Anatomy 2 Pleura Sept28 M1 Flashcards
two sides of pleura
visceral on lung side
parietal on chest side
Different names of parietal pleura depending on location
Cervical (on top)
Costal (middle)
Diaphragmatic (bottom)
Mediastinal (on interior side facing heart)
what mediastinal means and what sits in correspond region
comes from mediastinum, region where heart sits
T-F: parietal and visceral pleura are separate
F: are continuous
volume of fluid in pleural cavity
8-10 mL
Consequence of disruption of intrapleural pressure
dyspnea
pneumothorax def and what happens
hole in pleura, air enters it
hemothorax def
blood enters pleural cavity
What is mediastinal shift, when it happens and consequence
heart moves to side where lung collapsed. (happens in severe pneumothorax) Compromises hemodynamic stability
which pleura has nervous innervation and why
both
visceral pleura sensitivity what innervates it and where pain is referred
Autonomic innervation, insensitive to pain
innervation of parietal pleura
Intercostal nerves innervate cervical, costal and exterior portion of diaphragmatic pleura
Phrenic nerve innervates interior or diaphragmatic pleura and mediastinal pleura
Pain to parietal pleura: where it is referred
If sensed by intercostal nerves: refer to lateral thoracic and abdominal walls
sensed by phrenic nerve: refers to neck and shoulders
Parietal pleura: somatic or autonomic innervation
somatic
pain in diaphragm: where it is felt
neck and shoulder
name of pleural cavities (what we say instead of cavities) and how many
pleural recesses, two
pleural recesses location, name and direction of expansion
costomediastinal recess (mediastinal, interior, expand on side) costodiaphragmatic recess: below lung on above diaphragm (expand vertically)
lobes in right and left lung
right: superior, middle, inferior
left: superior inferior
fissures in right and left lung
right and left have oblique fissure to separate superior (+ middle in right) from inferior
right has horizontal fissure to separate middle and superior
name of surface on bottom of lung
diaphragmatic surface
two characteristic structures of left lung and where
cardiac notch (on mediastinal surface in bottom) lingula, bottom interior
name of top of the lung and where it is
apex. 2-4 cm above clavicle
which lung bigger and why
right bc heart sits more towards left so left smaller
impressions in right lung
posterior to anterior: esophagus, azygos vein, SVC
impressions in left lung
posterior to anterior: aorta, cardiac impression
impression def
characteristics created by fixation bc surfaces stick together
lines used as anatomy landmarks to find chest structures on each side
parasternal lines: on each side of sternum
mid-clavicular lines: vertical lines that cross middle of clavicle on each side
How to find horizontal fissure
is along rib 4 in right lung
how to find oblique fissure
at rib 6 and mid-clavicular lines crossing, then goes up, to the side and to the back
right lung lobes position in front
sup: rib 1-4
middle: rib 5-6
inf: rib 6 to the back
left lung lobes position in front
sup: rib 1-6
inf: rib 6 to the back
where to place stethoscope for auscultation of apex
above clavicle
where to place stethoscope for auscultation of superior lobe of RIGHT lung
between ribs 2 and 3 on front
where to place stethoscope for auscultation of middle lobe of right lung
below rib 4 on front
where to place stethoscope for auscultation of inferior lobe of right lung
below rib 6, a little bit on the side
at what level does the horizontal fissure cross the midaxillary line and what it shows
rib 5. Bc crosses rib 4 at the front, it shows that it doesn’t go as up as steep as the ribs
Oblique fissure what it lines up to from back to front
Is at TIV, crosses ribs 4 and 5, and continues anteriorly along rib 6
Which ribs crosses midaxillary line at inferior border of the lung
Rib 8
Which ribs crosses midaxillary line at parietal pleura
rib 10
name of pleural cavity between rib 8 and 10
costodiaphragmatic recess
surface anatomy landmarks when looking at the back
paravertebral lines
What ribs cross the inferior border at midclavicular line at midaxillary line and at paravertebral line
6, 8, 10
What ribs cross the parietal pleura at midclavicular line at midaxillary line and at paravertebral line
8, 10, 12
which lobes can we listen to from the back (for each lung)
right: sup and inf
left: sup and inf
Tip to identify the oblique fissure easily when looking at patient from the back
Tell them to put both hands behind head. Oblique fissure goes along medial scapular border
How to auscultate apex of lung from the back
Stethoscope near rib 1
How to auscultate superior lobe of lung from the back
stethoscope between rib 3 and 4
How to auscultate inferior lobe of lung from the back
stethoscope between rib 8 and 9
Why trachea has cartilage rings
Keep airways open, no closing when kink when turning head
Level at which trachea branches to become primary bronchi and name of this branching
Carina. T4-T5 level
How many secondary bronchi in left and right lung
left: 2. Right: 3
What is also on level of carina
sternal angle of rib 2
Name of muscle found in trachea and function
Trachialis muscle. Allows trachea to contract and expand a little
How many tertiary bronchi in each lung and how they subdivide within the secondary bronchi
10 per lung. Right lung: 3 sup 2 middle 5 inf.
Left lung 5 sup 5 inf
Name of technique where take scope and look inside airways
bronchoscopy
See 3 holes in bronchoscopy camera, what do we know?
We’re at superior lobe of right lung
What tertiary bronchi correspond to
Correspond to numbered segments of the lung
How many segments in each lobe
Right lung: 3 in sup, 2 in inf, 5 in inf
Left lung: 5 in sup, 5 in inf
3 types of lung resections and def
Segmentectomy (remove lung segment)
Lobectomy (remove lung lobe)
Pneumonectomy (remove a lung)
End portion of the branching of a segmental bronchus
Bronchiole
Two portions of bronchiole
Terminal bronchiole and respiratory bronchiole
What is the largest structure name for gas exchange
respiratory bronchiole
how structure of bronchus changes as it branches more and more
less cartilage and more smooth muscle (in terminal and resp bronchioles)
where do we find smooth muscle in the airways exactly
In terminal and resp bronchioles
how many pulm arteries and veins
2 pulm arteries (one each side)
4 pulm veins (2 each side)
What provides blood supply and venous drainage to the bronchi and lung tissues
Bronchial arteries and veins
Hillum of the right lung
back to front: primary bronchus, pulm artery, pulm vein.
below: pulm vein
hillum of the left lung
superior to inferior:
pulm artery, primary bronchus, pulm vein.
in front: pulm vein
how to recognize primary bronchus on image (or macroscopically?)
grey bc of cartilage and more thick therefore
pulmonary ligament location and function
below hillum of each lung. makes the hillum hang down to provide space for vessel, veins, bronchus to expand
Nearest structure to trachea and lungs that provide nervous innervation + location
Anterior and posterior pulmonary plexuses. front and back of trachea
Where pulmonary plexuses stem from (what they’re made of)
contribution from nerves from T2-T6 and going out of sympathetic chain and also of vagus nerve (PSS)
Where SS info goes
bronchi and tracheobronchial tree
5 lymphatic structures in or near the lungs
Pulmonary nodes Hilar (bronchopulmonary) nodes Trachebronchial nodes Paratracheal nodes Bronchomediastinal trunk
lymphatic system, give 2 functions
immune response, fat transport
how recognize lymph nodes whe looking at mediastinal surface of lung
dark aggregates (are hilar lymph nodes)
pulmonary nodes location and can see them or not
nodes at capillary level within lung, can’t see them
hilar nodes location and can see them or not
where right primary bronchus enters lung, at hillum of the lung
tracheobronchial nodes location
where primary bronchi meet trachea at the carina
paratracheal nodes location
up on either side side of trachea
Bronchomediastinal trunks description
Lymphatic vessels draining lymphatic circulation from pulmonary nodes, etc. back to heart
left bronchomediastinal trunk termination
joins thoracic duct which then enters blood circulation at venous angle (angle between jugular vein, vertical and subclavian vein, horizontal)
right bronchomediastinal trunk termination
joins directly circulation at venous angle (angle between jugular vein, vertical and subclavian vein, horizontal)
