Session 5

Question 1

What is the thoracic duct and where does it join the vascular system?

Answer 1

The thoracic duct is the main lymphatic channel draining lymph from the lower half of the body and the bowel back to the blood stream. The bowel component is important because
fat is absorbed into the lymphatics so this is the only route for fat absorption. At the confluence of the left subclavian and left internal jugular vein.

Question 2

What structures are supplied by the three splanchnic nerves and where does a patient appreciate pain felt by these nerves?

Answer 2

Greater splanchnic nerve; fore gut, epigastrium. Lesser splanchnic nerve: midgut, round the umbilicus. Least splanchnic nerve, hind gut, suprapubic area.

Question 3

What structure lies immediately behind the trachea in the upper thorax and the left atria
in the lower thorax?

Answer 3

The oesophagus

Question 4

What structures drain blood into the azygous system?

Answer 4

The lateral and posterior chest wall and the lateral and posterior abdominal wall

Question 5

Why is the left recurrent laryngeal nerve at risk from thoracic disease but not the right?

Answer 5

The left recurrent laryngeal nerve passes into the thorax, round the aortic arch and
back into the neck. The right recurrent laryngeal does not pass through the thorax.

Question 6

Where do the sympathetic nerves attach to the central nervous system?

Answer 6

The thoracic 1-12 and lumber 1 and 2 spinal segmental nerves.

Question 7

What happens if the sympathetic nerves to the head and neck are damaged?

Answer 7

There will be no sweating on the face (anhidrosis) The eye lid will droop (ptosis)
The pupil will be constricted (miosis)
Slightly withdrawn eye ball (enopthalmos)
This is known as Horner’s syndrome; it almost always effects one side only.