Respiratory anatomy Flashcards
location of the left recurrent laryngeal nerve
between the trachea and oesophagus
right vagus nerve
lies on the trachea
right phrenic
lies on SVC
left vagus
lies on the aortic arch
phrenic nerve
lies anterior to lung roots
vagus
posterior to lung roots
blood supply to trachea
inferior thyroid arteries and bronchial arteries
inferior thyroid vein
lymph drainage from trachea
pre and para tracheal nodes
nerve supply of trachea
vagi, reccurent laryngeal and sympathetic trunk
describe the numbers of lung segments
10 in total
3 superior lobe
2 middle or lingual
5 lower lobe
oblique fissure
spine of T4 to rib 6
horizontal fissure
4th intercostal space until it meets the oblique fissure at the mid axillary line
describe the parts of the hilum
bronchi- posterior
pulmonary arteries- anterior superior
pulmonary veins- anterior inferior
pulmonary ligament
allows hilar movement
origin of the right bronchial artery
3rd posterior intercostal artery from the descending aorta
origin of two left bronchial arteries
direct branch from the descending aorta
drainage of bronchial arteries
may anastomose with pulmonary arteries
drains to azygous system
where does the deep lymphatic plexus drain to?
pulmonary nodes, located in the hila
where do the pulmonary nodes drain to?
bronchopulmonary nodes (around the main bronchi)
where do the bronchopulmonary nodes drain to?
inferior and superior tracheobronchial nodes ( around the carina)
where do the tracheabronchial and posterior mediastinal nodes drain to?
paratracheal nodes and bronchomediastinal lymph trunks
where would a chest drain be inserted
just above the rib to avoid damage to NV bundle
what nerve supplies the axilla wall and upper medial part of UL and is at risk in breast surgery
Intercostobrachial Nerve
what dermatomes supple the skin and muscles of the abdo wall
T7- 12
what does the ventral rami of t2-11 make
the intercostal nerves
what is the subcostal nerve made of
T12
runs along the border of the twelfth rib
where may a breast tumour spread to
anterior grp, central grp, apical grp mostly
but also to internal mammary nodes
where does the breast receive its blood supply from
internal thoracic artery
anterior intercostal branches
superior thoracic
thoraco acromonial and lateral thoracic branches of the axillary artery
so most lymph drains to apical nodes
where does thoracic wall lymph drain to
parasternal nodes
intercostal nodes
what veins drain the intercostal spaces
anterior intercostal veins
posterior intercostal veins
(both venae comitantes- int thoracic art and post intercostal art)
what muscles are described here:
lower ribs
posterior
internal surface
subcostales
what muscles are described here:
internal aspect of ribs and costal cartilages 3-6
downwards and medially to the sternum and costal margin
anterior ribs, internal surface
transversus thoracis
in what direction do the external intercostal muscles go
downwards and medially
what direction do the internal intercostal muscles go
downwards and laterally
what lies on top of the parietal pleura
endothoracic fascia
what type of joint is between a rib and costal cartilage
primary cartilaginous joint (hyaline)
what features can be seen on the first rib
scalene tubercle of scalenus anterior
groove for subclavian vein
groove for subclavian artery and lower trunk of the brachial plexus
where does the diaphragm attach
anterior to xiphoid process - T8/9
deep surfaces of ribs and costal cartilages 7-12
where is the median arcuate ligament
T12
sympathetic trunk goes behind
where is the medial arcuate ligament
body of L1 to transverse process L1
where is the lateral arcuate ligament
tip of L1 to transverse process t12 rib
subcostal vessels and nerve go behind
where is the left crus
L1 and 2 bodies
where is the right crus
L1, 2, 3 bodies
what comes through the diaphragm at t8
IVC
right phrenic nerve
what comes through the diaphragm at t10
oesophagus
vagus nerves
left gastric vessels
what comes through the diaphragm at t12
aorta
thoracic duct
azygous veins
what goes through the crura
splanchnic nerves
what is the arterial supply of the diaphragm
internal thoracic => pericardiophrenic
musculophrenic
sup phrenic arteries from aorta
lower internal intercostal arteries
where does bucket handle inspiration occur
ribs 8 -10 due to flat costo transverse joints that allow gliding
describe the pleural surface markings of reflections
Rise to level of neck of 1st rib, 2 cms above clavicle •2nd cc lie adjacent in the mid line •4th Lcc notch for the heart •6th cc deviate laterally •8th rib lie in the midclavicular line •10th rib lie in the mid axillary line •12th rib lie in the mid scapular line •Mid line level with T12 (just below the 12th rib)
what is the costomediastinal recess
anteriorly where pleura wraps around the mediastinum but lungs does not fill the recess
describe the surface markings of the lungs
Rise to level of neck of 1st rib, 2 cms above clavicle
•2nd cc lie adjacent in the mid line
•4th Lcc cardiac notch
•6th cc deviate laterally
•6th rib lie in the midclavicular line
•8th rib lie in the mid axillary line
•10th rib lie in the mid scapular line and mid line
2 spaces higher than the pleura
what segment is particularly prone to pneumonia
apical segment of the inferior lobe- inferolateral to the upper posterior position of the oblique fissure
listen below and lateral to the spine of T4
what is extension
a superimposed acute MI following a large MI
what nerves supply the intercostal spaces
intercostal nerves t1-11
ventral rami of t2 - 11 are the intercostal nerves
t12 is the subcostal nerve
in what direction do external intercostals go
downwards and medially
what direction do internal intercostals go
downwards and laterally
where are subcostales found
lower ribs, internal surfaces, posterior
where is transversus thoracis
anterior
what does the supreme intercostal artery supply
1st two ic spaces
from costocervical trunk
what does the intercostobrachial nerve supply
t2- supplies the thorax wall in the axilla and upper medial UL
what are the 3 segments of the upper lobe
post, ant, apical
what are the 2 segments of the middle lobe of the right lung
medial and lateral
what are the 2 segments of the lingual of the left lung
sup and inf
what are the 5 segments of the lower lobe
apical
med lat ant post
where does the single right bronchial artery arise
3rd posterior intercostal artery
where do the two left bronchial arteries arise
directly from the aorta
where do the bronchial arteries drain
azygous or pulmonary veins
describe lung lymph drainage
pulmonary bronchopulmonary tracheobronchial paratracheal bronchomediastinal thoracic duct or right lymphatic trunk
what is the nerve supply of the lung
pulmonary plexus
visceral pleura has no sensory supply
parietal pleura has sensory from intercostal and phrenic
what could lung tumours impinging on nerves cause
phrenic nerve- diaphragm paralysis
cervical sympathetic trunk - horners
left side only- LRLN -horseness
describe the int mammary
branch of first part of the subclavian
lies along the margins of the septum
terminates as the superior epigastric and musculophrenic arteries
supplies medial 1/2 breast
how many anterior intercostal arteries are there per space
2 per space in space 1-6
7-10 supplied by musculophrenic
11 and 12 have no anterior supply
what is the blood supply to the intercostal spaces
supreme intercostal ant intercostals post intercostals musculophrenic subcostal arteries
what is the venous drainage of the intercostal spaces
BCV
superior intercostal vein (2nd and 3rd spaces)
azygos venae comitantes
lymph drainage of the IC spaces
parasternal nodes
intercostal nodes on the rib heads
where would you listen for pneumonia
below and lateral to t4 spinous process- apical segment of inferior lobe
where does the horizontal fissure meet the oblique fissure
mid axillary line
