The Lungs and the Pleura Flashcards
(90 cards)
1
Q
What is the mediastinum?
A
- cavity surrounded by loose connective tissue
2
Q
What components make up the mediastinal cavity?
A
- lymph nodes and vessels - nerves - heart - trachea - thymus gland - great vessels
3
Q
What does pleura mean?
A
- greek for sides of the body
4
Q
What is the visceral pleura?
A
- visceral = organ
- loose areolar connective tissue
- on outside of the lungs
5
Q
What is the pleural space? (some refer to this as pleural cavity)
A
- space between the lungs (visceral pleura) and parietal space
- connected to the parietal pleura
6
Q
What is inside the pleural space?
A
- pleural fluid
- secreted by mesothelial cells
- lubricates and allows movement of lungs
7
Q
What is the parietal pleura?
A
- parietal means wall of the body
- covers the inside of the thoracic wall
8
Q
What are the 2 large pleural cavities either side of the mediastinum called?
A
- pleural cavities
- contain left and right lungs
9
Q
What is a lung root?
A
- structures that emerge from the lungs, called the hilum
- include principle bronchus, pulmonary arteries and veins
10
Q
What is the lung apex?
A
- the top of the lung
11
Q
What is the base of the lung?
A
- where the lungs meet the diaphragm - dome like appearance is due to domes of diaphragm - called the diaphragmatic
12
Q
What is the costal surface of the lung?
A
- the outside of the lung facing the ribs (costal)
13
Q
What are the fissures of the lung?
A
- fold of visceral pleura - separates the lobes of the lungs
14
Q
How many lobes are in the left and right lungs?
A
- right = 3 - upper, lower and medial lobes - left = 2 - upper and lower lobes
15
Q
What is the hilum of the lungs?
A
- interior/medial aspects of lungs
- site of entry/exit of structures from an organ
16
Q
Where is the best place to listen to the lung sounds of the apex of the lungs?
A
- 2 fingers to the left/right of the sternal/jugular notch
- above the clavicle
17
Q
Can the middle lobe be listened to on the anterior aspect of the chest wall?
A
- yes
- ribs 4-6
18
Q
in addition to the lung root, what other central component of the thoracic cavity can cause an impression on the inside of the lungs?
A
- mediastinum
19
Q
What fissures are present in the right lung?
A
- oblique - horizontal
20
Q
What do the oblique and horizontal fissures separate in the right lung?
A
- oblique = separates upper and lower lobes - horizontal = separates upper and middle lobe
21
Q
What does the oblique fissure separate in the left lung?
A
- upper and lower lobes
22
Q
When trying to identify which is left and right lung on the mediastinal surface of the lungs, what can you use to help you?
A
- indents on the mediastinal surface - aortic arch - other blood vessels - lobes (3 in right and 2 left)
23
Q
What is the name where the trachea bifurcates into left and right lungs located at the sternal angle/angle of louis?
A
- carina
24
Q
The primary bronchi bifurcates to provide the 3 main parts of the right lung. What are the 3 names of these?
A
1 - upper lobal bronchi 2 - middle lobar bronchi 3 - lower lobar bronchi
25
The primary bronchi bifurcates into 2 in the left lung, what are the names of these?
1 - upper lobal bronchi 2 - lower lobar bronchi
26
What is the basic organisation of the bronchial tree?
- principle bronchi - lobar bronchi - primary - secondary - tertiary - terminal bronchioles - respiratory bronchioles (BP segments) - alveoli
27
What are the bronchopulmonary segments?
- a specific segment of the lungs from the tertiary bronchi - receive their own blood supply - receive their own bronchi branch
28
Why are the bronchopulmonary segments important?
- able to act independently - reduces risk each segment can impair another - in cancer for example
29
How many bronchopulmonary segments are there in the left and right lungs?
- right lung = 10 - left lung = 8
30
What do the bronchopulmonary segments divide into?
- lobules - divisions of the lungs
31
What are the 3 bronchopulmonary segments in the superior/upper lobe of the right and left lung?
1 - apical (meaning anex so top) 2 - posterior 3 - anterior
32
What are the 2 bronchopulmonary segments in the medial lobe of the right lung?
1 - lateral 2 - medial
33
What are the 5 bronchopulmonary segments in the inferior/lower lobe of the right and left lung?
1 - Superior 2 - Posterior Basal 3 - Anterior Basal 4 - Medial Basal 5 - Lateral Basal
34
What is the arrangement following the terminal bronchi?
- respiratory bronchioles (BP segments) - alveolar ducts - alveolus - alveolar sacs - pores of kohn
35
Alveoli are made up of a single layer of epithelial cells, what are those cells?
- simple squamous epithelial cells (Type I cells) - simple cuboidal epithelial cells (Type II cells)
36
Roughly how many alveoli are there in each lung?
- 300-400
37
What is emphysema?
- emphysema = latin for swelling
- alveoli become damaged ⬇️ their elastic properties
- alveoli sacs merge forming 1 large sac, ⬇️ surface area
38
What does emphysema do to compliance and elasticity of the lungs?
- lungs are able to expand but not recoil - ⬆️ compliance - ⬇️ elasticity
39
What are the 2 most common symptom of emphysema?
1 - coughing 2 - shortness of breathe
40
What is a bunch of alveoli called?
- alveoli sac
41
What surrounds each alveoli to ensure perfusion?
- capillaries do assist with gas exchange
42
Why are alveoli spherical and not flat in the respiratory tract?
- increase surface area for gas exchange
43
What is an obstructive respiratory disease?
- disease causing damage to airways
- lungs can expand but not recoil
- difficult getting air out = ⬇️ FEV1
44
Why is emphysema an example of obstructive respiratory disease?
- damaged alveoli expand but do not recoil
- compliance is ⬆️ meaning air can enter the lungs
- elasticity is ⬇️ so it is difficult to get air out of the lungs
45
What are a few examples of obstructive respiratory disease?
- bronchitis - bronchiectasis (excess build up of mucus) - asthma
46
What does COPD mean?
- chronic obstructive pulmonary disorder - group of obstructive lung conditions
47
What is an restrictive respiratory disease?
- disease causing damage to airways - impacts lungs ability to get air in to the lungs
48
What is a pleural recess?
- space formed in pleural space
49
What are the 2 pleural recess in the thoracic cavity?
1 - costodiaphragmatic recess (reflection between costal+diaphragmatic pleura)
2 - costomediastinal recess (reflection between costal+mediastinal pleura)
50
What are the 4 regions of the parietal pleura around the lungs, given different names due to reflections?
1 - cervical (apex of lung) 2 - costal (facing the ribs) 3 - diaphragmatic 4 - mediastinal
51
What determines when one part of the parietal pleura becomes another?
- reflection of the parietal pleura - where one part of the pleura bends and becomes another
52
What nerves innervate the costal and cervical pleura?
- somatic supply so feel all sensations - intercostal nerves T1-T11
53
What nerves innervate the mediastinal and diaphragmatic pleura?
- phrenic nerve - somatic supply so feel all sensations
54
What is the pulmonary ligament?
- fusion of the parietal and visceral pleura - anchors lungs to superior mediastinal - NOT a true ligament
55
What is the costal groove?
- internal and inferior surface of the ribs
- allows blood vessels and nerves to run along rib
56
What is the purpose of the costal groove?
- to create a cavity for vessels - VAN = veins, arteries and nerves
57
What is tachypnoea?
- abnormal rapid respiratory rate
- short breathes
- normal respiratory rate = 16-20b/min
58
What is dyspnea?
- shortness of breathe
59
What is hyperpnea?
- slow abnormal breathing - long and deep breathes
60
What is pleuritis and/or pleural rub?
- inflammation and/or swelling of pleural space - on stethoscope sounds like hands rubbing together
61
What does pleural effusion mean?
- build up of excess fluid in pleura
- generally requires draining
- symptoms (if any) progress slowly
62
What does pneumothorax mean?
- pneumo greek for air
- thorax greek for thoracic
- means liung collapse with rapid onset of symptoms
63
What is pneumothorax?
- filling of air in the pleural cavities of the lungs
64
What is hemomothorax?
- blood has leaked into the pleural cavities of the lungs
65
What happens to intrapleural pressure if air, liquids or pus is able to enter the pleural space?
- air, fluids etc... fill the space so volume ⬇️
- intrapleural pressure will increase
- Boyles law = ⬇️ volume = ⬆️ pressure
66
What are the 3 different types of pneumothorax?
1 - closed 2 - open 3 - tension
67
What is closed pneumothorax? (can be air, fluid or pus)
- air has entered the pleural space from inside respiratory system
- air compresses the lungs
- air is eventually filtered out and lung returns to normal
68
What is open pneumothorax? (can be air, fluid or pus)
- air enters pleural space due to break in parietal pleura
- air enters from outside of respiratory system
- air compresses the lungs
- break is repaired and air is filtered out and lung returns to normal
69
What is tension pneumothorax? (can be air, fluid or pus)
- break in parietal pleura and air enters the pleural space
- creates one way valve so air cannot leave
- air compresses the lungs and lung collapses
- most dangerous of the 3
70
What are the 2 types of circulation in the lungs?
1 - pulmonary arteries and veins (gas exchange)
2 - bronchial arteries (supply O2 and nutrients to lungs)
71
What does the pulmonary circulation do in the lungs?
- pulmonary arteries bring de-oxygenated blood - pulmonary veins leave with oxygenated blood
72
What do the bronchial arteries do in the lungs?
- blood supply of the lungs
73
Where do the left and right bronchial arteries for the lungs originate?
- left = descending aorta - right = 3rd post intercostal artery
74
How do the pleural membranes of the respiratory tract receive blood?
- anterior and posterior intercostals arteries - azygos and internal thoracic vein
75
During hypoxic episodes what happens to the pulmonary and bronchial arteries?
- pulmonary = vasoconstriction (opposite to systemic circulation)
- bronchial = vasodilation
76
What are the 3 main lymphatic drainage avenues for the lungs and thoracic cavity?
1 - Mediastinal 2 - Parasternal 3 - Tracheobronchial
77
Where are the tracheobronhial lymph nodes located?
- around the carina (trachea and bronchi)
78
Where are the parasternal lymph nodes located?
- parasternal lines - anterior ends of the intercostal spaces - side of the internal thoracic artery
79
Where do the lymph nodes drain into?
- right lymphatic duct - thoracic/left lymphatic duct
80
How are the lungs innervated?
- controlled by autonomic system - pulmonary plexus
81
What are the main components of the pulmonary plexus that supply the lungs? I.e. what supplies sympathetic and para-sympathetic innervation?
- parasympathetic = vagus nerve (10th cranial nerve) - sympathetic = sympathetic chain
82
Where do the pulmonary plexus run in relation to the lungs?
- anterior and posterior at site of carina
83
What parts of the nervous system innervate the visceral and parietal pleura?
- visceral pleura = autonomic so stretch sensitive only
- parietal = somatic so feels all senses
84
Why is it important to know the nerves that innervate the lungs?
- clinical management will target nervous system
85
In an emergency situation and someone is having an asthma attach what drug might be useful?
- sympathetic drug (adrenoreceptors)
- B2 Gas receptor will vasodilate bronchi
- SABA - salbutamol high dose using nebuliser
86
Why is the pleural space always lower than intrapulmonary and atmospheric pressure?
- parietal pleural aim to move outwards
- visceral pleural aim to move inwards
- these movements increase the pleural space
- Boyles law = ⬆️ volume = ⬇️ pressure ⬇️ volume = ⬆️ pressure
87
What is the hilium of the lungs?
- location on lungs where things can enter or leave
88
What is the root of the lungs?
- collection of structures connecting the lung to the mediastinum
89
How does the diaphragm provide stability to the pericardium?
- central tendon provides attachment to fibrous pericardium
90
Which rib is the oblique fissure located at?
- generally 6th rib
