Pulmonary Structures Flashcards
Where does the trachea begin?
Immediately inferior to the cricoid cartilage
What forms the D-shaped cross section of the trachea?
The front of the trachea/cartilage rings will form C-shape
The back or the trachealis muscle will form a flat wall that connects to the c-shaped cartilage
Together, these make a “D” shape
Bifurcation of what structure happens at the level of the sternal angle?
The trachea: it will split into the left and right primary bronchi
What is the carina?
The ridge/point where the bifurcation/split of the trachea takes place
What are the first three divisions of the tracheobronchial tree?
-primary bronchi
-lobar bronchi
-segmental bronchi
What are primary bronchi?
The right and left bronchi that form after the first split of the trachea
What are lobar bronchi? How many are there on the right vs. the left?
The division of the primary bronchi will result in lobar bronchi
There are 2 lobar bronchi on the left (left primary bronchi splits once)
There are 3 lobar bronchi on the right (right primary bronchi splits twice)
What are segmental bronchi? How many are there?
The division of the lobar bronchi will result in segmental bronchi
There are 10 segmental bronchi on both sides (R and L)
How many times does the tracheobronchial tree divide before it reaches the alveoli?
Up to 20-25 times
At what segment does cartilage begin to disappear on the tracheobronchial tree?
Bronchioles (these will split to form terminal bronchioles)
-there is some cartilage but very small amount compared to other structures
Does gas exchange occur in the terminal bronchioles?
No, alveoli are not present here
Is there any cartilage on the terminal bronchioles?
No
What do terminal bronchioles split/divide into?
Respiratory bronchioles
Does gas exchange occur at the respiratory bronchioles?
Yes! begins here
Where do the alveoli begin to show up?
At the respiratory bronchioles (they will not be in clusters here, but some will be present on these bronchioles)
What three structures form the acinus?
-Respiratory bronchioles
-Alveolar ducts/sacs
-Clusters of alveoli
What is the top portion of the lungs known as?
Apex
What is the bottom portion of the lungs known as?
Base (“sits” on the diaphragm)
What is the hilum/root of the lungs?
The point where the lung becomes covered by the visceral pleura
The hilum/root serves an an entrance point into the lung tissue for which structures?
-Primary bronchi (R/L)
-Pulmonary arteries/veins
-Pulmonary nerves
-Lymph vessels/nodes
What are the 3 lobes of the right lung?
-superior lobe
-middle lobe
-inferior lobe
What fissure separates the superior and middle lobes of the RIGHT lung?
Horizontal fissure
What fissure separates the middle lobe and the inferior lobe of the LEFT lung?
Oblique fissure
How many bronchopulmonary segments does the superior lobe of the RIGHT lung have?
3
How many bronchopulmonary segments does the middle lobe of the RIGHT lung have?
2
How many bronchopulmonary segments does the inferior lobe of the RIGHT lung have?
5
How many lobes does the left lung have?
2- superior and inferior
What is the landmark on the superior lobe of the LEFT lung?
Lingula- analogous to the middle lobe of the right lung
-it is essentially the lower/bottom portion of the superior lobe of the left lung
What is the cardiac notch of the LEFT lung?
C-shaped curve of the left superior lobe that accommodates for the heart sitting in the thoracic cavity
What fissure divides the superior and inferior lobes of the LEFT lung?
Oblique fissure
How many bronchopulmonary segments does the superior lobe of the LEFT lung have?
5
(inferior lobe of the left lung also has 5)
What does inspiration do to the location of the inferior borders of the lungs (how does it change what level the borders are at rib-wise)?
Inspiration will contract the diaphragm
-As the diaphragm flattens, it will LOWER the inferior border
What are the two types of pulmonary pleura?
Visceral and parietal
What is the visceral pleura of the lungs?
The inner layer of the pleura which wraps around the lungs (follows the contour of each lung)
What kind of innervation does visceral pleura have?
Autonomic innervation
When it is irritated, there will be limited or diffuse nociception (pain)
*patient will not have localized pain, will have uncomfortable pain which is not very specific in location
What is the parietal pleura of the lungs?
The outer layer of the pleura which lines the thoracic wall/diaphragm (follows the contour of these)
What kid of innervation does parietal pleura have?
Somatic innervation
When it is irritated, there will be focal nociception (pain)
*patient will be able to point to a localized point of sharp pain
What is the pleural cavity?
The potential space between the two pleural layers
What is the pleural space lubricated by?
Serous pleural fluid, allows smooth frictionless surface for lungs and rib cage to move back and forth
What is a the costodiaphragmatic recess?
Space that is formed in between the diaphragmatic parietal pleura and the costal parietal pleura (along rib cage)
Where is the costodiaphragmatic recess located?
The junction between the posterior/lateral ribs and the diaphragm
What is the costophrenic angle? How can it be visualized?
-Junction of the ribs/diaphragm
Can be seen on a chest x-ray! (bottom corner)
**want a nice and sharp clean angle (if there is fluid accumulation in the recess, there will be a non-distinct angle due to the fluid pushing the lungs up)
What is the costomediastinal recess? WHich direction does it run?
A smaller pleural recess (space) which is located in the anterior rib cage
This space runs vertical
What does the costomediastinal recess run anterior to?
the heart
What does the costomediastinal recess run posterior to?
sternum
A thoracentesis will drain fluid from what recess?
costodiaphragmatic recess (removes fluid that would build up/push lungs up/blur the costophrenic angle)
*want to make sure you are in the SPACE and not hitting the lung or diaphragm
What is the difference between bronchial circulation and pulmonary circulation?
Pulmonary circulation: provides blood to ALVEOLI for gas exchange (brings blood from the heart to the lungs/alveoli for gas exchange, and bring the oxygenated blood back to the heart)
Bronchial circulation: provides blood to AIRWAY STRUCTURES (trachea, bronchi, etc.)
What is the pathway of PULMONARY circulation?
-Right ventricle pushes out a stroke volume to the pulmonary trunk
-Blood flows through the right and left pulmonary arteries
-Blood makes it’s way to the lungs and reaches the pulmonary capillaries where gas exchange will occur with the alveoli
-Oxygenated blood will return to the heart through the pulmonary veins ***There are 4 pulmonary veins: 2 on the left/2 on the right
-4 pulmonary veins will bring blood to the left atria and will then move to the left ventricle
-Blood will then be pushed out into the aorta
