Lungs And Pleura Flashcards
Describe the appearance of healthy lungs
Tissue is normally white (CT)
Turns pink when perfumed with blood
Describe the lymphatics in the lungs
Has a v rich lymphatic system, many macrophages
Lymphatic vessels reach nodes in hilum => infratracheal => paratracheal => circulation
How many lobes can be found on each lung and what are they all separated by?
Why are there different number of lobes on each side
R
RUL, transverse fissure, RML, oblique fissure, RLL
L
LUL, oblique fissure, LLL
L only has 2, heart is mainly on L
If 1 lobe is infected, only a small proportion of the total lung is affected
What sections of the lungs surround the heart
Cardiac notch on both lungs
L has lingula, loops around border of the heart
Describe the location of the fissures and how this would affect examination?
R
Horizontal fissure starts obliquely from post => horizontal
L
Oblique fissure splits L so LUL can only be examined from the front and LLL can only be examined from back
Describe 2 ways to image the lungs
CT/MRI, blood in pulmonary vessels can be seen
V vascular structures like cancers can also be seen
Radioactive isotopes in the blood targets glucose, can see which areas are metabolically active
- Bones
- Tumours
Describe how a pneumothorax would affect expiration if there is a patent hole
Expiration
As you breathe out, air also escapes via hole in PC
All structures move towards hole
Inspiration
As you breathe in, air also taken up via hole in PC
All structures move away from hole
Describe how a pneumothorax would affect ventilation if the hole is not always patent
Expiration (closed)
Acts as a valve so air cannot enter here
Internal structures move away slightly from the hole
Inspiration (open)
Valve opens, max P on affected side
Pushes lungs and heart to other side => tension pneumothorax
What is a tension pneumothorax
Puts +ve P on heart and intrathoracic structures
What would you expect to see in an image of a pneumothorax
Pleural stripe, shows where lung isn’t present
What would you expect to see in an image of pneumonia
Fluid consolidation (from immune response) Can be restricted to a lobe, can see difference between affected and unaffected lobes
What would you expect to see in an image of a pleural effusion
Appears white as irritants stimulate serous fluid production in PC
Insert chest drain in lower intercostal spaces to remove fluid
Describe the structure and function of the bronchopulmonary segments
Segments in each lobe, dictated by tertiary branches (3rd segmental division)
L has 2 lobar bronchi
R has 3 lobar bronchi
V well defined, each segment supplied by specific segmental bronchus and arteries
What structures are found in the lung root and their relative locations
Bronchus behind
Arteries above and in front
Veins below, this is due to how vessels leave and enter the heart
Lymphatics, PNS vagus, SNS T1-5
Pulmonary ligament at the bottom
Relationships of the R lung hilum
Oesophagus post to lung root
SVC and IVC found ant to lung root
Azygos comes post to oesophagus but comes ant to join with SVC
Subclavian artery superior to lung root
Smaller cardiac notch
Veins generally found on R
Relationship of the L lung hila
Oesophagus post to R lung root
Aortic arch arches over hilum to post, next to oesophagus
L subclavian artery superior to arch
L brachiocephalic vein also superior to arch
Larger cardiac notch found here
Arteries mainly found on L
What can happen as a result of the structures in the lung root being in suck close proximity to each other
Cancers of bronchus and lung root can compress/spread to azygos, oesophagus and LA
How would you find the locations of the fissures
R
Horizontal fissure = 5th R from MAP => 4th CC
Oblique fissure = 5th R from MAP => 6th CC
L
Rotated shoulder blades, bottom of scapula at the level of the horizontal fissure
Locations of the parietal pleura
V close together at 2-4th CC between lungs and go down to R10-12
Locations of the R lung and visceral pleura
Attach to R6 at sternum - R8
Locations of the L lung and visceral pleura
Attach to 6th CC - R8
Where can you find the costodiaphragmatic recess
R8-10 on both sides
Levels of the fissures
R lung T3-R5-4th CC (transverse fissure)
R lung R5-6th CC (oblique fissure)
L lung R5-6th CC (oblique fissure)
How would you auscultate the apex of the R lung
Just above clavicle
How would you auscultate the SRL
2nd ICS
Between nipple and clavicle
How would you ausculate the RML
Just left of nipple in 4th ICS
How would you auscultate the RLL
R bottom of R nipple
6th ICS
How would you auscultate the apex of L lung
Just above the corner of the scapula
How would you auscultate the SLL
2nd ICS, at corner of scapula
How would you ausculate the ILL
7th ICS, only when scapular rotated
Describe the lymphatic drainage of the lungs
Intrapulmonary lymph node => inf tracheobronchial => sup tracheobronchial => bronchomediastinal lymph trunk => subclavian veins
R lymph nodes => RSCV
L lymph nodes => R or LSCV
Describe the structure of the vagus
R and L vagus form ant and post pulmonary plexus around trachea/bronchus and oesophagus
Describe the innervations of the pleura
Cervical, costal pleura => intercostal nerves (somatic pain afferents)
Mediastinal, diaphragmatic pleura => phrenic nerve (pain referred to C3-5, shoulder)
How are the lungs innervated
SNS T2-4, bronchodilator, pain afferents
PNS vagus, bronchocontristion and bronchial gland secretion
