Lungs and Pleurae

what are the three compartments

two pulmonary cavities (lungs & pleurae) and mediastinum

what does the mediastinum hold

heart, great vessels, trachea, esophagus

what is the sternal angle plane location

T4/T5

what is the parietal pleura

lines the thoracic cavity and covers the diaphragm

what is the visceral pleura

covers the surface of the lungs

what are the four parts of the parietal pleura

cervical, costal, mediastinal, diaphragmatic

where does the cervical pleurae extend to

the 1st rib

what is the costodiaphragmatic recess

space in the lowest part of the thoracic cavity where the costal and diaphragmatic pleurae join

what is the purpose of the costodiaphragmatic recess

area for the lung to expand into during full inspiration and where excess fluids can accumulate when standing

what are the mediastinal and diaphragmatic pleura innervated by

the phrenic nerve

what is the visceral pleura innervated by

the autonomic nerve

what do the intercostal nerve innervate

cervical, costal, and lower part of the diaphragmatic

what are the dermatomes for the shoulder

C3, C4

where would pain from te mediastinal and diaphragmatic pleurae be referred to and why

shoulder, bc of innervation by the phrenic nerve

purposes of pleural fluid

lubrication for lungs to move within the pleural cavity during respiration, surface tension to keep visceral and parietal pleura and lungs in contac with thoracic wall and diaphragm

what is the innervation for parietal pleura

intercostal and phrenic nerves

what is the innervation for visceral pleura

autonomic nervous system- synpathetic and parasympathetic

parietal pleura is sensitive to what

somatic pain

what is the blood supply for the parietal pleura

intercostal and musculophrenic arteries

what is the blood supply for the visceral pleura

bronchial arteries

how many fissures does the right lung have

2

where is the lingula and cardiac notch

left lung

what is different between the right and left main stem bronchi

the right has a right middle bronchus and the left has segmental bronchi

where are aspirated objects more likely to go

right main stem bronchus

purpose of carina

divides lower part of trachea into right and left main stem bronchi

where do pulmonary arteries and bronchi run

within a lung segment

where do pulmonary veins run

between a lung segment

what does the autonomic nervous system innervate

smooth muscle, glands, and blood vessels in the bronchi

what fibers make up the pulmonary plexus

sympathetic and parasympathetic fibers

what are the parasynpathetic fibers of the pulmonary plexus

pulmonary branches of the vagus nerve

what are the sympathetic fibers of the pulmonary plexus

sympathetic trunks

what do parasympathetic nerves do

bronchoconstrictors, promotes secretion of mucous glands, relax blood vessels

what do sympathetic fibers do

bronchodilators, inhibit secretion of mucous

clinical correlation of nerves in the pulmonary plexus

inhalation of a sympatheomimetic substance (albuterol) will relax the smooth muscle in the bronchi and dilate the airways

where does the lymph typically go

follows the consectuive group of ipsilateral nodes

what occurs in 25% of individuals

lymph from left lower lobe drains into the lymphatics on the right side

what is pleurisy

inflammation of the pleura

what are some causes of pleurisy

viral and bacterial infections, pneumothorax, pulmonary embolism, lung cancer

what is one physical consequence of pleurisy

inflamed visceral and parietal pleura rub against each other and cause sharp pain during breathing, coughing, and sneezing

what does a physical exam for pleurisy reveal

rough scratchy sound as pleura rub

what does pleurisy inflammation lead to and what is it

pleural effusion, a build up of fluid in pleural space and especially costodiaphragmatic recess

what are the four fluids that can accumulate in the pleural space

serous fluid, blood, lymph, pus, air

what are each of the names for the accumulation of serous fluid, blood, lymph, pus, air in the pleura

hydrothorax, hemothorax, chylothorax, pyothorax, pneumothorax

what is a pleural effusion

excess pleural fluid that accumulates in the pleural cavity

signs and symptoms of a pleural effusion

short breath, decreased breath sounds, change in breathing sound, chest pain on deep inspiration

what is the procedure for removing excess air or water in pleural cavity

thoracocentesis

where does the catheter get inserted for a thoracocentesis

middle of rib space or above lower rib

how does a pneumothorax occur

injury to the parietal or visceral pleura or lung

result of a pneumothorax

lung collapses and patient can’t breathe

what causes a spontaneous pneumothroax in young children and adults

pulmonary blebs, weakened out pouchings in the lung, which can rupture and cause a pneumothorax

what is a tension pneumothorax

air enters pleural cavity during inspirtion but cannot escape due to the valve effect, leading to buildup of pressure

findings of tension pneumothorax

chest pain, respiratory distress, tachycardia (increased heart rate), tachypnea (rapid breathing)

how can a tension pneumothorax worsen

mediastinal shift to opposite side of chest, decreased systemic venous return, decreased cardiac output, medical emergency

what is a pulmonary embolism

blockage of pulmonary artery or its branch by a substance like a blood clot that has travelled from somewhere else in the body through bloodstream

symptoms of pulmonary embolism

difficulty breathing, chest pain during inspiration

clinical signs of pulmonary embolism

low blood O2, cyanosis, rapid breathing, rapid heart rate

how can a pulmonary embolism be treated

anticoagulants and thrombolytics

how many pulmonary veins are there and what are they

4, l/r and inferior l/r pulmonary veins

why are bronchial arteries important

they supply the structure of the lung

what is the sympathetic innervation of the pulmonary plexus

T2-5

what is the parasympathetic innervation of the pulmonary plexus

vagus nerve