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Anatomy 1-8 Lungs and Pleura
Lecture 9.06 on the lungs and pleura
55
Anatomy
Professional
09/06/2011

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Term
What do the bronchial buds become in the developing fetus?
Definition
Primary bronchi
Term
What are the two pleura in the thorax called? What do they surround?
Definition
parietal pleura surrounds each half of the thorax; visceral pleura surround each half of the lungs
Term
What are the superior surfaces of the parietetal pleurae called? The lateral surfaces? The medial surfaces? The inferior surfaces?
Definition
superior=cervical pleurae
inferior=diaphragmatic pleurae
lateral=costal pleurae
medial=mediastinal pleurae
Term
What is the most inferior corner of the pleural cavity called?
Definition
costodiaphragmatic recess
Term
What layers compose the pleural sac?
Definition
parietal + visceral pleurae
Term
Why is it important to be careful when performing invasive procedures in the area just above the clavicle?
Definition
The apex of the lung, the top of the pleural cavity and the subclavian artery are all located there.
Term
Where is the lowest level of the pleural cavity when viewed from the mid-clavicular line? The lowest level of the lungs?
Definition
8th rib; 6th rib
Term
What bones is the diaphragm attached to?
Definition
Anteriorly to the xiphoid process, laterally to ribs 7-12, posteriorly to the upper level of the lumbar vertebrae
Term
Posteriorly, at which rib do the lungs extend to? The pleural cavity?
Definition
10th rib; 12th rib
Term
What is happening in the process of a pneuomthorax?
Definition
Air can enter in either through a rupture in the lung or the pleural cavity wall; collapsing the lung. Air fills cavity, compressing collapsed lung and shifting mediastinum into the other lung, compressing that one.
During expiration, openings close like valves and pressure rises, increasing with each breath. Mediastinal and tracheal shifts augmented, diaphragm is depressed, and venous return is impaired
Term
Where does the parietal pleura receive most of its sensory innervation? What type of nerve fibers are innervated by this?
Definition
branches of intercostal nerves; somatic sensory fibers
Term
What is pleural adhesion?
Definition
when visceral and parietal pleura adhere to one another; causes localized stabbing pain upon exertion
Term
What is pleurisy or pleuritis?
Definition
inflammation of the pleura
Term
Why would damage to the parietal pleura be reported as localized pain instead of referred pain like most other organs?
Definition
parietal pleura is innervated by somatic sensory, not visceral afferent fibers which usually cause referred pain
Term
What important nerve innervates the diaphragmatic pleura?
Definition
phrenic nerve (made from C3-C5 branches of ventral rami)
Term
What is the phrenic nerve? What are some of its properties?
Definition
made from C3-C5 branches of ventral rami, contains somatic motor fibers (for innervating diaphragm), somatic sensory (diaphragmatic pleura), and postganglionic sympathetic fibers that supply the vasculature
Term
If a patient has an inflamed or irritated diaphragmatic pleura, what type of pain would be expected?
Definition
pain may be felt radiating over the shoulder, due to the relationship of these cervical dermatomes to the phrenic nerve
Term
What are the tops of the lungs called?
Definition
apex (apices)
Term
What is the diagonal groove in the lungs called?
Definition
oblique fissure
Term
What is the horizontal groove in the lungs called? On which side of the lung is this found?
Definition
horizontal fissure; right lung
Term
Which side of the lung has 3 lobes? Which side has 2 lobes?
Definition
right lung; left lung
Term
Which side of the lung has the cardiac notch? Which area of the ribs correspond to this area? Why is this area clinically relevant?
Definition
left lung; 4th-6th costal cartilage; Site where fluid can be withdrawn from the pericardial sac (no overlying lung tissue)
Term
What is the outcropping on the inferior portion of the left lung called?
Definition
lingula
Term
What are the 3 lobes of the right lung called?
Definition
Upper(superior), middle, and lower (inferior) lobes
Term
What is the hilum of the lung? At approximately what vertebral level is the hilum?
Definition
the site where the structures that comprise the root of the lung, the pulmonary and bronchial vessels, nerves, lymph nodes, lymphatics and bronchi enter its substance; located at T5-T7 level
Term
What makes up the conducting portion of the lungs? The respiratory portion?
Definition
Conducting = directs air to lungs, trachea which bifurcates into primary bronchi, which divide into secondary and then tertiary bronchi

Respiratory portion=contains alveoli and where gas exchange occurs
Term
How many secondary bronchi are there per side of the lungs?
Definition
3 on right (1 per lobe) and 2 on left
Term
Where is a foreign object likely to be lodged if inhaled? Why?
Definition
the right principal bronchus is shorter, wider and more vertical than the left. For this reason, if a patient has aspirated a foreign object, it is more apt to be found in the right bronchial tree.
Term
What functionally independent defined units are supplied by tertiary bronchi?
Definition
bronchopulmonary segments
Term
What is the trachea made of?
Definition
horseshoe- shaped pieces of hyaline cartilage
Term
What is the functional unit of respiratory exchange?
Definition
alveoli
Term
What level are alveoli first seen?
Definition
respiratory bronchioles
Term
What are the small openings between adjacent alveoli in which they can communicate? What is the benefit of these openings?
Definition
pores of Kohn; allow collateral air flow
Term
How many alveoli are in the adult lung?
Definition
~300 million
Term
What part of the pulmonary vasculature carries deoxygenated blood to the lungs? Return oxygenated blood to the left atrium?
Definition
pulmonary arteries;pulmonary veins
Term
What part of the pulmonary vasculature run independently, following courses between bronchopulmonary segments? Why are they important to surgeons?
Definition
pulmonary veins; used as landmarks for borders of the bronchopulmonary segments
Term
What part of the pulmonary vasculature follows the bronchial branching pattern and breaking into capillaries around each alveolus?
Definition
pulmonary arteries
Term
What arteries and veins supply the tissues making up the walls of the airways?
Definition
bronchial arteries/veins
Term
Pulmonary Embolism
Definition
Common sources of clots: deep veins in legs (external iliac v, femoral v, deep femoral v, popliteal v, posterior tibial v, soleal plexus v)
caused by venous stasis (bed rest), coagulation disorders, or trauma (causes known as Virchow's triad); postop/postpartum immobility, hormone medications cause blood clots.

signs: dyspnea, tachycardia

60-80% of PEs are silent due to small size, but complete occlusion of right pulm artery (saddle embolus) can cause right side heart failure and circulatory collapse

Lungs can stop small clots due to fibrinolytic (clot buster mechanism)
Term
What is the primary role of the lymphatic system?
Definition
The primary role of the lymphatic system in the lungs is to remove interstitial fluid in order to maintain an environment that is maximally suited for efficient gaseous exchange
Term
Where do most of the lymphatic vessels and nodes of the lungs drain to?
Definition
bronchomediastinal lymph trunk and then into the brachiocephalic vein
Term
Which lung drains lymph into the other?
Definition
Lymph from the inferior left lobe drains to the right lung
Term
How can otherwise clinically silent diseases of the lungs be detected?
Definition
Enlarged lymph nodes associated with disease processes often partially or totally occlude a portion of the bronchial tree. This may cause shortness of breath, a symptom than can be pivotal in the diagnosis of an otherwise clinically silent condition such as lung cancer
Term
How can a hoarse or weak voice lead to a diagnosis of lung disease?
Definition
An increase in size of bronchopulmonary nodes (or any nodes adjacent to the trachea) can cause a deviation of the carina from the midline. Enlargement of the bronchoplumonary or tracheobronchial nodes localized on the left side may compress the left recurrent laryngeal nerve, causing hoarseness or a “weak” voice
Term
What nerve branches to become the recurrent laryngeal nerves? What vessel does it wrap around before returning up to the larynx?
Definition
vagus nerve; aortic arch
Term
What do the parasympathetic fibers of the pulmonary plexus do?
Definition
1.Control the smooth musculature of the airway (bronchoconstrictor)
2.Initiate glandular secretory activity
Term
What do the sympathetic fibers of the pulmonary plexus do?
Definition
1.Monitor parasympathetic control of airways (bronchodilator)
2.Control blood flow through the pulmonary vessels (vasoconstrictor)
Term
What nerve provides the parasympathetic fibers and visceral afferent fibers to the pulmonary system?
Definition
vagus nerve
Term
What do the afferent fibers of the pulmonary plexus do?
Definition
1.Mucosa of the bronchi – initiate cough reflex
2.Muscles of the bronchi – respond to stretch
3.Interalveolar septae - limit inspiration
4.Pulmonary arteries – pressoreceptors
5.Pulmonary veins – chemoreceptors
Term
Where are the arterial chemoreceptors of the mediastinal area located? What do they do?
Definition
located in the aortic and carotid bodies work in concert with vagal afferent fibers to monitor changes in arterial blood gas tensions and the pH of the blood
Term
How does pain in the lungs work?
Definition
Most of the “pain” associated with the lungs is transmitted by somatic sensory fibers contained within the intercostal and phrenic nerves that supply the parietal pleura. However, there are a limited number of visceral afferent fibers from the bronchi that accompany the sympathetics. Pain is referred over the anterior chest wall (dermatomes T1 – T5)
Term
What dermatome is activated by referred pain from the bronchi?
Definition
T1-T5
Term
What type of nerve fibers make up the pulmonary plexus?
Definition
Postganglionic sympathetic fibers
Preganglionic parasympathetic fibers Visceral afferent fibers
Term
What happens when a large lung tumor invades towards the mediastinum? The superior end of the pleural cavity?
Definition
the tumor can impinge on the sympathetic trunk and causes horner's syndrome (neural problems in the face), and if really invasive, can compress vena cava and causes facial edema, distended veins, and dyspnea

When a tumor invades up, it can compress the brachial plexus and cause extremity pain
Term
What is the brachial plexus?
Definition
A large, intricate group of ventral rami controlling movements of the upper extremity
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