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pt momints ver 2.0 > Org Ana: Pleura and Lungs > Flashcards

Org Ana: Pleura and Lungs Flashcards

1
Q

describe the apex of the lungs

A

it projects into the neck

1 in above the medial third of clavicle

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2
Q

describe the right lung

A

from sternoclavicular joint it reaches behind sternal angle until xiphisternal joint

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3
Q

describe the left lung

A

begins behind sternoclavicular joint and deviates laterally beyond the lateral margin of sternum at 4th costal cartilage to become the cardiac notch

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4
Q

describe the lower border of the lung

A

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

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5
Q

describe the posterior border of the lung

A

extends down from the spinous process of C7 to the T10 1.5 in away from midline

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6
Q

what is the oblique fissure

A

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

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7
Q

what is the horizontal fissure

A

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

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8
Q

what is the purpose of pleural reflection

A

indicates the limit of pleura bc the lungs need space to expand

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9
Q

where is the cervical pleura located

A

at apex of lungs and bulges upward into the neck

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10
Q

where is the anterior border R pleura located

A

behind the SC joint almost reaching midline behind the sternal angle up to the xiphisternal joint

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11
Q

where is the anterior border L pleura located

A

similar but at 4th CC it deviates laterally to extend to lateral margin of sternum to form cardiac notch

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12
Q

where is the lower border of pleura located

A

crosses 8th rib in midclavicular line and 10th rib at midaxillary line and reach 12th rib lateral border of erector spinae

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13
Q

what is the costodiaphragmatic recess

A

distance between the lung and pleural border

space between lung at pluera to allow the lungs to expand

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14
Q

compare the lungs and the costal line of pleural reflection

A

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

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15
Q

describe the apex of the heart

A

formed by left ventricle and corresponds to apex beat at the 5th left ICS 3.5 in to midline

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16
Q

describe the superior border of the heart

A

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

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17
Q

describe the left border of the heart

A

left ventricle from 2nd CC from edge of sternum and apex beat

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18
Q

describe the right border of the heart

A

formed by R atrium from the 3rd right CC from the edge of sternum to the 6th right CC

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19
Q

describe the inferior border of the heart

A

formed by the right ventricle and apical part of the left ventricle from 6th right CC from sternum to apex beat

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20
Q

what is posterior injury to the back of the chest

A

trauma can possibly cause vertebral fracture with associated SCI or paraplegia of LE

if severe trauma - scapula can be injured (madami muscles)

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21
Q

what is sternum fracture

A

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

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22
Q

what is rib contusion

A

most common injury

bruising of rib due to trauma

pain and tenderness
pain in breathing

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23
Q

what is rib fracture

A

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

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24
Q

what is flail chest

A

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

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24
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
24
what is thoracostomy
creating and maintaining an opening into the thoracic cavity using needle or chest tube
24
what are the indications for thoracostomy
hemothorax pleural effusion pneumothorax open pnuemothorax prophylaxis pre-op in truma patients
25
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
26
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
27
what is tube thoracostomy
insertion of tube at 4th or 5th ICS at the anterior axillary line
28
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
29
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
30
what are hiccups
involuntary spasmodic contraction of diaphragm due to gastric irritation of vagus nerve can be symptoms of pleurisity, peritonitis, pericarditis or uremia
31
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
32
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
33
what is the pleural ligament
layers of pleura at the hilum of each lungs allows movement of pulmonary vessels and large bronchi during respiration
34
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
35
describe parietal pleura
sensitive to pain, touch and stretch needs anesthesia for chest tube
36
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
37
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
38
describe pleural fluid
5-10 ml of clear fluid lubricates visceral nd parietal capillaries of visceral pleura absorb this
39
explain pleural effusion
> 300 cc of fluid in pleural cavity
40
what is pleurisy
inflammation secondary to inflammation of lungs (pneumonia)
41
what is pneumothorax
air in pleural cavity from lungs or chest wall
42
what is empyema
collection of pus in pleural cavity
43
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
44
what are the anterior relationships of the trachea
sternum thymus gland left brachiocephalic vein origin of brachiocephalic left common carotid artery arch of aorta
45
what are the posterior relationships of the trachea
esophagus left recurrent laryngeal nerve
46
what are the right relationships of the trachea
azygos vein right vagus nerve pleura
47
what are the left relationships of the trachea
arch of aorta left common carotid left subclavian arteries left vagus nerve left phrenic nerve pleura
48
describe the bronchi
bifurcates behind the arch of aorta carina - end of junction trachea and principal bronchi; separates opening of bronchi
49
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
50
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
51
describe bronchioles
from division of smallest bronchi < 1 mm no cartilage - collapse easily lined by columnar epithelium cells
52
describe terminal bronchioles
.5 mm and branches from alveolar ducts possess outpouching from their walls; blood exchange happens here
53
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
54
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
55
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
55
describe the lungs
soft, spongy and elastic covered w visceral pleura
55
what is the hilum
depression in which the root of the lung is attached
56
describe the costal and mediastinal surface of the lungs
costal - follows concave chest wall mediastinal - molds into pericardium
57
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
58
what are the structures in the hilum
one pulmonary artery two pulmonary veins main bronchus bronchial vessels nerves and lymphatics
59
what are the structures at medial surface of right lung
heart inferior vena cava superior vena cava azygos vein esophagus
60
what are the structures at medial surface of left lung
heart aortic arch thoracic aorta esophagus
61
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
62
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
63
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
64
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
65
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
66
explain abdominal type of respiration
common in babies up to 2 yo males also used abdominal and thoracic
67
explain thoracic type of respiration
common in adults - esp female rely mainly on movement of ribs

pt momints ver 2.0 (14 decks)

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