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Cardiovascular and Respiratory > Superior & Posterior Mediastina. > Flashcards

Superior & Posterior Mediastina. Flashcards

1
Q

Where does the mediastinum sit?

A

between the two pleural cavities

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2
Q

Where is the superior and inferior mediastinum divided?

A

at the angle of louis - T4 lower edge

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3
Q

everything in the pericardial sac is in what division of the mediastinum?

A

middle inferior mediastina

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4
Q

What is the purpose of the Thymus gland?

A

Makes T cells in children - replaced with fat as you age -

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5
Q

What occurs at the T4 level?

A

bifurcation of trachea

bifurcation of pulmonary trunk (leaves from right ventricle)

azygos termination

ligamentum arteriosum

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6
Q

Where does the superior mediastinum span from ?

A

T1-T4

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7
Q

the upper pleural cavity extends where?

A

It superiorly extends all the way above the 1st rib

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8
Q

Describe the vessels of the mediastinum

A

internal jugular veins, subclavian veins, brachiocephalic veins (formed behind the sternoclavicular joint), R+L Brachiocephalic form SVC (behind 1st CC)

Azygos joins SVC (behind 2nd CC)

SVC runs into RA (behind 3rd CC)

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9
Q

Where does the Brachiocephalic vein form?

A

formed behind the Sternoclavicular joint

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10
Q

Where does the right/left brachiocephalic form the superior vena cava?

A

behind 1st CC

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11
Q

Where does the azygos join the superior vena cava?

A

behind the 2nd CC

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12
Q

Where does the SVC run into the right atrium?

A

behind the 3rd CC

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13
Q

what major vessels branch from the aorta?

A
  • brachiocephalic - then splits to form the right common carotid and right subclavian
  • Left common carotid
  • left subclavian
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14
Q

where should the trachea normally sit?

A

midline - if it is off center, you need to be wondering why

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15
Q

What two vessels lie over the first rib?

A
  • left/right sublcavian artery
  • left/right subclavian vein
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16
Q

What nerves run over the first rib?

A

The brachial plexus roots and the sympathetic trunk

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17
Q

What muscle runs over the first rib?

A

The scalene muscle?

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18
Q

The subclavian artery is divided into 3 by what referemce?

A
  • by relation to the the scalenus anterior
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19
Q

What are the branches of the first part of the subclavian artery?

A
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20
Q

Vertebral

thyrocervical trunk

  • inferior thyroid

transverse cervicle

suprascapular

internal thoracic

costocervical trunk

A
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21
Q

what are the major structures in the posterior mediastinum?

A

oesophagus

descending aorta

azygos venous system

thoracic duct

(nervous structurs = vagus nerves, and sympathetic chains)

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22
Q

Phrenic and vagus are generally found where?

A

phrenic is mostly anterior superior

vagus is mostly posterior inferior

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23
Q

how long is the oesophagus?

A

25 cm

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24
Q

where does the oesophagus begin?

A

cricoid cartilage = C6

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25
The cricoid cartilage is the begining of what two structures?
the oesophagus and the trachea
26
Where do you measure endoscopy levels from?
From the teeth
27
how far down is the cricoid cartilage?
it is 15cm from teeth
28
oesophagus passes through the diaphragm at what level?
T10
29
What are the layers of the oesophagus?
outer layer = connective tissue Muscular = outer longitudinal muscle, inner circular muscle, upper 2/3 striated, lower 1/3 unstriated \*the outer layer is fairly thin - allows for local spread of cancer)
30
what sort of cells are in the innermost area of the oesophagus?
stratified squamus (wear and tear epithelium)
31
Where is the squamo comlumnar junction?
lower part of oesophagus
32
What structures lie behind the oesophagus?
* posterior = thoracic vertebrae, thoracic duct, azygos vein, descending aorta * LEft = aortic arch and descending aorta * right = azygos vein * anterior = trachea, aortic arch, left bronchus, left atrium
33
Where do you see the aortic arch pressing on the trachea on endoscopy?
25cm
34
What is a transoesophageal echo?
echo from an endoscopy to see the strucutres like the aorta or trachea without interference of sternum or lymph
35
what is the arterial supply to the oesophagus?
upper third = inferior thyroid artery middle third = thoracic aorta lower third = left gastric artery from celiac trunk \*venous drainage is pretty much mirrored)
36
what is the lower third of the oesophagus venous system?
lower third = left gastric vein - drains into the portal vein- subject to portal pressure- reduced flow and oesophageal varices
37
What overlies the oesophageal veins?
only mucosa - nothing restricting the dilation of these vessels or preventing damage to them
38
How does the respiratory system develop from embryology?
it originates as a small diverticulum from the gut tube- then it devides into buds, the they then differentiate so the only place the two are connected is in the larynx - every communication between the two should cut off in a normal body
39
what is a tracheoesophageal fistula ?
esophagous and the trachea are still connected - potentially allow food to enter the lungs - cuases coughing and potential respiratory issues
40
what is oesophageal atresia?
there is complete fusion of the oesophagus - so the liquid flows over
41
what is a hiatus hernia?
part of stomach enters the thorax through the diaphragm- most commonly the gastroesophageal junction is present in the thorax
42
what is the term for iritation of the lower oesophagus?
oesophagitis - mainly from stomach acid irritation
43
Repeated damage to the oesophagus from stomach acid can lead to what?
Barrets oesophagus - eventually may lead to cancer
44
What are the visceral branches from the descending aorta?
peridcardial bronchial oesophageal
45
What are the parietal branches from the descending aorta?
mediastinal intercostal (and subcostal 12th) superior phrenic
46
How does Marfan's syndrome effect the aorta?
lack of collagen = weaker vessels break down over time
47
What is the thoracic duct an extension of?
The cisterna Caeli?
48
The thoracic duct moves behind the oesophagus at what level?
At T5
49
Which vein does the thoracic duct run into?
runs into left brachiocephalic vein - drains everything below diaphragm, drains left side above diaphragm
50
What are the attachments of the diaphragm?
Crura, median arcuate ligament, medial arcuate ligament, lateral arcuate ligament, lower 6CC's, xiphoid process -
51
Which vein peirces the central tendon ?
Inferior vena cava - gets smaller when the diaphragm contracts (pulls central tendon) At T8 along witht he Right phrenic Nerve
52
Does the oesophagus pierce the diaphragm through muscle? Or through the central tendon?
It pierces the muscle - there is a ring around it that prevents reflux at T10 along with the Vagi
53
What structure enters behind the diaphragm?
the aorta, thoracic duct, and azygos vein - T12
54
the splanchnic nerves enter through what part of the diaphragm?
the Crura
55
What are the roots of the motor supply to the diaphragm?
C3,4,5 the sensory are partly supplied by the lower 6 intercostal nerves
56
The superior phrenic arteries arise from what vessle?
the thoracic aorta
57
Why does the shoulder often recieve refered pain from the diaphragm?
B/c C3,4,5 - visceral nerves are really bad at pinpointint pain
58
where does the inferior phrenic artery arise from?
arises from the abdominal aorta
59
is the aorta affected by respiration?
no = lies behind the diaphragm
60
Does the IVC change shape during inspiration?
IVC widens during inspiration - along with the increased pressure whhich encourages venous return
61
The sympathetic trunks pass through what ligament of the diaphragm?
the medial arcuate ligaments
62
the subcostals pass through what ligaments of the diaphragm?
lateral arcuate ligaments

Cardiovascular and Respiratory (39 decks)

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