The Pleura and Lungs Flashcards
Abbreviation for layers of thorax and label the diagram below.
SSDMEPPV
Pleura definition
serous membrane that lines the pulmonary cavity and invests the lungs; parietal pleura and visceral pleura
pleural cavity definition
potential space between the layers of pleura
Parietal pleura lines the
pulmonary cavities
Visceral pleura lines the
invests/envelops the parenchyma each lung
What are the 4 parts of the parietal pleura?
- costal part - thoracic wall
- mediastinal part - mediastinum
- diaphragmatic part - superior surface of the diagram
- cervical pleura - lung apex
Costal part of parietal pleura is associated with the —— part of the thoracic wall.
anteriolateral
The cervical pleura sits at the
root of the neck and extends above the first rib (cervical vertebrae at the base of the neck
Pleural reflections
change in direction of pleura from one wall of pleural cavity to another:
- sternal reflection = anteriorly, costal parietal pleura becomes mediastinal part
- costal reflection = costal part becomes diaphragmatic part, an inferior reflection
- vertebral reflection = posteriorly, costal parietal pleura becomes mediastinal part
all parts are present on both left and right lungs
Pleural Recesses
slightly expanded pleural reflection
larger pleural spaces, allow for lung expansion in forced inspiration:
- costodiaphragmatic recess:
- costomediastinal recess
Costomediastinal recess
at costal and sternal reflection, on left hand side, greater change in direction as we have to go around the mediastinum
Costodiaphragmatic/ costophrenic recess
most inferior recess of costal reflection, costal part becomes diaphragmatic part, lungs expand when we inhale, so fill the space inferiorly.
Clinically importance of costodiaphragmatic recess
normally a sharp angle
if blunting of angle occurs, generally excess fluid in pleural recess, indicative of a pathology
How many secondary/lobar bronchi on the left?
2
How many secondary/lobar bronchi on the right?
3
Right main bronchus is short, wide and travels more vertically.
True or False?
True
Left main bronchus is long, narrow, inferolateral.
True or False?
True
Any inhaled foreign body is more likely to pass through the right main bronchus because
Wider and more vertical, hence a clearer continuation of the trachea
How many lobar bronchi are there?
5
One bronchi going to each lobe of the lung
2 left
3 right
Terminal bronchioles further divide into
respiratory bronchioles
Respiratory bronchioles further divide into
alveolar ducts and sac, which further divide into alveoli
How many alveolar ducts per respiratory bronchioles?
2-11
How many alveolar sacs per alveolar duct?
5-6 sacs
How many alveoli in the lungs?
300 million alveoli per lung
Location of the lungs
within respective pulmonary cavity, surrounded by visceral pleura
List the features of lungs (6):
- apex
- base
- lobes
- fissures
- surfaces
- borders
Apex of the lung:
covered by cervical pleura, extends into the root of the neck
apex of the lung is the superior peak; not always the case like the heart
Base of the lung:
Lays on each hemi-diaphragm
Opposite the apex
Lobes of the lung:
superior, middle (right only), inferior
Fissures of the lung:
oblique (both), horizontal (right only)
Surfaces of the lung:
Costal, diaphragmatic, mediastinal
Borders of the lung:
anterior, posterior and inferior
Change in direction in surface of the lung
Left lung features:
Lingula = little tongue like projection (posterior)
Cardiac notch = covers the heart/ middle mediastinum
Lobes = superior and inferior
Fissures = oblique fissure, higher posteriorly than anteriorly, separates superior and inferior lobe
Surfaces = costal, diaphragmatic, mediastinal
Borders= anterior, inferior, posterior
Diagram of left lung:
Right Lung features
Lobes = superior, middle, inferior
Fissures = oblique fissure in same orientation as left lung, horizontal fissure divides superior and middle lobes
Surfaces = mediastinal, costal, diaphragmatic
Borders = anterior, posterior, inferior
Bronchopulmonary segments:
- pyramidal shaped segments
- apices faces root (medially), base faces pleural surface (externally/superficially)
- 10 in right lung
- 8-10 in the left lung
- named after segmental/tertiary bronchus
Bronchopulmonary segments diagram
insert
serous membrane develops from what embryological structure?
lateral plate mesoderm
The cervical pleura is inferior to the clavicle.
True or False?
False
Cervical pleura is 2/3 cm superior to 1/3 of the medial clavicle or 3-4cm above the first costal cartilage
Root (lungs):
all structures collectively entering and exiting the hilum of the lung
Hilum
wedge shaped depression where those structures enter and exit
Root of the left lung:
- pulmonary artery
- superior pulmonary vein
- inferior pulmonary vein
- Bronchial artery x2
- Bronchial Vein
- Main bronchus
- Pulmonary plexus
- Lymphatic vessels
Root of the right lung:
- pulmonary artery
- superior pulmonary vein
- inferior pulmonary vein
- bronchia artery x3
- bronchial vein
- pulmonary plexus
- lymphatic vessels
General organisation of the root of lung diagram:
Hilum of the left lung diagram:
- pulmonary artery sits higher than the main bronchus
Hilum of the right lung diagram and deviation from general organisation:
-
Hilum features ( & root of lung):
Pleural Sleeve: reflection from parietal to visceral pleura, surrounding the root of the lung
Pulmonary ligament: inferior continuation of the pleural sleeve
What is the green and red label?
bit that hangs down is pulmonary ligament
Pulmonary circulation
supplies the lung parenchyma, involved in gas exchange
oxygenated and deoxygenated switched around out
Low pressure system
Bronchial circulation
supplies the tracheobronchial tree till respiratory bronchioles, root of lung, supporting lung tissue, visceral pleura
systemic system, follows normal oxygenated and deoxygenated, higher pressure
Pulmonary arteries are (2)
right and left
pulmonary veins are (4) and drain into
right superior
right inferior
left superior
left inferior
- bronchopulmonary segment veins merge and eventually form pulmonary veins which drain into the left atrium of the heart
Pulmonary circulatory system diagram
Bronchial arteries arise from
2 on the left
1 on the right
arise directly from the thoracic aorta on left
arise as a single trunk with the left superior bronchial artery or can branch off the right third posterior intercostal artery
Bronchial veins drain
Right and Left
Right vein drains into azygous vein
Left bronchial vein drains into accessory hemiazygous vein
all drains into azygous, which drains into the superior vena cava at bifurcation of trachea sternal angle
Bronchial circulation diagram:
Bronchial circulation diagram:
Innervatiion of parietal pleura is —– and therefore
somatic
Sensory supply to parietal pleura: left and right phrenic nerves, C3-C5, intercostal nerves
Innervation of visceral pleura, which ——–, hence —– and therefore ——
- visceral
- sensory supply to visceral pleura: sympathetic trunk T2-T6
Innervation of lungs are ——- afferents and ——-
visceral afferents and autonomic
Mixed signals of sympathetic and parasympathetic travel to and fro from lungs via a
plexus
Pulmonary Plexus (mixed) innervation LUNGS
Sensory supply: Vagus nerve (parasympathetic pathway) C10
Somatic nervous system: Sympathetic Trunk T2-T6
Parasympathetic Nervous System: Vagus nerve C10
what dermatomes for referred parietal pleura pain
C3-C5; cervical and shoulder
Innervation of any serous membrane lining viscera will have same innervation
as viscera it is lining
Innervation diagram:
Last card about dermatome confusion pain
complete
Right lung:
