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Year 2 Semester 1 Part 2 > Trachea, bronchial tree and lungs > Flashcards

Trachea, bronchial tree and lungs Flashcards

1
Q

What are the conducting portions of the respiratory system?

A
  • Nose, nasal cavity, paranasal sinuses
  • Pharynx (nasopharynx, oropharynx, laryngopharynx)
  • Larynx
  • Trachea
  • Bronchi, bronchial tree
  • Terminal bronchioles
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2
Q

What are the respiratory portions of the respiratory system?

A
  • Respiratory bronchioles
  • Alveoli (ducts and sacs)
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3
Q

Describe the Trachea

A
  • Fibrous and cartilaginous tubeconducting air from larynx to bronchi
  • 10-11 cm long, ~2.5cm diameter, from C6 to T4/5 vertebral levels
  • Has “c shaped” cartilage rings to maintain patency
  • Posteriorly, smooth muscle called trachealis which joins each end of the rings, controls diameter
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4
Q

Describe the Carina

A

Point where the trachea divides into two main bronchi T4/5 level

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5
Q

What structures are posterior to the Trachea?

A
  • Oesophagus
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6
Q

What structures are anterior to the Trachea?

A
  • Thyroid gland isthmus
  • Brachiocephalic trunk, Left brachiocephalic vein
  • Cardiac plexus nerves (sympathetic and parasympathetic)
  • Tracheobronchial lymph nodes
  • Manubrium
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7
Q

What surface landmark marks the bifurcation of the Trachea?

A

Sternal Notch

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8
Q

What structures pass laterally to the Trachea?

A
  • Thyroid gland lobes
  • Parathyroid glands
  • Left and Right Common carotid arteries
  • Aortic arch and left subclavian artery
  • Azygous arch and right Vagus nerve
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9
Q

What structures lie posterolaterally to the Trachea?

A
  • Left and right recurrent laryngeal nerves
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10
Q

Describe the arterial supply of the Trachea

A
  • Inferior thyroid artery
  • Bronchial artery
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11
Q

Describe the venous drainage of the Trachea

A
  • Inferior thyroid vein
  • Bronchial veins
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12
Q

Describe the lymphatic drainage of the Trachea

A
  • Pre and Paratracheal nodes
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13
Q

Describe the nerve supply of the Trachea

A

Pulmonary plexus

  • Parasympathetic from Vagus nerve
  • Sympathetic from Sympathetic trunk
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14
Q

What is the sympathetic system’s effect on the Trachea?

A

Dilation

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15
Q

What is the parasympathetic system’s effect on the Trachea?

A

Constriction

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16
Q

Describe the structure of the Bronchi

A

Continuation of the Trachea
- Complete cartilage rings
- Smooth muscle

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17
Q

How many secondary bronchi are there?

A

3 Right
2 Left

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18
Q

How many Bronchial Arteries are there?

A

1 Right
2 Left

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19
Q

Describe Bronchioles

A
  • Serial divisions of conducting bronchioles, down to 20-25 generations
  • As number increases size individually decreases but total surface area increases
  • Becomes respiratory bronchioles –> alveolar ducts –> alveolar sacs
20
Q

Describe Alveoli

A
  • Single cell thick sac
  • Surrounded by vasculature
  • Large surface area - efficient for gas exchange
21
Q

Describe the histology of the Trachea

A
  • Cartilage - ossifies with age
  • Respiratory epithelium - ciliated pseudostratified columnar
  • Trachealis muscle
22
Q

Describe the histology of the bronchioles

A
  • No cartilage
  • Smooth muscle
  • Respiratory epithelium - ciliated pseudostratified columnar
23
Q

What are club cells?

A
  • Non-ciliated cuboidal epithelial cells found in terminal bronchioles
  • Produce protective secretions
24
Q

Describe the walls of the Alveoli

A

Pneumocytes
* Type I - thin to allow for gas exchange
* Type II - produce surfactant

25
Q

What are the functions of the Lungs?

A
  • Gas exchange
  • pH balance
  • Prostaglandin synthesis
  • Metabolic functions - angiotensin I to angiotensin II
26
Q

Describe the lobes and fissures of the left lung

A

Superior Lobe
Oblique Fissure
Inferior Lobe

27
Q

Describe the lobes and fissures of the right lung

A

Superior Lobe
Horizontal Fissure
Middle Lobe
Oblique Fissure
Inferior Lobe

28
Q

Where do the vasculature and airways enter the lung?

A

Root of the Lung in the Hilum

29
Q

Describe Lung Segments

A

Right and Left:
* Superior lobe
Apical
Posterior
Anterior

  • Inferior lobe
    Superior (apical)
    Anterior basal
    Posterior Basal
    Medial basal
    Lateral basal

Right only:
* Lateral and medial segments of middle lobe

Left only:
* Superior lingular and inferior lingular of superior lobe

Segments and tertiary bronchial supply
30
Q

Describe the clinical significance of Lung Segments

A

Separated by Septa
* Infection typically confined to one segment
* Can be resected as one unit
* Each have own arterial supply from pulmonary artery

31
Q

What is the Root of the Lung

A

Connection of the Lung to the Mediastinum
Contains:
* Main bronchus
* Pulmonary Arteries and Veins
* Bronchial Arteries and Veins
* Lymph Nodes and Vessels

32
Q

Describe the Arterial Supply of the Lung

A

Bronchial Arteries
* 2 Left - supplied by Aorta
* 1 Right - supplied by 3rd Intercostal Artery

Pulmonary Arteries
* From pulmonary trunk
* Most superior structure in Hilum

33
Q

Describe the Venous Drainage of the Lungs

A

Bronchial Veins
* Drain to Azygos on the Right, Hemiazygos on the Left
* Can re-enter pulmonary circulation

Pulmonary Veins
* Two per side (Superior and Inferior)

34
Q

Describe the Pulmonary Plexus

A

Divided into Anterior and Posterior parts
* Relative to the trachea and bronchi

Supplied from
* Vagus parasympathetically
* Sympathetic Trunk

Supplies lungs and visceral pleura

35
Q

Describe the parasypathetic system’s effect on the lungs

A

Bronchoconstriction, vasodilation and secretomotor

36
Q

Describe the sympathetic system’s effect on the lungs

A

Bronchodilation and vasoconstriction

37
Q

Describe the Lymphatic drainage of the Lungs

A
  • Subpleural plexus
  • Intrapulmonary Nodes
  • Hilar Nodes
  • Tracheobronchial Nodes
  • Paratracheal Nodes
  • Bronchomediastinal trunks
38
Q

Describe the clinical considerations of Asthma

A

Commonest lung condition - >8 million people UK

Airway diameter reduced by inflamation

Different types
* Allergic
* Non-allergic
* Occupational

Salbutamol treatment
* β2 receptor agonist - relaxes bronchial muscle

39
Q

Descrobe the clinical considerations of COPD

A

Common - biggest risk factor is smoking

Causes
* Mucus hypersecretion
* Alveolar desctruction
* Emphysema
* Chronic bronchitis

40
Q

Describe the clinical considerations of Lung Cancer

A

Smoking is the biggest risk factor
* Bronchial carcinoma (95% of primary tumours)
* Common site for metastatic tumours - via lymphatic system

Asbestos
* Mesothelioma

Pancoast Tumour
* Tumour in the Apical lobe
* Can cause nerve compression

Poor prognosis

41
Q

Describe the clinical considerations of pneumothorax

A

Air in pleural cavity - “Collapsed Lung”

Causes
* Spontaneous in tall, thin males
* Penetrating chest injury
* Lung damage
* Higher risk in certain syndromes

42
Q

Describe the clinical considerations of Pneumonia

A

Infective
* Bacterial
* Viral
* Fungal

Can affect one or multiple lobes
* Lobar pneumonia

More likely with underlying health conditions or frailty

Lying supine is a risk factor

43
Q

Describe the clinical considerations of Cystic Fibrosis

A

Commonest genetically transmitted disease
* Autosomal recessive
* 1 in 2000

Mucous too thick due to abnormal ionic composition
* Malfunctioning chloride transporter

44
Q

Describe the clinical considerations of Foreign Body Aspiration

A

Items have tendency to the right bronchus
* Not always detectable by X-ray

Bronchoscopy to visualise/retrieve

45
Q

Describe the clinical considerations of Pulmonary Embolism

A

Blockage occurs in pulmonary artery
* Thrombus from lower limb
* Fat
* Air
* Tumour

Risk factors
* Immobilisation
* Recent surgery
* Malignancy
* Paralysis
* Smoking
* Obesity

46
Q

Describe a Tracheostomy

A

Incision into trachea via 2nd and 3rd tracheal rings
* Non-emergency procedure
* Likely to be long term
* Consider position of the inferior thyroid veins

47
Q

Describe a Bronchoscopy

A

Camera inserted to visualise the lungs
* Performed under sedation
* Can occur alongside device to remove foreign body or take biopsy

Year 2 Semester 1 Part 2 (3 decks)

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