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Anatomy of lower respiratory tract Flashcards

1
Q

What is the pleura composed of?

A

Double membrane

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2
Q

What are the 2 layers of the pleura?

A

Parietal: lines interior thoracic walls and covers mediastinum

Visceral: Is inseparable from the lung over all surfaces including those in the fissures

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3
Q

What is the pleural cavity?

A

The fluid filled cavity between visceral and parietal pleura

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4
Q

How much fluid is there in the pleural cavity?

A

~15ml

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5
Q

What does pleural fluid do?

A

They lubricate the friction from damaging lining during visceral and parietal pleura

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6
Q

What is the condition in which there is liquid that leaks into the pleural cavity?

A

Pleural effusion

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7
Q

What are the 4 parts of the parietal pleura?

A

Cervical pleura (covered by layer of endothoracic fascia, the suprapleural membrane)

Costal pleura

Mediastinal pleura

Diaphragmatic pleura

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8
Q

How high does the cervical pleura project?

A

5 cm above top costal cartilage and 2.5cm above medial 1/3 of clavicle into base of the neck

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9
Q

What binds the cervical pleura anteriorly and posteriorly??

A

Anteriorly: the subclavian artery

Posteriorly: The neck of the 1st rib

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10
Q

What is the costal pleura bound by?

A

Back of the sternum, ribs and intercostal spaces, and sides of the bodies of T1 - T12

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11
Q

What is the mediastinal pleura made up of?

A

Reflected onto the pulmonary vessels and bronchi that forming the root of the lung form a tubular sheet around them

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12
Q

What does the diaphragmatic pleura cover?

A

Superior surface of the diaphragm except along costal attachments and where diaphragm is fused to pericardium

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13
Q

What are the costophragmatic recesses?

A

They are the 2 valleys formed by the parietal pleura next to the diaphragm and ribs

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14
Q

What is the function of the costophragmatic recesses?

A

During inspiration the inferior border of the lungs can enter those areas when the diaphragm contracts

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15
Q

What is the pulmonary ligament?

A

The parietal and visceral pleurae continue with each other around the root of the lung and form a loose cuff hanging inferiorly at the hilum. This is the pulmonary ligament

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16
Q

What does the pulmonary ligament do?

A

They provide extra space for veins to dilate when blood is returning from lung

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17
Q

What is the difference between hilum and root of the lung?

A

Hilum is the site/region containing the root of the lung. ie wedge shaped depression

Root of the lung is structure in the lung containing all the blood vessels and the bronchi

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18
Q

What happens to visceral and parietal pleura at the hilum?

A

They are fused and become continuous with each other

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19
Q

Where on the surface does the cervical pleura appear?

A

Cervical pleura is a dome shaped part of the parietal pleura that curves from sternoclavicular joint to the medial 1/3rd of the clavicle and the dome extends 2.5cm superior to 1/3rd of clavicle and 5 cm superior to the 1st costal cartilage.

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20
Q

What is the sternal line?

A

There are 2 sternal lines medially. Right and left lines which descend inferomedially and become narrower.

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21
Q

At what level does the sternal line become narrow?

A

At the level of the second costal cartilage and the manubriosternal joint

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22
Q

How is the left sternal line different to the right?

A

At the level of the 4th costal cartilage it will deviate 1 inch laterally and descend until the 6th costal cartilage

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23
Q

Why does the left sternal angle descend differently to the right?

A

Due to the heart being deviated to the left

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24
Q

What covers the bare area of the heart?

A

The pericardium is only covered by intercostal muscles ribs and skin with no pleura at the bare area of the heart.

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25
What is the clinical significance of the bare area of the heart?
It is the only place where certain medical procedures can be performed such as cardiac centesis (fluid removed from the heart with a needle) or pericardial effusion.
26
What happens to lung at the location where the heart protrudes to the left?
It deviates laterally 2 cm
27
What is the space of deviation created between heart and lung?
Area of superficial cardiac dullness or cardiac notch
28
What is the area of superficial cardiac dullness used for?
can be evaluated by percussion (the sound over the lung is tested for resonance (no fluid) or dull (fluid) in the case of the area of superficial cardial dullness it can be head and located using percussion) or oscultation
29
What is the costodiaphragmatic line?
It lines the descent of the costodiaphragmatic pleura. This line starts right above the xiphisternal joint and passes through middle of the 7th and 8th costal cartilage at the level of the middle of the clavicle (mid-clavicular line). The costodiaphragmatic line then passes the 10th rib at the mid-axillary line and the 12th rib at the lateral border of the erector spinae muscle and ends 2cm lateral of the spine at T12.
30
At what level does the costodiaphragmatic line pass through the middle of the 8th rib?
Mid-clavicular line
31
At what level does the costodiaphragmatic line cross the mid-axillary line?
At the level of 10th rib.
32
At what level does the costodiaphragmatic line pass through the 12th rib?
At the lateral border of the erector spinae
33
Where does the costodiaphragmatic line end?
2cm lateral to the spine of T12
34
Where does the vertebral/posterior line extend?
The medial edges of the pleura follow a line joining transverse processes of T1-T12 2cm away from midline on either side.
35
What is the costodiaphragmatic recess?
Slit-like space between costal and diaphragmatic pleurae and are the most dependent parts of the pleural cavities and the site of collection of pleural effusion
36
What does most dependent part of the pleural cavities mean?
Any fluid will accumulate in these areas
37
Where are the costomediastinal recesses located?
Slit-like space between the costal and mediastinal pleurae and lies between sternum and costal cartilages.
38
What is the function of the costomediastinal recesses?
The anterior border of the lung enters into it during deep inspiration
39
How is the lung attached to the mediastinum?
Only by the root of the lung through the blood vessels and bronchi
40
What surfaces do the lungs have?
Costal and mediastinal surfaces
41
What are the 3 borders of the lungs?
Anterior Posterior Inferior
42
What is the difference between the right and left lungs?
Right lung is broader but shorter. Left lung is narrower and longer Right lung has 3 lobes and is divided by 2 fissures. Left lung has 2 lobes and is divided by 1 fissure Left lung has cardiac notch at location of the heart's apex
43
What fissure is present in right lung but absent in left lung?
Horizontal (transverse) fissure
44
Why is the right lung shorter than the left?
The liver makes right side of diaphragm higher than the left side
45
Where does the lung apex project?
Rounded/blunt apex projects up into the root of the neck 2.5 cm above medial 1/3 of clavicle. Apex rises 5cm above 1st costal cartilage but level posteriorly
46
What shape is the base of the lung?
Broad, concave and resting on the ipsilateral dome of the diaphragm.
47
Which lung has a deeper concavity?
The right lung
48
What is the base of the lung bound by laterally and posteriorly?
Inferior borders
49
What does the anterior border look like?
Sharp, thin and overlaps the heart where the costal and mediastinal surfaces meet anteriorly
50
What does the posterior border look like?
Rounded, thick and lies in the cavity at the side of the vertebral column where the costal and mediastinal surfaces meet posteriorly
51
What does the inferior border look like?
Thin/sharp, semilunar in shape and circumscribes the base of the lung. Extending into the costodiaphragmatic recess.
52
What is the shape of the costal surface?
Convex
53
What covers the endothoracic fascia anteriorly?
Covered by the costal pleura and endothoracic fascia which separates the lung from the ribs and intercostal muscles.
54
What is the shape of the mediastinal surface of the lung?
Concave because it is adapted to the heart at the cardiac impression
55
What does the mediastinal surface of the lung contain?
Contains the hilum through which bronchi, vessels, nerves forming the root of the lung enter and exits the lung.
56
What is the root of the lung?
A short broad pedicle connecting mediastinal surface of the lung to mediastinum consisting of structures entering and leaving the lungs.
57
Where does the root of the lung sit?
Opposite to the vertebral bodies of T5/T7
58
What surrounds the structures of the root of the lung?
Folds of the mediastinal pleura which form pleural sleeve/tubular sheet which is continuous with visceral pleura.
59
What structures pass through the roof of the lung?
Principle bronchus in the left lung and eparterial and hyparterial bronchi in the right lung Pulmonary artery most superiorly. Superior and inferior pulmonary veins (posteriorly and inferiorly) Bronchial arteries (one in the right and 2 in the left) Bronchial veins Lymphatics Anterior and posterior pulmonary nerve plexus
60
What are the structure that are most anterior to most posterior structures of the hilum?
Pulmonary vein (superior) Pulmonary artery Bronchus
61
What is the difference between the right main bronchus that enters the lung and the left main bronchus?
Right main bronchus is called eparterial bronchus or superior lobar bronchus. Inferior lobar bronchus is called the hyparterial lobar bronchus.
62
What is the basis of the name of the bronchus?
Above or below the pulmonary artery.
63
What impressions are on the mediastinal surface of the right lung?
Cardiac impression Groove for oesophagus posterior and superior to the hilum Groove of SVC and IVC run superiorly and inferiorly respectively. Groove for azygous vein and its arch run anteriorly and over the hilum of the lung
64
Where does the Right vagus nerve pass relative to the root of the right lung?
Posterior to the hilum
65
Where does the right phrenic nerve pass relative to the root of the right lung?
Anterior to the hilum
66
Where does the right phrenic nerve pass relative to the root of the right lung?
Anterior to the hilum
67
Which is more lateral the loop of azygous or the oesophagus?
The loop of the azygous veins
68
What structure lies superior to the hilum of the lungs?
Arch of the aorta
69
Where does the descending aorta pass through relative to the hilum?
Posteriorly
70
What impression is largest on the left lung?
The cardiac impression
71
Where does the left phrenic nerve pass relative to the hilum?
Anterior
72
Where does the left vagus nerve pass relative to the hilum?
Posterior
73
How is the cardiac impression related to the left lung's hilum?
It is inferior and anterior
74
Which part of the heart forms the cardiac impression on the mediastinal surface of the left lung?
The left ventricle
75
What groove lies superior to the hilum of the left lung?
The subclavian artery
76
How is lung surface anatomy related to the parietal pleura?
Lung is 2 ribs higher than the pleura
77
What structure does the right lung follow closely?
The right sternal line of pleural reflections. On the left, at the level of 4th costal cartilage it passes laterally for about 4 cms before curving inferomedially to reach the 6th costal cartilage
78
Does the anterior border of left lung reach the left sternal line of pleural reflection / area of superficial cardiac dullness?
No it ends at the 6th costal cartilage
79
How far is the lung lateral deviation at the 4th rib?
2 inches (~4cm); compared to pleural reflection which is 1 inch (~2cm)
80
Where is the inferior border of the lungs?
2 ribspaces higher than costodiaphragmatic line of parietal pleura: 6th rib in mid clavicular line 8th rib in mid-axillary line 10th rib in scapular line and ends 2cm lateral to the spine of T10
81
Does the inferior border of the lung follow the costodiaphragmatic line of pleura?
No it is more horizontal than costodiaphragmatic line of pleural reflections.
82
What do the oblique fissures do?
They divide lungs into superior and inferior (inferior+middle) lobes
83
What is the location of the oblique fissure in surface anatomy?
Marked by line drawn obliquely downwatds and outwards from 2cm lateral to the spine of T4 to the 6th costochondral junction.
84
Which lung has transverse fissure?
RIght lung
85
What does the transverse fissure separate?
Superior and middle lobes
86
Where is the transverse fissure relative to surface anatomy in the right lung?
Marked by horizontal line extending from 4th right costal cartilage to meet the oblique fissure near the mid-axillary line
87
Where does the lung get nerve supply?
Sympathetic fibers (T2 - T5) Parasympethtic fibers Sympathetic and parasymapthetic nerves form plexuses anteriorly and posteriorly to pulmonary arteries
88
What does sympathetic innervation do to lung?
Inhibitory to the bronchial tree (bronchodilation) and excitatory to pulmonary vessels. Inhibitory to submucosal glands
89
What does parasympathetic innervation do?
Excitatory to bronchial tree (bronchoconstriction) and inhibitory to pulmonary vessels Stimulatory to submucosal glands
90
What parasympathetic nerves provide parasympathetic innervation of lungs?
Vagus nerves
91
What is the thoracic pain line?
Thoracic pain line is a line that passes through the plane of sternal angle just above the bronchi.
92
What information does the thoracic pain line give us?
Visceral afferents below the thoracic pain line follow the sympathetic nerves. Visceral afferents above the thoracic pain line follow parasympathetic nerves. ALL VISCERAL AFFERENTS THAT ARE REFLEXIVE FOLLOW PARASYMPATHETIC NERVE FIBERS
93
Do visceral afferents of the trachea follow sympathetic or parasynmpathetic nerve fibers?
Parasympathetic
94
What arteries supply the lungs?
Bronchial arteries
95
How many bronchial arteries does the left lung get?
Two bronchial arteries
96
How many bronchial arteries does the right lung get?
One bronchial artery
97
What artery does the right bronchial artery arise from?
Right 3rd posterior intercostal artery
98
What artery does the left bronchial artery arise from?
2 bronchial arteries which arise directly from descending aorta
99
What do the bronchial arteries do?
Supply oxygenated blood to bronchial tree as far distally as the respiratory bronchioles lung tissue and visceral pleura.
100
What is the blood supply of the veins?
Bronchial artery (1 in right lung and 2 in left lung) Bronchial vein
101
What veins does the right bronchial vein drain into?
Azygous veins
102
What veins do the left bronchial veins drain into?
Left bronchial veins into accessory hemi-azygous vein
103
What structures do pulmonary arteries follow?
The bronchi and pulmonary artery are paired in the lung branching simultaneously and running parallel to each other to the alveoli.
104
Are pulmonary veins paired with the bronchi and pulmonary arteries?
No
105
How do pulmonary veins run?
Their tributaries are intersegmental and they run independently from pulmonary arteries and bronchi
106
Do bronchial arteries and veins supply the alveoli?
No
107
Bronchial veins:
Left superior and inferior bronchial veins drain into accessory hemiazygous vein and then azygous veins. Right bronchial vein drains directly into azygous vein
108
What lymphatics drain the lungs?
Superficial lymphatic plexus (subpleural) lies under visceral pleura and lung tissue into bronchopulmonary nodes Deep lymphatic plexus lies along bronchial tree and pulmonary vessels and drain into the intrapulmonary nodes within the lung substance then into the bronchopulmonary hilar nodes
109
What is the sequence of lymph nodes drained by the deep lymphatic plexus?
Deep lymphatic plexus -> Intrapulmonary nodes -> Bronchopulmonary (hilar) nodes -> Tracheobronchial nodes ->bronchomediastinal lymph trunks -> Right lymphatic duct/thorcacic duct

IMED3001 (46 decks)

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