Pulm Anatomy Flashcards
Laryngopharynx is continuous with what structure?
esophagus
Follow the flow of air from the larynx to the bronchial tree.
Larynx -> trachea -> R/L mainstem bronchi -> bronchial tree
What structure keeps the trachea open?
The trachea has cartilaginous rings. The carina helps with this as well.
What area of the larynx is really sensitive?
The carina; if touched during intubation, the patient will VIOLENTLY cough.
What are the 3 major compartments?
L pleural cavity, R pleural cavity, and mediastinum
What are the structures in the pulmonary system?
Anterior: sternum (top manubrium, T2/3)
Posterior: vertebral column
Lateral: ribs and costochondral cartilage
Inferior: diaphragm/inferior thoracic aperture
Superior: neck/superior thoracic aperture
Which ribs are true ribs?
1-7, because of their direct connection with the sternum.
What are the false ribs?
8-10, because of their indirect connection to the sternum. They connect with each other and then have some cartilage that connects them to the sternum.
What are the floating ribs?
11 and 12
Which part of the sternum ossifies with age?
Xiphoid process
What is important about the costal facet of the transverse process?
Patients can get joint arthropathy here, and we can give them steroid injections for the pain.
What are the parts of the sternum?
manubrium, body, xiphoid process
jugular notch, sternal angle
What is the sternal angle? What does it define?
The superior portion of the pericardium, beginning and end of the aortic arch, entrance of superior vena cava to the heart, bifurcation of the trachea, and superior limit of the pulmonary trunk.
What is the superior thoracic aperture?
Entry point of the Esophagus, trachea, L/R internal jugular, L/R common carotid.
What is the inferior thoracic aperture?
Diaphragm (penetration of aorta- passes more posteriorly while the esophagus and IVC actually penetrate, esophagus, and IVC).
What is the arterial supply from the aorta?
Intercostal arteries anastomose with internal thoracic arteries (branch of subclavian) - internal thoracic runs inferiorly and supplies the musculophrenic artery. Costal groove on the inferior rib margin where the arteries run on the ribs.
What does the musculophrenic artery supply?
Supplies diaphragm and abdomin with blood.
What is the venous drainage of intercostal veins needed to get to the R side of the body/SVC?
Azygous vein of the R side of thorax drains into the SVC. Hemiazygos (inferiorly) and accessory hemiazygos (superiorly) veins on the L side of the thorax drain into the azygous. Internal thoracic vein drains into the brachiocephalic veins which becomes SVC.
Describe the lymphatic drainage of the thoracic wall.
Maintain blood volume and return lymph to circulation. Parasternal and intercostal nodes drain into the bronchomediastinal trunk -> thoracic duct -> junction of internal jugular vein/subclavian. Easy way for lung cancer to spread.
Describe the lymphatic drainage of the structure of the thorax.
Tracheobronchial nodes drain into the bronchomediastinal trunk -> thoracic duct -> junction of the internal jugular vein/subclavian. Easy way for lung cancer to spread.
What are the intercostal nerves?
(T1-T11 spinal nerves; T12 is known as subcostal nerve). Provide motor innervation to intercostal and abdominal muscles. Sensory innervation (aka dermatomes) to the skin and parietal pleura of the thoracic wall.
Out of VAN, which structure is most exposed?
The nerve, then the artery, then the vein.
For chest tube insertion, where do we want to go?
Between 4th or 5th intercostal space, typically in the mid-axillary line.
What is the main function of the intercostal muscles?
Breathing and protection.
What are the intercostal muscles?
External intercostals, Internal intercostals, Innermost intercostals.
What is the function of external intercostals?
Move the ribs superiorly to support inspiration.
What is the function of internal intercostals?
Move the rib inferiorly to support expiration.
What is the innermost intercostals?
Assist with forced expiration.
The phrenic nerve supplies the ________ and originates from ________.
Diaphragm and originates from C3, C4, C5.
Which of the phrenic nerves supplies the most motor innervation to the diaphragm?
C4
What is the costal groove on inferior rib margin?
Vein, Artery, Nerve (VAN).
What is the diaphragm?
Central tendon (pericardium attachment). Blood supply: some from pericardiophrenic/musculophrenic arteries (superior branches of internal thoracic arteries), most from the anterior phrenic arteries which branch off the abdominal aorta.
The visceral and parietal pleura is named the ______ space.
pleural
What is the costodiaphragmatic recess?
(costophrenic angles) as potential space for fluid accumulation ‘blunting’.
What does the term ‘blunting’ mean?
Lower lobe pneumonia. Lungs don’t expand in this area. Fluid can pool here in inspiration. Only time lungs MAY expand here is during forced inspiration.
What can we see on the posterior view of the lungs?
Right lung is bigger than the left. The base, apex, costal, mediastinal surfaces, hilum of lungs vs root. Pulmonary ligament.
What are the structures of the right lung?
IVC anterior to hilum/root. Esophagus posterior to hilum/root. 3 lobes with oblique and horizontal features.
What is the hilum?
Where structures enter the lung.
What is the root?
The root of the structures that are entering the lung.
What is the pulmonary ligament?
Multiple layers of pleura that stabilizes and attaches to the diaphragm.
Which lung has 3 lobes?
Right
Are the SVC and IVC anterior or posterior to the hilum?
Anterior
Is the esophagus anterior or posterior to the hilum?
Posterior
What are the two fissures that separate the lobes of the right lung?
Horizontal and oblique
What are the structures of the left lung?
Aorta and esophagus posterior to hilum/root. 2 lobes with oblique fissure. The lingula and cardiac notch.
What is the lingula and cardiac notch?
The lingula is a little flap of lung tissue that hugs the heart anteriorly and the cardiac notch is the flap/inlet right above the lingula.
Where is the most common place for a FB?
R. mainstem bronchi, because it is wider and more vertical.
What is the basis of a lobectomy?
Lung can still function fine if we resect one of the following lobes that is necrotic or non-functioning.
What is the flow of inspiration?
Trachea (cartilaginous rings) -> R / L mainstem bronchi -> lobar bronchi -> segmental bronchi -> bronchioles (less cartilage, more elastic/smooth muscle fibers).
The right bronchial artery is supplied by what branch?
Right third posterior intercostal artery.
Why is our pulse oxy always around 98-99%?
Because the venous system dumps about 1% of deoxygenated blood into the left atria on its way to the pulmonary trunk of the heart to get oxygenated.
What is the flow of blood through the lungs?
Pulmonary ARTERIES: carry deoxygenated blood AWAY from the heart (arise from pulmonary trunk-R ventricle of the heart).
Pulmonary VEINS: carry oxygenated blood TO the heart from the lungs and dump oxygenated blood into the L atrium of heart.
What is the flow of blood to/from the lungs?
Bronchial arteries from thoracic aorta. Bronchial veins drain into azygos/superior intercostal (R lung) and pulmonary veins/L atrium (L lung).
What is the nervous supply to the lungs?
Vagus nerve (parasympathetic)- CN X- bronchoconstriction and vasodilation (branches into recurrent laryngeal).
Sympathetic trunk- bronchodilation and vasoconstriction.
In addition to gas exchange (of O2 and CO2) what are some other functions of the respiratory systems and what structures are involved?
Help us talk by passing air in and out of the larynx, we are able to produce sound by vibration of the vocal cords. Assists w/ olfaction
What are the two portions of the respiratory system an what structures are included in each portion?
Conducting portion: structures within our nose, nasal cavity , oro and nasopharyngx, larynx. Continues past our neck and throat down into the thoracic cavity inferiority.
Respiratory portion: in the lung tissue we have alveoli that allow for gas exchange to occur between the conducting portion that brings the air in, down to the alveoli and the portions of our bronchi that are capable of gas exchange
What are some of the important dermatome locations?
C4- neck C5- outside of arm, C6- thumb, C7- pointer and middle finger, C8-ring and pinky finger T10- belly button
What is a dermatome
areas of skin on your body that rely on specific nerve connections on your spine.
What is the orientation and function of the external intercostals?
“Hands in the pocket” muscle fiber orientation and they function for forced inspiration
What is the orientation and function of internal intercostals?
“Hands to the heart” muscle fiber orientation and they function in forced expiration
What is the orientation and function of the innermost intercostals?
Deep to the internal intercostals “hands to the heart” muscle fiber orientation and they function in forced expiration
Note the anatomy and presence of the internal thoracic artery. Where does this artery run? How does it receive blood supply and what structures does the internal thoracic artery supply?
branches off the subclavian artery and runs on the posterior aspect of the rib cage. As it descends, it gives off anterior intercostal arteries. The anterior intercostal arteries run w/ VAN. They anastomose w/ posterior intercostal arteries
What structure separates the abdominal and thoracic cavities
Diaphragm
Note the presence of the ligaments connections of the diaphragm. Research a condition known as “median arcuate ligament syndrome” and identify what sx and/ or structures may be associated with this condition:
The ligament pushes on the celiac artery which is the main blood vessel supplying the stomach, liver, and other abdominal organs. N/V/D, stomach pain after eating or exercising, unintended weight loss, fear of eating because of pain, tripoding?
Identify and follow the path of the phrenic nerve, do more research on this nerve and the specific functions (sensory and motor). Note the phrenic nerve appears to be “vibrating” in the screen, this is due to its proximity to the heart.
originates from the cervical spinal cord at levels C3, C4, and C5, travels down the neck, through the thorax, and ultimately supplies motor innervation to the diaphragm
How many intercostal spaces are found lying between adjacent ribs on each side of the thoracic cavity?
11
The intercostal nerves which innervate the muscles of the intercostal spaces and overlying skin, are direct continuations of what structures?
Ventral (anterior) rami
What is the vertebral level of the IVC?
T8
What is the vertebral level of the esophagus?
starts at C6 and ends at T11
What is the vertebral level of the aorta?
Begins at T4 and bifuractes at L4
What anatomical structure lies immediately posterior to the esophagus in the mid region of the thorax?
Thoracic duct
A tumor growing on the posterior aspect of the heart within the posterior mediastinum would most likely begin to compress what structure?
Esophagus
What prominent bony landmark aligns w/ the beginning and end of the aortic arch?
Sternal angle
Which vessel do the majority of posterior intercostal veins drain into on the right side of the thorax?
Azygous vein
Where anatomically is it morleikely for someone to aspirate? What structures contribute to this?
R. main bronchus or lung, because it is more steep. AN aspirated item is most likely to end up in the vascular segment of the inferior lobe of the right lung (when in an upright position). In a supine position, an aspirated is most likely to end up in the superior segment of the inferior lobe or the posterior segment of the superior lobe (most gravity-dependent areas)
Note the absence of cartilage as you enter the terminal bronchioles of the repsiratry tract. What are some notable structures and surrounding the terminal bronchioles?
Have thick layers of smooth muscle bands in their walls that spiral down the wall of the air passageway. As the terminal bronchioles branch into respiratory bronchioles, the amount of smooth muscle diminishes. Respiratory bronchioles are a transitionary zone in the respiratory system, they aid in air conduction and gas exchange. The elastin fibers and capillaries surround the alveoli.
What is the function of goblet cells?
specialized epithelial cells that primarily function to produce and secrete mucus, which forms a protective barrier over the lining of various body surfaces like the intestines and airways, protecting against bacterial invasion and lubricating the passage of food or air; essentially acting as a first line of defense against harmful substances
Does the pulmonary artery carry deoxygenated or oxygenated blood?
Deoxygenated
Does the pulmonary vein carry deoxygenated or oxygenated blood?
Oxygenated
During the inspiration and expiration what structures expand?
Alveoli-volume change is an accommodation of these ducts
What are the smallest conducting bronchioles?
Terminal bronchioles
What is the major function of the respiratory system?
Acid base balancing to regulate homeostasis
What is the name of the respiratory system that warms, moistens, filters, and channels air?
Conducting
What is the name of the portion of the respiratory system that is directly involved in the diffusion of gases?
Respiratory
What air passageway is the termination of the trachea and brings air into and out of the lungs?
Primary main bronchi
What is the name of the layer of serous membrane lining of the thoracic wall adjacent to the r. And l. Lungs?
Parietal pleura
Note how the ribs articulate with the thoracic vertebrae and sternum, what is the general name for these joints?
Costovertebral joints
Costotransverse joints
Sternocostal joints
What structures pass anterior or posterior to the bronchi of the lungs?
Esophagus
Aorta
Vena Cava
Esophagus: posterior to the bronchi and punctures the diaphragm
Aorta: posterior to bronchi and travels most posteriorly to behind the diaphragm
Vena Cava: anterior to the bronchi and punctures the diaphragm
Identify the lobes of the right lung
Superior, middle, and inferior lobes
Horizontal and oblique fissure
Identify the lobes of the left lung
Superior and inferior
Oblique fissure
The pulmonary trunk branches into what structures?
L/R pulm arteries that carry deoxygenated blood
What is the sensory and motor fucntion of the recurrent laryngeal? Where does it originate? What does it supply?
Sensory: area below the vocal cords within the larynx
Motor: most muscles of the larynx (voice box), allowing for vocal cord movement
Originates: Vagus (CN X)
Supplies: all intrinsic muscles of the larynx except the cricothyroid
What is the sensory and motor fucntion of the Vagus? Where does it originate? What does it supply?
Sensory: heart, lungs, abdomen, and throat, including the skin behind the ear, the external ear canal, and the larynx. Also provides taste sensation
Motor: muscles of the larynx, pharynx, and soft palate. Stimulates the heart muscles to slow the resting heart rate.
Originates: CN X from brainstem
Supplies: heart, lungs
What is the sensory and motor fucntion of the Phrenic? Where does it originate? What does it supply?
Sensory: central tendon aspect of the diaphragm
Motor: diaphragm
Originates: anterior rami C3, C4, C5 nerve roots
Supplies: diaphragm
What vertebrae does the maubrium sit at?
T2-T3
What vertebrae does the sternal angle sit at?
T4-T5
If someone came into the ER with a neck injury, what are we worried about?
The C3, C4, C5 spinal nerves because they supply the diaphragm and if these are cut off, they won’t be able to breath
If someone came into the ER with a thoracic vertebrae injury, what are we worried about them developing?
The thoracic vertebra and their associated spinal nerves supply the intercostal muscles and so the patient might have some trouble breathing and may develop hypoxia
The central tendon of the diaphragm has an important function with the heart, what is it?
It helps with pericardium attachment
Where does most of the blood supply to the diaphragm come from?
inferior phrenic arteries which branch off the abdominal aorta
Does the IVC run anterior or posterior to the hilum?
anterior
Does the esophagus run anterior or posterior to the hilum?
posterior
does the aorta run anterior or posterior to the hilum?
posterior
immediately anterior to the hilum there is an indention in the left lung. Why?
This is where the heart sits
What dermatome covers the nipples?
T4ish
