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pt momints ver 2.0 > Org Ana: Pleura and Lungs > Flashcards

Org Ana: Pleura and Lungs Flashcards

1
Q

describe the apex of the lungs

A

it projects into the neck

1 in above the medial third of clavicle

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2
Q

describe the right lung

A

from sternoclavicular joint it reaches behind sternal angle until xiphisternal joint

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3
Q

describe the left lung

A

begins behind sternoclavicular joint and deviates laterally beyond the lateral margin of sternum at 4th costal cartilage to become the cardiac notch

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4
Q

describe the lower border of the lung

A

follows a curved line crossing the 6th rib and 8th rib midaxillary and reaches the 10th rib posteriorly

for left lung after 4th ICS it produces a cardiac notch then turn laterally to 6th ICS and downward to 8th rib then posteriorly to T10

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5
Q

describe the posterior border of the lung

A

extends down from the spinous process of C7 to the T10 1.5 in away from midline

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6
Q

what is the oblique fissure

A

from spine of scapula down lateral and anterior following the course of 6th rib to 6th costochondral junction

left lung: upper lobe lies above and anterior; lower lobe below and posterior

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7
Q

what is the horizontal fissure

A

only on the right bc it has 3 lobes

runs horizontal along the 4th CC to meet oblique fissure at the midaxillary line of 6th rib

upper lobe lies above and middle and lower lobe lies below

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8
Q

what is the purpose of pleural reflection

A

indicates the limit of pleura bc the lungs need space to expand

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9
Q

where is the cervical pleura located

A

at apex of lungs and bulges upward into the neck

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10
Q

where is the anterior border R pleura located

A

behind the SC joint almost reaching midline behind the sternal angle up to the xiphisternal joint

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11
Q

where is the anterior border L pleura located

A

similar but at 4th CC it deviates laterally to extend to lateral margin of sternum to form cardiac notch

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12
Q

where is the lower border of pleura located

A

crosses 8th rib in midclavicular line and 10th rib at midaxillary line and reach 12th rib lateral border of erector spinae

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13
Q

what is the costodiaphragmatic recess

A

distance between the lung and pleural border

space between lung at pluera to allow the lungs to expand

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14
Q

compare the lungs and the costal line of pleural reflection

A

midclavicular
- lungs: rib 6
- costal line of pleural reflection: rib 8

midaxillary
- lungs: rib 8
- costal line of pleural reflection: rib 10

paravertebral
- lungs: rib 10
- costal line of pleural reflection: rib 12

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15
Q

describe the apex of the heart

A

formed by left ventricle and corresponds to apex beat at the 5th left ICS 3.5 in to midline

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16
Q

describe the superior border of the heart

A

formed by roots of the great blood vessels from 2nd left CC (sternal angle) .5 in front of sternum up to 3rd right CC .5 in from edge of sternum

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17
Q

describe the left border of the heart

A

left ventricle from 2nd CC from edge of sternum and apex beat

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18
Q

describe the right border of the heart

A

formed by R atrium from the 3rd right CC from the edge of sternum to the 6th right CC

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19
Q

describe the inferior border of the heart

A

formed by the right ventricle and apical part of the left ventricle from 6th right CC from sternum to apex beat

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20
Q

what is posterior injury to the back of the chest

A

trauma can possibly cause vertebral fracture with associated SCI or paraplegia of LE

if severe trauma - scapula can be injured (madami muscles)

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21
Q

what is sternum fracture

A

usually sternum in resilient bc of CC - not common

occurs in high speed MVA

heart lies posterior to the sternum and may be contused; hematoma

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22
Q

what is rib contusion

A

most common injury

bruising of rib due to trauma

pain and tenderness
pain in breathing

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23
Q

what is rib fracture

A

commonly occurs at the angle of rib - 5th to 10th rib most common

upper ribs less common since arms and shoulders protect it

common complication is pneumothorax due to penetration of lungs
- severe trauma
- portion of fractured rib pierces the pleural cavity and into lungs
- puncture of lungs and air will be released and it will cause lung collapse
- heart shifted to other side bc too much air in the remaining lung pushes it

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24
Q

what is flail chest

A

an injury to a section of ribs causing is to be detached or float - multiple fractures

life threatening - pneumothorax and respiration may cause floating ribs to be sucked in and out

signs and symptoms:
- pale and cool skin
- weak pulse and tachycardia
- paradoxical chest movements
- cyanosis
- pain when breathing = intubate

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24
Q

explain paradoxical chest movement

A

injured area moves opposite - naiiwan

inhale: ribs rise but flailed section sucks in
exhale: ribs fall but flailed section bulges out

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24
Q

what is thoracostomy

A

creating and maintaining an opening into the thoracic cavity using needle or chest tube

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24
Q

what are the indications for thoracostomy

A

hemothorax
pleural effusion
pneumothorax
open pnuemothorax
prophylaxis pre-op in truma patients

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25
Q

what is the safe triangle

A

position of chest drain

boundaries:
anterior border of lats
lateral borer of pec major
apex of axilla
horizontal line level of nipple

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26
Q

discuss the approach for thoracostomy using needles

A

ant - 2nd ICS midclavicular

lat - 2nd ICS midaxillary

needle should be kept to upper border to avoid the subcostal groove

27
Q

what is tube thoracostomy

A

insertion of tube at 4th or 5th ICS at the anterior axillary line

28
Q

what are the complications for thoracostomy

A

malpositioning with liver, spleen or diaphragmatic injury

insertion into pleural parenchyma

exsanguination through test tube from massive intrathoracic injury

29
Q

what diaphragmatic hernia

A

due to incomplete fusion of septum transversum, dorsal mesentery and pleuroperitoneal membrane

stomach content may go up and lung may collapse

may occur:
- plueroperitoneal canal
- opening betw xiphoid and costal margin
- esophageal hiatus

30
Q

what are hiccups

A

involuntary spasmodic contraction of diaphragm due to gastric irritation of vagus nerve

can be symptoms of pleurisity, peritonitis, pericarditis or uremia

31
Q

explain the anatomic changes of the lungs with age

A

kyphosis due to degeneration of IV discs or compression fracture (osteoporotic)
- lung volume and diameter decreases
- wedging thoracic vertebrae

rib cage becomes rigid and loses elasticity

disuse and atrophy of thoracic and abdominal muscles
- lung cannot adapt to diseases (pneumonia)

degeneration of elastic tissue - exercise to maintain

32
Q

describe the pleural cavities

A

found on either sides of the mediastinum divided into parietal and pleural

boundaries:
sup - extends above rib 1 to root of neck
inf - extends to level just above the costal margin
medial - mediastinum

33
Q

what is the pleural ligament

A

layers of pleura at the hilum of each lungs

allows movement of pulmonary vessels and large bronchi during respiration

34
Q

discuss the parts if parietal pleura

A

costal - inner surface of ribs, CC and sides of vertebral bodies and the sternum
- intercostal nerves

diaphragmatic - covers thoracic surface of diaphragm
- phrenic and 6 intercostal nerves

mediastinal - covers the mediastinum
- phrenic nerve

cervical - dome shape layer lining the cervical extension

35
Q

describe parietal pleura

A

sensitive to pain, touch and stretch

needs anesthesia for chest tube

36
Q

describe visceral pleura

A

continuous w parietal pleura at the hilum of each lungs

attached to surface of lungs

visceral afferent nerve

no pain; stretch and touch only

37
Q

discuss the recesses

A

costodiaphragmatic - space betw costal and diaphragmatic; lower area where lung expands

costomediastinal - along anterior costal margin; largest on left in the region overlying heart

38
Q

describe pleural fluid

A

5-10 ml of clear fluid

lubricates visceral nd parietal

capillaries of visceral pleura absorb this

39
Q

explain pleural effusion

A

> 300 cc of fluid in pleural cavity

40
Q

what is pleurisy

A

inflammation secondary to inflammation of lungs (pneumonia)

41
Q

what is pneumothorax

A

air in pleural cavity from lungs or chest wall

42
Q

what is empyema

A

collection of pus in pleural cavity

43
Q

describe the trachea

A

mobile tube about 5 in long and 1 in in diameter

starts from cricoid C6 and divides into principal bronchi at sternal angle T4-5

trachealis muscle - smooth muscle connecting U shaped cartilage
- u shaped prevents collapse

vagus and recurrent laryngeal nerve and sympathetic trunk

44
Q

what are the anterior relationships of the trachea

A

sternum
thymus gland
left brachiocephalic vein
origin of brachiocephalic
left common carotid artery
arch of aorta

45
Q

what are the posterior relationships of the trachea

A

esophagus
left recurrent laryngeal nerve

46
Q

what are the right relationships of the trachea

A

azygos vein
right vagus nerve
pleura

47
Q

what are the left relationships of the trachea

A

arch of aorta
left common carotid
left subclavian arteries
left vagus nerve
left phrenic nerve
pleura

48
Q

describe the bronchi

A

bifurcates behind the arch of aorta

carina - end of junction trachea and principal bronchi; separates opening of bronchi

49
Q

compare the left and right bronchus

A

right: wider, shorter and more vertical
- 1 in long
- divides into superior lobar bronchus and at hilum into middle and inferior lobar bronchus

left: narrower, longer and more horizontal
- 2 in long
- passes below arch of aorta and infront of esophagus
- divides into superior and inferior lobar bronchus

50
Q

what are lobar bronchi

A

they further subdivide into segmental bronchi supplying the bronchopulmonary segments

each will divide into several million terminal bronchioles that terminate in one or more respiratory bronchiole

each respiratory bronchiole divide into 2-11 alveolar ducts that enter the alveolar sac

51
Q

describe bronchioles

A

from division of smallest bronchi

< 1 mm

no cartilage - collapse easily

lined by columnar epithelium cells

52
Q

describe terminal bronchioles

A

.5 mm and branches from alveolar ducts

possess outpouching from their walls; blood exchange happens here

53
Q

what are bronchopulmonary segments

A

subdivisions of a lung lobe where each lobar bronchus pass to give segmental bronchus

a structural unit that can be surgically removed

has a segmental bronchus, artery, lymph and autonomic nerve

segmental vein is the CT betw adjacent segments

54
Q

what are right bronchopulmonary segments

A

10 segments

superior: apical, posterior, anterior

middle: lateral and medial

inferior: superior, medial basal, anterior basal, lateral basal, posterior basal

55
Q

what are left bronchopulmonary segments

A

8-10 segments

superior: apical, posterior, anterior, superior lingular, inferior lingular

inferior: superior, medial basal, anterior basal, lateral basal and posterior basal

55
Q

describe the lungs

A

soft, spongy and elastic

covered w visceral pleura

55
Q

what is the hilum

A

depression in which the root of the lung is attached

56
Q

describe the costal and mediastinal surface of the lungs

A

costal - follows concave chest wall

mediastinal - molds into pericardium

57
Q

describe the anterior border of the lungs

A

cardiac notch - concave indentation of anterior margin of left where anterior surface of heart is exposed

lingula - tongue like projection of anterior margin of left lung from inferior end of cardiac notch

58
Q

what are the structures in the hilum

A

one pulmonary artery
two pulmonary veins
main bronchus
bronchial vessels
nerves and lymphatics

59
Q

what are the structures at medial surface of right lung

A

heart
inferior vena cava
superior vena cava
azygos vein
esophagus

60
Q

what are the structures at medial surface of left lung

A

heart
aortic arch
thoracic aorta
esophagus

61
Q

what is the nonrespiratory circuit

A

supplies the tissue of respiratory tree and lungs

bronchial artery from descending aorta supply bronchi, CT of lung and visceral pleura

bronchial vein drains into azygos and hemiazygos vein

62
Q

what is the respiratory circuit

A

where gas exchange occurs

segmental arteries (terminal branch of pulmonary arteries) carry deoxygenated blood into the BP segments and to alveoli

intersegmental vein carry oxygenated blood from alveolar capillaries and flow the CT septa of the BP segment to pulmonary vein root

63
Q

what is the nerve supply of the lungs

A

pulmonary plexus - from efferent and afferent fibers via ANS

sympathetic efferent fibers - bronchodilation and vasoconstriction
- inhibitory to alveolar glands

parasympathetic efferent fibers - bronchoconstriction, vasodilation and increase gland secretions
- secretomotor to glands

64
Q

compare quiet and forced inspiration

A

quiet - contraction of diaphragm and intercostal muscles
- 1st rib fixed by scaleni muscles

forced:
- scalenus anterior and medius
- SCM
- scapula fixed by traps, levator scapulae and rhomboids
- serratus anterior and pec minor pull ribs up

65
Q

compare quiet and forced expiration

A

quiet - passive elastic recoil of diaphragm and intercostals

forced: active
- anterior abdominal wall
- quadratus lumborum pulls 12th rib down
- serratus posterior inferior and lats

66
Q

explain abdominal type of respiration

A

common in babies up to 2 yo

males also used abdominal and thoracic

67
Q

explain thoracic type of respiration

A

common in adults - esp female

rely mainly on movement of ribs

pt momints ver 2.0 (14 decks)

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