Lecture 4

Question 1

Describe the visceral pleura?

Answer 1

It is pleura that is adherent to the the lung.

Question 2

Describe the parietal pleura?

Answer 2

It is pleura that is adherent to the abdominal wall.

Question 3

Describe the nervous supply of the visceral pleura?

Answer 3

It has the same nerve supply as the lung - somatic. So we do not feel pain in the same way we do if it was a limb.

Question 4

Describe the nervous supply of the parietal pleura?

Answer 4

It is supplied by the intercostal nerves - autonomic nervous. So we get the sensation of pain.

Question 5

What is in-between the pleura?

Answer 5

Pleura space - filled with fluid, but there shouldn’t really be a space, just the potential for a space.

Question 6

What happens if you damage the pleura?

Answer 6

Pneumothorax. So air will be in the pleura space. Air will come in from the outside (stab in the chest) or damage to the lung and leaks out into the pleura space.

Question 7

Describe pleura reflections and recesses?

Answer 7

Som parts of the thoracic cavity where there will be pleura but no lung.
At the level of rib 2 the pleura is in contact with the lung. As you come down inferiorly the pleura (left lung) starts moving to the left as it makes way for the heart. The 6th rib, the pleura has been reflected at the RHS as well. As you look out posteriorly at T12, the pleura is reflected against itself.

Question 8

What is a costodiaphragmatic recess?

Answer 8

Where the pleura reflects against itself. The lung doesn’t extend down into here. Any extra fluid in the pleural space will collect down there. Important to look, especially in chest x-rays.

Question 9

What is the risk of a costodiaphragmatic recess?

Answer 9

Can damage the pleura. As you can get a pneumothorax.

Question 10

Where does the Trachea run?

Answer 10

From the back of the mouth, through the neck and through the mediastinum and into the thorax where it carries air into the lungs.

Question 11

What happens when the trachea gets into the mediastinum?

Answer 11

It bifurcates into two - primary bronchi. This occurs at the level of T4-5. It occurs at the carina.

Question 12

Describe the primary bronchi?

Answer 12

There is left and right primary bronchi. These continue to divide into the different lungs - lobar bronchi (secondary bronchi). The right lung has 3 lobar bronchi whilst the left lung has 2 lobar bronchi.

Question 13

Describe the left primary bronchus?

Answer 13

It is on an angle.

Question 14

Describe the right primary bronchus?

Answer 14

It is vertical, wider and shorter.

Question 15

What is the clinical significance of the right primary bronchus?

Answer 15

If there has been a foreign body that has gone down the trachea, it will end up on the right hand side. This is due to the anatomy of the bronchus.

Question 16

How many lobes are in the left lung?

Answer 16

2 lobes: superior and inferior.

Question 17

Describe the superior lobe on the left lung?

Answer 17

Sits anteriorly. Has an extra outgrowth at the bottom = lingula which wraps around the heart.

Question 18

Describe the inferior lobe on the left lung?

Answer 18

Extends a long way up the back. When you are osculating, you are listening to the inferior lobe most of the time as the inferior lobe sits posteriorly.

Question 19

What separates the lobes of the left lung?

Answer 19

Oblique fissure.

Question 20

How many lobes does the right lung have?

Answer 20

3 lobes: superior, middle and inferior.

Question 21

Describe the superior lobe of the right lung?

Answer 21

Sits anteriorly.

Question 22

Describe the inferior lobe of the right lung?

Answer 22

Sits posteriorly.

Question 23

Describe the middle lobe of the right lung?

Answer 23

Sits in-between the superior and inferior lobe.

Question 24

Describe the oblique fissure on the left lung?

Answer 24

Runs between the superior and inferior lobes.

Question 25

Describe the horizontal fissure on the right lung?

Answer 25

Runs between the middle and superior lobes.

Question 26

What do you find in the pulmonary hilla?

Answer 26

1. Bronchus - left and right main bronchus. There is also a bronchus to the superior lobe.
2. Pulmonary artery - deoxygenated blood comes through this vessel.
3. Pulmonary vein - oxygenated blood goes back to the heart. There are two pulmonary veins.
4. Lymph nodes - big and black in elders patients as they are common for infections.

Question 27

What are bronchial arteries and veins?

Answer 27

Bronchial vessels are the artery and vine that supply the lung like any other organ. Often run near the bronchus.

Question 28

What occurs at the hilla of the lung?

Answer 28

Where the parietal pleura meets the visceral pleura. They extend down inferiorly as a pulmonary ligament.

Question 29

Describe the flow of blood?

Answer 29

Enters the RA via the SVC and IVC. Then passes through the tricuspid valve to get to the RV. It then goes through the pulmonary valve to get to the pulmonary trunk. It then goes through the left and right pulmonary arteries to get to the right and left lungs. It then becomes oxygenated blood and passes through the right and left pulmonary veins to reach the LA. It then goes through the mitral valve to get to the LV. It then goes through the aortic valve to get to the aorta to supply the body with oxygenated blood.

Question 30

What is between the pulmonary trunk and the arch of the aorta?

Answer 30

Ligamentum arteriosum. In utero it is open (patent).

Question 31

What is the nerve supply of the lungs?

Answer 31

1. Vagus - from Cranial nerve X and gives off parasympathetic.
2. Sympathetics.
3. Intercostals.
4. Phrenic.

Pulmonary plexus.

Question 32

What happens in utero in regards to our lungs?

Answer 32

The lungs don’t function properly, as we are receiving oxygenated blood from our mother. At birth you want to stop the blood going form the pulmonary trunk into the aorta, so the blood can get oxygenated.

Question 33

In utero what connects the RA to the LA?

Answer 33

Foramen Ovale.

Question 34

In utero what connects the pulmonary trunk to the aorta?

Answer 34

Ductus arteriosus.

Question 35

What happens to the foramen oval when birth occurs?

Answer 35

The formen ovale turns into the fossa ovalis and closes off.

Question 36

What happens to the ductus arteriosus when birth occurs?

Answer 36

The ductus arteriosus becomes the ligamentum arteriosum.

Question 37

What are chest drains?

Answer 37

Stick an aspirate in to drain the chest.

Question 38

Why do you perform chest drains?

Answer 38

If there is air or fluid in the pleura space.

Question 39

Where do you put a chest drain in?

Answer 39

It all depends on the reason as to why you’re putting it in in the first place.

Question 40

What do you go through in a chest drain?

Answer 40

Skin, fat, fascia, intercostal muscles and parietal pleura. You cannot go through visceral pleura.

Question 41

Where do you put the needle in-between the ribs?

Answer 41

You put it above the ribs, not below the ribs, as that is where the costal groove is - where the neurovascular bundle is. You really want to put it in just above the rib above the collateral branches. But in the intercostal space you want it for the lower half, not the upper half.