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Lungs and Diaphragm
Info from 8.25.11 - Lung and Diaphragm Lab
25
Anatomy
Professional
08/27/2011

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Term
Thoracic Cavity
Definition
region enclosed by the thoracic wall
Term
Pleurae
Definition
  • serous sacs investing (surrounding) the lungs
  • Visceral pleura lines the lung surface
  • Parietal pleura lines walls of thoracic cavity
  • visceral and parietal are continuous with one another
  • visceral pleura has no somatic sensory (temp/touch/pain sensations) innervation
  • parietal pleura is sensitive to pain/temp/touch (intercostal nerves and phrenic nerve)
  • (pleurisy) inflammation of the v. and p. pleura can lead to adhesion of these layers, resulting in acute pain with elevated activity (somatic sensory)
Term
Pleural Cavities
Definition
  • potential space between the visceral and parietal pleura
  • L and R pleural cavities are independant
  • surfactant as a lubricant in space
  • Hydrothorax - an accumulation of fluid in pleural cavity
  • Pneumothorax - accumulation of air in pleural cavity
  • Hemothorax - accumulation of blood in pleural cavity
Term
Costodiaphragmatic recesses
Definition
  • inferolateral recesses within the pleural cavities
  • with inspiration, the lungs expand and these recesses decrease in area
  • with expiration, these recesses enlarge again
Term
Thoracentesis
Definition
  • procedure to drain excess fluid or blood from pleural cavity
  • needle is inserted into an intercostal space (avoiding inferior protion of superior rib and superior border of inferior rib)
  • good location to perform = posterior aspect of 7-9th intercostal spaces, as the needle enters the costodiaphragmatic recess, avoiding injury to lungs and nearby organs
Term
Lung (root, apex, base)
Definition
  • lung elasticity - if thoracic wall is breached, then lung will shrink to about 1/3 of its normal size
  • root of lung = collection of structures entering/exiting the lung (eg. pulmonary vessels/ bronchi)
  • apex = superior portion of the lungs
  • base = inferior portion of the lungs (concave and adjacent to diaphragm)
Term
Right Lung
Definition
  • Right lung
    • 3 lobes (superior, middle, inferior)
    • horizontal fissure - separates superior and middle lobes
    • oblique fissure - separates middle and inferior lobes
Term
Left Lung
Definition
  • 2 lobes (superior and inferior)
  • oblique fissure - separates superior and inferior lobes
  • superior lobes and cardiac notch on anterior margin
Term
Trachea
Definition
  • located inferior to the larynx
  • palpable at jugular notch due to cartilaginous rings
  • c- shaped hyaline cartilages
  • bifurcates at sternal angle (T4-T5)
  • Carnia - ridge at the bifurcation of the trachea into the right and left main bronchi (at T4-T5)
Term
Right and Left Main Bronchi
Definition
  • extrapulmonary (outside the lungs)
  • supported by hyaline cartilage
  • right bronchus is wider, shorter, and more vertical and left main bronchus
  • aspirated objects are therefore more likely to lodge in the right bronchus due to its shape
Term
Lobar bronchi
Definition
  • each main bronchus divides into lobar bronchi
  • intrapulmonary (inside lungs)
  • right lung has 3 lobar bronchi (superior, middle, inferior)
  • left lung has 2 lobar bronchi (superior, inferior)
Term
segmental bronchi
Definition
each lobar bronchi divides into segmental bronchi, corresponding to a specific bronchopulmonary segment
Term
bronchopulmonary segments (10 per lung)
Definition
  • area of lung supplied by a segmental bronchus and segmental branch of pulmonary artery
  • separated from adjacent segments by connective tissue septa (therefore can be surgically resected if affected by disease)
  • tributaries of pulmonary veins lie in the connective tissue between adjacent segments
Term
Pulmonary Vessels (name them)
Definition
  • pulmonary trunk - exits the right ventricle of the heart and divides into L and R pulmonary arteries (enter the lungs)
  • Pulmonary arteries - carry oxygen poor blood from the heart to the lungs for oxygenation
    • each PA divides into lobar and segmental arteries, running parallel with bronchi
  • Pulmonary veins - 2 on each side - carry Oxy rich blod from lungs to L atrium of heart
    • pulmonary veins in the intersegmental connective tissue separating bronchopulmonary segments, do not course through arteries and bronchi
Term
Bronchial Vessels (supply lung with oxygen -- different from blood being oxygenated by the lung)
Definition
  • bronchial arteries - carry oxygen rich blood to the tissues of lung itself, they are branches off thoracic aorta
  • bronchial veins - return oxygen poor blood from tissues of lung directly to the azygos system or via  intercostal veins to the azygos system
Term
Lung Innervation
Definition
  • all organs are innervated by the autonomic NS
  • ANS includes Peripheral NS and Sympathetic NS nerves
  • Innervation of lungs is via the pulmonary plexuses w/ contributions from Vagus Nerves (L and R) and sympathetic splanchnic nerves
Term
Vagus Nerves (CN X; parasympathetic) achieve bronchoconstriction
Definition
  • preganglionic cell bodies lie in brain
  • preganglionic fibers constitute vagus nerve
  • postganglionic cell bodies lie in wall of the target organ (lung)
  • postganglionic fibers also lie in wall of target organ (very short in length)
Term
Sympathetic Innervation (bronchodilation)
Definition
  • preganglionic cell bodies lie in lateral horn of the thoracic spinal cord
  • preganglionic fibers travel from lateral horn to ventral root to spinal nerve to ventral ramus to white ramus to paravertebral ganglion of sympathetic trunk
  • postganglionic fibers (pulmonary nerves) travel from paravertebral ganglia to grey ramus to ventral ramus and into the lungs
Term
Diaphragm
Definition
  • separates abdominal and thoracic cavities
  • composed of skeletal muscle surrounding C-shaped central tendon
  • 2 domes (right dome is higher than the left dome due to liver)
  • heart lies on central tendon
  • attachments = xiphoid process, costal margin, ribs 11-12, lumbar vertebrae (R and L crura)
Term
3 openings of the diaphragm
Definition
  • Caval Opening - T8, through central tendon, for inferior vena cava
  • Esophageal hiatus - T10, for esophagus and CN X
  • Aortic hiatus - T12, for aorta, thoracic duct, azygos vein
Term
Diaphragm Sensory Innervation
Definition
Phrenic nerves (primary) and intercostal nerves (peripherally)
Term
Motor Innervation of Diaphragm
Definition
  • Phrenic nerves - ("C3, C4, C5 - keep the diaphragm alive")
  • L and R phrenic nerves independantly innervate L and R domes
  • Primary muscle of inspiration -- contaction = dome descends and flattens (decreasing volume of abdominal cavity); expiration = relaxation and domes rise
  • lesion of phrenic nerve - paralyzes corresponding half of the diaphragm.  CXR will show a depressed (active side) and domes (rasied, paralyzed side) of diaphragm
Term
Inspiration
Definition
  • contraction of diaphragm (abdominal contents forced down as flattening occurs); increases vertical dimension of thorax
  • contraction of muscles that elevate the ribs (external intercostals) expands thoracic cavity laterally (transversely) -- bucket handle movement
  • forceful inspiration, the pectoral muscles may be recruited
Term
Expiration
Definition
  • thoracic cavity reduces in size - diaphragm relaxes and elastic recoil of lungs
  • during forceful expiration, abdominal muscles (external and internal obliques, rectus abdominis) are recruited to compress abdominal viscera upward, expelling air from lungs
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