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ACE Unit 2 > TBL 9 - Body Cavities Diaphragm Thoracic Wall and Lungs > Flashcards

TBL 9 - Body Cavities Diaphragm Thoracic Wall and Lungs Flashcards

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1
Q

Space between what layers creates the embryonic body cavity?

A

Parietal and visceral layers of the lateral plate mesoderm

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2
Q

What is the dorsal mesentery and what forms it?

A

Continuity of parietal and visceral mesoderm forms it and it suspends the gut tube from the posterior body wall into the cavity

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3
Q

From where do the lung bud and liver bud arise?

A

Invaginations of the distal foregut endoderm into the pericardial cavity and septum transversum

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4
Q

What is the septum transversum

A

A wedge of visceral mesoderm that separates the pericardial (abdominal) cavity from the distal foregut, midgut, and hindgut

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5
Q

What happens as the gut tube closes and the anterior body wall is completed?

A

The vitelline duct and obliterated yolk sac become part of the connecting stalk and degenerate

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6
Q

What are the pericardioperitoneal canals?

A

They are each side of the foregut and maintain continuity between the pericardial and peritoneal cavities as the growth of the liver processes into the septum transversum

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7
Q

Parietal pleura lines what?

A

Pleural cavities

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8
Q

Visceral pleura lines what?

A

The lungs

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9
Q

Why can a congenital diaphragmatic hernia be fatal

A

Caused by failure of one or more pericardioperitoneal membranes to close the pericardioperitoneal canals causing the peritoneal and pleural cavities to be continuous. A hernia results causing pulmonary hypoplasia and dysfunction

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10
Q

Ribs and intercostal muscles are forms by what?

A

Somite-derived mesenchymal. Paraxial mesoderm

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11
Q

Sternum and costal cartilages are derivatives of what?

A

mesenchymal cells from parietal mesoderm

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12
Q

Landmark articulation of the 2nd ribs

A

Sternal angle

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13
Q

Costal margin and what ribs end posterior to this?

A

Costal cartilages of ribs 8-10 attach to the cartilage of the rib above forming the margin. 11th and 12th ribs end posterior as they lack costal cartilages

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14
Q

Posterior articular sites for ribs?

A

costal facets on thoracic vertebral bodies and transverse processes

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15
Q

Where is the subcostal space and which spinal nerve constitutes the subcostal nerve?

A

Space below the 12th rib and the spinal nerve of T12 is the subcostal nerve

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16
Q

Why does rib counting during physical exams start at the second rib?

A

1st rib is not palpable but the 2nd is so it is possible to count from there.

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17
Q

Boundaries of superior thoracic aperture

A

Posterior - vertebra T1 (body protrudes anteriorly)
Lateral - 1st pair of ribs and costal cartilage
Anterior - superior border of manubrium

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18
Q

Structures that pass through the superior thoracic aperture

A

trachea
esophagus
nerves
vessels that supply and drain the head, neck, and upper limbs

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19
Q

Why do a diminished radial pulse, cutaneous pallor, and coldness of the upper limb indicate a supernumerary cervical rib?

A

A supernumerary cervical rib could interfere with neuromuscular structures through the superior thoracic aperture resulting those symptoms. In particular, the subclavian artery

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20
Q

Where are the nipples (men and young nulliparous women) located?

A

Adjacent to the midclavicular lines at the 4th intercostal space

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21
Q

What creates the superior projection into the subcostal space and how far up does it reach

A

Liver, stomach, and spleen. The superior part of the liver can reach the 4th ICS

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22
Q

Describe breathing and the nerves involved

A

The phrenic nerves induce contraction of the diaphragm flattening the domes of the lungs drawing air in. Relaxation of the diaphragm expels air.

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23
Q

Why after ipsilateral paralysis of the diaphragm, does the paralyzed dome ascend during inspiration and descend during expiration?

A

It ascends because it is pushed up by the abdominal viscera that is compressed by the active dome on the contralateral side. It descends because of positive pressure in the lungs

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24
Q

Describe forced inspiration

A

External intercostal muscles elevate the ribs and expand the dimensions of the thoracic cavity. The scalene muscles in the neck fix the first two ribs assisting elevation

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25
Q

Describe forced expiration

A

Internal intercostal muscles lower the elevated ribs back to the resting position

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26
Q

Why do patients experiencing dyspnea lean on their knees to assist respiration?

A

Fixes their pectoral girdle allowing these muscles to act on the rib attachments and expand the thorax

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27
Q

What do the anterior rami of the thoracic spinal nerves that constitute the intercostal nerves innervate

A

intercostal muscles

28
Q

What provides sensory innervation to the anterolateral thoracic wall? What is special about T2 related to this?

A

Lateral cutaneous branches of the anterior rami. The lateral cutaneous branch of spinal nerve T2 also extends into the dermatomes of the medial sides of the arms

29
Q

What do the posterior rami of the intercostal nerves supply? Their cutaneous branches?

A

Intrinsic muscles of the back. The cutaneous branches supply the posterior thoracic wall

30
Q

What do the white and gray communicating rami to and from the paravertebral ganglia of the sympathetic trunks enable the intercostal nerves to do?

A

Convey visceral motor fibers to smooth muscle and sweat glands in the body wall

31
Q

Where do the internal thoracic arteries arise from and what are its terminal branches?

A

Subclavian arteries. The terminal branches are the superior epigastric and musculophrenic arteries

32
Q

Where do the posterior and anterior arteries arise from and what happens to them in the ICS?

A

They arise from the thoracic aorta and internal thoracic arteries and anastomose in the ICS

33
Q

What separates the right and left pleural cavities (the space between the visceral and parietal pleurae)

A

Continuity of the pleurae at the roots of the lungs

34
Q

The 4 regional parts of the parietal pleura

A

Costal, mediastinal, diaphragmatic and cervical pleura

35
Q

What creates the costodiaphragmatic recesses?

A

Normal respiration, the lungs do not fully occupy the pleural cavity. The lowest part of the costal pleura and the peripheral part of the diaphragmatic pleura creates the costodiaphragmatic recesses

36
Q

How does the thin fluid layer in the pleural cavity normally sustain inflation of the lungs during inspiration?

A

When the airway passages are open to breath, the surface tension due to the fluid helps the outer surface of the lungs adhere to the inner surface of thoracic walls creating low air pressure inside the lungs inhaling air

37
Q

How is fluid sampled in the costodiaphragmatic recess without damaging the inferior border of the lungs? How do contents of the ribs’ costal grooves determine proper execution of the procedure?

A

Needle inserted superior to 10th rib in the 9th ICS midaxillary line during expiration, high enough to avoid collateral branches of vessels, angled upward will avoid the inferior border of the lung and avoid penetrating the deep side of the recess.

38
Q

Why can irritation of the parietal pleural produce either local or referred pain?

A

Lots of intercostal and phrenic nerves which can cause pain to project to dermatomes supplied by that spinal ganglia

39
Q

What covers the apex of the lungs and where does it extend to

A

The cervical pleura and the apex extends into the root of the neck.

40
Q

Pancoast’s Syndrome

A

Associated with a history of smoking. Occurs when an apical lung tumor compresses the trunks of the brachial plexus. Pain extends down the ipsilateral arm into the hand

41
Q

Horner’s Syndrome

A

When the apical lung tumor compresses the sympathetic trunk causing the ipsilateral eye to be affected

42
Q

What creates a pneumothorax and what happens if the wound creates a tissue flap that allow air to enter but not leave the pleural cavity

A

Penetrating wound through the side of the thoracic wall. Parietal pleurae ruptured and air enters the pleural cavity collapsing the ipsilateral lung from the pressure. Continuous expansion due to the tissue flap would permanently push the heart to the contralateral side and compress the contralateral lung resulting in a tension pneumothorax that could be fatal

43
Q

Why is the cervical pleura vulnerable during infancy and early childhood?

A

The cervical pleura reaches higher in infants and young children due to their short necks making the cervical pleura vulnerable.

44
Q

What are common causes of a pneumothorax, hydrothorax, and hemothorax?

A

Pneumothorax - penetrating wound of parietal pleura
Hydrothorax - pleural effusion where fluid escapes into the parietal pleura
Hemothorax - blood from a chest wound enters the pleural cavity (usually from injury to intercostal or internal thoracic vessel)

45
Q

With a pneumothorax, why is the mediastinum only shifted toward the affected side during expiration?

A

Air is moved into the cavity so when inspiring, the mediastinum is shifted towards the contralateral side. When expiring, the air is pushed out it moves towards the ipsilateral side

46
Q

What do the oblique and horizontal fissures create and where is the horizontal fissure

A

lobulation of the lungs. The horizontal fissure is at the inferior border of the right 4th rib and costal cartilage

47
Q

Anterior aspect of lungs formed by what lobes? Posterior?

A

Superior and middle lobes of right lung.

Inferior lobes of both lungs

48
Q

What does the left lung have that the right lung doesn’t

A

cardiac notch and lingula

49
Q

What causes impressions on the mediastinal surface of the embalmed lungs?

A

The heart, great vessels, and esophagus

50
Q

What causes lobar impression on the right lung? Left lung?

A

Right - superior vena cava and esophagus

Left - heart and aorta

51
Q

What is the hilum

A

Doorway for structures to enter and leave the lungs. The two main bronchi, pulmonary arteries, the main pulmonary veins go through this

52
Q

Where do the trachea and pulmonary trunk bifurcate into the left and right bronchi and pulmonary arteries? What do they then divide into?

A

The level of the sternal angle. The pulmonary arteries divide into lobar arteries and the main bronchi into the bronchi that supply the lobes of the lungs

53
Q

Which main bronchus is more likely to lodge an aspirated foreign body?

A

Right main because it is wider, shorter, and runs more vertically

54
Q

What is the primary cause of bronchogenic carcinomas and where do primary tumors most commonly arise? Why is the brain a common site of hematogenous metastasis?

A

Cigarette smoke
Tumors in mucosa of the large bronchi
Brain probably because it is one of the first places to get blood from the heart

55
Q

Why are bronchopulmonary segments resectable and what forms them?

A

They are formed by lobar bronchi that generate multiple segmental bronchi. Septa (a thin connective tissue) separates the segments making them resectable

56
Q

What forms the alveolar sacs and what unites with them after tapering?

A

Clusters of pulmonary alveoli form the sacs. The Segmental bronchi form bronchioles that unite after tapering

57
Q

What accompanies the tapering bronchioles

A

Branches of the pulmonary arteries accompany the bronchioles and supply the pulmonary capillaries within the walls of the alveoli.

58
Q

Where do the pulmonary capillaries drain?

A

The ventral tributaries of the pulmonary veins

59
Q

How do clinical outcomes from an embolus lodged in the main pulmonary artery differ from one lodged in a segmental pulmonary artery?

A

Embolus in the main pulmonary artery is really bad, heart dilates and people die. In the segmental pulmonary artery, the result is a pulmonary infarct (area of necrotic lung tissue) in a bronchopulmonary segment.

60
Q

Describe the path of blood into and out of the lung

A

Aorta to brochial arteries through the hilum supplying the capillaries. Bronchial veins exit the hilum and return blood from bronchial and bronchiolar walls to superior vena cava

61
Q

Where do the lymphatic vessels drain to?

A

The hiler lymph nodes into the tracheobronchial lymph nodes at the tracheal bifurcation. Then it goes into through multiple paratracheal lymph nodes into the right and left bronchomediastinal trunks into veins of the neck

62
Q

What do cardiopulmonary splanchnic nerves consist of and what differs about them from normal sympathetic nerves?

A

They are post-synaptic sympathetic fibers from the paravertebral ganglia of T1-T5 that do not return through the gray communicating rami, instead they directly enter the hilum of the lungs

63
Q

What is the vagus nerve and what does it do?

A

It is a presynaptic parasympathetic fiber (10th cranial nerve or CN X) and enters the hilum to synapse with postsynaptic neurons of parasympathetic ganglia within the walls of the bronchi and bronchioles

64
Q

What makes put the right and left pulmonary plexuses

A

Parasympathetic and sympathetic fibers that accompany all branches of the bronchi and bronchioles

65
Q

What causes bronchoconstriction?

A

Parasympathetic-mediated contraction of smooth muscle in the walls of bronchi and bronchioles

66
Q

What causes bronchodilation?

A

Sympathetic-mediated inhibition of the smooth muscle contraction

ACE Unit 2 (4 decks)

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