Sem 1 - E - Pleura & Lungs - Pulmonary cavities & linings/surface markings, Relations of hilum, Bronchial Tree, Lymphatics

Question 1

What are the three main divisions of the thoracic cavity?

Answer 1

The right hemithorax, the left hemithorax, and the mediastinum

Question 2

Body cavities and the organs they contain are lined with/covered by a serous membrane What is the function of the serous membrane? What is the specific serous membrane in the pulmonary cavities known as? What is the specific serous membrane in the abdomen known as?

Answer 2

The function of the serous membranes is to produce a small amount of fluid to lubricate the movement of the organ within its cavity * Pulmonary cavity serous membrane is known as the PLEURA * Abdominal cavity serous membrane is known as the PERITONEUM

Question 3

What are the two different parts of the pleura lining the pulmonary cavity?

Answer 3

This would be the visceral pleura and the parietal pleura

Question 4

True or false Visceral pleura lines the pulmonary cavity? Parietal pleura lines the pulmonary cavity?

Answer 4

False Right answer = The visceral pleura covers the surface of the lung True = The parietal pleura lines the pulmonary cavity (and is attached to the thoracic wall separated by the endothoracic fascia)

Question 5

What are the different parts of the parietal pleura? Where does the parietal pleura meet the visceral pleura?

Answer 5

The parietal pleura consists of the cervical, costal, diaphragmatic and mediastinal pleura The mediastinal parietal plerua meets the visceral pleura at the hilum (the root) of the lung

Question 6

State what each box is pointing to What is the mediastinal pleura continuous with superiorly and inferiorly?

Answer 6

Black - cervical plparietal pleura Red - costal parietal pleura Blue - visceral pleura Green - diaphragmatic pleura Pink - mediastinal pleura Superiorly, mediastinal becomes cervical pleura Inferiorly mediastinal becomes diaphagmatic pleura

Question 7

The visceral pleura connects with the parietal pleura (mediastinal part) at the hilum of the lung What is the reflection of the mediastinal parietal pleura on each side of the lung root known as? What is the function of this?

Answer 7

THis is the pulmonary ligamanet - it serves to hold the lower part of the lungs in position

Question 8

What is the membrane lying superior to the cervical parietal pleura that is important in restricting lung expansion into the root of the neck?

Answer 8

This would be the suprapleural membrane

Question 9

What is the layer of connective tissue that is continuous with the suprapleural membrane? What does it attach to the thoracic wall?

Answer 9

The endothoracic fascia is the layer of connective tissue which is continuous with the suprapleural membrane - it attaches the costal parietal pleura to the thoracic wall

Question 10

It is important to know the pleural surface markings of the lung The lungs/visceral pleura (covers the surface of the lungs) have different pleural markings from the parietal pleura What rib is reach when looking at the visceral pleura/lung in the mid-clavicular line, mid-axillary line and scapular line on mid inspiration?

Answer 10

Visceral pleura/lung surface marking Mid clavicular line - rib 6 Mid axillary line - rib 8 Scapular line - rib 10

Question 11

What rib is reach when looking at the parietal pleura in the mid-clavicular line, mid-axillary line and scapular line on mid inspiration? What is the scapular line?

Answer 11

Parietal pleura surface marking Mid clavicular line - rib 8 Mid-axillary line - rib 10 Scapular line - rib 12 The scapular line is a line passing vertically through the inferior angle of the scapula to the 12th rib

Question 12

State again the surface markings of the lung and parietal pleura? Which rib is the parietal pleura always in relation to the visceral pleura?

Answer 12

Lung - Mid-clavicular line - rib 6 Mid-axillary line - rib 8 Scapular line - rib 10 Parietal pleura Mid-clavicular line - rib 8 Mid-axillary line - rib 10 Scapular line - rib 12 Parietal pleura is always 2 ribs lower than visceral pleura

Question 13

When looking at a lateral view of the lungs - this is a view of the costal surface of the lung What are the three surfaces of the lung? What are the three borders of the lung? How many lobes does each lung have?

Answer 13

Three surfaces Costal, diaphragmatic and mediastinal surface of the lungs Anterior, posterior and inferior borders of the lung Left lung has 2 lobes (usually) Right lung has 3 lobes

Question 14

Can identify the fissures and lobes when removing the lung from the pulmonary cavity The hilum is where everything is entering and leaving the lung – should be able to identify the bronchus and pulmonary veins, will also be able to identify the hilar lymph nodes at the hilum What is the impression in the right lung that arches above the hilum and where does this structure empty?

Answer 14

The arch of the azygous vein creates an impression above the hilum of the right lung before it empties into the superior vena cava

Question 15

What separates the diaphragmatic surface of the lung from the costal and mediastinal surfaces?

Answer 15

The inferior border of the lung

Question 16

Starting with the 12 oclock black circle, work clockwise stating what the circles are covering

Answer 16

12 oclock circle - Arch of the azygous vein Pulmonary ligament - picture on the right Oesophagus impression - posterior to hilum of lung Cardiac impression Superior vena cava Brachiocephalic vein

Question 17

Where does the posterior border of the right lung lie?

Answer 17

Posteiror border of the right lung lies between the posteiro of the oeophgeal impression and the anterior of the lower lobe of the lung

Question 18

The left lung only has an upper and lower lobe WHat does the upper lobe have which is the equivalent to the middle lobe of the right lung?

Answer 18

The upper lobe has a lingula which is very small and thin due to the heart compressing it

Question 19

On the right lung most of the impressions were venous impressions On the left lung most of the impressions are arterial In the right lung the oesophagus forms an impression posterior to the hilum with the azygous vein arching above the hilum What forms these impressions in the left lung?

Answer 19

The descending aorta forms the impression posterior to the hilum with the arch of the aorta arching above the hilum of the lung Sometimes will see a left subclavian artery impression

Question 20

Is the cardiac impression bigger in the right or left lung?

Answer 20

The cardiac impression is far bigger in the left lung as most of the heart sits left of the sternum

Question 21

Need to be able to orientate yourself at lung hilum to understand which lung you are looking at – variation means not always do lungs have 3 lobes and 2 lobes Which vessels sit in the hilum of the lung and which is the most important for being able to orientate which lung is being looked at?

Answer 21

There is the pulmonary veins, pulmonary arteries and bronchus of the lung The pulmonary veins are essential for orientating the lung - they are the most anterior and inferior structure of the hilum of the lung

Question 22

Where are the pulmonary arteries and the bronchus located in the hilum?

Answer 22

The pulmonary arteries are located superiorly in the hilum The bronchus is located posteriorly in the hilum

Question 23

If looking at the right lung, the bronchus will be to the right of the most anterior pulmonary vein (right means posterior - just because looking at the lung medially) If looking at the left lung the bronchus will be to the left of the most anterior pulmonary vein (left mens posterior - just because looking at the lung medially) State again the location of the vessels of the hilum?

Answer 23

The pulmonary veins will always be the anterior and inferior vessels The bronchus will be posterior to the pulmonary veins (in the left lung, to the left if looking medially) (in the right rung to the right if looking medially) The pulmonary arteries will be superior

Question 24

Two structures which do not leave impressions on the lung are the vagus and phrenic nerve Where do they pass in relation to the lung hilum?

Answer 24

The vagus nerve always passes posterior to the lung hilum The phrenic nerve always passes anterior to the lung hilum

Question 25

Which main bronchus is more vertical and therefore inhalation of foreign pathogens (be it bacteria or small objects) are likely to enter this bronchus preferably?

Answer 25

The right main bronchus is more vertical and therefore inhalation of foreign pathogens (be it bacteria or small objects) are likely to enter the right main bronchus over the left main bronchus

Question 26

After the trachea splits into the right and left main bronchus at the carina, what do these split into?

Answer 26

Right main bronchus splits into 3 lobar bronchi Left main bronchus split into 2 lobar bronchi The lobar bronchi then split into segmenetal bronchi

Question 27

How many segmental bronchi are in each of lobe of each lung?

Answer 27

There are typically 3 segmental bronchi in the upper lobe of the right lung, 2 in the middle lobe and 5 in the lower lobe In the left lung there is typically 5 segmental bronchi in each lobe

Question 28

Segemental bronchi are still large vessels so each segemental bronchus will branch many many times to give bronchioles and they can be divided up into three different types of bronchioles What are the three different types of bronchioles?

Answer 28

Conducting, terminal and respiratory bronchioles

Question 29

How do the respiratory bronchioles allow for gaseous exchange?

Answer 29

The respiratory bronchioles end by branching into alveolar ducts which connect with alveolar sacs (alveoli) and these alveoli have once cell thick walls intimately associated with capillaries which are one cell thick and this allows gaseous exchange to occur

Question 30

The lung has a very profuse lymphatic drainage What would be the first point of which the whole lung drainage meets? What is another name for the carinal lymph nodes draining the lung?

Answer 30

This would be the hilar lymph nodes (bronchopulmonary lymph nodes) Inferior tracheobronchial lymph nodes

Question 31

Describe the flow of lymph from lung to right and left lymphatic ducts

Answer 31

Lymph drains to the pulmonary nodes then to the hilar nodes - then to the tracheobronchial nodes (superior and inferior) which drain to the paratracheal nodes which drains into the right and left bronchomediastinal lymph trunks These drain into the right and left lymphatic ducts