Respiratory System Flashcards
Describe the fibrocartilaginous components (trachea, bronchi, carina)
The trachea begins below the cricord cartilege (about C6) and divides at the sternal angle into right and left primary bronchi. The carina (radiological landmark) is the intersection of the division.
Describe the asymmetry of the right main bronchus.
What accounts for the asymmetry and what is the clinical significance?
What is the blood supply?
larger diameter, more vertical, shorter than the left
has the eparterial bronchus to the upper lobe
has bronchus intermedius (hyparterial) to the middle and lower lobes
3 lobes instead of 2
- as trachea descends it is pushed to the right because aorta is coming to the left
- clinically if someone aspirates something into trachea probably will fall to right side because its larger and more vertical
right bronchi splits early so comes as 2 not as one
supply supply is from aorta and posterior intercostal a
Describe the left main bronchus.
longer, smaller diameter than right, more horizontal
branches into secondary bronchi to upper and lower lobes
Describe the bony landmarks of the back that pertain to the projection of trachea and bronchi on back.
scapula- superior border of T2
inferior angle- about T7
sternal angle- projects posteriorly to about T4
What are the basic anatomical features of the lungs?
How are they divided?
What is blood supply?
What is lympathic drainage?
apex, base, root, hilum
each lung is divided into broncho-pulmonary segments supplied by a single artery. Pulmonary veins are located in the septa separating the broncho-pulmonary segments
blood supply is from bronchial arteries which are brancehs off the aorta and posterior intercostal a.
lymphatic drainage is from pulmonary nodes to tracheobronchial nodes to bronchomediastinal nodes
What does the root of lung do?
What surrounds to the root?
What does the hilum contain?
root connects the medial lung surface to the trachea and heart. It is the part of heart where things come and go (pulmonary arteries/veins, bronchi, etc)
reflection of the parietal to the visceral pleura surrounds the root
the hilum contains the main bronchus, pulmonary artery/veins, bronchial vessels, nerves and lymphatics
What are the three surfaces of the lungs?
costal surfaces- ribs
mediastinal surfaces- associated with mediastinum
diaphragmatic- associated with diaphragm
Describe the lobes and fissures of the left lung.
2 lobes
superior lobe with lingula (which is inferior to cardiac notch)
inferior lobe separated by oblique fissure (starts posteriorly at T2 and intersects anteriorly at 6th costal arch…separates the lobes)
8 broncho-pulmonary segments
has cardiac notch and lingua
is grooved by aorta and left subclavian a
Where do you auscultate the inferior and superior lobes?
inferior lobe- from behind
superior lobe- from anterior wall
Describe the relationship of pulmonary arteries/veins.
artery is superior to veins, anterior to bronchus
vessels are anterior to trachea/bronchi
Describe the lobes and fissures of the right lung.
superior lobe
middle lobe
inferior lobe
lobes separated by horizontal fissure (divides middle lobe, tracks along the 4th rib)
and oblique fissure (begins posteriorly at T2 and intersects anteriorly at 6th costal cartilage/rib
has 10 broncho-pulmonary segments
grooved by trachea, esophagus and IVC
Where does the cardiac notch start and where does it project?
Where do the lungs project laterally?
4th rib
projects along costal arch (6th)
left side - T2 to 6th costal arch
right side - 4th rib, horizontal fissure projecting to 6th
Where is the apex of the lung? What is the significance?
in root of neck. ribs project inferiorly back to front so can see the thoracic structures in the root of neck and if there is some penetrating wound there, could be collapsed lung..
What are the two vascular supplies to the lungs?
pulmonary- airate the blood (delivered by pulmonary arteries carrying unoxygenated blood from the right side to be oxygenated)
bronchial- supply the lung tissues themselves (bronchial arteries are carrying airated blood)
Describe the pulmonary arteries.
they carry most blood to the lung
they track along the fissures
What happens during cardiac contraction (systole)?
The blood in the right ventricle enters the pulmonary trunk.
Where are pulmonary arterial branches distributed?
in the bronchopulmonary segments in association with the bronchi
Where are the two pulmonary venous components located?
they are in the supporting connective tissue between the bronchopulmonary segments
Describe the lymphatics of the lungs.
bronchopulmonary nodes are in the root of the lung
tracheobronchial lymph nodes near the tracheal termination and the two main stem bronchi
Why might adult lymph nodes in and near the lung appear dark? (What term do we use to describe this?)
anthracotic
-some node tissues in lungs themselves will pick up carbon particles that macrophages cannot digest - accumulate with age!
Describe the innervation of the lungs.
autonomic
pulmonary plexus comprises parasympathetic (X) and sympathetic components
Describe respiration of an adult.
the diaphragm moves down (primarily involves diaphragm in adults)
anterior (upper) thoracic wall moves anteriorly
lower (lateral) thoracic wall moves laterally
Describe the respiration of a child.
the major component consists of the diaphragm moving down
the ribs in the child are nearly horizontal and thus the rib displacement is limited
Describe why runners might grasp knees when gasping for breath.
the serratus anterior stabilizes the scapula
runners might hold knees to reverse the role of serratus anterior, stabilize the scapula through upper limb and use serratus anterior to expand chest wall even more
(gasping for air- neck muscles straining to lift first rib so other follow and increase the volume of the thoracic cavity)
Describe the pleural cavity as a closed sac with its two layers.
What can from as a result of bad cold-like infection?
two layers- visceral layer (inside) and parietal layer (outside) between the two is a potential space with just a little serous fluid for lubrication
as lung expands and contracts visceral and parietal layers slide
adhesions can form - connective tissue that forms between visceral and parietal pleura “stitch” is a sharp pain when breathing that breaks the small adhesions
What is the pleural cavity?
a potential space (not a true space)
normally contains a thin layer of serous fluid
pneumothorax- air in there, collapsed lung
hemathorax- if full of blood or something else
Describe the pleural sac.
(membrane) that surrounds each lung
parietal pleura lines the interior surface of the thoracic wall
(surface projectsions: 2-midline,4(L)-bare area,6-costal arch,8-midclavicular line,10-midaxillary line,12-posteriorly)
visceral pleura covers the complete surface of the lung. It is adherent to lung tissue and continuous with parietal pleura at hilum of lung
(surface projectsion: 2-midline, 4(L)cardiac notch, 6-mid-clavicular, 8-mid-axillary, 10-posteriorly)
parietal pleura must be anchored firmly to chest wall on the inside… necessary for respiration to occur!. visceral pleura dragged along passively and then because of the vacuum we have exhalation, an elastic rebound
What are the 4 components included in the parietal pleura?
costal- all inner thoracic surfaces including the thoracic vertebrae
mediastinal
diaphragmatic
cupola
Describe the cupola
part of parietal pleura
extends into root of the neck, suspended by Sibson’s fascia
refers to parietal layer in the root of neck, (visceral lining- apex of lung)
runs along the sternal angle to midsternal line
Describe the extensions of the diaphragm, parietal pleura, thorax.
thorax and parietal pleural extend to T12 posteriorly because that’s the end of the thorax
parietal pleura extends but the lung does not
diaphragm is domed and projects inferiorly to L2
What are the two pleural recesses that form between the parietal and visceral pleura? What is their purpose?
they form potential spaces that allow for maximum expansion of the lung during forced ventilation
costodiaphragmatic recess
costomediastinal recess
Why might a chest x-ray technician ask a patient to take a deep breath and hold it?
the inferior border of the diaphragm is a gutter into which the lung can expand and if you take a breath there is a space for viceral/pleura/lung to expand
take breath and hold it to expand all the way to the costodiaphragmatic recess, by filling lung in this recess you can see if anything is in there because gravity would bring it down and if anything got into pleural cavity it would go into the recess
What is the costomediastinal recess?
it is pleura coming around the ribs posteriorly and reflects along the mediastinal border and changes direction and the recess is there, another area you can expand tissue upon deep inhalation
Where does the pleura intersect inferiorly?
8th rib at midclavicular line , then laterally to mid axillary line where the 10th rib is intersected
Where do the visceral and parietal pleura intersect at midclavicular line and midaxillary line?
2 rib difference w visceral vs parietal
at midclavicular- pareital pleura at 8, visceral at 6
midaxillary- parietal intersects chest wall at 10, visceral at 8th and so forth
(costodiaphragmatic recess as it goes front to back)
Describe the 3 main tubes of posterior mediastinum.
3 tubes pass through diaphragm at levels T8, 10, 12
(I ate 10 eggs at noon.)
inferior vena cava - at T8 passes through to heart
esophagus - at T10 esophagus passes through diaphragm
aorta- at T12 passes through diaphragm
thorax ends at T12 because that’s as far as parietal pleura will go, muscles of diaphragm to go L2.
What is in the posterior mediastinum ?
the aorta, esophagus, vagus, azygos and hemiazgos veins, thoracic duct, sympathetic chain
Describe:
azygos and hemiazgos veins
thoracic duct
sympathetic chain
azygos and hemiazgos veins- venous system accepting posterior intercostal veins from posterior mediastinum
thoracic duct - main channel for lymphatic system drainage except upper right quadrant
sympathetic chain- within posterior mediastinum
Where does the vagus nerve go?
goes into diaphragm by following esophagus
Describe the pulmonary artery in the hilum.
right -anterior
left- superior
What is in the posterior mediastinum?
descending aorta azygos and hemiazygos v esophagus vagus n. (L vagus becomes ant. esophageal) thoracic splanchnic n. thoracic duct
