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CV > pleural cavity and lungs > Flashcards

pleural cavity and lungs Flashcards

1
Q

upper respiratory tract

A
  1. Nose/nasal cavities/paranasal sinuses
  2. Pharynx
  3. Larynx
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2
Q

lower respiratory tract

A

C. Lower respiratory tract

  1. Trachea
  2. Bronchi
  3. Lungs
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3
Q

contents of pulmonary cavities

A

lungs, pleura, and pleural cavity.

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4
Q

Trachea

A

a. Starts at CV6 and runs through neck and superior mediastinum along midline.
b. Bifurcates into right and left primary (main) bronchi at the transverse thoracic plane.
c. Composed of C-shaped hyaline cartilage bars; filled in posteriorly with longitudinal smooth muscle called the trachealis.
d. Carina – last cartilage ring located at bifurcation of trachea; projects into lumen; identifiable on bronchoscopy and on chest x-ray.
e. Vascular supply – bronchial, inferior thyroid vessels.
f. Lymphatic supply – paratracheal lymph nodes.
g. Innervation – recurrent laryngeal branches of vagus nerves.

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5
Q

tracheal pathology

A

Pathologies such as bronchial carcinoma can cause the carina to be distorted due to spread of metastatic cancer cells into inferior tracheobronchial (carinal) lymph nodes.

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6
Q

carina

A

point at which trachea bifurcates into right and left main bronchii.
last cartilage ring located at bifurcation of trachea; projects into lumen; identifiable on bronchoscopy and on chest x-ray.

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7
Q

bronchi

A

a. Left and right primary (main) bronchi.
b. Right bronchus is wider, shorter, and more vertically oriented than the left bronchus; thus foreign objects will typically lodge in the right bronchus.
c. Primary bronchi pass inferolaterally within the root of the lung.
d. Within lung, primary bronchi give rise to secondary (lobar) bronchi; 3 lobes on the right and 2 lobes on the left.
e. Secondary bronchi further branch into tertiary (bronchopulmonary segmental) bronchi; 10 bronchopulmonary segments on the right and 8 bronchopulmonary segments on the left

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8
Q

Describe structure of lungs

A

tertiary bronchi branch 18 - 20 times; bronchioles give rise to alveolar ducts; alveolar ducts give rise to alveoli (thin-walled structures which compose the parenchyma of the lungs and are visualized using microscopy. See histology lectures)

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9
Q

airway conduction system

A

Trachea –> R&L main bronchi–> Lobar (secondary) bronchi (1 to each lobe, 3 on right, 2 on left)–> segmental (tertiary) bronchi to each broncho-pulmonary setment (10 on right, 8 on left)

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10
Q

General feature of pleura

A
  1. Thin, serosal membranes (parietal and visceral) surrounding the lung.
  2. Composed of simple squamous epithelial cells + thin layer of loose connective tissue.
  3. Provides smooth surface for the lungs to move on during respiration.
  4. Secrete serosal fluid (a watery, lubricating secretion derived from the blood supply) which fills the pleural cavity and allows lungs to slide in a near frictionless space. This small amount of serous fluid is the only thing that is IN the pleural space.
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11
Q

visceral pleural

A
  1. Intimately adherent to all external surfaces of the lungs (including fissures).
  2. Reflects (turns 180 degrees) and is continuous with parietal pleura at the hilum of the lung.
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12
Q

Parietal pleural

A

lines internal surface of thoracic wall

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13
Q

surfaces of parietal pleura

A

named for the structure it lies upon

a. Costal surface – costal portion of the parietal pleura
b. Diaphragmatic surface – diaphragmatic portion of the parietal pleura
c. Mediastinal surface – lines mediastinal surfaces; continuous with the visceral pleural at the hilum of the lung; together with the visceral pleura forms the pulmonary ligament, an inferior extension of pleura which assists in maintaining position (i.e. a point of fixation) of lung in thoracic cavity.
d. Cervical extension – extends superiorly into the root of the neck reaching its apex slightly superior to the neck of the first rib; reinforced by the suprapleural membrane (Sibson’s fascia) which is a thickening of the endothoracic fascia.

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14
Q

parietal pleura lines of reflection

A

a. Vertebral – costal pleura becomes continuous with mediastinal pleura posteriorly.
b. Costal – costal pleura becomes continuous with diaphragmatic pleura inferiorly.
c. Sternal – costal pleura becomes continuous with mediastinal pleura anteriorly.

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15
Q

Clinical correlations of pleura

A
  1. CLINICAL CORRELATION: The extention of the cervical pleura into the root of the neck is clinically relevant as it may be punctured due to wounds in the neck which causes a pneumothorax.
  2. CLINICAL CORRELATION: If the pleura membranes become inflamed due to disease (pleuritis or pleurisy), they become rough and no longer slide easily over one another. Pleuritis can be very painful because the parietal pleurae receive extensive sensory innervation from intercostal and phrenic nerves. Thus, pain is referred to the area of the thoracic wall or to the point of the shoulder via the phrenic nerves
    (C3,4,5). The visceral pleura sensory nerves travel with autonomic fibers.
  3. CLINICAL CORRELATION: The right sternal reflection passes inferiorly in the medial plane to the level of the 6th costal cartilage; the left sternal reflection passes inferiorly in medial plane to the level of the 4th costal cartilage and then turns laterally and inferiorly to the level of the 6th costal cartilage, creating a notch allowing a small part of the pericardium to be in direct contact with the anterior thoracic wall (bare area of the heart; This becomes important when performing a pericardiocentesis).
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16
Q

Pleural cavity

A

Contains a minimal amount of lubricating serous fluid; between parietal and visceral pleura. NOTHING else in IN the pleural cavity.

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17
Q

Pleural recesses

A

a. Areas of pleural cavity which the lungs do not completely occupy during quiet respiration; two layers of parietal pleura come into contact with each other.
b. Costomediastinal – where mediastinal pleura reflects to become costal pleura anteriorly.
c. Costodiaphragmatic – where costal pleura reflects to become the diaphragmatic pleura (inferiorly, around periphery of diaphragm. Readily seen on chest x-ray).
d. The costodiaphragmatic recess can inadvertently be damaged during procedures (like renal biopsies) or injuries in the abdomen since it reflects at TV12 posteriorly

18
Q

Pneumothorax

A

Pneumothorax results from puncture of the visceral or parietal pleura (from a broken rib, ice pick, emphysema etc) This allows air to enter the pleural cavity and this potential space becomes a real space. When the pleural cavity is compromised, the natural elasticity of lung causes it to collapse. Air (pneumothorax), blood (hemothorax), or fluid (hydrothorax; chylothorax) may accumulate in pleural recesses and must be aspirated (sucked out) to allow the lungs to reinflate once the pleura heals. Treatment is tube thoracostomy (i.e. chest tube placement)

19
Q

Tension pneumothorax

A

Tension pneumothorax can have several causes (including trauma, emphysema, lung cancer, COPD etc). It is caused by a loss of integrity of the visceral or parietal pleura resulting in air entering the pleural space, however this air is unable to exit. Thus, a one-way valve is created. With each breath more air accumulates in the pleural space and intrathoracic pressure becomes high. The increased pressure will cause a shift in mediastinal contents to the contralateral side. This shift compromises venous return through the superior and inferior venae cavae. Signs of tension pneumothorax include distended neck veins and hypotension due to low cardiac output. Treatment is tube thoracostomy (i.e. chest tube placement)

20
Q

Spontaneous pneumothorax

A

Spontaneous (primary) pneumothorax typically occurs in tall, lanky males and can cause significant respiratory distress. Treatment is tube thoracostomy (i.e. chest tube placement)

21
Q

Surface projections of right lung

A
  1. Apex – extends to level of neck of first rib.
  2. At midclavicular line, lung projects inferiorly to rib 6.
  3. At midaxillary line, lung projects inferiorly to rib 8.
  4. At scapular line, lung projects inferiorly to rib 10.
22
Q

Surface projections of left lung

A

a. Apex – extends to level of neck of first rib.
b. At midsternal line, lung projects inferiorly to rib 4, then turns inferolaterally to 6th rib at MCL. This sharp lateral turn creates the cardiac notch.
c. At midaxillary line, lung projects inferiorly to rib 8.
d. At scapular line, lung projects inferiorly to rib 10.

23
Q

Hilum

A

the area where all structures enter and leave the lung. (on mediastinal surface of lung.)

24
Q

Lobes and fissures

A
  1. Right lung
  2. 2 fissures (oblique and horizontal) thus,
  3. 3 lobes (superior, middle, inferior)
  4. Left
  5. 1 fissure (oblique) thus,
  6. 2 lobes (superior, inferior)
  7. Cardiac notch and Lingula
  8. The oblique fissures (of right and left lungs) pass anteroinferiorly, from the 4th rib posteriorly to the 6th rib and costal cartilage anteriorly.
  9. The horizontal fissure (of the right lung) follows the course of the 4th rib.
    (So the middle lobe lies between the 4th and 6th ribs anteriorly)
25
Q

Root of the lung : all the structures that enter or leave the lungs

A
  1. Pulmonary artery – usually the most superior
  2. Pulmonary veins – usually anterior and inferior
  3. Primary bronchi – usually posterior (right superior lobar bronchus may branch within root of lung)
  4. Bronchial arteries and veins (typically 1 on right and 2 on left)
  5. Pulmonary plexus of nerves (on posterior surface of bronchi, branches with bronchi)
  6. Lymphatic vessels and lymph nodes
26
Q

Bronchopulmonary segments

A
  1. Smallest functional unit of the lung.
  2. Area supplied by 1 tertiary bronchus and associated branch of pulmonary artery.
  3. Separated from adjacent segments by connective tissue septa.
  4. Pulmonary veins run between bronchopulmonary segments (i.e. intersegmentally)
27
Q

Clinical correlations of bronchopulmonary segments

A

Diseases of the lung (tumors, abscesses) often localize to a bronchopulmonary segment. These segments can be surgically resected without altering function of other segments.

a. Pneumonectomy = surgical removal of one lung
b. Lobectomy = surgical removal of one lobe of the lung
c. Segmentectomy = surgical removal of a bronchopulmonary segment

28
Q

Pulmonary circulation

A

a. Pulmonary arteries
1. Carry poorly-oxygenated blood from right ventricle to lungs.
2. Originate from the pulmonary trunk (artery) at the level of sternal angle.
3. Branch and course with the bronchial airways.
4. Supply distal portions of the tracheobronchial tree (small bronchioles and alveoli) and visceral pleura.
b. Pulmonary veins
1. Superior and inferior veins.
2. Return oxygenated blood to the left atrium.
3. Originate from capillary beds around alveoli and course intersegmentally. (within the intersegmental connective tissue.)

29
Q

pulmonary embolism

A

results when a blood clot (usually from the lower extremities) travels to the pulmonary artery or one of its branches and blocks blood flow to a portion of the lung. This is a life-threatening condition due to decreases in blood oxygenation and obstruction of pulmonary blood flow. Large emboli (blocking the main pulmonary artery) result in acute respiratory distress and often lead to death in a matter of seconds to minutes. Smaller emboli result in pulmonary infarction.

30
Q

systemic circulation

A

a. Bronchial arteries
1. Originate from thoracic aorta.
2. Typically two on the left and one on the right; the right often originates from 3rd right posterior intercostal artery.
3. Courses with the bronchial tree.
4. Supply trachea and bronchii.
b. Bronchial veins – course with bronchial arteries; terminate in azygos veins.

31
Q

Lymphatic drainage

A
  1. Pulmonary nodes – within substance of lung.
  2. Bronchopulmonary (hilar) nodes – at hilum of lung.
  3. Superior and Inferior Tracheobronchial nodes – at tracheal bifuration.
  4. Superficial (subpleural plexus) lymphatic system
    a. Drains visceral pleura and most of lung parenchyma.
    b. Drain to bronchopulmonary nodes → superior and inferior tracheobronchial nodes → bronchomediastinal trunk.
    c. The bronchomediastinal trunk drains to the thoracic duct on the left and to the right lymphatic duct on the right.
  5. Deep pulmonary plexus
    a. Drains larger bronchioles and bronchi.
    b. Drain to pulmonary nodes → bronchopulmonary nodes → tracheobronchial nodes → bronchomediastinal trunk
    - Note: lymph from the left inferior lobe can drain to right tracheobronchial nodes and vice versa
  6. Note: lymphatic drainage of the parietal pleura is to the thoracic wall (mainly intercostal, but also parasternal, diaphragmatic, axillary lymph nodes).
32
Q

Innervation of lungs

A
  1. The lungs receive both parasympathetic and sympathetic innervation.
  2. These nerves distribute to the lungs via the anterior and, primarily, the posterior pulmonary plexuses located along the primary bronchi. These plexuses are a continuation of the deep cardiac plexus.
33
Q

sympathetic innervation of lung

A

a. Preganglionic nerve cell bodies are located in T2-T6 segments of the spinal cord, their nerve cell processes enter sympathetic chain.
b. Postganglionic nerve cell bodies located in upper thoracic and cervical
portions of the sympathetic chain ganglia.
c. Postganglionic nerve cell processes form cardiac branches which are called cardiopulmonary splanchnic nerves. The thoracic cardiopulmonary splanchnic nerves are the primary sympathetic supply to the lungs.
Cause bronchodilation, vasoconstriction, inhibit gland secretion.
d. Visceral afferents: transmit acute pain.

34
Q

parasympathetic innervation of lung

A

a. Preganglionic nerve cell bodies in the brain stem, preganglionic nerve cell processes travel in the vagus nerve.
b. In the thorax, the vagus gives off thoracic cardiac parasympathetic branches which contribute to the cardiac and pulmonary plexuses.
c. Postganglionic nerve cell bodies are in the wall of the airways.
Cause bronchoconstriction, vasodilation, gland secretion.

35
Q

referred pain

A

Innervation of the parietal pleural is via nerves supplying the thoracic wall including intercostal and phrenic nerves. Thus, pain is referred to the area of the thoracic wall supplied by the intercostal nerve or to the root of the neck/shoulder via phrenic nerve.

36
Q

atelectasis

A

collapse or incomplete expansion of the lung

37
Q

pleura effusion

A

watery fluid in pleural cavity

38
Q

hemothorax

A

blood in pleural cavity

39
Q

pneumothorax

A

air in pleural cavity

40
Q

tension pneumothorax

A

air in pleural cavity with mediastinal shift leading to decreased venous return ergo decreased cardiac output and death if not quickly identified and treated

41
Q

Empyema (pyothorax)

A

pus in pleural cavity

42
Q

chylothorax

A

chyle (lymphatic fluid) in pleural cavity due to injured thoracic duct

CV (15 decks)

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