Lungs and bronchial tree

Question 1

Describe the anatomy the trachea

Answer 1

The trachea starts from position C6 to T7 . It marks the beginning of the brachial tree. It has C shaped cartilages anteriorly and it is supported by the trachealic muscles posteriorly to allow the distention of the esophagus.

Question 2

Describe the basic anatomy of the bronchopulmonary segments of both the left and right lung

Question 3

Describe the clinical significance of them

Question 4

What parts of the respiratory systems are the conducting portions and the respiratory portions?

Answer 4

Conducting portion - nasal cavity, pharynx, larynx, trachea, primary and secondary bronchi, bronchioles, terminal bronchioles
Respiratory portion - respiratory bronchiole, alveolar duct, alverolar sac, alveoli

Question 5

What is the difference between the conducting and respiratory portion of the respiratory system?

Answer 5

Conducting portion - moves air in and out of the lungs
Respiratory portion - where it exchanges gases and oxyginates blood

Question 6

Describe the basic anatomy of the bronchi

Answer 6

The trachea splits in two, demarkated by the CARINA.
Then the right and left primary bronchi. The right one is more VERTICAL, SHORTER, and WIDER than the left. It makes an angle of 25 degrees, whilst the left of 45 degrees.
Then each segmental bronchi is connected to each segment of the lung.

Question 7

Describe the CARINA

Answer 7

Description: HOOK SHAPED PROCESS projecting backwards from the lowest tracheal ring

Location: sternal angle. Separating the left and right main bronchi.

Function: Triggers cough reflex because it is MOST SENSITIVE AREA OF TRACHEA

Question 8

What does carinal widening mean?

seen in radiology

Answer 8

Indicates carcinoma spread of the lymph nodes around the tracheal bifurcation.

Question 9

What is the name of the surgery that allows access to the trachea during airway obstruction?

Answer 9

Trache - ostomy

Question 10

What is the difference between the cartiledge of primary bronchi and lobar bronchi?

Answer 10

Lobar bronchi are surrounded by CARTILAGE PLATES

Question 11

What do bronchioles not have compared to the other bronchis?

Answer 11

No hyaline cartilege
No goblet cells (mucus producing)

Question 12

Describe bronchioles

Answer 12

They have SMOOTH MUSCLES and ELASTIC FIBRES (like the other bronchi)

Question 13

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What is the clinical advantage of bronchopulmoary segments having their own arterial supply?

Answer 13

If one of the Brachio pulmonary - BP segments needs to be resected (removed), it can be done WITHOUT AFFECTED ADJACENT SEGMENTS.
It is likely an infection of a segment will not spread to the other segments

Question 14

What two conditions spread to other (brachio-pulmonary) BP segments?

Answer 14

TB and BRONCHO-GENIC carcinoma

Question 15

What two vessels separate each BP segment?

Answer 15

Venous and lymphatic

Question 16

Name and point out the BP segments of the lungs

Answer 16

RIGHT LUNG -
Superior lobe: 1. Apical, 2. Posterior, 3. Anterior,
Middle lobe: 4. Lateral, 5. Medial
Inferior lobe: 6. Apical basal, 7, Medial basal, 8. Lateral basal, 9. Anterior basal, 10. Posterial basal

LEFT LUNG
Superior lobe: 1. Apical, 2. Posterior, 3. Anterior
Inferior: 4. Superior lingular, 5. Inferior lingular
6. Apical basal, 7. Medial basal, 8. Lateral basal, 9. Anterial basal, 10. Posterial basal.

Question 17

Supine (laying back)

Which BP segment is most likely to be filled with fluid in supine patients?

CLINICAL SIGNIFICANCE

Answer 17

6 and 10 DUE TO GRAVITY

Question 18

Describe the position of the lungs and how they relate to each other

Answer 18

The anterior and the posterior borders separate the costal surface from the medial surface of the lung. Unlike the ant+infer borders (sharp), the post is rounded and smooth.

The inferior border of the lung is sharp and it separates the base from the costal surface.

Base of the lungs seats on the diaphragm (diaphragmatic surface)
The apices project above the first rib and into the root of the neck.
The costal surfaces lie immediately adjacent to the ribs and the intercostal spaces of the thoracic wall. The mediastinal surface lies in contact with the mediastinum anteriorly, and the vertebral column posteriorly.

Question 19

What structures make the lateral walls of the mediastinum?

Answer 19

Lungs and hila

Question 20

What is in the hilum of the RIGHT and LEFT LUNG?

Answer 20

LEFT - Primary bronchi spitting into lobar bronchi
1 Pulmonary arteries (carries blood to lung)
2 Pulmonary vein (carries blood to heart)
Pulmonary cartiledge

RIGHT - Primary bronchi spitting into lobar bronchi
2 Pulmonary arteries (carries blood to lung)
2 Pulmonary vein (carries blood to heart)
Pulmonary cartiledge

Connective tissue
Pleural reflection and pulmonary ligaments
Broncho-pulmonary lymph nodes
Pulmonary plexus of nerves (CN X) sympathetic plexus

Question 21

What structures are found AROUND the hilum of the RIGHT LUNG?

Answer 21

Brachiocephalic veins
Superior vena cava
Azygous vein
Oesophagus
Inferior vena cava

Question 22

What structures are found AROUND the hilum of the LEFT LUNG?

Answer 22

Aortic arch
Subclavian artery
Common Carotid artery
Brachiocephalic artery
Brachiocephalic vein
Descending aorta
Oesophagus

Question 23

What lymph nodes supply the lungs?

Answer 23

Broncho-pulmonary lymphs

Question 24

Mnemonic: B, and P vessles

What 2 structures of the lungs form the ROOT of the lungs?

Answer 24

Main bronchi, and PULMONARY VESSELS

Question 25

# It is sounds like friendly... What are the nerves supplying the diaphragm?

Answer 25

PHERNIC NERVES (C3, 4, 5) They are ANTERIOR to the hilum They provide MOTOR and SENSORY supply

Question 26

What nerve runs POSTERIOR to the hilum?

Answer 26

The VAGUS NERVE (CN X)

Question 27

What structures do BRONCHIAL ARTERIES supply blood to? (Bonous question, where do the bronchial arteries come from?)

Answer 27

BRONCHI LUNG ROOTS VISCERAL PLEURA Bonous question answer: DESCENDING AORTA

Question 28

Where do RIGHT BRONCHIAL veins drain into?

Answer 28

AZYGOUS VEIN

Question 29

Where do the LEFT bronchial veins drain to?

Answer 29

ACCESSORY HEMIZYGOUS VEINS

Question 30

What are the nerves for the lungs?

Answer 30

PARASYMPATHETIC (VAGUS NERVE CNX) - Constricts smooth muscles of the bronchi (for coughing), and VASODIALATES pulmonary vessels (slower blood flow) SYMPATHETIC (SYMPATHETIC TRUNK) - Relaxes smooth muscles of the bronchi, and VASOCONSTRICT pulmonary vessels (faster blood flow) VISCERAL - sends PAIN to SENSORY GANGLION of the Vagus Nerve.

Question 31

# The one outside What lymph drains the parenchyma of the lungs? | Parenchyma - functional tissue of the lungs. They perform the activity ## Footnote Explain the lymphs of the lungs

Answer 31

SUPERFICIAL (subpleural) plexus

Question 32

# The one inside What lymph drains the lung root?

Answer 32

The DEEP plexus

Question 33

Where do both the superficial and deep lymph plexus drain into?

Answer 33

Tracheobronchial (around the bifurcation around the main bronchi) --> passes into the right and left broncho-mediastinal trunks | Bifurcation - where it splits BM - part showing the trachea and bronchi

Question 35

Describe the surface markings of the lungs.

Answer 35

For the lungs: - Midaxillary - T6; Laterally - T8; Posteriorly - T10 For the pleura: - Midaxillary - T8; Laterally - T10; Posteriorly - T10

Question 36

# think about what the word itself means What is the relevance of the cotodiaphragmatic recess?

Answer 36

This at the space in at the bottom of the lungs on the side, where if filled with fluid, it would appear dark in colour.

Question 37

Describe the diaphragm

Answer 37

It has two domes. The right side of the dome is higher than the left. The dome is made of mostly skeletal muscles and tendons. It has a right and left crus, a central tendon at the top (which is continuous with the pericardium). It has a left arcuate ligament. It has 3 openings: Caval hiatus: IVC and the 2 phrenic nerves Oesophageal hiatus: oesophagus and the 2 vagus nerves Aortic hiatus: Aorta, thoracic duct and the azygous vein It is innervated by the C3, C4, C5