Pleura and Diaphragm Flashcards
what is found on either side of mediastinum?
Two pleural cavities and surrounds the lungs
explain margins of pleural cavities
Superiorly – extends above Rib 1 into neck.
Inferiorly – extends to level just above costal margin.
Medial wall of pleural cavity – Mediastinum
Names given to part of parietal pleura correspond to which parts?
Parts of the wall they are associated with..
Name and explain each part of parietal pleura.
costal part- related to ribs and intercostal spaces.
Diaphragm part- covering diaphragm.
mediastinum part- covering the mediastinum.
cervical pleura- pleura that is dome-shaped layer lining the cervical extension of the pleural cavity.
which structure covers superior surface of cervical pleura, distinct dome-shaped layer of fascia.?
Suprapleural membrane
provides support for the pleura cavity in the root of the neck.
in which region, does the mediastinal pleura reflects as a tubular sleeve, covering structure which pass between lung and mediastinum
T5-T7
Sleeve-like covering and the structures it contains forms the root of the lung.
Root of lung joins medial surface of lung at the hilum of the lung, where visceral and parietal pleura are continuous.
what is the innervation of parietal pleura?
parietal pleura is innervated by branches of Somatic afferent fibers.
what innervate costal pleura?
intercostal nerves.
Pain would be felt in relation to the thoracic wall.
Diaphragmatic pleura and mediastinal pleura are innervated mainly by which nerve?
phrenic nerve
(C3, C4, C5 spinal nerve)
along which dermatomes will the pain be felt along?
C3, C4, C5
lateral aspect of neck and the supraclavicular region of the shoulder
why the pleural cavity doesn’t extend above the first rib.?
- projects 3-4cm above first costal cartilage
- all this due to the articulation of the first rib 1 and manubrium and slope that rib 1creats
anterior what does these cavities do?
they approach each other at the posterior part of the upper part of the sternum.
Inferiorly, the costal pleura reflects onto diaphragm above costal margin, at which levels?
Midclavicular line the pleural cavity extends to ~Rib8
Midaxillary line it is at Rib10.
Courses horizontally to reach T12 vertebrae.
what is continuous of parietal pleura at the hilum of the lung?
visceral pleura
visceral pleura is firmly attached to what?
surface of the lung as well as in the fissure of the lung
Visceral pleura is innervated by—————-that accompaies bronchial vessels.
visceral afferent
However, pain is generally not stimulated from this tissue.
The sensory fibres mainly detect stretch.
Nerve supply is via autonomic nervous system.
when does the expansion of the lungs occurs into these spaces?
during forced respiration
what else does the recesses also provide?
potential spaces in which fluids can be collected and be aspirated.
what happens when lungs do not fill the regions of the pleural cavity?
This creates two recesses where two layers of parietal pleura become opposed.
Costomediastinal recesses
is found anterior.
occurs on either side where the costal pleura is opposed to mediastinal pleura.
largest is found on the left side in the region overlying the heart.
The Largest recesses and that is clinically relevant?
costodiaphragmatic Recesses.
where does the costodiaphragmatic recesses occurs?
in the pleural cavity between the costal and diaphragmatic pleura.
between which margins does the costodiaphragmatic lie
Found between the inferior margin of the lung and inferior margin of pleural cavities.
when does this recesses become deepest and why?
Deepest after forced expiration, shallowest after forced inspiration.
Because the lung deflects( move upward)
They will be fluid in the recess
what happens to costodiaphragmatic recess during quiet respiration in the inferior margin of the lung?
crosses rib 6 in the midclavicular line
rib 8 in the midaxillary line
horizontally rib T10
inferior margin of the lung.
pleural cavity remains the same true or false?
true
rib 8, rib 10 AND T12
Define diaphragm?
thin, musculotendinous structure that fills the inferior thoracic aperture separating the thoracic and abdominal cavities.
what are the peripheral origin points of the diaphragm?
Xiphoid process of sternum.
Costal margin.
Ribs 11 and 12.
Ligaments running across structures of Posterior Abdominal Wall.
Vertebrae of Lumbar Region.
at which points does the fibers converge to join the Central tendon?
Peripheral points of diaphragm
what anchors the diaphragm to the lumbar vertebrae?
crura.
the attachments of the left and right crura(crus)
right crus- L1-L3
left crus-L1-L2
The crura are connected across the midline by which tendinous arch?
median arcuate ligament
The position of the medial arcuate ligament?
found of the left side
attached to L1/L2 and transverse of L1.
lies lateral to crura and covers Psoas major.
The position of lateral arcuate ligament
found on the righten side
attached to L1, L2NAD L3
and rib 12
covers quadratus lumborum.
Structures Passing Through The Diaphragm
AORTIC HIATUS – Level T12
Aorta lies anterior to the vertebral bodies at T12 and is posterior to the median arcuate ligament.
Thoracic Duct and Azygos Vein also pass through here.
OESOPHAGEAL HIATUS – Level T10
Oesophagus passes through right crus at T10 just left of the aortic hiatus.
Anterior and Posterior Vagal Trunks also pass through here.
CAVAL OPENING – Level T8
Inferior Vena Cava passes through tendinous part at T10.
Right phrenic nerve also passes through here.
where does the dome level lies on?
Classic dome appearance on right and left side is due to abdominal contents that pushes the lateral parts upward and the pericardial sac that pushes the central tendon downwards.
LEFT DOME- AT THE 5TH INTERCOSTAL SPACE
RIGHT DOME AT RIB 5
explain the blood supply of diaphragm?
Superior surface – Pericardiophrenic, Musculophrenic and superior phrenic arteries.
Inferior surface – Inferior phrenic artery.
the innervation of the diaphragm?
phrenic C3, C4 AND C5)
what happens when ribs are elevated ?
they move the sternum upward and forward
when ribs are depressed?
depressed the sternum is moved downward and backward (posteroinferiorly).
when shaft are elevated what happens?
the middle of the shaft move laterally superiorly
this create bucket-handle
