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Respiratory: Anatomy > Pulmonary Consequences of Chronic Cough > Flashcards

Pulmonary Consequences of Chronic Cough Flashcards

1
Q

What are the pulmonary consequences of a chronic cough?

A

* Rupture of the lung and visceral pleura
* A small pneumothorax
* A large pneumothorax
* Tension pneumothorax

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2
Q

What can cause rupture of the lung and visceral pleura?

A

Dynamic airway compression in asthma:
*expiration difficult
* build up of air trapped in alveoli can lead to rupture of lung & visceral pleura

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3
Q

What can cause a small pneumothorax?

A

* Penetrating injury to the parietal pleura
* Rupture of the visceral pleura

In both cases, the vacuum is lost, the elastic lung tissue recoils towards the lung root and a small pneumothorax results

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4
Q

What is a pneumothorax?

A

When air enters the pleural cavity

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5
Q

What is a small pneumothorax?

A

<2cm gap between lung and parietal pleura

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6
Q

What is a large pneumothorax?

A

>2cm gap between lung and parietal pleura

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7
Q

What can cause a large pneumothorax?

A

* Penetrating injury to the parietal pleura
* Rupture of the visceral pleura

In both cases, the vacuum is lost, the elastic lung tissue recoils towards the lung root and a large pneumothorax results

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8
Q

How is a pneumothorax diagnosed?

A

* History - sudden onset SOB + chest pain, cough, rapid HR + RR
* Examination: reduced ipsilateral chest expansion, reduced ipsilateral breath sounds, hyper-resonance on percussion
* Investigation (CXR): absent lung markings peripherally, lung edge visible

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9
Q

What does examination of pneumothorax involve?

A

* reduced ipsilateral chest expansion
* reduced ipsilateral breath sounds
* hyper-resonance on percussion

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10
Q

What does investigation of pneumothorax via CXR show?

A

* absent lung markings peripherally
* lung edge visible

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11
Q

Is a pneumothorax always unilateral?

A

Can be bilateral

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12
Q

Explain the process of formation of a tension pneumothorax

A

* the torn pleura can create a one-way valve that permits air to enter the pleural cavity on each inspiration but prevents air escaping again on expiration
* with each inspiration more air enters the pleural cavity
* the pneumothorax expands & the lung collapses towards its root
* eventually the build up of air in the pleural cavity applies tension (pressure) to the mediastinal structures

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13
Q

What can tension pneumothorax result in?

A

Mediastinal shift

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14
Q

What is the mediastinum separated into?

A

4 segments

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15
Q

What are the 4 segments of the mediastinum?

A

* Superior mediastinum
* Anterior inferior mediastinum
* Middle inferior mediastinum
* Posterior inferior mediastinum

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16
Q

Where is the heart located?

A

Middle mediastinum

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17
Q

Where is the superior mediastinum separated from the inferior mediastinum?

A

At the level of the sternal angle (rib 2)

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18
Q

What are consequences of mediastinal shift?

A

* Tracheal deviation away from the side of a unilateral pneumothorax
* SVC compression reduces venous return to the heart, leading to hypotension

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19
Q

What does SVC compression due to mediastinal shift result in?

A

Reduces venous return to the heart, leading to hypotension

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20
Q

What is hypotension?

A

Low arterial blood pressure

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21
Q

Where can the trachea be palpated?

A

In the jugular notch

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22
Q

Is tension pneumothorax always unilateral?

A

Can be bilateral

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23
Q

Does deviation of trachea affect patency?

A

No, will maintain patency

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24
Q

How is a large pneumothorax treated?

A

* Needle aspiration (thoracentesis) or
* The siting of a chest drain

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25
Q

Where are needle aspiration and the siting of a chest drain carried out?

A

The 4th or 5th intercostal space in the midaxillary line

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26
Q

What is the “safe triangle” for treatment of a large pneumothorax?

A

Formed by
* The anterior borer of the latissimus dorsi
* The posterior border of the pectoralis major
* The axial line superior to the nipple

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27
Q

Why is the “safe triangle” named as such?

A

Will not risk hitting diaphragm

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28
Q

What layers must be pierced/incised in treatment of large pneumothorax?

A

* Skin
* Superficial/deep fascia
* 3 layers of intercostal muscles
* Parietal pleura
* Into pleural cavity

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29
Q

Why is it important for the needle to enter into the middle of the 4th or 5th intercostal space in the treatment of a large pneumothorax?

A

To avoid coming into contact with the neurovascular bundle located behind intercostal groove

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30
Q

How is tension pneumothorax treated? (Emergency)

A

Large gauge canula inserted into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax

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31
Q

What layers must be pierced/incised in treatment of tension pneumothorax?

A

* Skin
* Superficial/deep fascia
* 3 layers of intercostal muscles
* Parietal pleura
* Into pleural cavity

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32
Q

What is a non-pulmonary consequence of a chronic cough?

A

Herniae

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33
Q

What is a hernia?

A

Any structure passing through another, so ending up in the wrong place

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34
Q

What 2 factors are required for the development of a hernia?

A

* Weakness of one structure: commonly a part of the body wall
* increased pressure on one side of that part of the wall

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35
Q

What are parts of the body that have a normal anatomical weakness?

A

* Diaphragm - diaphragmatic hernia
* Umbilicus - umbilical hernia
* Inguinal canal - inguinal hernia
* Femoral canal - femoral hernia

36
Q

What can result in abnormal weakness of the body walls?

A

* Congenital abnormalities (e.g. congenital diaphragmatic hernia)
* Surgical scars (incisional hernia)

37
Q

What can cause increased pressure on one side of the weak body wall?

A

Chronic cough

38
Q

How does a chronic cough result in hernia?

A

* Chronic cough causes repeated bouts of increased intra-abdominal pressure on the diaphragm and anterolateral abdominal wall
* Structures are pushed through the wall to produce a hernia

39
Q

Where do diaphragmatic herniae develop?

A

Normal anatomical weaknesses at:-
* Attachments to the xiphoid
* Posterior attachments
* Oesophageal hiatus (opening in the diaphragm), caval opening for IVC and aortic hiatus

40
Q

Where do oesophagus, aorta and IVC pass through diaphragm?

A

I 8 10 Eggs At 12

I - IVC
8 - T8 (IVC passes at T8 through caval opening)
10 - T10
Eggs - Oesophagus (Oesophagus passes at T10 through oesophageal hiatus)
At - aorta
12 - T12 (Aorta passes at T12 through aortic hiatus)

41
Q

What is a paraoesophagheal hiatus hernia?

A

The herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesophagus & sit inside the chest

42
Q

What is a sliding hiatus hernia?

A

The herniated part of the stomach slides through the oesophageal hiatus into the chest WITH the gastro-oesophageal junction

43
Q

What is the inguinal region?

A

Inguinal = groin

44
Q

Name the structures labelled A and B (pic)

A

A - the anterior superior iliac spine (ASIS)
B - the pubic tubercle

45
Q

Where do the inguinal ligaments attach?

A

* Between the ASIS and pubic tubercle

46
Q

What is formed by the medial halves of the inguinal ligaments?

A

The floors of the inguinal canals

47
Q

What borders are formed by the inguinal ligaments?

A

The inferior borers of the external oblique aponeuroses

48
Q

What are the inguinal canals?

A

* ~4cm long passageways through the anterior abdominal wall in the inguinal regions

49
Q

What is the inguinal canal floor formed by?

A

The medial halves of the inguinal ligaments

50
Q

Where does each inguinal canal run?

A

Each canal runs between a deep ring (the entrance to the canal) and a superficial ring (the exit from the canal)

51
Q

What is the deep ring?

A

The entrance to the inguinal canal

52
Q

What is the superficial ring?

A

The exit form the inguinal canal

53
Q

What is the structure of the superficial ring?

A

The superficial ring is a “v” shaped defect in the external oblique aponeurosis

54
Q

Where do the superficial rings lie?

A

Lie superolateral to the pubic tubercle

55
Q

Where is the deep ring located?

A

Superior to the midpoint of the inguinal ligament

56
Q

Where do inguinal herniae form?

A

In the medial half of the inguinal region

57
Q

Are inguinal herniae bilateral?

A

Can be unilateral or bilateral

58
Q

Where is the weakness that is required for the formation of an inguinal hernia?

A

Weakness for inguinal hernia results from the presence of the inguinal canal in the inguinal part of the anterolateral abdominal wall

59
Q

How is the inguinal canal formed?

A

The inguinal canal is formed embryonically during the passage of the testes or the round ligament of the uterus into the perineum

60
Q

What does the adult inguinal canal contain?

A

* The spermatic cord or
* The round ligament of the uterus

61
Q

What causes the increased intra-abdominal pressure required for formation of an inguinal hernia?

A

* chronic cough
* chronic constipation
* occupational lifting of heavy weights
* athletic effort

62
Q

Name the layers of the anterolateral abdominal wall in the inguinal region labelled A - M

A

A - Testicular artery
B - Testicular vein
C - Visceral peritoneum
D - Parietal peritoneum
E - transversalis fascia
F - Lower border of transversus abdominus
G - Lower border of internal oblique
H - Inguinal ligament
I - Deep fascia
J - Superficial fascia of the scrotum
K - Scrotal skin
L - The gubernaculum
M - The vas deferens

63
Q

What is the testicular artery?

A

Branch of the abdominal aorta

64
Q

What is the testicular vein?

A

Tributary of the IVC (right) or left renal vein (left)

65
Q

Where is the vas deferens before testes descend?

A

Attached inferiorly in the pelvis in the region of the developing prostate gland

66
Q

What is the function of the gubernaculum?

A

Embeds in superficial fascia and pulls testes towards the scrotum during descent

67
Q

Explain the process of the testes descending into the scrotum

A

* Gubernaculum pulls testes towards scrotum
* As it descends, takes some of the transversalis fascia with it which becomes the internal spermatic fascia
* The processus vaginalis is formed (caused by an outpouching of parietal peritoneum)
* As testes descend further, take a layer of internal oblique muscle which becomes the cremasteric fascia
* As testes (and associated layers) pass through external oblique aponeurosis, create a ‘v’ shaped defect
* Takes some of the external oblique aponeurosis, which forms the external spermatic fascia
* The summation of these layers forms the spermatic cord
* The tunica vaginalis is formed from the remains of the processus vaginalis

68
Q

What is the processus vaginalis?

A

An outpouching of parietal peritoneum

69
Q

What is the internal spermatic fascia?

A

A covering go transversalis fascia

70
Q

What is the cremasteric fascia?

A

A covering of skeletal muscle fibres from the internal oblique

71
Q

What is the function of the cremasteric fascia

A

Involved in temperature control through contraction and relaxation (not to be confused with dartos muscle)

72
Q

What is the external spermatic fascia?

A

A covering of external oblique aponeurosis

73
Q

How is the deep ring of the inguinal canal formed?

A

From testis pushing into the transversalis fascia

74
Q

How is the superficial ring of the inguinal canal formed?

A

The defect in the external oblique aponeurosis where the testis passed into the superficial fascia of the scrotum

75
Q

What is the function of the tunica vaginalus?

A

Sheath that allows smooth movement of the testes inside the scrotum

76
Q

Name the structures in the diagram labelled A - O (pic)

A

A - transversus abdominis
B - internal oblique
C - external oblique
D - ilioinguinal nerve
E - the inguinal ligament
F - the superficial ring
G - the internal spermatic fascia
H - the cremasteric fascia
I - the external spermatic fascia
J - Visceral peritoneum
K - Parietal peritoneum
L - Transversalis fascia
M - the deep ring
N - rectus abdominis
O - The conjoint tendon

77
Q

What is the conjoint tendon?

A

The medial end of the combined aponeuroses of the internal oblique and transverses abdominis

78
Q

What is the function of the conjoint tendon?

A

Anchors the internal oblique and transverses abdominis to the pubic bone

79
Q

What is the spermatic cord composed of?

A

* The 3 layers of ‘coverings’ gained as the testis passed through the inguinal canal * The structures contained within

80
Q

What are the 3 layers the spermatic cord is composed of?

A

* The internal spermatic fascia
* The cremasteric fascia
* The external spermatic fascia

81
Q

What structures are contained within the spermatic cord?

A

* Vas deferens * Testicular artery * Pampiniform plexus

82
Q

What is the function of the vas deferens?

A

Transport of sperm

83
Q

What is the function of the testicular artery?

A

Supplies oxygenated blood to testis

84
Q

What is the function of the pampiniform venous plexus?

A

Drains deoxygenated blood from testis

85
Q

What is a direct inguinal hernia?

A

A “finger” of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum (bypasses deep ring)

86
Q

What is an indirect inguinal hernia?

A

A “finger” of peritoneum is first forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum

87
Q

How do you clinically differentiate between direct and indirect herniae?

A

* “Reduce” the hernia
* Occlude the deep ring with a finger tip
* Ask the patient to cough If it is a direct hernia, the lump will reappear If it is an indirect hernia, the lump will not reappear

Respiratory: Anatomy (4 decks)

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