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MD3001 - Respiratory Anatomy > Diaphragm, mechanisms of respiration and surface projections > Flashcards

Diaphragm, mechanisms of respiration and surface projections Flashcards

1
Q

Describe the diaphragm

A

Muscular at its periphery and tendious centrally

Thin musculotendinous structure that separates the thoracic and abdominal acivities

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2
Q

What is the does the diaphragm close?

A

inferior thoracic aperture

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3
Q

What is the shape of the diaphragm?

A

J-shaped

both saggittal and transverse planes

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4
Q

How many domes does the diaphragm have?

A

2

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5
Q

What dome of the diaphragm is higher and by how much?

A

Right

1cm

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6
Q

In full expiration what is the upper border of the diaphragm on the RHS?

A

4th intervertebral space

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7
Q

In full expiration what is the upper border of the diaphragm on the LHS?

A

5th intevertebral space

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8
Q

What is the diaphragm attached to laterally and anteriorly?

A
  • xiphoid process of the sternum
  • deep surface of the last 6 ribs and costal cartilages (costal margin)
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9
Q

What is the function of the median arcurate ligament?

A

surrounds aorta and forms aortic hiatus

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10
Q

What is the diaphragm attached to posteriorly?

A
  • Lumbar vertebrae and vertebral discs
    • Right crus (L1-3)
    • Left crus (L1-2)
  • Median acruate ligament - medial borders of crura
  • Medial acruate ligament - body to transverse process of L1
  • Lateral arcruate ligament - transverse process of L1 - rib 12
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11
Q

Where does the diaphragm insert?

A

central tendon (centrum tendineum)

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12
Q

What is the level of the central tendon of the diaphragm?

A

xiphosternal synchondrosis

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13
Q

What sits on the central tendon?

A

the heart

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14
Q

What is the central tendon fused to and what is its function?

A

fused to the pericardium and halts its descent during forced inspiration

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15
Q

What ligaments prevent the excessive descent of the diaphragm?

A

pericardiophrenic ligaments

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16
Q
A

black = left crus

purple = right crus

blue = median arcruate ligament

red = lateral arcruate ligament

green = medial arcruate ligament

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17
Q

Describe the caval opening

A
  • At the level of T8 through the central tendon
  • Inferior vena cava
  • right phrenic nerve
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18
Q

Describe the oesphageal opening

A
  • At the T10 level, through the right crus
  • oesphagus
  • both vagus nerves
    • Anterior = left vagus
    • Posterior = right vagus
  • left gastric vessels
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19
Q

Describe the aortic hiatus

A
  • At T12 level behind the median arcruate ligament
  • Aorta
  • thoracic duct
  • azygous and hemiazygos
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20
Q

What travels through the crura?

A
  • branches of left phrenic nerve
  • splanchnic nerves
  • azygos and hemiazygos
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21
Q

What travels behind the medial arcruate ligament

A

sympathetic trunk

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22
Q
A

green = caval opening

red = oesphageal opening

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23
Q
A

Black = aortic hiatus

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24
Q
A

green = inferior phrenic nerve

25
Q

Where are the three major openings in the diaphragm?

A 
T8 = VENA CAVA
T10 = Oesphagus

T12 = Aortic Hiatus

26
Q

What is the vascular supply of the diaphragm?

A
  • superior phrenic artery - branch of thoracic aorta (superior)
  • branches of musculophrenic arteries
  • branches of pericardiophrenic arteries
  • inferior phrenic artery - branch of abdominal aorta (inferior)
27
Q

What is the neural supply of the diaphragm?

A
  • Phrenic nerve (efferent and afferent)
    • Motor
    • Sensory from central tendon, pariteral pleural and pericardium
  • Intercostal nerves
    • sensory from the periphery of the diaphragm
28
Q
A

blue = phrenic nerve afferent

red = phrenic nerve efferent

green = intercostal nerves

29
Q

what is Boyle-Mariotte’s law?

A

the absolute pressure exerted by a given mass of an ideal gas is inversely proportional to the volume it occupies if the temperature and amount of gas remain unchanged within a closed system

30
Q

What is respiration

A

inspiration + expiration

31
Q

What occurs during inspiration to the size of the thorax and the pressures within it?

A
  • diameters of the thorax increase
    • creates negative intra-thoracic pressure (less than atmopsheric pressure)
    • air is sucked into the lungs
32
Q

How does expiration occur?

A

by muscle relaxation and elastic recoil of the elastic tissue in the lungs and bronchi

33
Q

What happens to the diaphrgam during inspiration?

A

contraction of the diaphragm flattens the domes

  • domes descend
  • vertical diameter increases
  • volume of the thorax increases
  • intrathoracic pressure decreases
  • air is drawn into the lungs
34
Q

What is the action of the external intercostal muscles?

A

as the body of the rib passes obliquely downwards, contraction of the external intercostal muscles to raise the body of the rib towards the one above lifts the sternum and pushes it anteriorly

35
Q

What happens to the lung due to the external intercostal muscles during inspiration?

A
  • the saggittal diameter increases
  • volume of the thorax increases
  • intrathroacic pressure decreases
  • air is drawn into the lungs
36
Q

What is responsible for the pump-handle movement?

A

external intercostal muscles

37
Q

What is the direction of the costal cartilages of ribs 5 to 10?

A

pass obliquely upwards to the sternum

38
Q

How do the external intercostal muscles affect the ribs

A

lefts the costal cartilages of ribs 5 - 10 lifting them and displacing the rib laterally

39
Q

What diameter of the lungs are the costal cartilages responsible for increasing during contraction (inspiration)

A

transverse diameter

40
Q

What is responsible for the bucket handle movement?

A

costal cartilages and external intercostals

41
Q

What makes lateral splay/pump handle action possible?

A

the costal cartilages of ribs 4-9 lie obliquely

42
Q

What rib is there no layeral movement of?

A

first rib

43
Q

What movement occurs in forced inspiration and what is the purpose of this?

A

bucket-handle

get as much air into the lungs as possible

44
Q

Where does the bucket-handle movement occur? And why?

A

ribs 8-10 that have flat costo-transverse joints that allow gliding

gives a small, additional increase in the lateral thoracic diameter and therefore volume

45
Q

When are the accessory muscle of respiration used?

A

when more power is required

46
Q

What are the major accessory muscles of respiration and what do the help with?

A
  • pectoralis major = inspiration
  • latissiums dorsi = expiration and inspiration
  • abdominal wall muscles = expiration
  • neck and back muscles = help fix ribs
    • trapezius
    • sternocleidomastoid
    • scalene muscles
47
Q
A

red = four corners of the hart

green = lungs and fissues

blue = pleura

48
Q

What is the surface anatomy of the pleura?

A
  • rise to the level of the neck of the 1st rib, 2cm above clavicle
  • 2nd CC = lie adjacent in the midline
  • 4th left CC = notch for the heart
  • 8th rib = the midclavicular lines
  • 10th rib = the mid axillary line
  • T12 = mid-line
49
Q

How does the surface anatomy of the lung differ from the pleura?

A

2 levels up from the pleura

50
Q

Describe the surface anatomy of the lung

A
  • the apex of the lung projects into the neck
  • 2nd CC - lie adjacent in the midline
  • 4th left CC - cardiac notch
  • 6th CC - deviate laterally
  • 6th rib - midclavicular line
  • 8th rib = mid axillary line
  • 10th rib = midscapular line and midline
51
Q

What can accumuklate in the pleural recesses?

A

fluid

52
Q

What is the costodiaphragmatic recess?

A

narrow potential space between the periphery of the diaphragm and the ribs

53
Q

What is the oblique fissure?

A

curved line that begins between the spinous processes of the vertebrae T3 and T4, crosses the mid-axillary line at 5th intercostal space, and then follows the contour of rib 6

54
Q

What is the horizontal fissue?

A

follows the 4th intercostal space from the sternum until it meets the oblique fissure as it crosses rib 5.

55
Q

When does a pneumothorax occur and how does this affect the lungs?

A

if air enters the pleural caivty

surface tension and negative pressure are lost and the lung collapses

56
Q

What occurs in the affected side of a pneumothorax?

A
  • no thoracic movement
  • flat hemi-diaphragm
  • shift of mediastinum to the unaffected side
57
Q

Where is the triangle of safety and what is inserted here?

A
  • anterior border of latissimus dorsi
  • lateral border of pec major
  • horizontal level of the nipple
  • apex below the axilla
58
Q

What occurs during respiration in a frail chest?

A

the segment freed by fracture is sucked inwards, instead of lifting upwards

paradoxical respiration

MD3001 - Respiratory Anatomy (5 decks)

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