Trachea, Bronchi, Lungs, Diaphragm, and Respiration Flashcards
What does the trachea consist of?
15-20 C-shaped cartilaginous rings that open posteriorly. Filling the posterior gap is the trachealis muscle
Where does the trachea bifurcate into left and right main bronchi?
The sternal angle
Define carina.
A prominent ridge located within the trachea at its bifurcation, which separates the openings of the right and left main bronchi
Which main bronchus passes under the azygos vein and gives off the superior lobar bronchus before entering the hilum of the lung?
Right main bronchus
T or F. The right main bronchus divides into the superior and inferior lobar bronchi within the hilum.
False; it divides into the middle and inferior lobar bronchi within the hilum.
Which main bronchus passes anterior to the esophagus and divides into superior and inferior lobar bronchi within the hilum of the lung?
Left main bronchus
A patient in your waiting room is eating peanuts and suddenly begins coughing non stop. What could have happened to this patient? Explain the mechanism.
1) Aspiration of a foreign object
2) The peanut enters the right main bronchus due to its wide, short, vertical arrangement
3) The carina is covered with sensitive muscous membrane. It represents the lowest point in the tracheobrachial tree where the cough reflex is mechanically initiated
What happens if a small object that was once stuck in the carina passes and the coughing stops?
Chemical bronchitis and atelectasis may occur
What is the blood supply to the trachea? (2)
1) Inferior thyroid artery
2) Bronchial arteries
What is the innervation of the trachea? (2)
1) Vagus nerve
2) Sympathetic trunk
What is the innervation of the trachea? (2)
1) Vagus nerve
2) Sympathetic trunk
Name the 3 surfaces of the lung.
1) Costal
2) Mediastinal
3) Diaphragmatic
What is the hilum?
Opening through which the vessels, nerves, and bronchi pass
What is the root of the lung formed by and what is its purpose?
The structures that pass through the hilum. Connects the heart to the trachea
What is the pulmonary ligament?
Formed by a double layered membrane that is a continuation of the pleura that covers the root of the lung
How many bronchopulmonary segments does each lung have?
10
Name the lobes and fissures of the right lung.
Superior, middle and inferior
Oblique and horizontal fissure
What are the characteristic features of the right lung?
1) Groove for azygos vein
2) Groove for esophagus
3) Cardiac impression
4) Groove for superior vena cava
5) Groove for right brachiocephalic vein
Name the lobes and fissures of the left lung.
Superior and inferior lobe
Oblique fissure
What are the characteristics of the left lung?
1) Lingula
2) Cardiac notch
3) Cardiac impression
4) Groove fore arota
5) Groove for left subclavian artery
Why are the bronchopulmonary segments important to the lung? What do they consist of?
Functional units of the lung
1) segmental bronchus
2) branch of the pulmonary artery
3) segment of lung tissue
4) surrounding septum
Why are the bronchopulmonary segments important to the lung? What do they consist of?
Functional units of the lung
1) segmental bronchus
2) branch of the pulmonary artery
3) segment of lung tissue
4) surrounding septum
What is the blood supply of the lungs?
Bronchial arteries from the thoracic aorta and bronchial veins to the azygos and accessory hemiazygos veins
Draw the tracheobronchial tree.
On page 74 in book.
What is the innervation of the lungs?
Anterior and posterior pulmonary plexuses that lie in front of and behind the root of the lung. Formed by fibers from the vagus nerve and sympathetic trunk
T or F. Sympathetic activation produces bronchial dilation and vasoconstriction.
True
T or F. Sympathetic activation increases glandular secretion.
False: it decreases glandular secretion
T or F. Parasympathetic activation produces bronchial constriction and vasodilation.
True
Does parasypathetic activation increase or decrease glandular secretion in the lungs?
Increases glandular secretion
Does parasypathetic activation increase or decrease glandular secretion in the lungs?
Increases glandular secretion
What is asthma?
An obstructive airway disease characterized by coughing, wheezing, and difficulty breathing
What is asthma caused by?
Spasms of smooth muscle which lies in the segmental bronchi and bronchioles
What is asthma accompanied by?
Excessive secretions of mucus
Name the two types of asthma and what they are triggered by.
1) Extrinsic asthma- triggered by allergens
2) Intrinsic asthma- triggered by non-allergic stimuli such as stress, cold, or exercise
Explain how chiropractic care helps asthmatic patients.
1) Associated with upper thoracic subluxations
2) Adjustment brings relief
3) Sympathetics originate from T2-T5- impingement may allow parasympathetic activation to dominate
4) Lower thoracics (T9-T11) supply adrenal medulla, which secretes ephinephrine, a potent bronchodilator
Where does lymph from the lungs drain into?
The pulmonary and bronchopulmonary nodes located in the hilum. These in turn drain into the trachrobronchial nodes
Why are the lungs and tracheobronchial tree rich with lymphatics?
They are an interface with the environment so they are rich to filter the incoming air
T or F. The respiratory epithelium is ciliated.
True
Why is the respiratory epithelium ciliated?
Mucocillary clearance- moves mucus up and out of the larynx
Why do smokers cough?
Their ciliated respiratory epithelium gets damaged
Explain bronchogenic carcinoma.
1) Primary tumor of bronchus
2) Directly related to cigarette smoking
3) Highly metastatic. It spreads quickly to lymph nodes and enters the blood stream by eroding a venule and traveling via the pulmonary veins to the heart and systemic circulation.
Often times, bronchogenic carcinoma causes enlargement of which nodes?
Sentinel node (hard and painless)
What nerves can lung cancer affect?
1) Phrenic nerve- resulting in paralysis of half the diaphragm
2) Recurrent laryngeal nerve- at apex of lung, resulting in paralysis of half the larynx
T or F. Intrathoracic diseases such as bronchogenic carcinoma or lung infections may refer pain to lower cervical cord segments.
False; Intrathoracic diseases such as bronchogenic carcinoma or lung infections may refer pain to upper or middle thoracic cord segments
T or F. Both sympathetic and vagal branches to the lungs contain sensory fibers.
True
What structure separates the thorax from the abdomen?
Diaphragm
T or F. The left dome of the diaphragm is slightly higher, because it overlies the liver.
False; the right dome is slightly higher because it overlies the liver
Name the two parts of the diaphragm.
1) Muscular part
2) Central tendon
Where does the muscular part of the diaphragm take origin from and insert into?
Originates from a number of bony sources and inserts into a muscular tendon
What are the 3 points of origin of the muscular part of the diaphragm?
1) Sternal from xiphoid process
2) Costal from the lower 6 costal carilages
3) Lumbar from lumbar vertebrae 1-3 and the medial and lateral arcuate ligaments
Which opening of the diaphragm is located at T8 within the central tendon?
Caval Opening
Which opening of the diaphragm transmits the inferior vena cava and right phrenic nerve?
Caval opening
Which opening of the diaphragm is located at T10?
Esophageal hiatus
Which opening of the diaphragm transmits the esophagus and the anterior and posterior vagal trunks?
Esophageal hiatus
Which opening of the diaphragm is located at T12?
Aortic hiatus
Which opening of the diaphragm transmits the aorta, thoracic duct, and azygos vein?
Aortic hiatus
Which vessels supply blood to the diaphragm?
1) Musculophrenic artery
2) Pericardiacophrenic artery
3) Superior phrenic artery
4) Inferior phrenic artery
Which nerves innervate the diaphragm?
1) Phrenic nerve (C3, C4, C5)- motor and sensory to central part
2) Intercostal nerves- sensory ro peripheral part
A 50 year old patient presents with symptoms of belching and epigastic pain due to gastroesophegal reflux. What could this patient potentially have?
1) Hiatal hernia
2) Due to weakness in the diaphragmatic wall around esophegeal hiatus
3) The upper part of the stomach slides up into the thoracic cavity through the opening
What chiropractic adjustment could help with hiatal hernia?
SOT technique
What are the three major movements of inspiration?
1) Piston movement
2) Bucket handle movement
3) Pump handle movement
What happens in piston movement?
The diaphragm contracts, pulling the domes inferiorly into the abdomen. Results in an increase in the vertical diameter of the thorax
What happens in bucket handle movement?
Elevation of the lower ribs about an antero-posterior axis. Results in an increase in the transverse diameter of the thorax.
What happens in pump handle movement?
Elevation of the upper ribs about a transverse axis. Results in an increase in the antero-posterior diameter of the thorax.
What do the three movements of inspiration result in?
An increase in intrathoracic volume and a decrease in intrathoracic pressure
What happens in normal expiration?
The diaphragm and external intercostal muscles relax and air is expelled passivley
What happens in forced expiration?
The internal intercostals, innermost intercostals, and the muscles of the anterior abdominal wall contract.
What happens to abdominal volume and pressure during inspiration?
Abdominal volume is decreased while intra-abdominal pressure is increased
Why is abdominal pressure and volume important clinically?
Important factor in occurrence of inguinal hernias
What is a result of spasmodic contraction of the diaphragm?
Hiccups
Hiccups are caused by irritation of which nerve?
Phrenic nerve
What are some underlying causes of hiccups?
Brain lesions, pleuritis, peritonitis
