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Pulmonology > Pulmonary Anatomy > Flashcards

Pulmonary Anatomy Flashcards

1
Q

Conducting Zone Structures

A
  • Trachea
  • R and L main (primary) bronchi
  • Lobar (secondary) bronchi
  • Segmental (tertiary) bronchi

*Segmental bronchi divide repeatedly to form bronchioles, which are less than 1 mm in diameter

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2
Q

Trachea

A

(windpipe)

  • Fibro-musculo-cartilage tube (~11 cm in length)
  • Extends from the lower border of cricoid cartilage (opposite C6) to the sternal angle (lower border of T4)
  • Divides into R and L principle bronchus at the sternal angle

CARINA = last tracheal rings

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3
Q

Relations of Trachea

Anterior Neck

A
  • Skin, superficial and deep cervical fasciae
  • Jugular venous arch (suprasternal space)
  • Overlapped by sternohyoid and sternothyroid muscles
  • Crossed by isthmus of the thyroid gland, opposite 2nd, 3rd, and 4th rings of the trachea
  • Anastomosis between two superior thyroid arteries above the isthmus
  • Inferior thyroid veins below the isthmus
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4
Q

Relations of Trachea

Anterior Thorax

A
  • Crossed by the left brachiocephalic vein
  • In line with the brachiocephalic trunk and left common carotid artery
  • Deep cardiac plexus and the arch of the aorta are near the tracheal bifurcation
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5
Q

Relations of Trachea

Posterior Neck & Thorax

A

Neck:

  • Esophagus
  • Recurrent laryngeal nerve on each side, lodging in the trachea-esophageal groove

Thorax:
- Esophagus and left recurrent laryngeal nerve

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6
Q

Relations of Trachea

R & L Thorax

A

Right:

  • R lung & mediastinal pleura
  • R vagus nerve
  • Arch of azygos vein

Left:

  • L lung & mediastinal pleura
  • Arch of aorta, L common carotid artery, & L subclavian arteries
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7
Q

Principal/Primary Bronchi

A

Right:

  • Wider, shorter, more vertical
  • Foreign body usually aspirated into the right lung through these

Left:
- Longer, narrow, more oblique

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8
Q

Secondary/Lobar Bronchi

A
  • Divisions of the principal bronchus
  • 3 on the right, 2 on the left
  • Each supplies a lobe of the lung
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9
Q

Tertiary/Segmental Bronchi

A
  • Subdivisions of the secondary bronchus
  • Aerates the bronchopulmonary segments of the lung
    • 10 total in each lung
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10
Q

Bronchopulmonary Segments

A

= segments that receive air through one tertiary bronchi (10 in each lung)

  • Independent, wedge-shaped respiratory district (bases facing periphery & apex towards lungs)
  • Separated by intersegmental areolar septa (prevents spread of infection)
  • In line w/ branches of the pulmonary artery
  • Branches of the pulmonary vein runs between segments
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11
Q

Bronchovascular segments

A
  • Tributaries of pulmonary veins running in the intersegmental septa
  • Bronchovascular segments = areas of the lung drained by an intersegmental tributary of vein
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12
Q

Layers of the Tracheal Wall

A

Mucosa:

  • Ciliated, pseudostratified epithelium w/ goblet, serous, brush, clara, and argentaffin cells (of Kulchitsky)
  • Catch foreign bodies entering w/ inspiration

Submucosa:
- Connective tissue w/ seromucous glands

Adventitia:
- Outermost layer; connective tissue encasing C-shaped rings of hyaline cartilage

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13
Q

Tracheal Structures

A

Trachealis Muscle:

  • Connects posterior parts of the cartilage rings
  • Contracts during coughing to expel mucus

Carina:

  • Last tracheal cartilage rings (hyaline)
  • Point of bifurcation into two bronchi
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14
Q

Structures of the Bronchial Tree

A
  • Bronchi -> Bronchioles (divide 15x)
  • Cartilage rings become plates (cartilage is absent in bronchioles)
  • Epithelium changes from pseudostratified columnar to cuboidal
  • Cilia and goblet cells become sparse
  • Amount of smooth muscle increases
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15
Q

Respiratory Zone

A
  • Respiratory bronchioles, alveolar duct& alveolar sacs (clusters of alveoli)

~300 million alveoli

  • -> account for most of the lung’s volume
  • -> main site of gas exchange
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16
Q

Alveoli

A
  • Encased by fine elastic fibers
  • Contain open pores that connect adjacent alveoli
  • Equalize air pressure throughout the lung

Alveolar walls contain–(1) Single layer of squamous epithelium (type 1 pneumocytes) (2) Scattered type II pneumocytes (3) Alveolar phagocytes

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17
Q

Type 2 Pneumocytes

A
  • Secrete surfactant & antimicrobial proteins
  • Usually develops at 24 weeks gestation
  • Premature babies lack this –> respiratory problems
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18
Q

Alveolar Phagocytes

A
  • Derived from monocytes, phagocyte bacteria, dust particles, and extravasated RBC’s in CCF
  • heart failure cells* or dust cells
  • -digest RBCs that leaked from capillaries due to edema
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19
Q

Respiratory Membrane

A

~0.05 um-thick air-blood barrier

  • Alveolar endothelial lining + basement membrane & capillary endothelial lining + basement membrane (fused in places)
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20
Q

Lungs

A
  • Occupy all of the thoracic cavity except the mediastinum
  • 10 bronchopulmonary segments per lung
  • Lobules are the smallest subdivision; served by bronchioles & branches

Color:

  • Rosy pink in newborns
  • Dark slaty grey in adults (d/t deposition of carbonacious particles)
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21
Q

Lung Surfaces

A
  • Apex: superior tip
  • Base: inferior surface; rests on diaphragm
  • Costal: anterior, lateral & posterior surfaces
  • Medial: vertebral & mediastinal surface
  • Root: site of vascular & bronchial attachments (outside the lung)
  • Cardiac notch of left lung: concavity that accommodates the heart
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22
Q

Hilum

A

area on the mediastinal surface through which blood vessels, bronchi, lymphatic vessels, and nerves enter or leave the lung

A part of the lung

23
Q

Pathological Processes of Lung Anatomy

A
  • Breath sounds are more audible over the R lung b/c the trachea is closer
  • Aspiration is MC in the R lung b/c the R principal bronchus is shorter, wider, & vertical
  • Sub-carinal angle > 90 = enlarged
  • MC site for lung abscess by aspiration = (1) apical segment of lower lobe (2) posterior segment of upper lobe b/c these segments are most dependent in the recumbent position
    • Bronchial segment is more straight
  • Tuberculosis is MC in the upper lobe b/c it contains more oxygen
24
Q

Pulmonary circulation

A

Low pressure, high volume
- Pulmonary arteries deliver systemic venous blood
^ Branches profusely, along w/ bronchi
^ Feeds into pulmonary capillary networks
- Pulmonary veins carry oxygenated blood from the respiratory zones to the heart

25
Q

Systemic Circulation

A

High pressure, low volume
- Bronchial arteries provide oxygenated blood to the lung tissue
^ Arise form aorta
^ Enter lungs at the hilum
^ Supply all lung tissue, except alveoli
- not involved in gas exchange
- Bronchial veins anastomose w/ pulmonary veins, which carry most venous blood back to the heart

26
Q

Pulmonary Lymphatic Drainage

A

2 sets of plexus: Superficial, Deep

Broncho-pulmonary (hilar nodes) –> superior & inferior tracheo-bronchial (sub-carinal) nodes –> R and L paratracheal nodes

27
Q

Superficial Plexus

Pulmonary Lymphatic Drainage

A
  • Ramifies beneath the pulmonary pleura and around the extra-pulmonary bronchi
  • Drains into the bronchi-pulmonary lymph nodes at the hilum (hilar nodes)
28
Q

Deep Plexus

Pulmonary Lymphatic Drainage

A
  • Arranged around the intrapulmonary bronchi & inter-lobular septa
  • Drains into the bronchi-pulmonary lymph nodes (hilar nodes)
29
Q

Nerve Supply of the Lungs

A
  • Supplied by the anterior and posterior pulmonary plexuses, which surround the lung roots
  • Sensory fibers are mostly parasympathetic
  • Act as stretch receptors (j-receptors) around the lung alveoli –> reflex control of respiration (e.g. Hering-Breuer reflex)
  • Irritation of the nerve endings in the bronchial mucous membrane initiates the cough reflex
30
Q

Pulmonary Plexus

A

Parasympathetic fibers:

  • Vagus nerves
  • BronchoCONSTRICTORS & secretomotor to bronchial glands (increase mucus secretions)

Sympathetic fibers:

  • Upper 4 or 5 thoracic ganglia of the sympathetic trunks
  • BronchoDILATORS & vasomotor
31
Q

Right Lung

A
  1. Shorter, wider, more capacious
  2. Weight – 20 oz.
  3. 3 lobes, separated by 2 fissures
  4. Base, more concave
  5. Absence of cardiac notch
  6. Absence of lingula
  7. Usually supplied by 1 bronchial artery
32
Q

Left Lung

A
  1. Longer, narrower, less capacious
  2. Weight – 18 oz.
  3. 2 lobes, separated by 1 fissue
  4. Base, shallow
  5. Presence of cardiac notch
  6. Presence of lingual (superior & inferior) corresponds w/ the middle lobe of the R lung
  7. Usually supplied by 2 bronchial arteries
33
Q

Pulmonary Pleurae

A
  • Thin, double-layered serosa*
  • Parietal pleura on thoracic wall & superior face of diaphragm
    • Moves w/ thoracic cage (inspiration)
  • Visceral pleura on external lung surface except at the hilum & attachment of the pulmonary ligament
    • Shiny, glistening
  • Pleural fluid fills the slit-like pleural cavity
    • Provides lubrication & surface tension
34
Q

Recess of Pleura

A

Costo-diaphragmatic: Cleft-like potential space b/t the lower limit of the pleural sac & the lower lung border

  • Costal & diaphragmatic pleura are in apposition in quiet respiration
  • Most dependent part of the pleural sac (1st place to collect fluid in pleural effusion)

Costo-mediastinal:
- Behind the sternum & the costal cartilages

35
Q

Pleural Blood Supply

A

Arteries:

  • Costovertebral pleura–intercostal & internal thoracic arteries
  • Mediastinal pleura–branches of bronchial, internal thoracic, upper diaphragmatic & mediastinal arteries
  • Cervical pleura–branches of subclavian arteries

Veins:
- Drain into systemic veins in the thoracic wall –> drains into the superior vena cava

36
Q

Pleural Lymphatic Drainage

A
  • Costovertebral pleura drains to the internal thoracic & intercostal chain
  • Diaphragmatic pleura drains into the mediastinal, retrosternal, & coeliac axis nodes
37
Q

Visceral Pleura

A
  • Integral part of the lungs*

- Arterial supply & venous drainage provided by the bronchial vessels

38
Q

Pleural Nerve Supply

A
  • Costal & peripheral diaphragmatic parietal pleura innervated by intercostal nerves
  • Mediastinal & central diaphragmatic pleura supplied by the phrenic nerve

Irritation of the parietal pleura is referred to the respective dermatomes

39
Q

Pleurisy or Pleuritis

A

Inflammation of the pleura

  • S/S: Chest pain
  • If not treated, will lead to pleural effusion
40
Q

Pleural Effusion

A
  • Accumulation of a significant amount of fluid in the pleural cavity (serous, transudate, exudate-pus, blood-hemothorax)
  • Causes: inflammation, trauma, congestive heart failure
41
Q

Paracentesis

A
  • Pleural Tap*
  • Usually performed posterior to the mid-axilary line at 1 or more intercostal spaces below the fluid level w/ the pt in a sitting position (not below the 9th ICS)
42
Q

Pneumothorax

A

= Air in the pleural cavity

2 types: Open & Tension

43
Q

Muscles of Respiration

A
  • Diaphragm
  • Intercostalis
  • Abdominal recti
  • Sternocleidomastoid
  • Serratus anterior
  • Scaleni
44
Q

Diaphragm

A

*Principal muscle of respiration

Origin: Inner surfact of the thoracic outlet in 3 groups-(1) sternal (2) costal (3) vertebral (e.g. lumbar)

Insertion: Into the central tendon

45
Q

Diaphragm Nerve Supply

A

Motor–phrenic nerve

Sensory–phrenic & lower 6 or 7 intercostal nerves

*Hiccups occur when the phrenic nerve is irritating –> diaphragm contraction

46
Q

Diaphragm Blood Supply

A
  1. Musculophrenic & pericardio-phrenic branches of the internal thoracic artery
  2. Lower 5 or 6 posterior intercostal artery
  3. Superior phrenic artery–last branch of descending thoracic artery
  4. Inferior phrenic artery–first branch of the abdominal aorta
47
Q

Intercostal Muscles

A
  • Arranged in 3 sheets
  • From outside inwards:
    • Intercostalis externa
    • Intercostalis internus
    • Intercostalis intimus
48
Q

Intercostalis Externa

A
  • Origin: lower border of upper rib
  • Insertion: outer lip of the upper border of the lower rib (anteriorly it forms the anterior intercostal membrane)
  • Direction: downwards, forwards, & medially in the anterior portion; downwards & laterally in the posterior portion
49
Q

Intercostalis Internus

A
  • Origin: costal groove of the upper rib
  • Insertion: intermediate part of the upper border of the lower rib
  • Posteriorly it forms the posterior intercostal membrane
  • Direction: right angles to the intercostalis extern
50
Q

Intercostalis Intimus

A
  • Absent in upper 2 ICS
  • Origin: upper lip of the costal groove of the rib above
  • Insertion: inner lip of the upper border of the rib below
  • Direction: right angles to the intercostalis extern
51
Q

Intercostal Muscle Nerve Supply

A

Ventral ramus of a thoracic nerve (corresponding to the intercostal nerves)

52
Q

Anterior Intercostal Muscle Blood Supply

A
  • Anterior intercostal arteries*
  • Upper 6 spaces: branches of the internal thoracic arteries
  • Succeeding 3 spaces: branches of the musculo-phrenic artery

Last 2 spaces are devoid of anterior intercostal arteries

53
Q

Posterior Intercostal Muscle Blood Supply

A
  • Posterior intercostal arteries*
  • Upper 2 spaces receive from superior intercostal arteries (branch of the costocervical trunk of the subclavian artery)
  • Lower 9 spaces derived from the descending thoracic aorta

Pulmonology (8 decks)

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