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Anatomy MD3001 > Trachea, Bronchial tree and lungs > Flashcards

Trachea, Bronchial tree and lungs Flashcards

1
Q

How long is the trachea?

A

10-11cm long

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2
Q

How wide is the trachea?

A

2.5cm

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3
Q

Where does the trachea start?

A

C6

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4
Q

Where does the trachea end?

A
  • Intervertebral disc between T4/5
  • At the carina
  • At the sternal angle
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5
Q

Describe the structure of the trachea

A
  • C shaped hyaline cartilage
  • Connected by ligaments and membranes
  • Trachealis muscle (posteriorly towards the ends of the tracheal muscle) alters the tracheal diameter (Smooth muscle so under autonomic control)
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6
Q

Red arrow

A

Trachealis muscle

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7
Q

What is the trachea related to in the cervical region?

A
  • Sternothyroid muscle
  • Sternohyoid muscle
  • Isthmus of the thyroid gland
  • Inferior thyroid muscles
  • Carotid sheath
  • Brachiocephalic trunk
  • Jugular venous arch
  • Recurrent laryngeal nerve (between the trachea and oesophagus)
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8
Q

How does the trachea enter the thoracic cavity?

A

Through the thoracic inlet

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9
Q

Where is the left recurrent laryngeal nerve?

A

In the groove between the trachea and the oesophagus

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10
Q

What does the trachea divide into and at what level?

A
  • Into left and right principle bronchi
  • Sternal angle (T4/5 intervertebral disc)
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11
Q

What is the difference between the principle bronchi?

A

The right is slightly more vertical, shorter and wider

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12
Q

What do the lobar bronchi divide into?

A

segmental bronchi

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13
Q

What happens to the bronchioles as you move distally?

A
  • number increases
  • Diameter decreases
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14
Q

What do the segmental bronchi become?

A

Terminal bronchi

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15
Q

What do the terminal bronchi become?

A

Respiratory bronchioles

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16
Q

What causes the greatest resistance to flow in the conducting passages?

A

Bronchioles

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17
Q

What do respiratory bronchioles open into?

A
  • Alveolar ducts
  • Open in to alveolar sacs
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18
Q

What do respiratory bronchioles open into?

A
  • Alveolar ducts
  • Open in to alveolar sacs
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19
Q

What are the surfaces of the lung?

A
  • Costal: anterior and lateral
  • Diaphragmatic: inferior
  • Mediastinal: medial
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20
Q

What are the margins of the lung?

A
  • Anterior
  • Posterior
  • Inferior
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21
Q

What is another name for the apex of the lung?

A

Cupula

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22
Q

Describe the shapes of the right and left lung

A
  • Right is shorter and wider (due to the liver)
  • Left has cardiac notch and lingula
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23
Q

Lobes of the right lung

A
  • Superior (upper)
  • Middle
  • Inferior (lower)
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24
Q

Lobes of the left lung

A
  • Upper
  • Lower
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25
Q

Fissures of the right lung

A
  • Oblique
  • Horizontal
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26
Q

Fissures of the left lung

A

• Oblique

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27
Q

What structures are located in the root of the lung?

A
  • Pulmonary artery
  • 2 Pulmonary veins
  • A main bronchus
  • Bronchial vessels
  • Nerves
  • Lymphatics
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28
Q

What is the root covered by?

A

Sleeve of mediastinal pleura that reflects onto the surface of the lung

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29
Q

What is the pulmonary ligament

A

The pleura that has extended inferiorly below the root of the lung- it is not tight

• Allows the lungs to be slightly mobile

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30
Q

What are bronchopulmonary segments?

A
  • Smallest functionally and structurally independent unit
  • Section of lung with its own branch of pulmonary artery, nerves and segmental bronchus
  • there is no anastomosis between segments

• They block the spread of disease

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31
Q

What is the shape of the bronchopulmonary segments?

A
  • Pyramid shaped
  • Apices towards the hilum
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32
Q

What separates the bronchopulmonary segments?

A

Connective tissue

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33
Q

Red arrow

A

Pulmonary artery

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34
Q

Green arrow

A

Segmental tertiary bronchus

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35
Q

Blue arrow

A

Pulmonary vein

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36
Q

In the bronchopulmonary segments, where do the pulmonary vein and lymphatics pass?

A

In the inter-segmental septum

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37
Q

How many bronchopulmonary segments does each lung have?

A

10

  • On left: each lobe has 5
  • On right: inferior has 5, middle has 2, superior has 3
38
Q

Bronchopulmonary segments in the upper lobe in the right lung

A
  • Apical
  • Anterior
  • Posterior
39
Q

Bronchopulmonary segments in the middle lobe in the right lung

A
  • Medial
  • Lateral
40
Q

Bronchopulmonary segments in the lower lobe in the right lung

A
  • Superior or apical
  • Posterior
  • anterior
  • Lateral
  • Medial
41
Q

Bronchopulmonary segments in the upper lobe in the left lung

A
  • Apical
  • Anterior
  • Posterior
  • Superior
  • Inferior
42
Q

Bronchopulmonary segments in the lower lobe in the left lung

A
  • Superior or apical
  • Posterior
  • anterior
  • Lateral
  • Medial
43
Q

Epithelium in the bronchi

A

• pseudostratified columnar epithelium of the bronchi

44
Q

Epithelium in the bronchioles

A

• Simple cuboidal epithelium

45
Q

Type 1 alveolar cells

A

Permits diffusion

46
Q

Type 2 alveolar cells

A

Produces surfactant

47
Q

What is viewed in a bronchoscopy?

A
  • Whole of the trachea
  • Main and lobar bronchi
  • Commencement of the first segmental divisions can be seen
48
Q

How should the carina appear in a bronchoscopy and what could it be if different?

A
  • Sharp
  • If distorted, something is growing inferior to it - tumour or enlarged lymph node
49
Q

What is the significance of the apical segment of the inferior lobe?

A
  • Inferolateral to the upper, posterior portion of the oblique fissure
  • Its tertiary bronchus drops off the bronchial tree posteriorly and is prone to pneumonia
  • Especially in bed ridden patients (gravity)
50
Q

What is the arterial supply of the lung tissue?

A
  • Bronchial arteries
  • 1 on the right from the 3rd posterior intercostal artery or the superior posterior Intercostal artery
  • 2 on the left from the aorta
51
Q

What may bronchial arteries anastomose with and where?

A
  • Pulmonary arteries
  • in the walls of the bronchioles
52
Q

What is venous blood drained by?

A
  • Bronchial veins (into the azygos system)
  • Or by pulmonary veins
53
Q

What is the function of the Pulmonary arteries

A

• Carry deoxygenated blood to the lungs at a low pressure

54
Q

Describe the position of the right pulmonary artery

A
  • Passes anterior to the right pulmonary bronchus and posterior to the ascending aorta and Superior vena cava
  • The left pulmonary artery is shorter
55
Q

What is the primary lymph drainage and what do they drain to?

A
  • Deep lymphatic plexus and superficial lymphatic plexus
  • Drains to the pulmonary nodes buried in the hilum
56
Q

Where is the deep lymphatic plexus?

A

Runs alongside the arteries and dividing bronchial tree

57
Q

Describe the lymph drainage from the pulmonary nodes

A
  • Pulmonary nodes to
  • Bronchopulmonary (around the main bronchi in the hilum) to
  • Inferior and superior tracheobronchial to
  • Paratracheal (posterior mediastinal also drain to the paratracheal) to
  • Bronchomediastinal lymph trunks (left and right) (parasternal and anterior mediastinal also drain to here)
  • Thoracic duct
58
Q

Red arrow

A

Superior tracheobronchial

59
Q

Green arrow

A

(carinal) inferior tracheobronchial

60
Q

Blue arrow

A

Paratracheal

61
Q

Black arrow

A

Left and right bronchomediastinal trunk

62
Q

Nerve supply to the lungs

A
  • Supplied by pulmonary plexuses around the main bronchi at the root of the lung
  • Parasympathetic from the vagus synapse in the plexuses
  • postganglionic fibres: Bronchoconstrictor, vasodilator, secretomotor

• Sympathetic fibres from the sympathetic trunk synapse in the sympathetic ganglia

  • postganglionic fibres: Bronchodilator, vasoconstrictor
63
Q

Tumour impinging on phrenic nerve

A

Paralysis of the diaphragm on the affected side

64
Q

Tumour impinging on the sympathetic trunk

A

Horners syndrome

65
Q

Tumour impinging on the aorticopulmonary window

A
  • Left recurrent laryngeal nerve injury
  • Hoarseness of the voice
66
Q

What is a tracheostomy?

A

• Surgically created air passage to help patient breath

67
Q

What are the indications for a tracheostomy?

A
  • Laryngeal obstruction: diptheria, foreign body, tumour
  • Evacuation of excessive secretion
  • For long lasting artificial respiration
68
Q

What are the indications for a tracheostomy?

A
  • Laryngeal obstruction: diptheria, foreign body, tumour
  • Evacuation of excessive secretion
  • For long lasting artificial respiration (poliomyelitis, severe chest injuries)
69
Q

What are the indications for a tracheostomy?

A
  • Laryngeal obstruction: diptheria, foreign body, tumour
  • Evacuation of excessive secretion (severe postoperative chest infection in a patient too weak to cough adequately)
  • For long lasting artificial respiration (poliomyelitis, severe chest injuries)
70
Q

Where is an incision for a tracheostomy made?

A

A vertical incision is made downwards from the cricoid cartilage

• Halfway between cricoid and suprasternal notch

71
Q

Why is the incision for a tracheostomy vertical?

A

To avoid the anterior jugular vein

72
Q

What is a disadvantage of a vertical incision in a tracheostomy?

A

Langer’s lines are horizontal

• Scar tissue

73
Q

What is an alternative to the vertical incision in tracheostomy?

A

Transverse skin crease incision

74
Q

What would happen if the isthmus of the thyroid was hit?

A

It is an endocrine organ so has a huge blood supply and would bleed lots

75
Q

What would happen if the isthmus of the thyroid was hit?

A

It is an endocrine organ so has a huge blood supply and would bleed lots

76
Q

What are the two ways to treat a pneumothorax?

A
  • Needle aspiration: 2nd-3rd intercostal space in the midclavicular line
  • Catheter aspiration: 4th or 5th intercostal space at the midaxillary line
77
Q

What is the red arrow?

A

Bronchopulmonary (around main bronchi in the hilum)

78
Q

What is the green arrow?

A

Inferior and superior tracheobrachial

79
Q

What is the blue arrow?

A

paratracheal

80
Q

What is the red arrow?

A

Left recurrent laryngeal nerve

81
Q

label

A
82
Q

label

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83
Q

Label

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84
Q

Label

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85
Q

Label

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86
Q

Label

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87
Q

Label

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88
Q

Label

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89
Q

Label

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90
Q

When doing a needle aspiration for a pneumothorax, what structures does the needle pass thorugh?

A
  • Skin
  • Pectoralis major and possibly minor
  • external, internal and innermost intercostal
  • endothoracic fasica
  • parietal pleura

Anatomy MD3001 (13 decks)

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