SGD10:LowerRespiratoryPassages

1.
Discussthetracheaastolength,framework,commencement,termination,position,
relations,andneurovascularsupply
TRACHEA

chondromusculomembranoustube1014cms
Commencement:belowcricoidcartilageatlevelofCV6
Termination:belowtheangleofLouisatlevelofTV67
growth:first2years45cms6th8thyear57cmsadolescence910cms
Cshapedhyalinecartilage:15201inchrings(adult),intertwinedandconnectedby
elasticfibroustissue
OpenedPosteriorlytomakeitmoreflexible.WhenSomethingPassesthrough
theesophagus,itcanadjustitsshape
Posteriorlythegapbet.thefreeendsoftheCisspannedbya
musculomembranouswallcomposedoffibroelastictissuewithsomesmooth
musclefibers(Trachialismuscle)
Thewalliscloselyopposedtotheanteriorlongitudinalmusclesoftheesophagus
whichliespoteriortoit

bloodsupply:upperhalfinferiorthyroidarteries
lowerhalfinternalthoracicarteries
bifurcationbronchialarteries
nerveinnervations:vagus,recurrentlaryngeal,sympathetictrunks=totrachealisand
mucosallining
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relationships:

anterior

Posterior

right

left

sternum,thymus,
leftbrachiocephalic
vein,originsof
brachiocephalic&
leftcommoncarotid
arteries,archof
aorta

esophagus,left
recurrent
laryngealnerve

azygosvein,
rightvagus,
pleura

archofaorta,left
commoncarotid&
subclavian
arteries,left
vagus,leftphrenic
nerves,pleura

bifurcation:
belowsternalangleofLouis(TV67)intorightandleftprimarybronchi
:internally,indicatedwithmucosalridge=carina(T5)
LymphNodesPretracheal,Paratrachealanddeepcervicallymphnodes

2.
Comparetherightfromtheleftprimarybronchus.
3.
Discussthepleuraastoitslayers,neurovascularsupplyandrecesses.
4.
Discussthegrossfeaturesofeachlungastoits
4.1.
borders,surfaces,lobes
4.2.
apex,neurovascularsupply,drainage
Apex
Apexofthelungprojectsintotheneck,canbemappedoutontheanteriorsurfae
ofthebodybydrawingacurvedline,convexupward,fromtheSCMjointtoapoint1
inchabovethejunctionofthemedialandintermediatethirdsoftheclavicle.

Neurovascularsupply
Innervation
Innervationviathepulmonaryplexuseslocatedatanteriorandposteriortothe
lungroots.
Innervationofsmoothmuscleofbronchialtree,pulmonaryvessels,glandsof
bronchialtree
Postganglionicfibersfromsympathetictrunks
Preganglionicparasympatheticfibersfromvagusnerve(CNX),small
parasympatheticganglia,andpostganglionicparasympatheticnerves
Parasympatheticfibersarebronchoconstrictors,vasodilators,secretomotortothe
glands.
Visceraafferentfiberscarryinformationforcoughreflexes,stretchreception,
bloodpressure,chemoreception,nociception.

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5.
6.

Vasculature
Eachlungissuppliedbyapulmonaryartery,carryingunoxygenatedbloodfrom
thepulmonarytrunkfromtherightventricleoftheheart.Eachpulmonaryartery
givesrisetolobarandsegmentalarteries.
Intrasegmentalveinsdrainintotheintersegmentalveinsinthepulmonarysepta
whichrunsaseparatecoursefromthepulmonaryandsegmentalarteriesand
whichdraintotwopulmonaryveinsforeachlung.
Pulmonaryveinscarryoxygenatedbloodtotheleftatriumoftheheart.
Bronchialarteriesfromthoracicaortacarryoxygenatedbloodtothetissueofthe
lungs,travelalongposteriorsurfaceofthebronchi.
Leftbronchialarteriescomefromthoracicaortasinglerightbronchialarterymay
alsoarisefromthesuperiorposteriorintercostaloraleftsuperiorbronchial
artery.
Bronchialarteriesanastomosewithbranchesofthepulmonaryarteries.

Drainage
Pulmonaryveinsdrainbloodtothelungssuppliedbythebronchialveins,
Lymphfromlungsdraintopulmonarylymphnodes(alongthelobarbronchi),
bronchopulmonarylymphnodes(alongthemainstembronchi),superiorand
inferiortracheobronchiallymphnodes(superiorandinferiortothebifurcationof
thetrachea)

Discusswithillustrationthebronchopulmonarysegments:itscompositionand
characteristics
Onthemediastinalsurfaceofthelung,describethe:
6.1.
hilus
6.2.
pulmonaryroot
6.3.
pulmonaryligament

HILUS
triangulardepressionaboveandbehindthecardiacimpressionwherestructureswhichform
therootofthelungenterandleave
connectsthemedialsurfaceofeachlungtotheheartandtrachea
surroundedbypleuraprolongedbelowasthepulmonaryligament
structuresinclude:
1.pulmonaryartery
2.superiorpulmonaryveins
3.inferiorpulmonaryveins
4.lymphaticvessels
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5.bronchus,withbronchialvesselssurroundingit
Pulmonaryroot
rootofthelungisformedofstructuresenteringandleavingthelung
madeupof:
1.bronchi
2.pulmonaryartery
3.pulmonaryveins
4.lymphvessels
5.bronchialvessels
6.bronchialnerves
surroundedbya
tubularsheathofpleura
,whichjoinsthemediastinalparietalpleuratothe
visceralpleuracoveringthelungs
Pulmonaryligament
rootofthelungiscoveredinfront,aboveandbehindbypleura,andthatatitslowerborderthe
investinglayerscomeintocontactheretheyformasortofmesentericfold,the
pulmonary
ligament
,whichextendsbetweenthelowerpartofthemediastinalsurfaceofthelungandthe
pericardium
justabovethediaphragm,theligamentendsinafreefalciformborderitservestoretainthe
lowerpartofthelunginposition

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