Pleura and Lungs Flashcards
Relate the disposition of the parietal pleura to adjacent structures or spaces using the regional names to describe the relationships.
- costal pleura - lines ribs, sternum, costal cartilage, intercostal muscles
- mediastinal pleura - covers mediastinum on medial surface of each pleural cavity
- Diaphragmatic pleura - covers superior surface of diaphragm
- Cervical pleura - over the apex of the lung
Define what anatomically constitutes the pleural recesses; where are they found>
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.
- right and left costodiaphragmatic recesses
- left costomediastinal recess (cardiac notch)
What is pleural effusion?
when fluid builds up between the visceral and parietal pleura - usually in the costodiaphragmatic recesses.
Describe how fluid is removed from the pleural cavity
thoracentesis
Describe the relationship of the phrenic nerve to the parietal pleura and fibrous pericardium.
The phrenic nerve lies lateral to the fibrous pericardium and innervates both the fibrous pericardium and the mediastinal and central diaphragmatic parietal pleura
At the hilum of each lung, be able to distinguish the pulmonary veins and arteries and their positions relative to the primary bronchi.
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.
Identify the structures making up the root of the lung.
the pulmonary arteries, the pulmonary veins, the bronchi
the pulmonary plexus is here as well
Describe the relationship of the vagus nerve and the phrenic nerve to the root of the lung.
THe vagus nerve passes BEHIND the root of the lung
the phrenic nerve passes in FRONT of the root of the lung
How many bronchopulmonary segments are present in each lung?
10 - there are 10 segmental bronchi per lung
Describe the anatomy of a bronchopulmonary segment.
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)
Where does the trachea divide into primary bronchi? What structure supports the bifurcation?
supine position: at T4-T5
erect: T6
supported by the carina - a sagitally placed ridge of cartilage
What are the different types of pneumothorax?
spontaneous
open - from a wound
tension (valvular)
How is thoracentesis performed?
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
Below the root of the lung, the thickened fusion of the visceral and parietal pleura is called what?
the pulmonary ligament
How is the parietal pleura innervated?
intercostal nerves supplying the costal and peripheral diaphragmatic pleura
phrenic nerve supplying the mediastinal and more central diaphragmatic pleura
Can the visceral pleura signal pain or contact?
nope - no nerves for general sensation or pain
THe left lung has a superior and inferior lobe. which one has a cardiac notch?
the superior lob - it’s a nothc on the anterior border due to the bulging heart.
What lies just inferior to the cardiac notch in the left lobe? WHere does it extend durig inspiration?
the lingula - it extends into the costomediastinal recess
Why is the right lung shorter and wider than the left?
the mass of the liver pushes up against it
which lung has larger capacity?
right lung
The primary bronchi divide into ___ bronchi, which divide into ___ bronchi.
lobar bronchi segmental bronchi (about 10 per lung)
Why is an inhaled object more likely to lodge in the right bronchus? WHat does this cause?
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
What are the two sets of arteries that supply the lungs?
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
What are the two sets of veins that drain the lung?
pulmonary veins and bronchial veins
What are the two major channels of pulmonary veins? WHere do they bring blood to in the heart? is it oxygenated or deoxygenated?
the superior an inferior pulmonary veins
they bring newly oxygenated blood to the left atrium
What are sympathetic nervous system affects on the lungs?
bronchodilation and vasoconstriction
WHat are the parasympathetic nervous system affects on the lungs?
bronchoconstriction, vasodilation and increased glandular secretion
VIsceral afferent fibers signal stretch from where?
stretch in the alveoli and receptors in the walls of the bronchi
What happens in pleuritis?
inflammation of the pleura which can lead to pleural adhesions.
the rough surfaces rub together and can be heard with a stethoscope. (pleural rub)
What happens in hydrothorax? WHat’s the usual cause?
accumulation of significant amounts of fluid in the pleural cavities - usually from CHF
A hemothorax is an accumulation of blood in the pleural cavity. Which arteries are usually the source?
intercostal arteries
What is atelectasis? Causes?
colapse of the lung at the level of the alveoli.
mucous accumulation from surgery, asthma, CF
decrease in surfactant
tumors
clots
