Flashcards in Fiser Chapter 25. THORACIC Deck (100)
What runs along right side of SVC and dumps into it?
What runs along the right side, crosses midline at T4-T5, and dumps into the left subclavian vein at its junction with the IJ?
What runs anterior to hilum and posterior to hilum?
Anterior to hilum: phrenic nerve
Posterior to hilum: vagus nerve
Right and left lung volumes
Muscle use in quiet inspiration
Diaphragm 80%, intercostals 20%
Greatest change in dimension is superior/inferior
What are the accessory muscles?
SCM, levators, serratus poterior, scalens
Type I and II pneumocytes
I: gas exchange
II: surfactant production
Pores of Kahn
Direct air exchange between alveoli
What is the minimum postop FEV1 needed before pneumonectomy?
FEV1 > 0.8 (or >40% of predicted postop value)
If too close, get a qualitative VQ scan to see contribution of that portionof lung to overall FEV1. If low, may still be able to resect.
What is tthe minimum postop DLVO needed?
10 mL/min/mmHg CO (or >40% of predicted postop value)
Measures CO diffusion and represents OXYGEN EXCHANGE CAPACITY. Depends on pulmonary capillary surface area, hemoglobin content, and alveolar architecture.
What are minimum preop values of pCO2, pO2, and VOx max (max O2 consumption) before lung resection?
pCO2 < 50
pO2 > 60 at rest
VOx max > 10-12 mL/min/kg
Most common cx after wedge resection / segmentectomy?
Persistent air leak
Most common cx after lobectomy?
Most common cx after pneumonectomy?
Cough, hemoptysis, atelectasis, PNA, pain, weight loss
Get CXR to look for lung cancer
MCC cancer related death in US
Strongest influence on survival in lung ca?
Mets in lung cancer?
- Brain most common
- Supraclavicular nodes, other lung, bone, liver, adrenals
Lung cancer recurrence
Usually appears as disseminated mets
80% is within first 3 years
Lung ca overall 5 year survival
10% -> 30% with resection for cure
Lung ca resectability
Stage I and II resectable
Stage IIIa (T3N1M0) possibly resectable
Lung ca types
Non-small cell carcinoma (80%): squamous cell (central), adeno (peripheral and most common)
Small cell carcinoma (20%): neuroendocrine in origin, usually unresectable at time of diagnosis (<5% candidates for surgery), overall <5% 5 year survival; T1N0M0 has a 50% 5yr survival, most get just chemoradiation
Suspect lung cancer and PET shows mediastinal lymphadenopathy (>1cm), what's next step?
What is unresectable in lung cancer?
T4 (mediastinum, esophagus, trachea, vertebra, heart, great vessels, malignant effusion)
-Can still resect if invading chest wall, pericardium, diaphgram, phrenic nerve, or <2cm away from carina)
Lung ca and hypercalcemia
PTHrP from squamous cell carcinoma
Lung ca and ACTH and ADH
Small cell Ca (ACTH most common paraneoplastic lung ca)
Most malignant lung tumor
Mesothelioma: aggressive local, nodal, and distance mets
Non-small cell Ca chemo (stage II or higher)
Small cell lung Ca chemo