Respiratory Anatomy Flashcards
anatomy of upper resp tract
right + left nasal cavities
orla cavity
naso-oro + laryngo-pharynx
larynx
lower resp tract anatomy
trachea right + left main bronchi lobar bronchi segmental bronchi bronchioles alveoli
C6 verterbra
larynx becomes pharynx
pharynx becomes oesophagus
where can the trachea be palpated
jugular notch of manubrium
where is the isthmus of the thyroid gland
anterior to tracheal cartilage 2-4
roles of chest wall
protect lung and heart
make movements of breathing
break tissue - lactation
roles of chest cavity
within chest wall
contains vital organs
contains major vessels + nerves
consists of mediastinum + right + left pleural cavities
role of pleurae
secrete fluid nto pleural cavity: a lubricant + proves surface tension
describe lung lobe
area of lung each lobar bronchi supply with air
what are lung lobes separated by
fissures
right lung - oblique + horizontal fissure
left lung - oblique fissure
name lung lobes
left - superior and inferior lobe
right - inferior, superior + middle lobe
describe bronchopulmonary segment
area of lung lobe that each one of segmental bronchi supply air with
each lung = 10 bronchopulmonary segments
list features of thoracic skeleton
12 pairs of ribs
(true ribs 1-7 attach via their costal cartilage to sternum
false ribs 8-10 attach via their costal cartilage above sternum
floating ribs 11 + 12 no attachment to sternum)
intercostal spaces
costal margin
12 thoracic vertebrae
clavicle and scapula
sterum
-manubrium, body, xiphoid, sternal angle
list 3 layers of skeletal muscles located between ribs + within intercostal space
external intercostal muscles
internal intercostal muscles
intermost intercostal muscles
where do layers of intercostal muscles attach
between adjacent ribs
how do layers of intercostal muscle make chest wall expand
pull adjacent ribs upwards and outwards
state another skeletal muscle important in breathing
diaphragm
define intercostal
between ribs
how many intercostal spaces are there
11
what does each intercostal space carry
neuro-vascular bundle
(vein, artery + nerve)
between internal and inter-most intercostal muscle layers
Nerve supply of intercostal space
anterior ramus of spinal nerve
Blood supply of posterior and anterior intercostal spaces
posterior
arterial supply = thoracic aorta
venous drainage = azygous vein
anterior
arterial supply = internal thoracic artery
venous drainage = interna thoracic vein
key features of diaphragm
internal
floor of chest cavity
roof of abdominal cavity
openings to permit passage between 2 cavities
what type of tendon does the diaphragm have
unusal central tendon
is the right or left dome of the diaphragm more superior
right
what does the muscular part of the diaphragm peripherally attach to
sternum
lower 6 ribs + costal cartilages
L1-L3 vertebral bodies
what is the muscular part of the diaphragm supplied by
phrenic nerve (C3, 4 + 5 = anterior rami)
describe phrenic nerves
anterior rami of C3, 4, 5
anterior surface of scalenus anterior muscle = located
descending over later aspects of chest
what keeps the diaphragm alive
C3, 4, 5
outline inspiration mechanisms
- Diaphragm contracts (increases vertical chest dimension)
- Intercostal muscles contract = elevated ribs (increase A-P and lateral chest dimensions)
- Chest walls pull lungs outwards with them (pleura)
- air flows into lungs (-ve pressure)
outline expiration mechanism
- Diaphragm relaxes + rises (decreased vertical thoracic dimension)
- Intercostal muscles relax lowering ribs (decrease A-P + lateral chest dimensions)
- Elastic tissue of lung recoils
(air flows out of lungs)
4 quadrants of the breast
nipple
areola
axillary tail
regiona lymphatics
where is the trachea palpated
jugular notch of manubrium
list the muscles of anterolateral chest wall
skin clavicle deltoid cephalic vein - in delto-pectoral groove pectoralis major sensory nerves - intercostal nerves deep fascia - fibrous, tough, protection superficial fascia - adipose tissue, insulation
list the muscles of anterolateral chest wall
pectoralis major
serratus anterior - anchors scapula to ribs
latissimus dorsi
long thoracic nerve - supplies serratus anterior
what does paralysis off serratus anterior result in
winged scapula
what are diaphragm domes covered with
parietal fluid
where are lungs connected to mediastinum
at lung root
explain costodiaphragmatic recess
most dependent part of pleural cavity
between diaphragmatic parietal pleura +costal parietal pleura
most inferior region - costophrenic angle
abnormal fluid on pleural cavity drains into recess => blunting of angles
structure of lung root
1 main bronchus 1 pulmonary artery 2 pulmonary veins lymphatics visceral afferents sympathetic nerves parasympathetic nerves
define asucltation
listening to sound of air moving through larynx
normal breath sounds are what in nature
rustling
auscultating areas anterior
lung apex
middle lobe (mid-clavicular + midaxillary)
horizontal fissure
oblique fissures
auscultating areas posterior
T11 vertebral bases left costodiaphragmatic recess of the pleural cavity left scapular line oblique fissure inferior lobe
coughing = stimulation of sensory receptors in
oropharyngeal mucosa
laryngopharyngeal mucosa
laryngeal mucosa
what are the sensory rectors stimulated in sneezing
CN V
CN IX
sensory receptors stimulated in coughing
CN IX
CN X
describe carotid sheaths
protective tubes of deep fascia
attach superiorly bones of base of skull
blends inferiorly to bones of skull base
blends inferiorly with fascia of mediastinum
what do carotid sheaths contain
vagus nerve
internal carotid artery
common carotid artery
interbal jugular veins
how does the CNS respond
rapidly
muscles of normal inspiration
external intercostal
internal intercostal
intermost intercostal
accessory muscles of DEEP inspiration
pectoralis major
pectoralis minor
sternicleidomastoid
scalenus anterior, medius + posterior
accessory muscles use clinical sign suggesting
dyspnoea
outline CNS reponse
- DEEP inspiration using diaphragm, intercostal muscles + accessory muscles of inspiration
- Adduction of vocal cords close to rima glottides
- Contraction of anterolateral abdominal wall muscles = builds intra-abdominal pressure - pushes diaphragm superiorly + builds up pressure in chest/respiratory tree inferior to adducted vocal cords
- vocal cords abduct + open rima glottides
- soft palate tenses + elevates + closes nasopharynx + direct air through oral cavity as cough not nasal cavity as sneeze
pulmonary consequence of chronic cough
dynamic airway compression in asthma - expiration = difficult
build up of air trapped in alveoli = rupture of lung + visceral pleura
breach in visceral pleura = alveolar air enters pleural cavity
small pneumothorax
small amount air enters pleural cavity via
a= penetrating injury to parietal pleura
b= rupture of visceral pleura the vacuum is lost, elastic lung tissue recoils towards lung root
small pneumothorax measurement
<2cm gap between lung + aprietal pleura
large pneumotorax
large amount air enters pleural cavity via
a= penetrating injury to parietal pleura
b= rupture of visceral pleura vacuum = lost, lung tissue recoils towards lung root = large pneumothorax
large pneumothorax measuremnet
> 2cm gap between lung + parietal pleura
diagnosing pneumothorax
history
examination
= reduced ipsilateral chest examination
= reduced ipsilateral breath sounds
= hyper- resonance on percussion
investigation
=absent lung markings peripherally
=lung edge visible
tension pneumothorax
1 way valve allowas air to enter but not escape
each inspiration = more air in pleural cavity
pneumothorax expands + collapses towards its root ====> tension created to mediastinal structure
what type of pneumothorax can cause mediastinal shift
tension pneumothorax
explain tracheal deviation
deviation away from side of unilateral tension pneumothorax
where is mediastinal shift papable
jugular notch
what does SVC reduce
venous return to heart ==> hypotension
management of large pneumothorax
needle aspiration chest drain (4th/5th intercostal space in midaxillary line)
list safe triangles
anterior borders of latissimus dorsi
posterior border pectoralis major
axial line superior to nipple
emergency management of tension pneumothorax
large gauge cannula into pleural cavity (2nd/3rd intercostal space in midclavicular line on side of tension pneumothorax)
define herniae
any structure passing through another = ending up in wrong place
2 factors required for herniae development
- weakness of 1 structure normally part of body wall
2. increased pressure on 1 side of that part of the wall
parts of body with normal anatomical weakness
diaphragm = diaphragmatic hernia
umbilicus = umbiical hernia
inguinal canal = inguinal hernia
femoral canal = femoral hernia
congenital abnormalities = congenital diaphragmatic hernia
surgical scars = weaken body wall = incisional hernia
increased pressure on 1 side of that part of wall
chronic cough
repeated bouts of increased pressure = structures pushed through wall = hernia
diaphragmatic herniae
xiphoid attachment
inguinal herniae
medial half of inguinal region
unilateral or bilateral
-weakness in inguinal area = presence of inguinal canal
-increased pressure = intra-abdominal
increased pressure in intra-abdominal
chronic cough
chronic obstruction
occupational lifting of heavy weights
athletic effort
how to differentiate direct + indirect herniae
‘reduce’ herniae
occlude the deep ring with finger tip pressure
ask patient to cough
direct = lump will reappear indirect = herniae will not reappear
explain spermatic cord
3 layers of coverings gained as the testis passes through inguinal canal + structures contained within
