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Y2S1 CARDIO. > Thoracic Cavity > Flashcards

Thoracic Cavity Flashcards

1
Q

What are body cavities lined with

A 
serous membranes
– Allows movement, expansion,
contraction of organs
– Compartmentalize
– With miniscule layer of fluid; lubricated potential space; friction free
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2
Q

visceral layer

A

covers the organs

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3
Q

parietal layer

A

outer layer

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4
Q

what are the three compartments of the thoracic cavity

A

the left and right plural cavities and the mediastinum

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5
Q

where does the parietal pleura attach to

A
  • thorax wall (costal pleura)
  • the fascia at the thoracic inlet (first rib + T1)
  • fibrous pericardium and other mediastinal structures (mediastinal pleura)
  • diaphragm (diaphragmatic pleura)
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6
Q

mediastinum

A

✓Highly mobile region→volume and pressure changes

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7
Q

what are the two areas of the mediastinum

A

superior, inferior (anterior, middle and posterior)

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8
Q

superior mediastinum

A

behind manubrium, between the inlet and the plane through the sternal angle (and T4/5 disk)

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9
Q

Inferior Mediastinum

A

inferior to the transverse plane through the sternal angle and the diaphragm

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10
Q

structures to the right of the mediastinum

A

relate to the right atrium and veins:

  • SVC
  • Arch of the azygous
  • IVC
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11
Q

structures to the left of the mediastinum

A

relate to the left ventricle and its arteries:

  • left common carotid artery
  • left subclavian artery
  • arch of the aorta
  • thoracic aorta
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12
Q

MIDDLE MEDIASTINUM

A

✓Contains
− Heart
− Pericardium

• Origins of great vessels (aorta, pulmonary trunk), terminal parts of SVC and IVC

• Smaller vessels (pulmonary veins)
− Phrenic nerves
− Branches of Vagus

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13
Q

PERICARDIUM

A

✓ Fibro-serous sac that encloses the heart and the roots of the great vessels

✓ Comprises two layers:
– Fibrous pericardium (externally)
– Serous pericardium (internally)

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14
Q

function of the pericardium

A

✓ Functions:
– Anchoring the heart to surrounding tissues without compromising cardiac movement
– Preventing overfilling (overexpansion) of the heart

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15
Q

FIBROUS PERICARDIUM

A

✓ The apex is fused with the adventitia of the great vessels
✓ Anteriorly, related and attached by the sterno-pericardial ligament to the body of the sternum, and 3rd- 6th costal cartilages
✓ Posteriorly, related and attached by the pericardiovertebral ligaments to 5th - 8th thoracic vertebrae
✓ Inferiorly, blends with the central tendon of the diaphragm (Pericardiophrenic ligament)
✓ Attachment of fibrous pericardium to diaphragm halts descent of the diaphragm during inspiration

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16
Q

SEROUS PERICARDIUM

A 
✓ Has two layers: Parietal and visceral
✓ Parietal layer:
− Lines the inner aspect of
the fibrous pericardium
– Reflects onto itself around the roots of the great vessels and continues as the visceral layer
✓ Visceral layer = epicardium
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17
Q

PERICARDIAL CAVITY & FLUID

A

✓ Pericardial cavity:
− Between parietal and visceral layers of serous pericardium
✓ Pericardial fluid: − 10-15 mL
− Produced by serous pericardium
− Reduce friction during contraction of the heart

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18
Q

embryological development of the pericardium

A

the heart tube folds and invaginates into the serous pericardium (within the fibrous sac)→2 sinuses are formed within the serous pericardium

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19
Q

what are the two sinus formed in the pericardium

A

the transverse pericardial sinus and the oblique pericardial sinus

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20
Q

TRANSVERSE PERICARDIAL SINUS

A

✓ Sinus of Theile
✓ Separates the arterial and venous ends of the heart tube

✓ Posterior to the ascending aorta and pulmonary trunk, anterior to the superior vena cava.
✓ Superior to the left atrium and the pulmonary veins

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21
Q

OBLIQUE PERICARDIAL SINUS

A

✓ Haller’s cul-de-sac
✓ Surrounded by the reflection of the serous pericardium around the right and left pulmonary veins and the inferior vena cava

22
Q

nerve supply to the pericardium

A

✓ Sensory fibers from the phrenic nerve

✓ Vasomotor fibers from vagus nerve and the cardiopulmonary splanchnic nerves (sympathetic).

23
Q

PHRENIC NERVE

A

✓ A branch of the cervical plexus
✓ Arises from ventral rami of C3,4,5
✓ Over scalenus anterior muscle
✓Enters the mediastinum between the venous and the arterial planes (subclavian a. and subclavian v.)

24
Q

location of the phrenic nerve

A

✓Passes anterior to the root of lung
✓Lies between fibrous pericardium and parietal pleura
✓Right phrenic nerve passes through the Caval opening
✓Adjacent to superior vena cava, then inferior vena cava
✓Passes through the Caval opening
✓Crosses the aortic arch
✓Over left ventricle

25
Q

function of the phrenic nerve

A 
✓Sole motor supply to the diaphragm
✓Also supplies sensory fibres to
 ✓the mediastinal parietal
pleura
✓peritoneum and pleura related to the central tendon of the diaphragm
✓parietal pericardium
26
Q

phrenic nerve and referred pain

A
  • Referred pain?
  • Supraclavicular Nerves: C3-4
  • Lateral supraclavicular nerve supplies skin over shoulder, which is the C4 dermatome
  • Therefore, structures with a sensory supply via the phrenic may refer pain to the back of neck, the supraclavicular region, shoulder tip
27
Q

phrenic nerve injury

A

✓ Division of the phrenic nerve in the neck
✓ What if there is no paralysis ?
✓ Radial incisions in the diaphragm from the costal margin to the oesophageal hiatus
✓ Cardiac surgery: instillation of saline slush for myocardial preservation
✓ Thoracic surgery
✓ Lung tumours
✓ Mediastinal tumours
✓ Polio
✓ Iatrogenic?

28
Q

ANTERIOR MEDIASTINUM

A 
T4
T5
✓ Prevascular compartment
✓ Boundaries
• Sternal body and xiphisternum 
• pericardium
• lungs with pleura
✓ Contents
• Thymus (±)
• Internal mammary vessels
• Lymph nodes (Terrible)
• Connective tissue
• Fat tissue
• Lower pole of Thyroid
• Ectopic parathyroid
29
Q

THYMUS

A

✓ Bi-lobed organ of lymphoid tissue
✓ Between the manubrium, sternum
and pericardium
✓ Related to Pericardium; Superior vena cava and aorta; Left and Right brachiocephalic veins; Pleura; Phrenic nerves; Trachea
✓ Extends from lower neck (jugular notch) to 4th costal cartilage (sometimes below aortic arch)
✓ Active in childhood until puberty
✓ Increasing fibro-fatty infiltration with age

30
Q

trachea

A

starts at level C6 and ends as tracheal bifurcation, can rise and descend to the level of T4 and T6 with inspiration and expiration

31
Q

Posterior to the sternoclavicular joint

A

Formation of the brachiocephalic veins (BCV) by the Internal jugular (IJV) and subclavian (ScV) veins; division of Brachiocephalic trunk to its branches on the right side

32
Q

Posterior to 1st right CC

A

Formation of superior vena cava (SVC) by right and left BCVs

33
Q

Posterior to 2nd right CC

A

Arch of the azygos vein joins SVC

34
Q

Posterior to 3rd right CC:

A

SVC enters the right atrium

35
Q

what makes up the posterior mediastinum

A 
✓Vertebral bodies ✓Proximal (posterior)
costal segments
✓Proximal segments of posterior intercostal vessels
✓Proximal segments of intercostal nerves
✓Sympathic chain with its ganglia
36
Q

thoracic aorta

A

begins at the level of the sternal angle and runs till the aortic hiatus (T12)
lies on the left of the thoracic vertebral bodies, but moves to the midline in the lower thorax

37
Q

visceral branches of the thoracic aorta

A 
✓ Oesophageal arteries
✓ Bronchial arteries → usually 2 on the
left + 1 on the right
✓ Pericardial branches
✓ Mediastinal branches
38
Q

role of the oesophagus

A

transport food and fluid to the stomach
✓ Starts in the midline as the continuation of the pharynx at C6, inferior border of cricoid cartilage
✓ It descends between the trachea and the vertebral column
✓ Enters the thorax behind trachea, with the arch of the aorta to its left in the superior mediastinum

39
Q

upper third of the oesophagus

A

striated muscle as swallowing is voluntary and rapid

40
Q

middle third of the oesophagus

A

mixed striated and smooth

41
Q

lower third of the oesophagus

A

smooth muscle

42
Q

what type of cells line the oesophagus

A

stratified squamous epithelium

43
Q

movement of the oesophagus in the posterior mediastinum

A

swings forwards and to the left and pierces the diaphragm at T10

44
Q

what cause the four constrictions of the oesophagus

A

upper oesophageal sphincter
arch of the aorta
left main bronchus
diaphragm

45
Q

where do the upper and middle thirds of the oesophagus drain

A

azygous, hemiazygous, acessory hemiazygous (systemic)

46
Q

where does the lower third of the oesophagus drain to

A

left gastric vein (portal system)

however ANASTOMOSIS between middle and lower thirds via; porto-systemic or portocaval anastomosis

47
Q

oesophagus nerve supply (thoracic part)

A

✓Left vagus→Anterior vagal trunk
✓Right vagus→Posterior vagal trunk
✓ Fibres from the anterior and posterior vagal trunks, together with sympathetic fibres form the oesophageal plexus around the oesophagus

48
Q

MEDIASTINAL LYMPH NODES

A

Superior and inferior tracheobronchial nodes
✓ Clustered around the trachea and oesophagus
✓ Receives the lymph from the lung→spread of lung tumour

49
Q

the anterior mediastinal nodes

A

are around the brachiocephalic veins

50
Q

The posterior mediastinal nodes

A

behind the heart and adjacent to the oesophagus

51
Q

THORACIC DUCT

A

✓ Carries the lymph from much of the body (except thorax, upper limb and head and neck of the right side)
✓ It starts at the cisterna chyli
✓ Lies between the aorta and azygos
vein in the posterior mediastinum
− Pulsation of the Aorta promotes lymph flow
✓ At T4/5 crosses behind the oesophagus to ascend on its left side
✓ Chylothorax - fluid leak between lung and chest wall
✓ Arches over the apex of the left lung and pleura
✓ Opens into the left brachiocephalic vein at the junction of the left internal jugular and the left subclavian vein (Pirogoff’s angle)

Y2S1 CARDIO. (47 decks)

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