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Anatomy: Respiratory > Consequences of Chronic Cough > Flashcards

Consequences of Chronic Cough Flashcards

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1
Q

What is dynamic airway compression?

A

When during expiration the intrapleural pressure rises above alveolar pressure which compresses the airways

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2
Q

Why is expiration more difficult than inspiration?

A

In expiration, the intrapleural pressure rises which compresses the airways narrowing them, making expiration more difficult

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3
Q

What can the build up of air in the alveoli due to dynamic airway compression lead to?

A

A rupture of the visceral pleura

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4
Q

What is the consequence of a rupture of the visceral pleura?

A

Air can enter the pleural cavity and the transmural pressure gradient is lost

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5
Q

What is a pneumothorax?

A

Air in the pleural space which results in the loss of the connection between the lung and the body wall

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6
Q

What defines a small pneumothorax?

A

Less than a 2cm gap between the lung and the parietal pleura

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7
Q

What defines a large pneumothorax?

A

Greater than 2cm between the lung and parietal pleura

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8
Q

What can cause a pneumothorax?

A

Penetrating injury to the parietal pleura

Rupture of the visceral pleura

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9
Q

What would be seen on examination of a patient with a pneumothorax?

A

Ipsilateral reduced chest expansion and breath sounds

Hyper-resonant percussion

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10
Q

What is a tension pneumothorax?

A

A pneumothorax where the torn pleura forms a one way valve which allows air into the pleural cavity on inspiration but prevents it leaving on expiration

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11
Q

What can a tension pneumothorax cause?

A

Mediastinal shift due to the increased pressure on one side of the thorax with each inspiration

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12
Q

What are the regions of the mediastinum?

A

Superior mediatstinum

Inferior mediastinum, made up of

  • anterior mediastinum
  • middle mediatstinum
  • posterior mediastinum
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13
Q

What level divides the superior and inferior mediatstinum?

A

Level of the sternal angle

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14
Q

Which region of the mediatstinum is the heart located in?

A

Middle mediastinum

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15
Q

What divides the anterior, middle and posterior mediatstinum?

A

The heart forms the middle mediastinum which puts anything anterior to the heart in the anterior mediastinum and anything posterior to the heart in the posterior mediastinum

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16
Q

What are the consequences of a tension pneumothorax?

A

Tracheal deviation

SVC compression can reduce venous return to the heart

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17
Q

What direction does the trachea deviate to in a unilateral tension pneumothorax?

A

Away from the side of the pneumothorax

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18
Q

What structure can be compressed in a tension pneumothorax which reduces venous return to the heart

A
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19
Q

What is the management of a large pneumothorax?

A

Thoracentesis (needle aspiration)

or

Chest drain

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20
Q

What is the purpose of thoracentesis/chest drain in the management of a large pneumothorax?

A

To remove the excess air from the pleural cavity

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21
Q

4th or 5th intercostal space in the midaxillary line

In the ‘safe triangle’

  • anterior border of lattismus dorsi
  • posterior border of pectoralis major
  • axial line superior to nipple
A
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22
Q

What are the borders of the ‘safe triangle’ in drainage of a large pneumothorax?

A

Anterior border of lattismus dorsi

Posterior border of pectoralis major

Axial line superior to nipple

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23
Q

From superficial to deep, which layers are penetrated in the drainage of a large pneumothorax?

A

Skin (superficial)

Superficial fascia

Deep fascia

External intercostal muscles

Internal intercostal muscles

Innermost intercostal muscles

Parietal pleura (deep)

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24
Q

What is the management of a tension pneumothorax?

A

Insertion of large bore cannula into the pleurl cavity via the 2nd or 3rd intercostal spaces in the midclavicular line on the side of the tension pneumothorax

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25
Where is the large bore cannula inserted in the management of a tension pneumothorax?
2nd or 3rd intercostal space, midclavicular line
26
What is used in the emergency management of a tension pneumothorax?
Large bore cannula
27
From superficial to deep, which layers must the large bore cannula penetrate in the treatment of a tension pneumothorax?
Skin Superficial fascia Deep fascia External intercostal muscle Internal intercostal muscle Innermost intercostal muscle Parietal pleura
28
What is a hernia?
The protusion of a structure outside the compartment meant to contain it
29
Which two factors are normally required for the development of a hernia?
Weakness of part of the wall containing a structure Increased pressure on one side of that wall
30
Which parts of the body wall have a normal anatomical weakness and what are the herniae which can arise from this?
Diaphragm - diaphragmatic hernia Umbilicus - umbilical hernia Inguinal canal - inguinal hernia Femoral canal - femoral hernia
31
Name a congenital hernia
Congenital diaphragmatic hernia
32
What is the name of the hernia which results from the weakness of the body wall due to surgical scars?
Incisional hernia
33
What can weaken the body wall?
Congenital abnormalities Surgical scars Some parts of the body have a natural anatomical weakness
34
What can cause an increase the pressure leading to herniae?
Cough
35
How can chronic cough cause herniae?
Coughing increases the pressure exerted on the anterolateral abdominal wall, diaphragm and inguinal/femoral regions which can push structures through any weak spots
36
What is the most common diaphragmatic hernia?
Hiatus herniae
37
What is a hiatus hernia?
Where part of the stomach pushes up into the thoracic cavity
38
Where are the natural weak spots in the diaphragm?
Oesophageal hiatus At the attachments to the xiphoid process Aortic hiatus Caval opening Posterior attachments
39
What are the two classes of hiatus hernia?
Paraoesophageal hiatus hernia - part of stomach passes into chest and is parallel to the oesophagus Sliding hiatus hernia - part of stomach passes into chest with the gasto-oesophageal junction
40
What kind of hernia is this?
Paraoesophageal hiatus hernia
41
What kind of hernia is this?
Sliding hiatus hernia
42
Where do the inguinal ligaments attach?
On the anterior superior iliac spine (ASIS) and the pubic tubercle
43
What is the oesophageal hiatus?
Hole in the diaphragm which the oesophagus passes through
44
What is the aortic hiatus?
Hole in the diaphragm which the aorta passes through
45
What is the caval opening?
Hole in the diaphragm which the inferior vena cava passes through
46
What is the iguinal canal?
A 4cm passageway through the anterior abdominal wall in the inguinal region
47
What is the anterior superior iliac spine?
Bony projection of the iliac bone
48
Name the numbered boney prominences
1. Anterior superior iliac spine 2. Pubic tubercle
49
What is the pubic tubercle?
Bony projection of the iliac bone
50
What forms the floor of the inguinal canal?
The medial half of the inguinal ligaments
51
What are the inguinal ligaments?
Inferior border of the external oblique aponeuroses
52
What are the entrance and exit to the inguinal canal called?
Deep ring (entrance) Superficial ring (exit)
53
What is the superficial ring?
A v-shaped defect in the external oblique aponeurosis
54
Where is the superficial ring located?
Immediately superolateral to the tubic tubercle
55
Where is the deep ring?
Superior to the midpoint of the inguinal ligament
56
What is an inguinal herniae?
Protusion of the contents of the abdominal cavity through the inguinal canal
57
Where do inguinal herniae form?
In the medial half of the inguinal region
58
What causes the weakness of the body wall in the development of inguinal herniae?
Presence of the inguinal canal
59
When is the inguinal canal formed?
Formed embryologically during the passage of the testes/round ligament of the uterus into the perineum
60
What does the inguinal canal contain in adults?
Spermatic cord (men) Round ligament of the uterus (women)
61
Name the numbered structures
1. Ureter 2. Rectus abdominus 3. Inguinal canal 4. Testes 5. Parietal peritoneum 6. Kidneys
62
Where do the testes descend from during their development?
Abdomen into the scrotum
63
Which layers of the anterolateral abdominal wall do the testes pass through during their developent?
Transversalis fascia Internal oblique muscle V-shaped defect of external oblique aponeurosis (pass into but don't penetrate) Superficial fascia
64
What forms the inguinal canal?
Descent of the spermatic cord/round ligament of the uterus through the anterolateral abdominal wall during embryonic development
65
What layer of tissue forms the deep ring?
Transversalis fascia
66
What layer of the spermatic cord does the internal oblique muscle become when the spermatic cord passes through it?
Cremasteric fascia
67
What layer of the spermatic cord does the transversalis fascia become when the spermatic cord passes through it?
Internal spermatic fascia
68
What layer of the spermatic cord does the external oblique aponeurosis become when the spermatic cord passes through it?
External spermatic fascia
69
From deep to superficial, what are the 3 layers of the spermatic cord and what tissue are they formes from?
Internal spermatic fascia - transversalis fascia (deep) Cremasteric fascia - internal oblique muscle External spermatic fascia - external oblique aponeurosis (superficial)
70
Name the numbered structures
1. Testiular artery 2. Testicular vein 3. Visceral peritoneum 4. Parietal peritoneum 5. Tranversalis fascia 6. Transversus abdominus 7. Internal oblique muscle 8. Inguinal ligament/external oblique aponeurosis 9. Deep fascia 10. Superficial fascia 11. Skin 12. Anterior superior iliac spine 13. Pubic tubercle 14. Peritoneal cavity 15. Testes 16. Abdominal organs 17. Vas deferens
71
Name the numbered structures
1. Testicular artery 2. Testicular vein 3. Parietal peritoneum 4. Transversus fascia 5. Transversalis abdominus 6. Internal oblique muscle 7. Inguinal ligament/external oblique aponeurosis 8. Deep fascia 9. Superficial fascia 10. Tunica vaginalis 11. Skin 12. Anterior superior iliac spine 13. Pubic tubercle 14. Deep ring of the inguinal canal 15. Spermatic cord 16. Superficial ring of the inguinal canal
72
What is the processus vaginalis?
Embryonic outpouching of parietal peritoneum
73
What is the tunica vaginalis?
Pouch of serous membrane which covers the testes
74
What embryonic structure is the tunica vaginalis derived from?
Processus vaginalis
75
What does the spermatic cord consist of?
3 layers developed as it passes through the inguinal canal - external spermatic fascia (from external oblique aponeurosis) - cremasteric fascia (from internal oblique muscle) - internal spermatic fascia (from transversalis fascia) Structures within it - testicular artery - vas deferens - pampiniform plexus
76
What layer of the abdominal wall is the internal spermatic fascia derived from?
Transversalis fascia
77
What layer of the abdominal wall is the cremasteric fascia derived from?
Internal oblique muscle
78
What layer of the abdominal wall is the external spermatic fascia derived from?
Aponeurosis of the external oblique muscle
79
What structures run within the spermatic cord?
Testicular artery Vas deferens Pampiniform plexus Autonomic nerves Genitofemoral nerve Lymphatics
80
From superficial to deep, what are the three layers of the spermatic cord and what skin tissues are they derived from?
External spermatic fascia - aponeurosis of external oblique (superficial) Cremesteric fascia - internal oblique muscle Internal spermatic fascia - transversalis fascia (deep)
81
Name the numbered structures
1. Transversus abdominus 2. Internal oblique 3. External oblique 4. Ilioinguinal nerve 5. Inguinal ligament 6. Superficial ring 7. Internal spermatic fascia (transversalis fascia) 8. Cremasteric fascia 9. External spermatic fascia (aponeurosis of external oblique) 10. Visceral peritoneum 11. Parietal peritoneum 12. Transversalis fascia 13. Peritoneal cavity 14. Abdominal organs 15. Deep ring 16. Rectus abdominus 17. Conjoint tendon
82
What is the conjoint tendon?
Medial end of the combined aponeuroses of the internal oblique and transversus abdominus which anchours those muscles to the pubic bone
83
What is the function of the conjoint tendon?
Anchors the internal oblique and transversus abdominus to the pubic bone
84
Name the numbered structures
1. Spermatic cord 2. Vas deferens 3. Testicular artery 4. Pampiniform plexus
85
Name the numbered nerves
1. Iliohypogastric nerve 2. Ilioinguinal nerve
86
What anterior ramus is the iliohypogastric nerve from?
Half of L1 (other half from ilioinguinal nerve)
87
What anterior ramus is the ilioinguinal nerve from?
Half of L1 (other half for iliohypogastric nerve)
88
Name the numbered structures
1. Inguinal ligament (cut) 2. Cremasteric fascia 3. Spermatic cord (severed) 4. Ilioinguinal nerve
89
Name the numbered structures
1. Inguinal canal 2. Spermatic cord 3. Superficial ring 4. Ilioinguinal nerve
90
Where does the ilioinguinal nerve lie in the inguinal canal?
Within inguinal canal but external to spermatic cord
91
Name the numbered structures
1. Vas deferens 2. Testicular artery 3. Pampiniform plexus
92
Which sex more commonly develop inguinal hernias and why?
Males Larger inguinal canal
93
What passes through the inguinal canal in females?
Round ligament of the uterus
94
What are the two classes of inguinal herniae and what is the difference?
Direct (structure directly pushes out of superficial ring) Indirect (structure passes through both deep and superficial rings)
95
How can you distinguish between direct and indirect herniae?
Reduce the hernia Occlude the deep ring with finger Ask patient to cough If direct hernia, lump will reappear If indirect hernia, lump won't reappear
96
What is a direct hernia?
One which directly protudes out the superficial ring without passing through deep ring
97
What is an indirect hernia?
One which passes through both the deep and superficial rings
98
If you reduce a direct hernia, occlude the deep ring and ask the patient to cough, what would be seen?
The hernia would reappear
99
If you reduce an indirect hernia, occlude the deep ring and ask the patient to cough, what would be seen?
The hernia would not reappear

Anatomy: Respiratory (3 decks)

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