Test 4 Lecture 2 Flashcards
Resting Respiratory Rate
12-20 breaths a minute
Inhalation is a/an _____ process
ACTIVE- you have to contract muscles so that you can expand lungs so air can come in
Inhalation requires which muscles to contract?
Diaphragm, External Intercostals
exhalation is a/an _____ process in the resting state
PASSIVE
- requires muscle relaxation as lungs rebound off the chest wall and diaphragm
- Surface tension in the airways causes to partial collapse (surface in airways stick and come together to help you push the air out to complete exhalation)
what does the diaphragm do during inhalation?
it moves down to the 6 intercostal space on right side, 7th rib on left side. It flattens out allowing the lungs to expand vertically
what does the diaphragm do during exhalation?
moves up to about the 4th rib on right side, and 4th interspace on the left side.
what do lungs do during exhalation
they kind of bounce of the diaphragm and the surface tension causes the lungs to get smaller as we force the air out as we exhale
transverse thoracis
Lies on the posterior surface of the anterior thoracic wall
Originates on side of sternum, Inserts on Ribs 2-6
a modified innermost intercostal
-helps with forced exhalation
Levatores Costarum
origin - transverse processes of cervical vertebra 7 and thoracic vertebrae 1-11.
insertion - rib below.
when they contract they lift ribs up, so they help you inhale
Serratus Posterior Superior
-thin as paper
origin - ligamentum nuchae.
insertion - ribs 2-5.
might help with inhalation, pull ribcage up to help us expand lungs to inhale
Seratus Posterior Inferior
-thin as paper
helps us to forcefully exhale because it pulls the rib spaces down
origin - supraspinous ligament of T11-L3.
insertion - ribs 9-12.
Scalenes
can lift ribcage up and help ribs expand
i. anterior
origin - transverse processes of cervical vertebrae 3-6.
insertion - first rib.
ii. middle
origin - transverse processes of cervical vertebrae 2-7.
insertion - first rib.
Sternocleidomastoid
STRONG MUSCLE- ELEVATES YOUR CHEST WALL/ RIBCAGE! and allow you to expand your chest and expand your lungs.
origin - sternal manubrium, sternal end of the clavicle.
insertion - mastoid process.
Subcostales
behind thoracic viscera, modified innermost intercostals.
Might help with forceful exhalation
Ribs 10-12
Abdominal Muscles
Best muscles to help with forceful exhalation. When you contract, it forces the diaphragm upwards.
Best muscles specifically to help with forceful exhalation?
The abdominal muscles. Specifically: Rectus Abdominas External Abdominal Oblique Internal Abdominal Oblique (deep to external) Transverse Abdominas (deep to the internal) -when they contract they compress your abdomen, abdominal wall, so it slams your diaphragm up causing your lungs to contract
Top of the lung is called the
apex
bottom of the lung is called
the broad concave BASE. It sits right onto of the diaphragm
The lung base covers the
Diaphragmatic Surface
tissue that covers the lung is called (deepest layer)?
visceral pleura (very thin)
layer over the visceral pleura is called
the parietal pleura
the space between visceral pleura and the parietal pleura
the pleural space or cavity- a potential space.
-on exams they’ll ask what lies within this space, and the answer is nothing, its a potential space that’s all
Costodiaphragmatic Recess
recess is the extension of the inferior pleural space into the area formed between the posterior body wall and the posterior dome of the diaphragm.
External Oblique O/I
origin - lower borders and outer surfaces of the lower 8 ribs.
insertion - lower 2 ribs, anterior half of the iliac crest, and the external abdominal oblique aponeurosis.
External Oblique O/I
origin - lower borders and outer surfaces of the lower 8 ribs.
insertion - lower 2 ribs, anterior half of the iliac crest, and the external abdominal oblique aponeurosis.
Internal abdominal oblique O/I
origin - posterior layer of the thoracolumbar fascia, anterior 2/3 of the iliac crest, lateral 2/3 of the inguinal ligament, and from the iliacus fascia.
insertion - forms an aponeurosis around the rectus abdominis to insert into the linea alba, lower 3 - 4 ribs and their cartilages, and the pubis.
Transversus abdominis O/I
origin - costal cartilages of the lower six ribs, thoracolumbar fascia, anterior 3/4 of the iliac crest, form the lateral 1/3 of the inguinal ligament, and from the iliacus fascia.
insertion - superior border of the pubis and pectin pubis, aponeurosis of the transversus abdominis to the linea alba.
Visceral pleura
shiny serous layer, which tightly adheres to the lungs
Parietal pleura
fibrous connective tissue layer that is attached to the bony thorax and diaphragm, and lies next to the fibrous layer of the pericardium
The parietal layer of the pleura is
___ applied, and descends about 2 rib spaces below the inferior extent of the lungs
loosely
pleural effusion
Sometimes fluid may accumulate in the Costodiaphragmatic Recess and settle into this pleural space
Parietal Pleura is divided into 4 regional parts:
- Costal Pleura (the largest portion, in contact with chest wall, and ribs)
- Diaphragmatic Pleura (on the base of the lung that’s in contact with the diaphragm)
- Cervical Pleura (tightly covers apex of the lung)
- Mediastinal Pleura (medial surface of lungs)
Lung apex- parietal pleura covers ___
tightly
The space between where the lungs base ends and the space that the pleura goes to is the
costodiapragmatic recess
the parietal pleura dips down about ________ further than the end of the lungs
2 RIB SPACE DIFFERENTIAL
(base of lung at following midclavicular line = 6th rib, base of parietal pleura = 8th rib
-important because it allows your lungs to expand!
midaxillary line-
lungs base goes to
parietal pleural base goes to
lungs base goes to: 8th rib
parietal pleural base goes to: 10th rib
paravertebral line
lungs base goes to
parietal pleural base goes to
lungs base goes to: 10th rib
parietal pleural base goes to: 12th rib
the 2 rib space differential between the parietal pleura and the lung base creates the
diaphragmatic recess
When a person has fluid build up in the diaphragmatic recess what do they do?
they go to the 11th rib area and go over- so they don’t hit the lungs but they don’t hit the intercostal artery and nerve
pleural effusion
inflammation of fluid
pleural effusion can lead to
pneumonia, or even nowadays COVID
A normal lung extends to where
1 inch above the clavicle (technically in posterior triangle!)
in an xray, normal lungs are
radioluctent
Hilum
where the blood vessels come in and deliver blood to the organ, and where blood vessels an organ
Hilum of the lung contains
pulmonary artery, pulmonary vein, and an airway as well
At the hilum of the lung, what do the vein and artery do?
the vein carries arterial blood (take bloods from the lungs, back to the heart oxygenated)
the arteries carrie venous blood (take blood into lungs from heart, so not oxygenated yet)
Hilum of the left lung
the airway lies immediately under the pulmonary artery, so we call it hypoarterial
-very consistent, this doesn’t change
Hilum of the right lung
the airway lies above and around the pulmonary artery, so we call it epiarterial
The cardiac notch is found on the
left lung
the cardiac depression is found on the
left lung, caused by the heart
the aortic arch impression can be found on the
left lung
the impression of the azygos vein can be found on the
right lung
the esophageal impression can be found on the
right lung
Lobes:
Subdivisions of the Lungs separated by fissures
Bronchopulmonary Segments:
Subdivisions of the Lobes separated by fibrous septa
Right lung has how many lobes?
3 (Upper, Middle, Lower)
Left lung has how many lobes?
2 (upper and lower)
-lingula (bottom part of upper)
Horizontal Fissure
separates the upper lobe from the middle lobe of the right lung
Oblique Fissure
separates the middle lobe from the lower lobe of the right lung
How many fissures on right lung?
2- the horizontal and oblique fissure
How many fissures on the left lung?
1- left oblique fissure
lingula
tongue like projection on the bottom of the left lungs upper lobe
Right Lung Bronchopulmonary segments
10 bronchopulmonary segments upper lobe: apical anterior posterior
middle lobe:
medial
lateral
lower lobe:
superior
medial & lateral basal
anterior & posterior basal
Left Lung Bronchopulmonary segments
Upper Lobe:
anterior
apieco-posterior
Lingula:
superior
inferior
Lower Lobe: superior posterior basal lateral basal antero-medial basal
REMINDER TO LOOK
AT NETTERS BRONCHOPULMONARY SEGMENTS
pulmonary hygiene or postural drainage
cystic fibrosis- a disease when you produce a lot of mucous in lungs
-if you know where bronchopulmonary segments lie, then you can pound on patients chest and help drain bronchopulmonary segment. It can help them cough the mucous out
a wedge resection is
someone who has cancer of the lungs, sometimes they can just take out a bronchopulmonary segment, rather than a lobectomy where they take our an entire lobe of a lung, or pneumoectomy where they take out an entire lung
What supplies blood to the lungs?
your bronchial arteries
the right side of the lungs has how many arteries and what does it or they branch off of?
1 Right-off the 3rd Posterior Intercostal A.
Follow the airway progression
the left side of the lungs has how many arteries and what does it or they branch off of?
2 Left-off the aortic arch
Follow the airway progression
What gets the blood out of the lungs?
the bronchial veins
Bronchial Veins
- what do they run with?
- what do they empty into?
Variable-run with bronchial arteries. They kind of create a plexus.
Empty into the Superior Vena Cava
costalphrenic recess
is a potential space in the pleural cavity, at the posterior-most tips of the cavity, located at the junction of the costal pleura and diaphragmatic pleura
-where the diaphragm comes to meet the thoracic wall
trachea normal size
the cervical part is 2 inches, the thoracic part is about 2 inches. So 4 inches total
How many cartilaginous rings does the trachea have
20 C shaped rings (incomplete posterior)
what completes the back of the trachea that has no cartilage?
tracheal (smooth) muscle
what runs behind the trachea?
the esophagus. It literally touches the trachea
what does the trachea bifurcate into?
Left/Right Mainstem Bronchi
Where does the trachea bifurcate?
Birfurcates at Sternal Angle
How is the right Mainstem Broncus different from the left mainstem bronchus?
the right is:
Shorter
Larger Diameter
More Vertical
How is the left mainstem bronchus different from the right?
the left is:
Longer
Smaller Diameter
More Horizontal
degree angle between the left and right mainstem bronchus?
62 degrees
If someone has a pathogen go into lungs, which side mainstem bronchi would they likely go in?
the right side because of gravity, its steeper. So that’s why people get pneumonia more on the right side
Fiber-optic Flexible Bronchoscopy
a broncoscopie is used to view the airways and check for abnormalities in the trachea or in the mainstem bronchi
the carina
the ridge that divides the trachea and separates it into the left from the right mainstem bronchus
-it’s not the last tracheal ring
how do mainstem bronchi divide?
they divide into the amount of lobes in that side of the lung (but the left side also has the lingular broncus)
- Right side= (3 Lobar Bronchi) upper, lower, middle lobar bronchi
- Left side= (2 Lobar Bronchi+ Lungular ) upper and lower LOBAR bronchi AND Lingual has it’s own called the lingular bronchus
How do lobar bronchi then divide?
Right: 10 Segmental Bronchi
Left: 8 Segmental Bronchi
describe the bronchi from the trachea down?
left and right mainstem bronchi divide into lobar bronchi (right side has upper, middle lower, left side has upper, lower and a lingular bronchus), then they divide into segmental bronchi (Right has 10, Left has 8), then they divide into Subsegmental Bronchi (20-25 Generations), which eventually divide into bronchioles
cartilage over bronchi goes from the trachea down to
the subsegmental bronchi, ends at bronchoioles
bronchioles
HAVE NO CARTILAGE. Just smooth muscular tubes
<1mm in diameter
why do we have cartilage around all of our bronchi but the bronchioles?
to keep our airway from collapsing and expanding every time we breath out.
Where do people with asthma have their difficulties?
Down in your little tiny bronchioles, when they swell
Where is carbon dioxide and oxygen exchanged with the blood?
at the alveoli level, NO EARLIER.
What do bronchioles terminate into
alveoli (the most distal end)
Where does cartilage of the trachea into the bronchi end?
at the bronchioles. They and the alveoli have no cartilage
Pulmonary arteries carry
venous blood
Pulmonary veins carry
arterial blood
Alveolar Capillaries
where we give off oxygen into our bloodstream
super thin- 0.2-0.5 microns thick
Capillaries have both
venous blood and arterial blood
What is the mediastinum?
it’s the space in between lungs
Why is the mediastinum space important?
it allows “placement” and location of the various internal structures of the Thorax
Are your lungs in your mediastinum?
No! You can’t be a boarder and a content at the same time
Subdivisions of the Mediastinum
- Superior mediastinum
- Inferior mediastinum
- anterior compartment
- middle compartment
- posterior compartment
superior mediastinum
your superior thoracic aperture formed by the first rib.
SUPERIOR BOUNDARY-draw line from super sternum notch straight up and back until it intersects with C7 and T1. The line should run parallel with the first rib
INFERIOR BOUNDARY-
draw line from the sternal angle of Louis straight back between intervertebral disc of T4 & T5
Inferior mediastinum
superior border- the line between the sternal angle and back to T4-T5
Inferior border- the diaphragm
-has the 3 compartments
Anterior Compartment
Space anterior to the heart up to the boney thorax
Middle Compartment
Space containing the heart
Posterior Compartment
Space posterior to the heart up to the vertebral column
What is found in the superior mediastinum?
anterior -> posterior (peel 1 off, and find 2, so on down)
- the thymus gland (reminant)
- Brachiocephalic Veins as they form the Superior Vena Cava
- Aortic arch and roots of it’s branches (brachiocephalic trunk, left common carotid artery, subclavian artery)
- trachea (thoracic portion)
- esophagus
Termination of the Thoracic (Lymphatic) Duct
- Begins below the diaphragm
- Thoracic Duct passes through the aortic hiatus
- Termination is at the junction of the Left Subclavian and Left Internal Jugular Veins which is called the left brachial cephalic vein. The majority of our lymph takes this pathway and is channeled back into bloodstream here
discuss the lymphatic system
it carries lymph, which is derived from your capillaries, and these lymphatic vessels carry it all over your body until it dumps back into your bloodstream where it gets swished through the capillaries
**Where is termination of the thoracic (lymphatic) duct? ***
in the superior mediastinum
Thoracic duct starts just under the diaphragm at the
Cisterna Chyli in the Abdomen
Cisterna Chyli gives rise to the
thoracic duct (keep in mind this is going superior)
the thoracic duct passes through the
diaphragm as it ascends the posterior thorax
When the thoracic duct gets into the superior mediastinum what happens?
it curves where it turns into the left subclavian vein, where it joins the left internal jugular vein, which forms the left brachiocephalic vein
termination of the right lymphatic duct occurs in the
superior mediastinum (same as left, but to the right side. so it drains into the right subclavian vein and right internal jugular vein into the right brachiocephalic vein_)
The thoracic duct drains
your left head, left neck, left upper trunk, left arm down to hand and waste down all by the thoracic duct (so like 3/4’s of your body)
the right lymphatic duct drains
your right head, right neck, right upper arm and thoracic region down to your right fingers. THATS IT (only maybe a quarter of your body
structures that pass through superior mediastinum to get where they need to go
vagus nerve
phrenic nerve
recurrent laryngeal nerves (left around aortic arch, right around subclavian artery)
anterior compartment of the inferior mediastinum contains
Lower Portion of the Thymus (or Thymic Remnant)
Internal Thoracic Vessels (internal thoracic artery)
Lymph Nodes
middle compartment of the inferior mediastinum contains
Heart, Coronary Vessels, and Pericardium
AND
Roots of the Great Vessels that originate/terminate in the heart:
Superior/Inferior Vena Cava (termination)
Pulmonary Veins (termination)
Ascending Aorta (originate)
Pulmonary Trunk (originate)
AND
Bifurcation of the trachea into 2 mainstem bronchi
-creates arch called Arch of the Azygos Vein and Termination in the SVC
-Phrenic Nerves-Pericardial Portion
Also, the Pericardicophrenic Artery (feeds the pericardial sac and diaphragm. It runs right with the phrenic nerve
space surrounding the heart is called
pericardium
essentially, the Middle Compartment of Inferior Mediastinum contains
anything regarding the heart
What runs under the Arch of the Azygos Vein
the right mainstem bronchus and right Pulmonary artery and vein
Pericardicophrenic Arteries
run with the phrenic nerve. The Pericardicophrenic Arteries supply blood to the
pericardium sac and the diaphragm
Posterior Compartment-Inferior Mediastinum contents
posterior to anterior:
Descending Portion-Thoracic Aorta
Continuation of the Esophagus from Superior Mediastinum
Thoracic Duct and Vagus Nerves (Runs with the Esophagus as a “plexus”)
Azygos Vein-right side
Hemiazygos/Accessory Hemiazygos Veins-left side
Origination of Greater, Lesser, & Least Splanchnic Nerves
Posterior Mediastinal Lymph Nodes
The sympathetic chain is NOT part of the mediastinum
because it is outside of the chest and it’s covered in parietal pleura
thoracic aorta creates an arch in the left and posterior, what does it bridge over?
Left Pulmonary Artery & Vein and Left Mainstem Bronchus passing under the aortic arch
azygos vein begins in the
diaphragm at the aortic hiatus and goes up
Hemiazygos and Accessory Hemiazygos Vein relationship
hemiazygos (LEFT) (starts and diaphragm and goes up) anastomoses with a vein that comes up from above down called the accessory vein
hemiazygos veins are formed by
the ascending lumbar vein (ones they pass the lumbar they are named right, Azygos and left, Hemiazygos)
formation of the communicating vein
joins hemiazygos and accessory Accessory Hemiazygos Vein with the Azygos vein
thoracic duct runs with your
esophagus and azygos
Greater Splanchnic Nerve
pre-ganglionic sympathetic that supplies sympathetic innervation to abdominal viscera
(T5-T9)
Lesser Splanchnic Nerve
(T10-T11)
pre-ganglionic sympathetic that supplies sympathetic innervation to abdominal viscera
Least Splanchnic Nerve
(T12)
pre-ganglionic sympathetic that supplies sympathetic innervation to abdominal viscera
Structures Found in More than One Subdivision of the Mediastinum
Thoracic Duct (Superior & Posterior compartment)
Phrenic Nerves (Superior & Middle compartment)
Esophagus (Superior & Posterior compartment)
Trachea (Superior & Middle-compartment for Bifurcation)
Thymus Gland (Superior & Anterior compartment)
Aorta (Superior, Middle compartment, Posterior compartment)
