Org Ana: Pleura and Lungs Flashcards
describe the apex of the lungs
it projects into the neck
1 in above the medial third of clavicle
describe the right lung
from sternoclavicular joint it reaches behind sternal angle until xiphisternal joint
describe the left lung
begins behind sternoclavicular joint and deviates laterally beyond the lateral margin of sternum at 4th costal cartilage to become the cardiac notch
describe the lower border of the lung
follows a curved line crossing the 6th rib and 8th rib midaxillary and reaches the 10th rib posteriorly
for left lung after 4th ICS it produces a cardiac notch then turn laterally to 6th ICS and downward to 8th rib then posteriorly to T10
describe the posterior border of the lung
extends down from the spinous process of C7 to the T10 1.5 in away from midline
what is the oblique fissure
from spine of scapula down lateral and anterior following the course of 6th rib to 6th costochondral junction
left lung: upper lobe lies above and anterior; lower lobe below and posterior
what is the horizontal fissure
only on the right bc it has 3 lobes
runs horizontal along the 4th CC to meet oblique fissure at the midaxillary line of 6th rib
upper lobe lies above and middle and lower lobe lies below
what is the purpose of pleural reflection
indicates the limit of pleura bc the lungs need space to expand
where is the cervical pleura located
at apex of lungs and bulges upward into the neck
where is the anterior border R pleura located
behind the SC joint almost reaching midline behind the sternal angle up to the xiphisternal joint
where is the anterior border L pleura located
similar but at 4th CC it deviates laterally to extend to lateral margin of sternum to form cardiac notch
where is the lower border of pleura located
crosses 8th rib in midclavicular line and 10th rib at midaxillary line and reach 12th rib lateral border of erector spinae
what is the costodiaphragmatic recess
distance between the lung and pleural border
space between lung at pluera to allow the lungs to expand
compare the lungs and the costal line of pleural reflection
midclavicular
- lungs: rib 6
- costal line of pleural reflection: rib 8
midaxillary
- lungs: rib 8
- costal line of pleural reflection: rib 10
paravertebral
- lungs: rib 10
- costal line of pleural reflection: rib 12
describe the apex of the heart
formed by left ventricle and corresponds to apex beat at the 5th left ICS 3.5 in to midline
describe the superior border of the heart
formed by roots of the great blood vessels from 2nd left CC (sternal angle) .5 in front of sternum up to 3rd right CC .5 in from edge of sternum
describe the left border of the heart
left ventricle from 2nd CC from edge of sternum and apex beat
describe the right border of the heart
formed by R atrium from the 3rd right CC from the edge of sternum to the 6th right CC
describe the inferior border of the heart
formed by the right ventricle and apical part of the left ventricle from 6th right CC from sternum to apex beat
what is posterior injury to the back of the chest
trauma can possibly cause vertebral fracture with associated SCI or paraplegia of LE
if severe trauma - scapula can be injured (madami muscles)
what is sternum fracture
usually sternum in resilient bc of CC - not common
occurs in high speed MVA
heart lies posterior to the sternum and may be contused; hematoma
what is rib contusion
most common injury
bruising of rib due to trauma
pain and tenderness
pain in breathing
what is rib fracture
commonly occurs at the angle of rib - 5th to 10th rib most common
upper ribs less common since arms and shoulders protect it
common complication is pneumothorax due to penetration of lungs
- severe trauma
- portion of fractured rib pierces the pleural cavity and into lungs
- puncture of lungs and air will be released and it will cause lung collapse
- heart shifted to other side bc too much air in the remaining lung pushes it
what is flail chest
an injury to a section of ribs causing is to be detached or float - multiple fractures
life threatening - pneumothorax and respiration may cause floating ribs to be sucked in and out
signs and symptoms:
- pale and cool skin
- weak pulse and tachycardia
- paradoxical chest movements
- cyanosis
- pain when breathing = intubate
explain paradoxical chest movement
injured area moves opposite - naiiwan
inhale: ribs rise but flailed section sucks in
exhale: ribs fall but flailed section bulges out
what is thoracostomy
creating and maintaining an opening into the thoracic cavity using needle or chest tube
what are the indications for thoracostomy
hemothorax
pleural effusion
pneumothorax
open pnuemothorax
prophylaxis pre-op in truma patients
what is the safe triangle
position of chest drain
boundaries:
anterior border of lats
lateral borer of pec major
apex of axilla
horizontal line level of nipple
discuss the approach for thoracostomy using needles
ant - 2nd ICS midclavicular
lat - 2nd ICS midaxillary
needle should be kept to upper border to avoid the subcostal groove
what is tube thoracostomy
insertion of tube at 4th or 5th ICS at the anterior axillary line
what are the complications for thoracostomy
malpositioning with liver, spleen or diaphragmatic injury
insertion into pleural parenchyma
exsanguination through test tube from massive intrathoracic injury
what diaphragmatic hernia
due to incomplete fusion of septum transversum, dorsal mesentery and pleuroperitoneal membrane
stomach content may go up and lung may collapse
may occur:
- plueroperitoneal canal
- opening betw xiphoid and costal margin
- esophageal hiatus
what are hiccups
involuntary spasmodic contraction of diaphragm due to gastric irritation of vagus nerve
can be symptoms of pleurisity, peritonitis, pericarditis or uremia
explain the anatomic changes of the lungs with age
kyphosis due to degeneration of IV discs or compression fracture (osteoporotic)
- lung volume and diameter decreases
- wedging thoracic vertebrae
rib cage becomes rigid and loses elasticity
disuse and atrophy of thoracic and abdominal muscles
- lung cannot adapt to diseases (pneumonia)
degeneration of elastic tissue - exercise to maintain
describe the pleural cavities
found on either sides of the mediastinum divided into parietal and pleural
boundaries:
sup - extends above rib 1 to root of neck
inf - extends to level just above the costal margin
medial - mediastinum
what is the pleural ligament
layers of pleura at the hilum of each lungs
allows movement of pulmonary vessels and large bronchi during respiration
discuss the parts if parietal pleura
costal - inner surface of ribs, CC and sides of vertebral bodies and the sternum
- intercostal nerves
diaphragmatic - covers thoracic surface of diaphragm
- phrenic and 6 intercostal nerves
mediastinal - covers the mediastinum
- phrenic nerve
cervical - dome shape layer lining the cervical extension
describe parietal pleura
sensitive to pain, touch and stretch
needs anesthesia for chest tube
describe visceral pleura
continuous w parietal pleura at the hilum of each lungs
attached to surface of lungs
visceral afferent nerve
no pain; stretch and touch only
discuss the recesses
costodiaphragmatic - space betw costal and diaphragmatic; lower area where lung expands
costomediastinal - along anterior costal margin; largest on left in the region overlying heart
describe pleural fluid
5-10 ml of clear fluid
lubricates visceral nd parietal
capillaries of visceral pleura absorb this
explain pleural effusion
> 300 cc of fluid in pleural cavity
what is pleurisy
inflammation secondary to inflammation of lungs (pneumonia)
what is pneumothorax
air in pleural cavity from lungs or chest wall
what is empyema
collection of pus in pleural cavity
describe the trachea
mobile tube about 5 in long and 1 in in diameter
starts from cricoid C6 and divides into principal bronchi at sternal angle T4-5
trachealis muscle - smooth muscle connecting U shaped cartilage
- u shaped prevents collapse
vagus and recurrent laryngeal nerve and sympathetic trunk
what are the anterior relationships of the trachea
sternum
thymus gland
left brachiocephalic vein
origin of brachiocephalic
left common carotid artery
arch of aorta
what are the posterior relationships of the trachea
esophagus
left recurrent laryngeal nerve
what are the right relationships of the trachea
azygos vein
right vagus nerve
pleura
what are the left relationships of the trachea
arch of aorta
left common carotid
left subclavian arteries
left vagus nerve
left phrenic nerve
pleura
describe the bronchi
bifurcates behind the arch of aorta
carina - end of junction trachea and principal bronchi; separates opening of bronchi
compare the left and right bronchus
right: wider, shorter and more vertical
- 1 in long
- divides into superior lobar bronchus and at hilum into middle and inferior lobar bronchus
left: narrower, longer and more horizontal
- 2 in long
- passes below arch of aorta and infront of esophagus
- divides into superior and inferior lobar bronchus
what are lobar bronchi
they further subdivide into segmental bronchi supplying the bronchopulmonary segments
each will divide into several million terminal bronchioles that terminate in one or more respiratory bronchiole
each respiratory bronchiole divide into 2-11 alveolar ducts that enter the alveolar sac
describe bronchioles
from division of smallest bronchi
< 1 mm
no cartilage - collapse easily
lined by columnar epithelium cells
describe terminal bronchioles
.5 mm and branches from alveolar ducts
possess outpouching from their walls; blood exchange happens here
what are bronchopulmonary segments
subdivisions of a lung lobe where each lobar bronchus pass to give segmental bronchus
a structural unit that can be surgically removed
has a segmental bronchus, artery, lymph and autonomic nerve
segmental vein is the CT betw adjacent segments
what are right bronchopulmonary segments
10 segments
superior: apical, posterior, anterior
middle: lateral and medial
inferior: superior, medial basal, anterior basal, lateral basal, posterior basal
what are left bronchopulmonary segments
8-10 segments
superior: apical, posterior, anterior, superior lingular, inferior lingular
inferior: superior, medial basal, anterior basal, lateral basal and posterior basal
describe the lungs
soft, spongy and elastic
covered w visceral pleura
what is the hilum
depression in which the root of the lung is attached
describe the costal and mediastinal surface of the lungs
costal - follows concave chest wall
mediastinal - molds into pericardium
describe the anterior border of the lungs
cardiac notch - concave indentation of anterior margin of left where anterior surface of heart is exposed
lingula - tongue like projection of anterior margin of left lung from inferior end of cardiac notch
what are the structures in the hilum
one pulmonary artery
two pulmonary veins
main bronchus
bronchial vessels
nerves and lymphatics
what are the structures at medial surface of right lung
heart
inferior vena cava
superior vena cava
azygos vein
esophagus
what are the structures at medial surface of left lung
heart
aortic arch
thoracic aorta
esophagus
what is the nonrespiratory circuit
supplies the tissue of respiratory tree and lungs
bronchial artery from descending aorta supply bronchi, CT of lung and visceral pleura
bronchial vein drains into azygos and hemiazygos vein
what is the respiratory circuit
where gas exchange occurs
segmental arteries (terminal branch of pulmonary arteries) carry deoxygenated blood into the BP segments and to alveoli
intersegmental vein carry oxygenated blood from alveolar capillaries and flow the CT septa of the BP segment to pulmonary vein root
what is the nerve supply of the lungs
pulmonary plexus - from efferent and afferent fibers via ANS
sympathetic efferent fibers - bronchodilation and vasoconstriction
- inhibitory to alveolar glands
parasympathetic efferent fibers - bronchoconstriction, vasodilation and increase gland secretions
- secretomotor to glands
compare quiet and forced inspiration
quiet - contraction of diaphragm and intercostal muscles
- 1st rib fixed by scaleni muscles
forced:
- scalenus anterior and medius
- SCM
- scapula fixed by traps, levator scapulae and rhomboids
- serratus anterior and pec minor pull ribs up
compare quiet and forced expiration
quiet - passive elastic recoil of diaphragm and intercostals
forced: active
- anterior abdominal wall
- quadratus lumborum pulls 12th rib down
- serratus posterior inferior and lats
explain abdominal type of respiration
common in babies up to 2 yo
males also used abdominal and thoracic
explain thoracic type of respiration
common in adults - esp female
rely mainly on movement of ribs
