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Flashcards in deck_1374038 Deck (48):
1

What is the pleura?

• A serous membrane consisting of a single layer of mesothelial cells with a thin layer of underlying connective tissue

2

What is the parietal pleura?

• Lines the inside of the hemithorax and becomes continuous at the hilum of the lung with the visceral pleura.

3

What does the visceral pleura line?

• Extends between the lobes of the lung into the depths of the oblique and horizontal fissures

4

What is the blood supply of the pleura?

• The intercostal and internal thoracic arteries and veins

5

What is the innervation of the pleura?

• Both somatic (intercostal and phrenic nerves) and autonomic

6

What is pleural space?

• A potential space between two layers of pleura which are continuous at the hilum

7

What is the purpose of pleural fluid?

• Allows the two layers of the pleura to slide over one another with minimal friction.

8

What is the blood and nerve supply to the parietal pleura?

• The intercostal arteries and internal thoracic arteries• Somatic innervation from phrenic and intercostal nerves

9

What is the blood and nerve supply to the visceral pleura?

• Bronchial arteries and drained by the bronchial veins• Only autonomic innervation

10

What is the pleural cavity?

• A potential space between two layers of pleura that are continuous at the hilum

11

What does the pleura fluid allow?

• Two layers to slide on one another

12

What are the lines of pleural reflection?

• The lines along which the parietal pleura change direction

13

Give three lines of pleural reflection

• Sternal• Costal• Diaphragmatic

14

Where does the trachea commence?

• At the lower border of the cricoid cartilage in the neck

15

What is the angle between the right and left main bronchi known as?

The carina

16

How is the trachea held open?

• By 18-22 C shaped cartilagesSupported posteriorly by trachealis muscle

17

What is the angle between the right and left main bronchi known as?

• Carina

18

What is the cell type which lines the trachea?

Pseudo stratified columnar ciliated epithelium

19

Which bronchus is wider, shorted and more vertical than the other?

• The right

20

What do the primary bronchi divide into?

• Lobar bronchi

21

What is the part of the lung supplied by each segmental bronchus called?

Bronchopulmonary segment

22

Describe a bronchopulmonary segment

• A pyramid shaped area of lung with its apex facing towards the hilum and base towards lung surface.Each is supplied by a segmental branch of the pulmonary artery and pulmonary vein

23

Why is knowledge of bronchopulmonary segments surgically important?

• Because they can be isolated and removed without much bleeding or air leakage, or intefering with other bronchopulmonary segments

24

What can be visualised with a bronchoscopy?

• The whole inner trachea, the carina, the main bronchi, lobar bronchi and the origin of the segmental bronchi can be visualisedCan be used to see bronchial carcinomas

25

What do bronchial arteries supply?

• Supply the bronchi from Carina to the respiratory bronchioles, visceral pleura and connective tissue

26

Outline the arterial supply of the thorax

• Thoracic aorta -> 2x left bronchial• Thoracic aorta -> 3rd intercostal -> 1xRight Bronchial

27

Outline the pulmonary circulation of the lungs

• Pulmonary trunk -> Pulmonary -> Lobar -> Segmental

28

Outline pulmonary drainage of the lungs

• Two pulmonary veins on each side• Middle lobe vein is a major tributary of the right superior pulmonary vein

29

What do the superficial group of bronchial veins drain into on the left?

• Drain visceral pleura and bronchi in the hilar region to the accessory hemiazygous vein

30

What do the superficial group of bronchial veins drain into on the right?

Drain visceral pleura and bronchi in the hilar region to the azygous vein

31

What do the deep bronchial veins drain and into what do they do this?

• Deep bronchi into main pulmonary vein or directly into left atrium probable impossible

32

What do the parietal pleura line?

• The costal, diaphragm and mediastinal surfaces of each hemi thorax

33

What is a line of pleural reflection?

• Relatively abrupt lines along which the parietal pleura changes direction from the costal surface to the diaphragmatic surface and mediastinal surface

34

Where does the apex of the pleural cavity and lung extend?

About 3cm above the medial part of the clavicle

35

What can you deduce if a patient presents with a harmless looking bulge in the supra-clavicular fossa?

• The supra pleural membrane which prevents the lungs and pleura bulging into the neck is not present

36

Where do the anterior borders of the pleural cavitys descend to?

• Behind the sternoclavicular joint to reach the midline at the level of the sternal angle

37

Describe the pat of the right pleural cavity

• Descends vertically to reach the 6th costal cartilage• Then loops round, crossing ○ The 8th rib at the midclavicular line ○ The 10th rib at the midaxillary line ○ The 12th rib in the back (scapular line) ○ Then ascends vertically with the paravertebral muscles

38

Describe the path of the left pleural cavity

• Deviates to the edge of the sternum, then descends vertically to reach the 6th costal cartilage• Then loops round, crossing ○ The 8th rib at the midclavicular line ○ The 10th rib at the midaxillary line ○ The 12th rib in the back (scapular line) ○ Then ascends vertically with the paravertebral muscles

39

Where do the lungs not fill the pleura?

• The lower margins• In front of the heart

40

How much higher is the lower margin of the lung than the lower margin of the pleura?

Two ribs higher

41

Describe the path of the lungs

• Crosses 6th rib at the midclavicular line• 10th rib at the midaxillary line• 10th rib in the backAscends vertically with paraverterbral muscles

42

What does the left lung have which means it skirts the pericardium?

• Cardiac notch• From the sternal angle, neraly reaches midclavicular line before curving round to the hearts apex in the 5th intercostal space

43

Where does the oblique fissure extend to and from?

• Between upper and lower lobes• Extends from spinous proces of T2 verterbra posteriorly to the 6th costal cartilage anteriorly

44

Where does the horizontal fissure extend to and from in the right lung?

• Mid axillary line, anteriorly along the 4th rib to the anterior edge of the lung

45

Why is it important to know the extent of the lungs and pleura?

• During clinical examination of the lungs and in interpreting chest x-raus

46

Name three procedures which can cause pneumothorax (air in the pleural cavity)

• Exposure of the kidney• Liver biopsy • Insertion of a sub-clavicular canulation line into the subclavianvein

47

Name three organs the lower parts of the abdominal organs overlap with

• Liver• Kidney • Spleen

48

Name two structures that lie below the apices of the pleura

• Subclavian vessels an• Brachial plexus