasia (inability to relax muscle)?

A

May be due to neurological or muscular disease or be compensatory response to Gastroesoph. reflux

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17
Q

How can you treat cricopharyngeal spasm?

A
  • Injection of Botox or management of GERD.

- Surgical myotome can also be performed

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18
Q

What is esophageal stricture?

A
  • Secondary to GERD

- Acid reflux inflames the esophageal lining causing scarring and subsequent constriction (along with ulceration)

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19
Q

What are the advantages of TEE?

A
  • Clearer image due to less tissue to have transverse
  • Aorta, pulm. artery, valves of heart, atria, atrial septum and left atrial appendage, coronary arteries can be imaged better
  • HIGH SENSITIVITY for located blood clot in left atrium
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20
Q

Disadvantages of TEE?

A
  • Fasting patient
  • Need team of medical personnel
  • Take longer to perform than TTE
  • May be uncomfortable for patient
  • May require sedation/general anesthesia
  • Risk: esophageal perforation
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21
Q

What do the vagus nerves form on the esophagus?

A
  • They break up to form the esophageal plexus that surrounds the esophagus.
  • Then they reform inferiorly into posterior and anterior vagal trunks
  • Change in orientation is a result of rotation of the developing gut
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22
Q

What nerves other than the vagus contribute to the esophageal plexus?

A

T1-5

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23
Q

What innervates the upper third of the esophagus?

A

Efferent branches of the vagus nerve

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24
Q

What type of fibers make up the esophageal plexus?

A

Sympathetic and Parasympathetic fibers

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25
What supplies the lower 2/3 of the esophagus? What do these nerve do?
- Sympathetic postgang. fibers that have synapsed in upper thoracic ganglia and preganglionic fibers from the greater splanchnic nerve supply the lower 2/3 of the esophagus - Inhibit peristalsis
26
How do we sense esophageal pain?
Afferent carried in sympathetic nerves
27
What increases peristalsis and glandular secretions?
Parasympathetics (X)
28
What inhibits peristalsis?
Sympathetics (T1-T5)
29
What is achalasia and what causes it?
- Failure of normal peristalsis (stenosis of LES and dilation of esophagus) - May be result of virus infection or autoimmune destruction of autonomic nerve fibers in esophageal muscle
30
What do patients present with in achalasia?
Dysphagia, chest pain or discomfort, weight loss and vomiting
31
What is a risk factor for esophageal cancer?
Achalasia
32
How to treat achalasia?
Balloon dilatation of the LES, botulinum toxin injection into the LES and surgical myotomy
33
How does the aorta enter the lower body cavity?
It goes through a natural opening (doesn't pierce diaphragm) formed by diaphragmatic crura at level of T12.
34
What supplies intercostal spaces 1-2?
Superior (supreme) intercostal artery | branch of costocervical trunk from the subclavian
35
Where do aortic aneurysms usually occur?
Ascending or descending aorta
36
What are symptoms of an aortic aneurysm?
- Hoarseness (pressure on left laryngeal) - Dysphagia (difficulty swallowing from pressure on esophagus) - Dyspnea (difficulty breathing due to aortic pressure)
37
When would you get surgery for an aortic aneurysm?
- Aneurysm size greater than 5.5-6 cm - Growth rate 0.5 cm over a period of 6 mo-1 yr - Presence of genetic disorders or familial history of thoracic aneurysms (marfan syndrome) - Patient ability to tolerate
38
What is a type I AA?
- In ascending aorta | - 70% of Aortic arch aneurysms
39
What is type II AA?
- In ascending aorta (front only) | - More common in Marfan syndrome
40
What is type III AA?
-Occurs distal to L subclavian artery and makes up about 20% of cases
41
What two branches form the azygos vein?
- R subcostal vein (12th inercostal) | - R ascending lumbar vein
42
Where can you see the impression of the arch of the azygos?
R lung
43
What is collateral venous circulation in an IVC obstruction?
Azygos vein
44
Where doe the thoracic duct drain lymph from?
75% of body
45
Where does the thoracic duct terminate?
Left internal jugular and left subclavian veins
46
What is a chylothorax, its causes and how to treat?
- Laceration of thoracic duct that results in lymph in thoracic cavity - Malignancies, penetrating trauma - Thoracocentesis can be used to remove the fluid
47
What do thoracic splanchnic nerves carry?
Preganglionic sympathetic fibers headed for abdomen (don't confuse with pelvic splanchnic nerves)
48
Where do the thoracic splanchnic nerves synapse?
- Prevertebral ganglia (in abdomen) | - DO NOT synapse in sympathetic trunk!
49
What are the three thoracic splanchnic nerves and where do they originate?
- Greater Splanchnic T5-9 - Lesser Splanchnic T10-11 - Least Splanchnic T12 - don't look for!
50
What is present in the mid-axillary region of chest?
Innermost intercostal muscles
51
What nerves are the white rami associated with? Why?
T1-L2 | -Preganglionic sympathetic neurons originate only from these spinal cord segments
52
What do gray rami do?
Connect entire sympathetic chain with 31 pairs of spinal nerves -They are gray bc they contain unmyelinated postganglionic sympathetic neurons
53
What is the importance of the thymus?
- Imp. role in development and maintenance of the immune system (T-cells, thymosin) - Most of its activity is complete after puberty - Slowly involutes and is replaced by fatty connective tissue
54
What did the ductus arteriosus do for the fetus?
Shunted blood from the pulmonary arteries to the aorta, bypassing the lungs.
55
What two veins form the brachiocephalic veins?
-Internal jugular and subclavian veins
56
What are the five birds of the thoracic cage?
``` Azygos Hemiazygos Accessory hemiazygos Esophagus Thoracic duct ```
57
Where does the duct lie?
Between two gooses: | Thoracic duct lies between the Azygos and the Esophagus
58
Narrowing of the esophagus may be caused by:
Compression by the aortic arch
59
What carries fibers that slow the rate of depolarization of cardiac pacemaker cells?
Superior cervical vagal cardiac nerve
60
``` Which are not found in the posterior mediastinum? A. Cricopharyngeus B. Descending Aorta C. Sympathetic trunk D. Thoracic vertebrae E. Tracheobronchial nodes ```
D

CRRAB Week 4 (6 decks)

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