Pleura and Lungs

Question 1

Relate the disposition of the parietal pleura to adjacent structures or spaces using the regional names to describe the relationships.

Answer 1

1. costal pleura - lines ribs, sternum, costal cartilage, intercostal muscles
2. mediastinal pleura - covers mediastinum on medial surface of each pleural cavity
3. Diaphragmatic pleura - covers superior surface of diaphragm
4. Cervical pleura - over the apex of the lung

Question 2

Define what anatomically constitutes the pleural recesses; where are they found>

Answer 2

three areas where the lungs do not extend to the limits of pleural cavity except in full inspiration. Here the parietal pleura in these areas actually contact each other with no intervening lung tissue.

1. right and left costodiaphragmatic recesses
2. left costomediastinal recess (cardiac notch)

Question 3

What is pleural effusion?

Answer 3

when fluid builds up between the visceral and parietal pleura - usually in the costodiaphragmatic recesses.

Question 4

Describe how fluid is removed from the pleural cavity

Answer 4

thoracentesis

Question 5

Describe the relationship of the phrenic nerve to the parietal pleura and fibrous pericardium.

Answer 5

The phrenic nerve lies lateral to the fibrous pericardium and innervates both the fibrous pericardium and the mediastinal and central diaphragmatic parietal pleura

Question 6

At the hilum of each lung, be able to distinguish the pulmonary veins and arteries and their positions relative to the primary bronchi.

Answer 6

RALS

RA - on the right lung, the pulmonary artery lies anterior to the primary bronchus. THe superior pulmonary vein is anterior to the artery and the inferior pulmonary vein is inferior to the bronchus

LS - on the left lung the pulmonary artery lies superior to the primary bronchus. THe superior pulmonary vein is anterior to both the broncus and artery and the inferior pulmonary vein is inferior to the bronchus.

Question 7

Identify the structures making up the root of the lung.

Answer 7

the pulmonary arteries, the pulmonary veins, the bronchi

the pulmonary plexus is here as well

Question 8

Describe the relationship of the vagus nerve and the phrenic nerve to the root of the lung.

Answer 8

THe vagus nerve passes BEHIND the root of the lung

the phrenic nerve passes in FRONT of the root of the lung

Question 9

How many bronchopulmonary segments are present in each lung?

Answer 9

10 - there are 10 segmental bronchi per lung

Question 10

Describe the anatomy of a bronchopulmonary segment.

Answer 10

A bronchopulmonary segment is that portion of lung supplied by a segmental bronchus and pulmonary artery branch. also has it’s own pulmonary vein.

note - the bronchus, pulmonary artery and bronchial artery will run together in the central part of the segment (which makes sense)

Question 11

Where does the trachea divide into primary bronchi? What structure supports the bifurcation?

Answer 11

supine position: at T4-T5
erect: T6

supported by the carina - a sagitally placed ridge of cartilage

Question 12

What are the different types of pneumothorax?

Answer 12

spontaneous
open - from a wound
tension (valvular)

Question 13

How is thoracentesis performed?

Answer 13

You insert a needle thorugh an intercostal space into the costodiaphragmatic recess. it’s important to place the needle above the diaphragm to avoid the liver and spleen, so the 9th interspace in the midaxillary line is the betst place

Question 14

Below the root of the lung, the thickened fusion of the visceral and parietal pleura is called what?

Answer 14

the pulmonary ligament

Question 15

How is the parietal pleura innervated?

Answer 15

intercostal nerves supplying the costal and peripheral diaphragmatic pleura

phrenic nerve supplying the mediastinal and more central diaphragmatic pleura

Question 16

Can the visceral pleura signal pain or contact?

Answer 16

nope - no nerves for general sensation or pain

Question 17

THe left lung has a superior and inferior lobe. which one has a cardiac notch?

Answer 17

the superior lob - it’s a nothc on the anterior border due to the bulging heart.

Question 18

What lies just inferior to the cardiac notch in the left lobe? WHere does it extend durig inspiration?

Answer 18

the lingula - it extends into the costomediastinal recess

Question 19

Why is the right lung shorter and wider than the left?

Answer 19

the mass of the liver pushes up against it

Question 20

which lung has larger capacity?

Answer 20

right lung

Question 21

The primary bronchi divide into ___ bronchi, which divide into ___ bronchi.

Answer 21

lobar bronchi
segmental bronchi (about 10 per lung)

Question 22

Why is an inhaled object more likely to lodge in the right bronchus? WHat does this cause?

Answer 22

the right bronchus is wider, shorter and more vertical - object has a greater chance of falling in that side.

this causes atelectasis - a collapsed and airless state of a lung

Question 23

What are the two sets of arteries that supply the lungs?

Answer 23

pulmonary arteries - per each bronchopulmonary segment, supplies areas of the lung concerned with gaseous exchange

bronchial arteries - three of them (one on the right arising from one of the itnercostals and two on the left arising directl from the aorta) - supply the lung tissue itself and the visceral pleura

Question 24

What are the two sets of veins that drain the lung?

Answer 24

pulmonary veins and bronchial veins

Question 25

What are the two major channels of pulmonary veins? WHere do they bring blood to in the heart? is it oxygenated or deoxygenated?

Answer 25

the superior an inferior pulmonary veins

they bring newly oxygenated blood to the left atrium

Question 26

What are sympathetic nervous system affects on the lungs?

Answer 26

bronchodilation and vasoconstriction

Question 27

WHat are the parasympathetic nervous system affects on the lungs?

Answer 27

bronchoconstriction, vasodilation and increased glandular secretion

Question 28

VIsceral afferent fibers signal stretch from where?

Answer 28

stretch in the alveoli and receptors in the walls of the bronchi

Question 29

What happens in pleuritis?

Answer 29

inflammation of the pleura which can lead to pleural adhesions.

the rough surfaces rub together and can be heard with a stethoscope. (pleural rub)

Question 30

What happens in hydrothorax? WHat’s the usual cause?

Answer 30

accumulation of significant amounts of fluid in the pleural cavities - usually from CHF

Question 31

A hemothorax is an accumulation of blood in the pleural cavity. Which arteries are usually the source?

Answer 31

intercostal arteries

Question 32

What is atelectasis? Causes?

Answer 32

colapse of the lung at the level of the alveoli.

mucous accumulation from surgery, asthma, CF
decrease in surfactant
tumors
clots