Flashcards in Pleurae, Lungs, And Tracheobronchial Tree Blue Boxes Deck (55)
Which structures project through the superior thoracic aperature, formed by inferior slope of 1st ribs, what structures are prone to injury?
Cervical pleura and the apex of the lung, posterior to sternocleidomastoid muscles.
Wounds to the base of the neck can result in the presence of air in the pleural sac is called?
An abdominal incision can enter the pleural sac in which three areas?
Right part of the infrasternal angle area, right and left areas of costovertebral angles. Areas at costovertebral inferomedial to 12th rib and posterior to superior poles of kidneys. Pneumothorax can occur here during kidney surgery.
Differentiate between primary atelectasis and secondary atelectasis.
Primary is the failure of the lung to inflate at birth, secondary is the failure of lung after previously inflated.
Describe how the lungs remain inflated in terms of visceral and parietal pleura and pleural fluid?
Normal lungs remain distended even when the airway passages are open due to the visceral pleura, parietal pleura, and pleura fluid. Visceral pleura(outer surface of lungs) adheres to inner surface of thoracic wall(parietal pleura) due to surface tension by the pleural fluid.
Describe the lungs if penetrated in regards to pressure.
Elastic recoil of the lungs causes the pressure in pleural cavities to be sub-atmospheric(normally -2mmhg, drops to -8mmhg). Penetration of thoracic wall or lung-->air sucked into pleural cavity due to negative pressure. Surface tension will be broken, lung collapses, air expelled due to elastic recoil.
Following lung collapse, describe the affect to the pulmonary cavity.
Pulmonary cavity may decrease in size during inspiration. Evident radiographically on the affected side due to elevation of diaphragm, intercostal space narrowing, and mediastinal shift and air filled trachea toward affected side. Collapsed lung appears more dense.
Open chest surgery requires what to operate the lungs?
Maintained by intubating the trachea with a cuffed tube and using positive pressure pump, varying the pressure to inflate and deflate the lungs.
Describe a potential complication of a bronchopulmonary fistula or a fractured rib.
Bronchopulmonary fistula or fractured rib, a result of a rupture of a pulmonary lesion into the pleural cavity, can result in a collapsed lung.
Pleural effusion can lead to what?
Pleural effusion, the escape of fluid into the pleural cavity, can lead to hydrothorax, the accumulation of fluid in the pleural cavity. If blood, described as a hemothorax.
Hemothorax is a common result during injury to which structures?
Chest would, or injury to the intercostal or internal thoracic vessel.
If air and fluid fill the pleural space, what can be seen.
An air fluid level or interface, that is horizontal and a sharp line.
Describe a thoracentesis generally?
Inserting a hypodermic needle through an intercostal space into the pleural cavity to obtain sample or remove fluid. If patient upright, obtain fluid through the 9th intercostal space at the MAL during expiration.
Precautions of a thoracentesis in regards to nerve and vessels?
Needle inserted superior to the rib, high enough to avoid the collateral branches and intercostal nerves. Also, remember VAN within intercostal spaces.
Where does fluid accumulate in an upright position?
The costodiaphragmatic recess.
Where and how to insert the needle during thoracentesis.
Inserted into the 9th intercostal space in the midaxillary line during expiration. Needle angled upward to avoid the deep side of recess( thin layer of diaphragmatic parietal pleura and liver)
The purpose of an insertion of a chest tube?
To remove air, blood, serous fluid, pus in the pleural cavity, to reinflate lung as well.
Location of chest tube insertion.
In he he 5th or 6th intercostal space in the midaxillary line, basically nipple level.
Directions chest tube insertion can take.
Suerpiorly towards the cervical pleura for air removal, or inferiorly toward costodiaphragmatic recess for fluid drainage. Suction can be used to prevent air from being sucked back into pleural cavity.
Failure to remove fluid from pleural cavity can lead to?
The development of a resistant fibrous covering that inhibits expansion unless peeled off (lung decortication).
What can cause obliteration of the pleural cavity?
By disease, as in pleuritis (inflammation of pleura) or during surgery with a pleurectomy, an excision of a part of the pleura.
Possible functional defects of loss of a pleural cavity.
No functional deficits, but pain during exertion.
Describe a pleurodesis.
Covering the apposing layers of pleura with an irritating powder or sclerosing agent to induce the adherence of the parietal and visceral layers of pleura.
Purpose of a pleurectomy or pleurodesis?
Both are performed to prevent recurring spontaneous secondary atelectasis caused by chronic pneumothorax or malignant effusion resulting from lung disease.
What is a thoracoscopy procedure?
A diagnostic procedure in which the pleural cavity is examined with a scope.
What condition might be detectable based on lung sounds, related to the pleura.
The sliding of the smooth and moist pleurae make no detectable sounds during auscultation of the lungs. Pleuritis can lead to friction, a pleural rub, that is detectable with a stethoscope.
What is pleural adhesion?
The parietal and visceral layers of pleura adhering together, can occur with pleuritis.
Symptoms of acute peluritis?
Acute pleuritis is marked by sharp, stabbing pain especially during extertion.
Possible variations of lung fissures?
Oblique and horizontal fissures may be incomplete or absent, resulting in changes to the lobes. Extra fissure dividing the lung, examples including three lobes in left lung, two lobes in right lung.