L4 Lungs and Pleura

Question 1

Pleural Damage

Answer 1

Costodiaphragmeatic recesses: If stabbed under 12th rib could damage the pleura

Question 2

Pleural Refections and Recesss

Answer 2

CostoMediastinal recesses
CostoDiaphragmatic recesses
-good place to look if there is extra fluid

Question 3

Pneumothorax

Answer 3

Air in pleural space

1. Air from external (stab/penetrating chest wound)
2. Damage to lung and air leaks into pleural space
   - can normally see lung markings (little white vascular markings). air=black + air rises into potential space between visceral and parietal pleura

Question 4

Fluid in Recess

Answer 4

Perfectly horizontal line

Question 5

Nerve supply of Visceral and Parietal Pleura

Answer 5

Visceral Pleura: same nerves supply as lung. Autonomic (No somatic) supply. Cannot feel pain
Parietal Pleura: Intercostal nerve supply. same nerve supply as chest wall/skin

Question 6

Tumour and nerves in lung

Answer 6

Often dont feel tumour as long as only invading lung tissue and visceral pleura (no somatic nerve supply)
-only until lesion is large enough or irritates parietal pleura
=pain

Question 7

Lung branches

Answer 7

1. Trachea
2. Carina = at Angle of Louis TVI/V = Bification
3. L and R Primary/Main Bronchus
4. L = 2 Lobar bronchi
   R= 3 Lobar bronchi

Question 8

Carina

Answer 8

Bification of Trachea

contains nerve tissue = inhaled and cough reflex if something hits it

Question 9

Left vs Right Main Bronchis

Answer 9

Left M Bronchus: Greater angle

Right M Bronchus: more vertical decent (greater chance of aspiration). wider. shorter.

Question 10

Left Lung

Answer 10

2x lobes. Oblique fissure

1. Superior Anterior. Lingula outgrowth at bottom, wraps around heart and slight compensation for only 2 lobes
2. Inferior. Extends quite posteriorly. Asuciltating posteriorly listening to inferior lobe majorly.

Question 11

Right Lobe

Answer 11

3x Lobes

• Oblique fissure (b/w superior and inferior)
• Horizontal fissure (b/w middle and superior lobes)
  1. Superior Anterior lobe
  2. Inferior Posterior Lobe
  3. Middle Lobe wedged b/w the S and I lobe

Question 12

Pulmonary Hila

Answer 12

Root of lung
Medial most portion where vessels travel.
-vessels tend to divide as they enter lung
1. (air) L and R main Bronchus
2. (blood) 1x Pulmonary Artery (DEO)
3. 2x Pulmonary veinS (OX)
4. Lymph nodes (often large + black w. chest infection/pneumonia/cancer)
5. Bronchial vessels (Artery + Vein) supply lung tissue. Run near bronchus.
6. Hilum = where Parietal meets Visceral = Pleural reflection. Extend inferiorly and Pulmonary ligament. Surrounded by pleura.

Question 13

Pulmonary Vasculature and Nerve Supply

Answer 13

R–>L
SVC + IVC –> Right Atrium –Tricuspid Valve–> Right Ventricle –Pulmonary Valve–> Pulmonary Trunk –> 2x L+R Pulmonary Arteries DEOX –> Right and Left Lung –> 4x L+R Pulmonary VeinS OX –> Left Atrium –Mitral/Bicuspid Valve –> Left Ventricle –Aortic Calve –> Aorta —-> Rest of the body

Question 14

Ligamentum Arteriosum

Answer 14

B/w Arch of Aorta + Pulmonary Trunk

Patent/Open in utero = lungs wet surrounded by fluid and not oxygenated. placenta provides oxygen

Question 15

Bronchial vessels

Answer 15

supply lung tissue itself
Left- directly off aorta
Right- branch off intercostal arteries

Question 16

Nerve Supply of Thorax

Answer 16

Somatic: paing and touch
Autonomic: run continuously irrespective of activity. regulate visceral functions (heart, lungs, gut). oppose/keep eachother in balance. Pulmonary plexus is Autonomic nerve supply for lungs. next to cardiac plexus.
1. Vagus (CX. “vagus”=wanderer. in abdomen as well)
2. Sympathetic (from sympathetic trunk, out of thoracic spinal cord + combine w. vagus ==> plexus surrounding heart and lungs)
3. Intercostals. somatic + intercostal spaces. travels to chest wall + parietal pleura
4. Phrenics. somatic + supplies diaphragm. (breath slowly/hold breath = stop diaphrgam moving)

Question 17

Lungs at birth

Answer 17

Lungs not functioning

1. Blood flows from right side –> pulmonary trunk –> Aorta
   - not required to pass through lungs
   - patent ductus arterosis closes –> Ligamentum Arteriosum
   - big problems if doesnt close as blood wont be oxygenated
2. RA hole –> LA. Foreamen ovale –> Fossa ovalis. smooth oval area. doesnt close completly in some people, but L heart has high pressures.

Question 18

Chest drains placemetn

Answer 18

Drain fluid in pleural space (cancer) to help bleed
Drain blood re trauma
Drain air re Pneumothorax to allow inflation
Do in different places depending on reason
1) Large/Tension Pneumothorax: 2nd intercostal space mid clavicular line. (only for air, and hesitant as lots of artery and veins running high)
2) fluid/ blood/ longterm. lower - 5th/9-10th intercostal space. Do with ultrasound to find collection

Question 19

Chest drain layers

Answer 19

1. Local Anaesthetic: Skin –> Fat –> 3x intercostal muscles –> Parietal Pleura
   - dont touch visceral pleura or lung as risk of pneumothorax
   - ABOVE rib (lower half). avoid neurovascular bundle of inferior intercostal groove. nerve= sore. artery=heamatoma. smaller colateral branches less of a worry