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CRAAB 2 > Ach: Pleura and Lungs > Flashcards

Ach: Pleura and Lungs Flashcards

1
Q

What are the three divisions of the thoracic cavity?

A

There are two closed and separate pleural cavities that are filled on both sides almost completely by the lungs. Then the mediastinum, which is the middle section of the thoracic cavity that contains the heart, great vessels, trachea and esophagus.

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2
Q

What is the visceral pleura?

A

A membrane which completely covers the lung except at the hilum where each lung is connected to the mediastinum via its root.

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3
Q

What is the pulmonary ligament?

A

It is the part of the visceral pleura below the root of the lung, that is a thickened fusion of the visceral and parietal pleura that ends in a free edge.

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4
Q

What supplies the visceral pleura?

A

Bronchial arteries

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5
Q

What is the parietal pleura?

A

It lines the walls of the pleural cavity and is continuous with the visceral pleura at the root of the lung.

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6
Q

What does the fluid found between the visceral and parietal pleura do?

A

Reduces friction; acts as a lubricant during respiration.

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7
Q

What arteries supply blood to the parietal pleura?

A

Branches of the intercostal and pericardioacophrenic.

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8
Q

What are the 4 pleural regions?

A
  1. Costal pleura (lines ribs, sternum, costal cartilages and intercostal muscles)
  2. Mediastinal pleura (covers the mediastinum on the medial surface of each pleural cavity)
  3. Diagphragmatic pleura (covers the superior surface of the diaphragm)
  4. Cervical pleura or pleural cupola (over the apex of the lung)
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9
Q

What is the sternal reflection?

A

Where the costal pleura is continuous with the mediastinal pleura posterior to the sternum.

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10
Q

What is the costal reflection?

A

Where the costal pleura is continuous with the diaphragmatic pleura at the chest margin.

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11
Q

What is the vertebral reflection?

A

Where hte costal pleura becomes continuous with the mediastinal pleura posteriorly

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12
Q

Why are the sternal, costal and vertebral reflections important?

A

They are important landmarks in clinical medicine b/c they demonstrate the limits of the pleural cavity.

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13
Q

What are the three areas that the lungs to not extend to except on full inspiration?

A
  1. Right and left costodiaphragmetic recesses

2. Left costomediastinal recess

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14
Q

What are the two types of somatic afferent innervation to the parietal pleura?

A
  1. Intercostal nerves supply the costal and peripheral diaphragmatic pleura.
  2. The phrenic nerve supplies the mediastinal and more central diaphragmatic pleura.
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15
Q

What is the main difference between parietal and visceral pleura in regards to pain?

A

The parietal pleura is extremely sensitive to pain, where as the visceral pleura is insensitive to pain or contact (it has no general sensation).

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16
Q

What are the lobes of the left lung?

A

Superior and inferior divided by a deep oblique fissure.

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17
Q

What is the cardiac notch?

A

A notch found on the superior lobe d/t the bulging heart.

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18
Q

Where is the lingula?

A

Just inferior to the cardiac notch, it extends into the costomediastinal recess upon inspiration.

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19
Q

What is the lingual equivalent to on the right lung?

A

RML

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20
Q

What are the three lobes of the right lung?

A

Superior, middle and inferior. They are dived by the oblique and horizontal fissures.

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21
Q

Are the lungs symmetrical?

A

NO!

The right lung is shorter and wider, pushed up by the mass of the liver. It has a slightly larger capacity than the left lung.

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22
Q

What are the three surfaces of the lung?

A

Costal
Mediastinal (site of the hilum)
Diaphragmatic (base)

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23
Q

Where does the apex of the lung lie?

A

It extends through the superior thoracic aperture into the neck.

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24
Q

What part of the lung rests on the diaphragm?

A

The base of the lung.

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25
Q

Where does the trachea terminate? What does it do there?

A

At the T4/5 level it bifurcates into the left and right primary bronchi.

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26
Q

What is the carina?

A

A sagitally placed ridge of cartilage between the openings of the main bronchi that helps support bifurcation.

27
Q

How do the primary bronchi of the two sides differ?

A
  1. The left bronchus is longer
  2. The left bronchus has a smaller diameter
  3. the angle of origin of the two bronchi differ with the left at 45 degrees and the right at 25 degrees
28
Q

In which bronchi is an inhaled object more likely to lodge? Why?

A

The right bronchus b/c it is wider, shorter and more vertical.

29
Q

What are the lobar bronchi?

A

The branches that extend from the primary bronchi. There are 2 (left side) and 3 (right side.)

30
Q

What do the lobar bronchi in turn divide into?

A

The tertiary or segmental bronchi

31
Q

Where may you find bronchiogenic carcinoma?

A

At the bifurcation of the trachea, the carina.

32
Q

What are bronchopulmonary segments and how many are usually in each lung?

A

The segments of a lung supplied by segmental bronchi (usually 10 in each lung). They each have their own segmental bronchus, artery and vein.

33
Q

What is the clinical value of knowing that bronchopulmonary segments are surgically separable?

A

Impt in the surgical tx of lung cancer.

34
Q

What are the two sets of arteries that supply the lung?

A
  1. Pulmonary arteries

2. Bronchial arteries

35
Q

What do the pulmonary arteries do?

A

Arise from the pulmonary trunk and carry deoxygenated blood w/ one artery going to each lung. They usually branch as they enter the hilum, w/ major branches corresponding to the segmental bronchi (segmental arteries). The pulmonary arteries serve the areas of the lung responsible for gaseous exchange.

36
Q

How many bronchial arteries are there?

A

3

  1. Single right bronchial artery arising from one of the intercostals.
  2. 2 bronchial arteries on the left, arising directly from the aorta.
37
Q

What do the bronchial arteries do?

A

Supply the lung tissue itself as well as the visceral pleura.

38
Q

What are the two types of venous drainage of the lung?

A
  1. Pulmonary veins

2. Bronchial veins

39
Q

What are the two channels of the pulmonary veins?

A

They PVs have two major channels, the superior and inferior that leave each lung. The exact number of branches may vary.

40
Q

What do the pulmonary veins do?

A

They carry freshly oxygenated blood to the left atrium.

41
Q

From where do the pulmonary veins receive most of their blood supply?

A

Bronchial arteries

42
Q

What’s the main difference between the bronchial veins and the bronchial arteries?

A

The veins follow the arteries, but tend to return much less blood than the arteries supply.

43
Q

The bronchial veins may be tributaries to what areas?

A

The intercostal, azygos or hemiazygos systems.

44
Q

Where is the lymphatic drainage in the lungs?

A
  1. Superficial and deep lymphatic plexuses drain into bronchopulmonary nodes. BPN drain to superior and inferior tracheobronchial nodes.
  2. Serially larger ducts drain into the R lymphatic duct and the thoracic duct.
45
Q

Where do primary lung cancers commonly metastasize?

A

Via blood/lymph to adrenal glands, liver, bone and brain.

46
Q

What is the pulmonary plexus and where is it located?

A

The pulmonary plexus is an extension of the cardiac plexus and is located at the root of each lung.

47
Q

What are the two components of the pulmonary plexus?

A
  1. Post-ganglionic sympathetic fibers
  2. Pre-ganglionic sympathetic fibers
  3. Visceral afferent fibers
48
Q

What are the characteristics of the post-ganglionic sympathetic fibers?

A
  1. derived from T1-5
  2. Synapse in upper thoracic/cervical sympathetic ganglia
  3. Produce bronchodilation/vasoconstriction
  4. Epinephrine
49
Q

What are the characteristics of the pre-ganglionic parasympathetic fibers?

A
  1. Derived from the vagus nerve
  2. synpase between pre and post neurons in the pulmonary pleura or the wall of the lung
  3. produce bronchoconstriction, vasodilation and increased glandular secretion
  4. mediators of allergic reactions and also cause bronchoconstriction
50
Q

Where do the visceral afferent fibers of the pulmonary plexus travel?

A

Travel centrally in both systems from stretch receptors in the alveoli and receptors in the walls of the bronchi.

51
Q

What is pleuritis?

A

An inflamation of pleura which can lead to pleural adhesions. rough surfaces rub together and can be heart with a stethoscope (pleural rub).

52
Q

What is a hydrothorax?

A

Accumulation of significant amts of fluid in the pleural cavities (often from CHF)

53
Q

What is a hemothorax?

A

Accumulation of blood in the pleural cavity. Intercostal arteries are the most common source.

54
Q

What is a pneumothorax?

A

Entry of air into a pleural cavity causing collapse of the lung.

55
Q

What is a spontaneous pneumothorax?

A

Partial collapse of the lung d/t rupture of blebs on the lung surface or a punctured lung.

56
Q

What is an open pneumothorax?

A

Stab wounds of the thoracic wall that also pierce the parietal pleura so the pleural cavity is open to the outside air via the lung or through the chest wall. Also called a blowing or sucking wound.

57
Q

What is a tension or valvular pneumothorax?

A

Air enters affected pleural cavity during inspiration and is trapped during expiration. It is potentially lethal, because air pressure builds up on the wounded side and pushes the mediastinum towards the opposite side. This is dangerous because one lung is collapsed and the other is compressed by the deflected mediastinum. Blood flow to the heart and lung is decreased and can cease.

58
Q

What are the clincial signs of a tension pneumothorax?

A

Distended neck veins (blood can’t return to heart), shifted trachea, decreased breath sounds in lungs, hypotension, agitation

59
Q

What do you do to relieve a PTX?

A

Insert a wide bore needle into the 2nd anterior or 4th lateral intercostal space

60
Q

What is atelectasis?

A

Partial or complete collapse of the lung at the level of the alveoli. May be caused by mucus accumulation, decreases in surfactant, tumors, clots.

61
Q

What is primary atelectasis?

A

Failure of the lung to inflate at birth.

62
Q

What is secondary atelectasis?

A

the collapse of a previously inflated lung. In infants, it is often d/t hyaline membrane disease or the result of elastic recoil of the lung when the infant is dying of something else.

63
Q

What is thoracentesis/pleural tap?

A

When you remove blood/fluid from pleural spaces with a needle. You insert the needle in an intercostal space closer to the upper border of the rib below to avoid intercostal neurovascular bundle. The 9th interspace in the midaxillary line is the safest place for the procedure.

64
Q

Why do you insert a chest tube?

A

To remove fluid/air in the plueral cavity. A small incision is made in the 4th-5th intercostal space in the midaxillary line (nipple level). Air is suctioned out slowly. The wound closes over several days.

CRAAB 2 (9 decks)

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