L4 Lungs and Pleura Flashcards
Pleural Damage
Costodiaphragmeatic recesses: If stabbed under 12th rib could damage the pleura
Pleural Refections and Recesss
CostoMediastinal recesses
CostoDiaphragmatic recesses
-good place to look if there is extra fluid
Pneumothorax
Air in pleural space
- Air from external (stab/penetrating chest wound)
- 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
Fluid in Recess
Perfectly horizontal line
Nerve supply of Visceral and Parietal Pleura
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
Tumour and nerves in lung
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
Lung branches
- Trachea
- Carina = at Angle of Louis TVI/V = Bification
- L and R Primary/Main Bronchus
- L = 2 Lobar bronchi
R= 3 Lobar bronchi
Carina
Bification of Trachea
contains nerve tissue = inhaled and cough reflex if something hits it
Left vs Right Main Bronchis
Left M Bronchus: Greater angle
Right M Bronchus: more vertical decent (greater chance of aspiration). wider. shorter.
Left Lung
2x lobes. Oblique fissure
- Superior Anterior. Lingula outgrowth at bottom, wraps around heart and slight compensation for only 2 lobes
- Inferior. Extends quite posteriorly. Asuciltating posteriorly listening to inferior lobe majorly.
Right Lobe
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
Pulmonary Hila
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.
Pulmonary Vasculature and Nerve Supply
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
Ligamentum Arteriosum
B/w Arch of Aorta + Pulmonary Trunk
Patent/Open in utero = lungs wet surrounded by fluid and not oxygenated. placenta provides oxygen
Bronchial vessels
supply lung tissue itself
Left- directly off aorta
Right- branch off intercostal arteries
Nerve Supply of Thorax
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)
Lungs at birth
Lungs not functioning
- 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 - RA hole –> LA. Foreamen ovale –> Fossa ovalis. smooth oval area. doesnt close completly in some people, but L heart has high pressures.
Chest drains placemetn
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
Chest drain layers
- 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
