GROSS ANATOMY: PLEURA

REFLECTIONS OF THE PARIETAL PLEURA: Superior extent: Neck of the 1st rib (3-4 cm above the 1st costal cartilage) Midclavicular line: Extends to Rib 8 Midaxillary line: Extends to Rib 10 Posterior: Extends to T12 vertebra Medial: Mediastinum Inferior: Reflects onto the diaphragm

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PLEURAL CAVITIES: Figure Legend: Development of Pleural Cavity: Analogy Lollipop stick = _____ containing bronchi, arteries, veins and nerves Lollipops = ______ Water-filled Balloon = _______

Root of the lungs Lungs Pleural Cavity

PLEURAL FLUID: Typically no more than _____ per side High daily turnover Fluid absorption is regulated by _______ as well as thoracic lymphatic drainage. Pleural effusion occurs when these mechanisms are ______ leading to excess fluid in the pleural cavity. Ex. TB, inflammation

15ml hydrostatic and oncotic forces unbalanced

LUNG DEVELOPMENT: Develops as an outpocketing from the floor of the endodermally lined ______. Develops from the ______.

gut tub foregut region

PLEURAL EFFUSION: Excessive fluid accumulation in the pleural space, which leads to lung compromise. Hydrothorax: pleural fluid (ex. _____) Hemothorax: blood (ex. due to ______) Chylothorax: ____ Pyothorax: _____ (empyema) Pneumothorax (air)

heart or renal failure penetrating injuries, laceration lymph pus

CERVICAL PLEURA: Dome-shaped & projects about 2-3 cm above _____ of the clavicle SUPRAPLEURAL MEMBRANE: dome-like connective tissue fascia supporting apex of pleural cavity attached laterally to the medial margin of _____, posteriorly to the transverse process of _____, superiorly it blends with ______; it covers the superior surface of cervical pleura

medial 1/3rd 1st rib CVII vertebra scalene muscles

Endothoracic fascia: connective tissue layer that attaches the costal portion of the ______ to the thoracic wall Suprapleural membrane: thick fascial layer that covers the ______ of the parietal pleura and attaches to the inner margin of the ______ and transverse process of _____ Phrenicopleural fascia: attaches the _____ portion of the parietal pleura to diaphragm

parietal pleura cervical portion, First Rib, C7 diaphragmatic

INNERVATION OF THE PLEURA: Parietal-sensitive to pain -Cervical & Costal branches of intercostal nerves _____; pain referred to ______ -Mediastinal & Diaphragmatic: phrenic nerve (_____); pain referred to C3-C5 dermatomes- _______ -Visceral is insensitive to pain; autonomic innervation derived from the pulmonary plexus at the ______

(T1-T11), thoracic wall C3-C5, lateral neck & supraclavicular shoulder root of the lung

THORACENTESIS: Performed to draw fluid out of the pleural cavity for analysis (pleural tap) or to remove excess fluid or air Needle is inserted in _____ intercostal space (between ribs 9 & 10) at the ______ Superior enough to avoid damaging intercostal nerves; angled up to avoid the ______; during ______ to avoid lung tissue

9th midaxillary line diaphragm exhalation

PLEURAL INJURY: Areas of the pleura that are more susceptible to traumatic injury: 1. ______ pleura: not covered or protected by bony structures. 2. Three (3) areas where pleura extends below the ribs: -Right infrasternal angle -Right costovertebral angle -Left costovertebral angle A puncture or tear of the _____ may lead to pneumothorax.

Cervical pleura

Drainage of costovertebral pleura: ____ nodes, ______ nodes, ______ nodes Drainage of visceral pleura: to deep pulmonary plexus -Right and left _____ trunk

Intercostal, diaphragmatic, parasternal bronchomediastinal

PNEUMOTHORAX: When ______ enters the pleural cavity, this is known as pneumothorax This causes loss of negative pressure within the pleural cavity and may cause the lungs to collapse (______). When a lung collapses (atelectasis) it occupies less volume within the pleural cavity. -Loss of volume in the affected side may cause the _____ to shift towards the ipsilateral side on chest X-ray.

air atelectasis trachea

VISCERAL PLEURA: Continuous with the parietal pleura at the _____ of each lung, where structures enter and leave the organ. Is firmly attached to the surface of the lung, including both opposed surfaces of the _____ that divide the lungs into lobes.

hilum fissures

PLEURAL BLOOD SUPPLY: Generally, blood and lymphatics to serous membranes, pleura, pericardium and peritoneum, are supplied by the organs that they line Parietal pleura: supplied by _____ arteries and veins Visceral pleura: _____ arteries and veins

intercostal bronchial

PLEURAL CAVITY: The potential space between the two layers of pleura is known as the pleural cavity. -The pressure in the pleural cavity is normally _____ than atmospheric pressure, what is referred to as ______ -Loss of negative intrapleural pressure can lead to ______ This space contains a thin layer of serous fluid produced by the mesothelial cells of the pleura. High daily _____ of fluid. -Provides lubrication to allow for smooth ______ of the lungs -______ of the fluid also keeps the two layers of pleura in close association with each other and couples movement of the chest wall and diaphragm with the lung.

less negative pressure. lung compromise. turnover expansion and contraction Surface tension

FUNCTIONS OF THE PLEURA: Protective Allows for changes in ______ Ensures smooth movement between visceral and parietal layers during _____

lung volume breathing

Left & right sternal lines of pleural reflection: edge between costal & _____ pleural regions Left & right costal lines of pleural reflection: edge between costal & ______ pleural regions

mediastinal diaphragmatic

ROOT OF THE LUNG: where the sleeve-like ______ covers the structures (airway, vessels, nerves, lymphatics) passing between the lung and mediastinum (TV-TVII Vertebrae) HILUM: the medial surface of each lung where airways, nerves, and vessels pass into and out of the ______; where the mediastinal pleura (parietal) is continuous with the _____

mediastinal pleura lung parenchyma visceral pleura

PLEURA SACS DEVELOPMENT: Developing lung buds push into the ______ (spaces). Pericardioperitoneal canals are already lined with ______ that becomes the inner (visceral) and outer (parietal) walls of the pleura. As a result, the lungs become covered by two layers of pleura: Visceral Parietal Note: Pericardium: lines the heart Peritoneum: lines the abdominal cavity Parietal layer: derived from _____ mesoderm Visceral layer: derived from _____ mesoderm

pericardioperitoneal canals mesoderm somatic splanchnic

MESOTHELIOMA: Aggressive cancer that arises from the _____ (mesothelium) _______ exposure is the main cause of pleura mesothelioma. When inhaled, asbestos fibers travel to the ends of small air passages and reach the pleura (mesothelium), where they can cause ______

pleura Asbestos inflammation and scaring.

PLEURAL RECESSES: Spaces that allow for lung expansion during ______ Costomediastinal: between the costal and mediastinal pleura bilaterally - larger on the _____ due to heart's position Costodiaphragmatic: between inferior border of the visceral pleura and inferior border of parietal pleura

respiration left

PLEURA Two-layered serous membrane (or mesothelium) lined by ______ epithelium that lines each pleural cavity. The mesothelium together with the associated supporting connective tissue form the pleura Develops as a closed invaginated sac surrounding each lung. Made up of two parts, based on location: Parietal pleura: pleura associated with _____ of the thoracic cavity Visceral pleura: adheres to and covers the ______ of each lung -Inseparable from the _____ -Begins at the _______ -Invaginates interlobar fissures, thus ensheathing each pulmonary lobe

simple squamous inner surfaces walls outer surfaces lung surface root of the lung

COSTAL PLEURA: lines the back of sternum, costal cartilages, ribs, intercostal spaces and sides of ______ MEDIASTINAL PLEURA: Covers and forms the lateral boundary of _______ DIAPHRAGMATIC PLEURA: Covers the (______) upper surface of the diaphragm

vertebral bodies middle mediastinum thoracic