Thorax II Flashcards
How many pleural cavities are there
2
Are the independent from each other?
yes!
What are the two layers of the pleura?
- Visceral layer
2. Parietal layer
Describe visceral layer
intimately related to surface of lung
Describe parietal layer
liners inner chest wall
, upper surface of diaphragm,
and sides of pericardium and mediastinum
What is the pulmonary ligament
where 2 layers become continuous at the root of the lung,
This pleural cuff hangs down in a loose fold
What is the pleuarl cavity
aka pleural space
Contains pleural fluid
separates parietal and visceral layers
What are the different parietal regions and recesses
Costal pleura Diaphragmatic pleura Mediastinal pleura Costodiaphragmatic recess costomediastinal recess
Is parietal pleura sensitiv eto pain, temperautre, touch, and pressure?
yes
What nerves are in costal pleura
Intercostal nerves
What nerves are in Mediastinal pleura
Phrenic Nerve
What neves are in the Diaphgragmatic pleura
Lower 6 intercostal nerves
What are parietal recesssess
region where pleural space is enlarged
What are the parietal recesses?
Costomediastinal recess (where heawrt protrudes to elft; ~3.5 inches from 5th rib, intercostal space)
2 Costodiaphragmatic recess
What is Open Pneumothorax. What way does heart shift
HOle in pleural cavity.
B/c Patm>Plung, lung defaltes
Cardiac shifts opposite trauma at inhale; and exhale, shifts back to place (emplty pleural cavity at at pressure)
What is tension pneumothorax
Trauma causes flap, which becomes a one way valve
Air goes into chamber, deflates lung, heart shift opposite trauma (Patm air pushing heart)
During exhale, atm pressure cannot get out b/c of one way valve flap => heart continues to shift opposite traubma–> BAD
How do you treat Tension Pneumothorax?
Release pressure from affected side by puncturing pleura ! Release Pressure. Poke on superior side of rib to avoid puncuring VAN
Where is surface anatomy of Trachea. Describe it’s cartilage
C6 (border of cricoid cartilage) - T4
Incompqlete U shaped cartialge deficient posteriorl (replaced by fibrous tissue)
What is the carina? What area is its surface anatomy
is tis where the trachea bifurcates!
It is located around T4
Orientation of trachea compared to esophagus and arch of aorta
Esophagus is POSTERIOR to trachea
Arch of aorta is to teh LEFT of trachea
Sternum, thymus
If a little kid inhales sosmething, which bronchi is it more likely in?
More likely right side because it is wider and shorter and more vertical than left side
What are lobes from right side
Supieror, middle and inferior lobes
What are lobes from left lung
superior and inferior lobes
Which lung is larger?
Right lung
What do the bornchial veins drain into? What drains from it
Drains bronchi, CT of lunch, and visceral pleura into azygos and hemiazygos veins
What is the nerve supply of the lungs
Pulmonary plexes
What is the pulmonary plexus
Afferent and efferent autonomic nerve fibers formed by branches of sympathetic trunk and receives PS fibers from vagus nerve supply to lungs
afferent and efferent ANS fibers, formed by branches of symp trunk and receive PS fibers from VAGUS N
What are the contents of the Mediastinum
Thymus Heart Large BV Trachea Esophagus Thoracic Duct Vagus Phrenic N. Sympatheric Trunks
What are the divisions of the Mediastinum
Superior
Inferior
What are inferior mediastinum divided into
Middle-pericardium and heart
Anterior- space between pericardium and sternum
Posterior- between pericardium and lower 8 thoracic vertebrae
Where does azgous vein ascend through in diaphragm? what side ?
Through aortic opening, on right side of AORTA to level of T5
Where does Azygos vein empty into
Into Posterior surface of Superior Vena Cava
Where does Hemiazygos vein arise from?
arises on left side by junciton of left subcostal adn ascending lumbar veins
Ascends on left side of vertebral column, posterior to thoracic aorta to level of T9,
Then crosses to right to join AZYGOS VEIN
Azygos vs Hemiazygos
Azygos- Right
Az ..that’s right
Hemiazygos & Accessory hemiazygos vein- Left
What is more superior; hemiazygoes or accessory hemiazygos
Accessory hemiazygos is mor`e superior
How long is esophagus and where does the surface anatomy extend from
10 inches long
Extending from lower border of cricoid cartilage to cardiac orfice of stomach
What does Esophagus structure consist of
Outer CT sheath
Muscular layer of exernal longitudinal circular fiber (striated in upper 2/3 and smooth in lower 1/3)
Submucosal layer containing mucous glands
Mucosal layer of stratified epithelium
What is the arterial supply of esophagus
Inferior thyroid artery
Branches of the descending thoracic aorta and left gastric artery
What is venous drainage from esophagous
Inferior thyroid and left gastric veins
What is the superior, middle and inferior esophageal constirctions
Superior- pharynx
Middle- aortic arch, Left bronchus
Inferior- through diaphragm
What is the thoracic duct
Main lymphatic duct
Conveys to the blood all lymph from lower limbs, pelvic cavity, abdominal cavity, left thorax, left arm and left side of head and neck
Where does thoracic duct begin? Through Aortic Opening in the diaphragm
in abdomen as dialted sace cisterna chyli
Ascends through aortic opening in diaphragm
Wha does Thoracic duct drain
Drains lymph from entire Left side and Lower right side
Where does Thoracic drain drain into?
empties into Left Brachiocephalic vein
Where does azygous vein drain?
Azygos vein empties into superior vena cava
What nerves go to thorax?
Right vagus nerve
Left Vagus nerve
What do the branches of the vagi supply?
Lungs and esophagus
What does right vagus give branchs off
Right vagus gives off cardiac bracnhes
Left vagus gives off…
left recurrent laryngeal nerve
course of left recurrent laryngeal nerve
Hooks aroudn ligamentum arteriosum and ascends between the trachea and esophagus on the left side to supply most muscles of the left vocal cord
What nerve(s) supply left recurrent laryngeal nerve
Left recurrent laryngeal nerve whcih is a branch of the left vagus nerve
Where does phrenic nerve arise? what does it innervate
Arise from ventral rami of cervical nerves 3, 4, 5
possess both efferent and afferent fibers an are sole nerve suply to diaphragm
Does phrenic nerve pas anterior or posterior to root of lung
travels anterior to root of lung
How does thoracis sypathetic trunk course
continuous wiht cervical (superiorly) and lumbar (inferiorly) parts of symp trunk
What is the most laterlaly placed structure in teh medastinum
Thoracic symp trunk
How ay ganglia does thoracic symp trunk have
12 (soemtimes 11 sementally arranged gnaglica,
Wher are postganglionic fibers T1-5 distributed from thoracic symp trunk?
to heart, aorta, lungs, and esophagus
What does preganglionic fibers from T5-T12 form?
splanchnic nerves
pierce crura of diaphrgam and supply the abdoinal viscera
what is greater splanchnic
lesser splanchinc
leas splanchnic
Greaer- T5-9
Lesser T10 -T11
Least T12
