Thorax 1 (Respiratory System) - part 2 Flashcards
What do dermatomes correspond with on the chest wall?
Intercostal spaces
What is a dermatome?
Area of skin supplied by a single spinal nerve
At the sternal angle, dermatome C4 lies immediately above T2 instead of C5, why is this?
C5-T1 supplies the arms
What dermatome is overlying the sternal angle?
T2
What dermatome is overlying the nipple area?
T4
What dermatome is overlying the umbilicus?
T10
What dermatome is overlying the inguinal region?
L1
What is the purpose of the lymphatic system?
Return lymph to the circulatory system
What is lymph?
Essentially plasma that has leaked from capillary beds due to hydrostatic pressures
What organs do not have lymphatic drainage?
Cartilage
Eyes
Inner ear
Brain
Spinal cord
What are the major groups of lymph nodes?
Axillary
Superficial and deep inguinal
Pectoral
Tracheobronchial
Lumbar/pelvis
Superficial cervical and deep cervical
Where are the axillary lymph nodes?
Root of the upper limbs
Where are the superficial and deep lymph nodes?
Root of the lower limbs
Where are the pectoral lymph nodes?
Around the pectoralis major muscle
Where are the tracheobronchial lymph nodes?
Bifurcation of trachea in thorax
Where are the lumbar/pelvic lymph nodes?
Around root of arteries in the abdomen and pelvis
Where are the superficial and deep cervical lymph nodes?
Head and neck
What is A?
Cervical lymph nodes
What is B?
Infraclavicular lymph nodes
What is C?
Axillary lymph nodes
What is D?
Para-aortic lymph nodes
What is E?
Inguinal lymph nodes
What is F?
Pelvic lymph nodes
What is G?
Spleen
What is H?
Mediastinal lymph nodes
What is I?
Supraclavicular lymph nodes
Where do lymph nodes tend to be clustered around?
Large veins
What do the axillary lymph nodes lie in relation to?
Axillary vein and its branches in the axilla
What are examples of axillary nodes?
Anterior (pectoral) group
Posterior group
Apical group
Central group
Lateral groups
What is A?
Axillary vein
What is B?
Central axillary nodes
What is C?
Lateral axillary nodes
What is D?
Posterior axillary nodes
What is E?
Subscapular vein
What is F?
Pectoralis minor
What is G?
Anterior axillary nodes
What is H?
Apical axillary nodes
Where does most of the lymph of the breast drain to?
Anterior (pectoralis) lymph nodes
Where is the base (glandular part) of the breast located?
Between ribs 2 to 6 and between the lateral border of the sternum and the midaxillary line
What is the glandular part of the breast divided into?
16-20 lobes and smaller lobules
What is the glandular part of the breast surrounded by?
Adipose (fatty) tissue
Where does the axillary tail of the breast extend?
Uperolaterally to penetrate the floor of the axilla
Which dome of the diaphragm is more superior?
Right
Why is the right dome of the diaphragm more superior than the left?
Left needs to make room for the heart
What level is this CT scan taken at?
T4
Trachea has just bifurcated, as has the pulmonary artery
What colour do the lungs and respiratory passages appear in a CT scan?
Black
Why do respiratory passages and the lungs appear black in CT images?
Air filled spaces
How does one view a CT scan by clinical convention?
Feet up
What is the relative position of the oesophagus to the trachea at all points along their length?
Posterior
Is their cartilage in a bronchiole?
No
How does the trachea branch?
Trachea - primary bronchi - secondary bronchi - tertiary (segmental) bronchi - bronchioles - terminal bronchioles - respiratory bronchioles - alveoli
What bronchus is extrapulmonary?
Primary bronchi
What bronchus is intrapulmonary?
Secondary and tertiary bronchus
What is tertiary bronchi also known as?
Segmental bronchi
What are the 2 portions of the branches from the trachea known as?
Conducting portion (no gas exchange)
Respiratory portion (gas exchange)
What is the last component of the conducting system of the respiratory system?
Terminal bronchioles
What is the beginning of the respiratory portion of the respiratory system?
Respiratory bronchioles
What is A?
Trachea
What is B?
Main bronchus
What is C?
Segmental bronchus
What is D?
Bronchioles
What is E?
Terminal bronchioles
What is F?
Respiratory bronchioles
How do you known this is a bronchus?
Presence of hyaline cartilage plates
What is A?
Hyaline cartilage plates
What is the diameter of a bronchioles?
1mm or less
What things are not present in bronchioles compared to trachea and larger bronchi?
Cartilage
Glands
This a slide of a bronchioles, what is A?
Terminal bronchioles
This is a slide of a bronchioles, what is B?
Respiratory bronchioles
What does this slide show?
Bronchioles
What is still present in the terminal bronchioles that is present in larger airways?
Some cilia and smooth muscle
What is the classification of the epithelium of terminal bronchioles?
Columnar or cuboidal
What is A?
Blood vessels
What is B?
Bronchiole
What is C?
Blood vessel
What is D?
Alveolar duct
Alveolus
What two connective tissue fibres are found in the alveolar walls?
Elastin
Reticulin
What 3 cells are found in the wall of an alveolus?
Type 1 pneumocyte
Type 2 pneumocyte
Macrophage
What is the function of a type 1 pneumocyte?
Permit gas exchange to take place
What is the function of a type 2 penumocyte?
Secrete pulmonary surfactant
What is the function of a macrophage?
Digest forign bodies
What is A?
Type II pneumocyte
What is B?
Macrophage
What is C?
Type I pneumocyte
What is the pleura?
Double layer of serous membranes that surround each lung
What does the pleura consist of?
Outer parietal layer (lining the inner wall of the chest cavity)
Inner visceral layer (adherent to the lung tissue)
Pleural space (or cavity, which is the space between these two membranes)
Which of the parietal and visceral layer of the pleura is outer and inner?
Parietal is outer (lines chest wall)
Visceral is inner (lines lungs)
What is A?
Trachea
What is B?
Pleura (lung lining)
What is C?
Lung
What is D?
Pleural space
How would you describe the relationship between the parietal and visceral layers of the pleura?
Continuous to each other
Which layer of the pleura enters and lines the fissures of the lungs?
Visceral
Which layer of the pleura is sensitive to pain?
Parietal
What nerves supplies pain sensation to the pleura?
Phrenic nerve
Intercostal nerves
What is the parietal pleura also named according to?
Its location within the thoracic cavity:
mediastinal pleura
diaphragmatic pleura
costal pleura
apical pleura
Where does the mediastinal pleura line?
The structures situated between the two pleural cavities (mediastinum)
Where does the diaphragmatic pleura line?
Superior surface of the diaphragm
Where does the costal pleura line?
Inner surfaces of the ribs and sternum
Where does the apical pleura line?
Apex of the lungs in the root of the neck
What is the apical pleura also known as?
Cervical pleura
What lies immediately above the apical pleura?
A fascial membrane known as the suprapleural membrane
What is A?
Apical/cervical pleura
What is B?
Costal pleura
What is C?
Mediastinal pleura
What is D?
Diaphragmatic pleura
What is the presence of air within the pleural space known as?
Pneumothorax
What occurs at the reflections within the pleura?
Space between the parietal and visceral pleura is greater than normal, forming a pleural recess
What can occur in a pleural recess?
Accumulation of fluid
What is 1?
Costodiaphragmatic recess and reflection
What is 2?
Costomediastinal recess and reflection
What is each part of the pleura innervated by?
Phrenic nerve - mediastinal adn diaphragmatic parietal pleura
Intercostal nerves - remainder of parietal pleura
What kind of innervation does the visceral pleura have?
Autonomic innervation for stretch
What is the surface markings of the pleura?
Starting 2.5cm above mid point of medial 1/3 of clavicle
Meet in midline at rib 2
Left side diverges at rib 4 to makr room for the heart, whilst the right continues parasternally to rib 6
Both cross rib 8 in the midclavicular line
Then rib 10 in the midaxillary line
Both reach posterior chest just below rib 12
(continuous red line)
What is the surface markings of the lungs?
2 rib spaces less than the pleura
(blue dotted line)
What are the surface markings of the fissues?
Oblique - spine of T3 vertebra to rib 6 anteriorly along medial border scapula
Horizontal (on right only) - rib/costal cartilage 4 to rib 5 in midaxillary line
(purple dotted lines)
What are the surface markings of the oblique fissue?
Spine of T3 vertebrae to rib 6 anteriorly along medial border of scapula
(purple dotted lines)
What are the surface markings of the horizontal fissure?
Rib/costal cartilage 4 to rib 5 in midaxillary line
(dotted purple line)
What fissure(s) are present on the left lung?
Oblique fissure
What fissure(s) are present on the right lung?
Oblique
Horizontal
What rib level is the lung at in the:
midclavicular line
midaxillary line
midscapular line
Midclavicular - rib 6
Midaxillary - rib 8
Midscapular - rib 10
What rib level is the parietal pleura at in the:
midclavicular line
midaxillary line
midscapular line
Midclavicular line - rib 8
Midaxillary line - rib 10
Midscapular line - rib 12
How many intercostal spaces difference is there between the inferior border of the lung and parietal pleura at each landmark?
2
What organ occupies the notch seen in the anterior border of the left lung between ribs 4 and 6?
Heart
What space does the heart occupy?
Ribs 4 to 6
The oblique fissure follows the course of what rib?
Rib 6
The horizontal fissure follows the course of what rib?
Rib 4
Where does the posterior border of each lung extend from?
C7 to T10
Why is pleural aspiration performed in the 9th intercostal space in the midaxillary line and not the 10th?
Risk of penetrating the abdominal (pritoneal) cavity
What is the diaphragm?
Sheet of skeletal muscle that forms the boundary between the thoracic and abdominal cavities
How many attachments does the diaphragm have?
4
How many hiatuses (openings) does the diaphragm have?
3 major and a number of minor
What do the hiatuses (openings) in the diaphragm permit?
Structures to pass between the thorax and abdomen
What is the purpose of the diaphragm?
Main muscle for respiration
Assists in raising inta-abdominal pressure during coughing, vomiting and defaecation
What is the main muscle of respiration?
Diaphragm
What are hiatuses?
Openings
Which of the left or right dome of the diaphragm lies more superior during normal expiration and why?
Right as the heart pushes down on the left
What cardiac structure is firmly attached to the central tendon?
Fibrous pericardium
At which vetebrae are the left and right crura attached?
Left - L1-L2
Right - L1-L3
What is the crura of the diaphragm?
Tendinous structures that extend below the diaphragm to the vertebral column, forming a muscular tether for contraction
Which membrane covers the superior surface of the diaphragm?
Parietal membrane
What is A?
Central tendon of diaphragm
What is B?
Opening for inferior vena cava
What is C?
Diaphragm
What is D?
Central tendon
What is E?
Medial arcuate ligament
What is F?
Left crus of diaphragm
What is G?
Aorta
What is H?
Diaphragm
What is I?
Oesophagus
What is J?
Right crura of diaphragm
When the diaphragm contracts, do the domes ascend or descend?
Descend
What is the shape of the central tendon?
Clover
What attachments does the diaphragm have?
1 central tendinous and 4 peripheral bony
What tendon is the diaphragm attached to?
Central tendon
What costal cartilages is the diaphragm attached to?
Costal cartilage 7 - 10
What part of the sternum is thr diaphragm attached to?
Xiphoid process
What vertebrae is the diaphragm attached to?
L1 - L3
How do major and smaller structures pass through the diaphragm?
Major structures pass through the major hiatuses
Smaller structures can pass along with the major structures or pass through a minor hiatus by themselves
What are the major structures that pass through the diaphragm?
Inferior vena cava
Oesophagus
Aorta
What vertebral level is the opening for the vena cava on the diaphragm?
T8
What vertebral level is the opening for the oesophagus through the diaphragm?
T10
What vertebral level is the opening for the aorta through the diaphragm?
T12
This shows the major structures passing through the diaphragm, what is A?
Sternum
This shows the major structures passing through the diaphragm, what is B?
Diaphragm
This shows the major structures passing through the diaphragm, what is C?
Inferior vena cava
This shows the major structures passing through the diaphragm, what is D?
Oesophagus
This shows the major structures passing through the diaphragm, what is E?
Aorta
This shows the major structures passing through the diaphragm, what is F?
Celiac trunk
This shows the major structures passing through the diaphragm, what is G?
Superior mesenteric artery
Through which part of the diaphragm does the inferior vena cava pass?
Tendinous not muscular
Why does the inferior vena cava pass through the tendinous and not muscular part of the diaphragm?
So it doesn’t contract and stop the blood flow
Why do the structures that pass through the diaphragm more anteriorly also pass through it at a higher vertebral level?
Due to the dome shape
What is a hiatus hernia?
Abnormal protrusion (herniation) of a structure into the thorax through a tear or weakness in the diaphragm caused by frequent hard coughin, heavy lifting or a number of other things
What things could herniat in a hiatus hernia?
Abdominal oesophagus
Upper part of the stomach
What kind of nervous innervation does the diaphragm recieve?
Motor and sensory supply on both its left, right, superior and inferior sides
What nerves supply innervation to the diaphragm?
Phrenic nerves (motor and sensory)
Lower intercostal nerves (sensory to peripheral parts of the diaphragm)
What vertebral levels of the spinal cord contribute to the phrenic nerves?
C3, 4 and 5
Nervous supply to the diaphragm, what is A?
Phrenic nerve
Nervous supply to the diaphragm, what is B?
Lower intercostal nerves
What kind of innervation does the phrenic nerves give the diaphragm?
Motor and sensory
What kind of innervation does the lower intercostal nerves give the diaphram?
Sensory
What parts of the diaphragm are innervated by the lower intercostal nerves?
Periphery of the diaphragm
What is required if damage to the spinal cord occurs above the level of the phrenic nerves?
Paralysis of the diaphragm and the need for artificial ventilation
How can you differentiate the vagus and phrenic nerves?
Vagus are thicker and lie more medially, and soon pass posteriorly in the thorax out of view to lie on the oesophagus
Phrenic nerves remain relatively anterior and visible throughout their course to the diaphragm
What is A?
Vagus nerve
What is B?
Phrenic nerve
How do muscles contribute to the respiratory movements of inspiration and expiration?
Inspiration involves active contraction of the respiratory muscles to increase volume of the chest capacity
Expiration is normally passive
What is forced inspiration/expiration?
Involves the action of accessory muscles, which are ussually attached to the superior and inferior boundaries of the thoracic cavity
(such as muscles of the neck attaching to the sternum and upper ribs, and muscles of the abdoment that attach to the lower ribs)
What happens during damage to the phrenic nerve?
Paralysis of ipslateral dome of the diaphragm
Intercostal muscles and nerves work to compensate and maintain some respiratory function
When should penetrating wounds be suspected to cause damage to the diaphragm?
Below the nipples (intercostal space 4) due to the upwards arching of the domes in quite expiration to the rib 5 if not higher
