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Cardiovascular and Respiratory > Superior & Posterior Mediastina. > Flashcards

Superior & Posterior Mediastina. Flashcards

1
Q

Where does the mediastinum sit?

A

between the two pleural cavities

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2
Q

Where is the superior and inferior mediastinum divided?

A

at the angle of louis - T4 lower edge

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3
Q

everything in the pericardial sac is in what division of the mediastinum?

A

middle inferior mediastina

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4
Q

What is the purpose of the Thymus gland?

A

Makes T cells in children - replaced with fat as you age -

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5
Q

What occurs at the T4 level?

A

bifurcation of trachea

bifurcation of pulmonary trunk (leaves from right ventricle)

azygos termination

ligamentum arteriosum

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6
Q

Where does the superior mediastinum span from ?

A

T1-T4

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7
Q

the upper pleural cavity extends where?

A

It superiorly extends all the way above the 1st rib

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8
Q

Describe the vessels of the mediastinum

A

internal jugular veins, subclavian veins, brachiocephalic veins (formed behind the sternoclavicular joint), R+L Brachiocephalic form SVC (behind 1st CC)

Azygos joins SVC (behind 2nd CC)

SVC runs into RA (behind 3rd CC)

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9
Q

Where does the Brachiocephalic vein form?

A

formed behind the Sternoclavicular joint

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10
Q

Where does the right/left brachiocephalic form the superior vena cava?

A

behind 1st CC

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11
Q

Where does the azygos join the superior vena cava?

A

behind the 2nd CC

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12
Q

Where does the SVC run into the right atrium?

A

behind the 3rd CC

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13
Q

what major vessels branch from the aorta?

A
  • brachiocephalic - then splits to form the right common carotid and right subclavian
  • Left common carotid
  • left subclavian
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14
Q

where should the trachea normally sit?

A

midline - if it is off center, you need to be wondering why

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15
Q

What two vessels lie over the first rib?

A
  • left/right sublcavian artery
  • left/right subclavian vein
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16
Q

What nerves run over the first rib?

A

The brachial plexus roots and the sympathetic trunk

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17
Q

What muscle runs over the first rib?

A

The scalene muscle?

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18
Q

The subclavian artery is divided into 3 by what referemce?

A
  • by relation to the the scalenus anterior
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19
Q

What are the branches of the first part of the subclavian artery?

A
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20
Q

Vertebral

thyrocervical trunk

  • inferior thyroid

transverse cervicle

suprascapular

internal thoracic

costocervical trunk

A
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21
Q

what are the major structures in the posterior mediastinum?

A

oesophagus

descending aorta

azygos venous system

thoracic duct

(nervous structurs = vagus nerves, and sympathetic chains)

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22
Q

Phrenic and vagus are generally found where?

A

phrenic is mostly anterior superior

vagus is mostly posterior inferior

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23
Q

how long is the oesophagus?

A

25 cm

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24
Q

where does the oesophagus begin?

A

cricoid cartilage = C6

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25
Q

The cricoid cartilage is the begining of what two structures?

A

the oesophagus and the trachea

26
Q

Where do you measure endoscopy levels from?

A

From the teeth

27
Q

how far down is the cricoid cartilage?

A

it is 15cm from teeth

28
Q

oesophagus passes through the diaphragm at what level?

A

T10

29
Q

What are the layers of the oesophagus?

A

outer layer = connective tissue

Muscular = outer longitudinal muscle, inner circular muscle, upper 2/3 striated, lower 1/3 unstriated

*the outer layer is fairly thin - allows for local spread of cancer)

30
Q

what sort of cells are in the innermost area of the oesophagus?

A

stratified squamus (wear and tear epithelium)

31
Q

Where is the squamo comlumnar junction?

A

lower part of oesophagus

32
Q

What structures lie behind the oesophagus?

A
  • posterior = thoracic vertebrae, thoracic duct, azygos vein, descending aorta
  • LEft = aortic arch and descending aorta
  • right = azygos vein
  • anterior = trachea, aortic arch, left bronchus, left atrium
33
Q

Where do you see the aortic arch pressing on the trachea on endoscopy?

A

25cm

34
Q

What is a transoesophageal echo?

A

echo from an endoscopy to see the strucutres like the aorta or trachea without interference of sternum or lymph

35
Q

what is the arterial supply to the oesophagus?

A

upper third = inferior thyroid artery

middle third = thoracic aorta

lower third = left gastric artery from celiac trunk

*venous drainage is pretty much mirrored)

36
Q

what is the lower third of the oesophagus venous system?

A

lower third = left gastric vein - drains into the portal vein- subject to portal pressure- reduced flow and oesophageal varices

37
Q

What overlies the oesophageal veins?

A

only mucosa - nothing restricting the dilation of these vessels or preventing damage to them

38
Q

How does the respiratory system develop from embryology?

A

it originates as a small diverticulum from the gut tube- then it devides into buds, the they then differentiate so the only place the two are connected is in the larynx - every communication between the two should cut off in a normal body

39
Q

what is a tracheoesophageal fistula ?

A

esophagous and the trachea are still connected - potentially allow food to enter the lungs - cuases coughing and potential respiratory issues

40
Q

what is oesophageal atresia?

A

there is complete fusion of the oesophagus - so the liquid flows over

41
Q

what is a hiatus hernia?

A

part of stomach enters the thorax through the diaphragm- most commonly the gastroesophageal junction is present in the thorax

42
Q

what is the term for iritation of the lower oesophagus?

A

oesophagitis - mainly from stomach acid irritation

43
Q

Repeated damage to the oesophagus from stomach acid can lead to what?

A

Barrets oesophagus - eventually may lead to cancer

44
Q

What are the visceral branches from the descending aorta?

A

peridcardial

bronchial

oesophageal

45
Q

What are the parietal branches from the descending aorta?

A

mediastinal

intercostal (and subcostal 12th)

superior phrenic

46
Q

How does Marfan’s syndrome effect the aorta?

A

lack of collagen = weaker vessels break down over time

47
Q

What is the thoracic duct an extension of?

A

The cisterna Caeli?

48
Q

The thoracic duct moves behind the oesophagus at what level?

A

At T5

49
Q

Which vein does the thoracic duct run into?

A

runs into left brachiocephalic vein - drains everything below diaphragm, drains left side above diaphragm

50
Q

What are the attachments of the diaphragm?

A

Crura, median arcuate ligament, medial arcuate ligament, lateral arcuate ligament, lower 6CC’s, xiphoid process

-

51
Q

Which vein peirces the central tendon ?

A

Inferior vena cava - gets smaller when the diaphragm contracts (pulls central tendon)

At T8 along witht he Right phrenic Nerve

52
Q

Does the oesophagus pierce the diaphragm through muscle? Or through the central tendon?

A

It pierces the muscle - there is a ring around it that prevents reflux

at T10 along with the Vagi

53
Q

What structure enters behind the diaphragm?

A

the aorta, thoracic duct, and azygos vein - T12

54
Q

the splanchnic nerves enter through what part of the diaphragm?

A

the Crura

55
Q

What are the roots of the motor supply to the diaphragm?

A

C3,4,5

the sensory are partly supplied by the lower 6 intercostal nerves

56
Q

The superior phrenic arteries arise from what vessle?

A

the thoracic aorta

57
Q

Why does the shoulder often recieve refered pain from the diaphragm?

A

B/c C3,4,5 - visceral nerves are really bad at pinpointint pain

58
Q

where does the inferior phrenic artery arise from?

A

arises from the abdominal aorta

59
Q

is the aorta affected by respiration?

A

no = lies behind the diaphragm

60
Q

Does the IVC change shape during inspiration?

A

IVC widens during inspiration - along with the increased pressure whhich encourages venous return

61
Q

The sympathetic trunks pass through what ligament of the diaphragm?

A

the medial arcuate ligaments

62
Q

the subcostals pass through what ligaments of the diaphragm?

A

lateral arcuate ligaments

Cardiovascular and Respiratory (39 decks)

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