Pleural Cavity & Lungs
What type of parietal pleura extends superior to the clavicle forming a dome referred to as the cupula?
cervical
Thoracocentesis: major amounts of air, blood, or fluid (or combination) in the pleural cavity are typically removed by insertion of a what?
chest tube
Do the body cavities (such as the pleural & pericardial cavities) develop early or late in development?
early
Where are paratracheal lymph nodes located?
either side of the trachea
What structure carries low-oxygen blood to the lungs for oxygenation?
pulmonary arteries
Obstruction of a pulmonary artery or one of its branches by an embolus is called what?
pulmonary embolism
Shortness of breath, chest pain, & cough are common signs of what?
pulmonary embolism
If a large clot blocks a pulmonary artery, the _________ side of the heart may __________ because blood cannot be pushed into the pulmonary circulation
right, dilate
Pulmonary artery: -Anterior to the main bronchus in the ________ lung -Superior to the main bronchus in the ________ lung
right, left
Each main bronchus divides into ___________ bronchi
secondary/lobar
Visceral sensory for reflex: 1st order cell bodies are located in the _________ _________ of the _________ nerve (CN X) near the brainstem
sensory ganglia, vagus
What is the "windpipe" that is composed of C-shaped cartilaginous rings?
trachea
Diaphragm: •Caval opening: ______ vertebral level •Esophageal hiatus: ______ vertebral level •Aortic hiatus: ______ vertebral level
T8, T10, T12
How many pulmonary arteries travel to each lung?
1
Visceral sensory for pain (nociception) follows the sympathetic pathway retrograde to spinal nerve then to dorsal root, describe this path (7 parts)
1) Cardiopulmonary splanchnic nerves 2) Sympathetic trunk 3) White ramus communicans 4) Dorsal root 5) Dorsal root ganglion (1st order cell body) 6) Dorsal root 7) Dorsal horn
Describe the lymph node drainage from the lungs to the lymph ducts
1) bronchopulmonary lymph nodes 2) tracheobronchial lymph nodes 3) paratracheal lymph nodes 4) bronchomediastinal trunks 5) thoracic duct (left side) or right lymphatic duct (right side)
Visceral sensory for reflex: peripheral processes of ______ order neurons compose part of the _______ nerve (CN X) (signal travels retrograde)
1st, vagus
How many lobar bronchi does the left lung have?
2
How many lobar bronchi does the right lung have?
3
What is the most common cause of respiratory emergency in dental clinics?
Aspiration of a foreign body
What compartment is the "in the middle" of the thoracic cavity?
Mediastinum
Visceral sensory of the visceral pleura: is it sensitive to pain, temperature, and pressure?
NO (poorly localized)
What is the potential space between visceral and parietal pleura layers?
Pleural cavity
Somatic sensory of the parietal pleura: is it sensitive to pain, temperature, and pressure?
YES
What are the two unique features of the superior lobe of the left lung?
cardiac notch and lingula
Any muscles attaching to the ribs can potentially move one rib relative to another & thus can act as an ___________ respiratory muscle
accessory
Pulmonary plexuses: smaller collection of fibers course along the anterior or posterior aspect of the roots of the lungs?
anterior
What is the blood supply of the parietal pleura?
anterior and posterior intercostal arteries and veins
Pulmonary veins: - _________ & _________ position
anterior, inferior
What are the three borders of the lung?
anterior, inferior, and posterior
What is the superior end of the lung that extends superior to 1st rib called?
apex
Is aspiration or ingestion of a foreign body more critical?
aspiration
What clinical concern arises when the potential space of the pleural cavity becomes a real space?
atelectasis
What is it called when there is a loss of surface tension between visceral & parietal pleura resulting in a collapsed lung or part of a lung?
atelectasis/pulmonary collapse (collapsed lung)
What is the concave inferior surface of the lung that rests on the diaphragm called?
base
Where are tracheobronchial lymph nodes located?
bifurcation of the trachea
After ~day 22, the lungs grow into the _________ _________
body cavity
Body cavities develop before, during & immediately after _______ _______ in week ____
body folding, 4
Right or left lung? pulmonary veins anterior & inferior
both
The trachea extends from the larynx to its bifurcation into the right & left main (primary) what?
bronchi
What supplies blood to the lung parenchyma (tissue) & visceral pleura?
bronchial arteries
What is the blood supply of the visceral pleura?
bronchial arteries (from thoracic aorta), venous drainage to the pulmonary veins (primarily) and bronchial veins (drain to azygos system of veins)
Visceral sensory for reflex conveys signals from what?
bronchial mucosa (sensation for cough reflexes), bronchial muscles (stretch), pulmonary arteries (blood pressure), pulmonary veins (chemoreceptors; blood gas
Venous drainage of the lungs: •Smaller portion drains to _________ _________ •Area near the _________ of the lung •Drain to __________ system of veins
bronchial veins, root, azygos
What is the deep indentation along the anterior border that is a consequence of the deviation of the apex of the heart to the left side?
cardiac notch
What type of parietal pleura lies internal to the endothoracic fascia of the thoracic wall (sternum, ribs, intercostal muscles & membranes, & lateral aspects of the vertebra)?
costal
What are the three surfaces of the lung?
costal, mediastinal, and diaphragmatic
The parietal pleura is named based on the surfaces it covers. What are the four types of parietal pleura?
costal, mediastinal, diaphragmatic, cervical
What pleural space lies between the costal & diaphragmatic portions of the parietal pleura?
costodiaphragmatic recess
What pleural space is located posterolateral to the sternum between the costal & mediastinal portions of the parietal pleura?
costomediastinal recess
What is the most common cause of a pulmonary embolism?
deep vein thrombosis
_________ results when the fibers of the diaphragm contract, __________ occurs when the diaphragm relaxes
depression, elevation
What is the thin, musculotendinous structure that fills the inferior thoracic aperture, is chief muscle of inspiration, and separates the thoracic & abdominal cavities?
diaphragm
What type of parietal pleura covers the superior surface of the diaphragm on either side of the mediastinum?
diaphragmatic
The serous pleural fluid in the pleural cavity keeps lungs in a ___________ position even when the airway passages are open
distended
One phrenic nerve or half of the upper cervical spinal cord damaged: one side of the diaphragm is paralyzed resulting in an __________ __________, may present with __________ (difficult or labored breathing)
elevated hemidiaphragm, dyspnea
What is a blood clot that forms in a blood vessel in one of the body and then travels to another area called?
embolus
What is the subserous layer between the musculoskeletal thoracic wall & the parietal pleura lining the thoracic wall?
endothoracic fascia
What structure passes through the diaphragm?
esophagus
Lungs begin to develop from the _________ as a ventral outpouching called the _______ _______ on ~day 22
foregut, lung bud
What does the mediastinum compartment contain?
heart, great vessels (thoracic portions), trachea (thoracic portions), esophagus, thymus gland
What are some symptoms of hiatal hernias?
heartburn, GERD, early satiety (feeling full soon after eating), shortness of breath, chest pain
Hemothorax can lead to ...?
hemopneumothorax
What is the presence of blood in the pleural cavity called?
hemothorax
A vast majority of individuals develop a small ________ ________ as they enter their upper decades of life, but they typically have no signs or symptoms
hiatal hernia
What is it called when the upper portion of the stomach bulges superiorly through the esophageal hiatus?
hiatal hernia
Large _________ __________ can allow food and stomach acid to back up into the esophagus
hiatal hernias
What is the "doorway" that is the area on the mediastinal surface of each lung through which the root of the lung structures pass through?
hilum of the lung
Where are bronchopulmonary lymph nodes located?
hilum of the lung
The visceral pleura is continuous with the parietal pleura at the _________ of the lung where the structures making up the ________ of the lung enter and leave the lung
hilum, root
Is hemothorax more common from injury to the blood supply of the thoracic wall or laceration of the lung?
injury to the blood supply of the thoracic wall
What are the most common causes of atelectasis?
injury, cystic fibrosis, lung cancer, anesthesia, inhaled foreign object, pleural effusion, pneumothorax
Parietal pleura innervation:
intercostal nerve (costal & cervical pleura) and phrenic nerve (mediastinal & diaphragmatic)
What is the "voicebox" that opens into the pharynx and is continuous with the trachea inferiorly?
larynx
The costodiaphragmatic recess is deepest at the ___________ aspects (mid-axillary line)
lateral
Is the right or left lung taller?
left
Right or left lung? pulmonary artery superior to the main bronchus
left
Which side of the costomediastinal recess is larger?
left
Superior and inferior pulmonary veins carry oxygenated blood from each lung to the _________ _________ of the heart
left atrium
What type of pain can be perceived from the lungs (visceral sensory for pain)?
limited, dull/diffuse pain
What is the thin, tongue-like process that is the most inferior & anterior part of the superior lobe?
lingula
The pulmonary arteries divide into _________ & then __________ arteries
lobar, segmental
The blood supply of the visceral pleura is the same as what other structure?
lungs
What makes up the root of the lungs?
main bronchus, pulmonary artery, pulmonary veins
What type of parietal pleura covers the lateral aspects of the mediastinum (lateral aspect of the fibrous pericardium, esophagus, trachea, etc.) and is continuous with the visceral pleura at the root of the lung?
mediastinal
Lungs are separated from each other by what?
mediastinum
Why is the right lung usually larger & heavier, but shorter & wider?
more superior position of the right dome of the diaphragm and left-projecting heart & pericardium
Give some examples of accessory respiratory muscles
muscles of the thoracic wall, muscles of the upper limb (pectoral region & serratus anterior), muscles of the abdominal wall, muscles of the neck
In thoracocentesis, the needle passes through what to reach the pleural cavity?
muscular layers, endothoracic fascia, and costal pleura
What is the uppermost part of the respiratory tract?
nasal cavity
What does the upper respiratory tract consist of?
nasal cavity, mouth, paranasal sinuses, pharynx, larynx
Do the lungs fully occupy the pulmonary cavities during expiration?
no
What is the one fissure of the left lung?
oblique
What are the two fissures of the right lung?
oblique and horizontal
Open pneumothorax involves what?
open wound
What are the extensions of the nasal cavities into surrounding bones?
paranasal sinuses
The portion of the serous membrane that remains adhered to the other structures surrounding the pleural cavity is ...?
parietal pleura
What lines the pulmonary cavities adhering to the thoracic wall, mediastinum, & diaphragm?
parietal pleura
Which pleura lines the pulmonary cavities?
parietal pleura
The muscular portions of the diaphragm are positioned ___________
peripherally
What is the musculofascial structure that connects the oral cavity & nasal cavities to the larynx, and is the common pathway for food & air?
pharynx
What nerve is damaged here? Paralysis and eventual atrophy of the muscular part of the corresponding (ipsilateral) half of the diaphragm
phrenic nerve
What nerve innervates the diaphragm?
phrenic nerve (C3, C4, C5)
What is the term for when the parietal & visceral layers of pleura adhere? -fibrotic bands may span the pleural cavity -may be local or diffuse -risks: prior surgery/trauma, infections, vascular disorders, environmental exposure
pleural adhesions
What is the potential space between the layers of pleura?
pleural cavity
Pneumothorax: fluid may start to accumulate in the pleural cavity due to ___________ ___________ (excess fluid in the pleural cavity; hydrothorax)
pleural effusion
What is the name for "water on the lungs" where there is a build-up of fluid in the pleural cavity (1.5 million cases diagnosed annually in the U.S.)?
pleural effusion
What allows the layers of pleura to slide smoothly over each other during respiration?
pleural fluid
What is inflammation of the pleura that makes the lung surfaces rough resulting in friction (pleural rub) which is detectable with a stethoscope?
pleurisy/pleuritis
Presence of air in the pleural cavity is called ...?
pneumothorax
Pulmonary plexuses: located primarily anterior or posterior to the roots of the lungs?
posterior
In the trachea, the open portion of the "C" faces anteriorly or posteriorly?
posteriorly
Pulmonary plexuses are composed of what types of nerves?
postganglionic sympathetic, preganglionic parasympathetic, visceral sensory for reflex and pain (nociception)
___________ ____________ is less frequently from a fat embolus (following a broken bone involving bone marrow), amniotic fluid, air bubbles, indwelling IV catheter
pulmonary embolism
What are the most common causes of pleural effusion?
pulmonary embolism, cancer (lung & breast most common), pneumonia, liver disease, kidney disease
Closed pneumothorax involves what?
pulmonary lesion that ruptures into the pleural cavity, or fractured ribs that tear the visceral pleura & lung
What innervates the lungs?
pulmonary plexuses
Pulmonary arteries arise from what?
pulmonary trunk
Vasculature of the lungs: venous drainage to what (primarily)?
pulmonary veins
Segmental and then lobar veins drain to two __________ _________ for each lung
pulmonary veins (superior and inferior)
Is the right or left lung heavier?
right
Is the right or left lung larger?
right
Is the right or left lung wider?
right
Right or left lung? pulmonary artery anterior to the main bronchus
right
Which main bronchus is shorter?
right
Which main bronchus is wider?
right
Which main bronchus runs more vertically?
right
What are the two bilateral compartments of the thoracic cavity that contain the lungs and pleurae?
right and left pulmonary cavities
What two compartments occupy the majority of the thoracic cavity?
right and left pulmonary cavities
Aspirated foreign bodies or food is more likely to enter & lodge in what bronchus (or one of its branches)?
right main bronchus
What are the three compartments of the thoracic cavity?
right pulmonary cavity, left pulmonary cavity, mediastinum
The body cavities are lined by what membrane?
serous
The pleural cavity contains a small amount of what type of fluid?
serous
The pleural cavity contains a lubricating layer of fluid called what?
serous pleural fluid
Acute pleurisy is marked by ...?
sharp, stabbing pain especially on exertion (increased & deeper respiration)
Venous drainage of the lungs: _________ volume of low-oxygen blood entering the _________ volume of oxygen-rich blood
small, large
The visceral pleura provides the lung with a _________ _________ surface enabling it to move freely on the parietal pleura
smooth slippery
If the spinal cord is damaged at the upper cervical levels, then the _________ ________ pathway to _____, _____, and _____ is also disrupted resulting in a loss of phrenic nerve innervation
somatic motor, C3, C4, C5
What are the two lobes of the left lung?
superior and inferior
Thoracocentesis: •Needle inserted _________ to a rib at an angle at the level of the _________________ recess •Avoid ___________ __________ bundle
superior, costodiaphragmatic, intercostal neurovasculature,
What are the three lobes of the right lung?
superior, middle, inferior
Serous pleural fluid provides _________ _________ between visceral & parietal pleura
surface tension
There is a central __________ in the diaphragm
tendon
Divisions of the bronchial tree continue to the level of __________ ___________
terminal bronchioles
Each lobar bronchus divides into several _____________ bronchi
tertiary/segmental
The innervation of the visceral pleura is the same as ...?
the lungs
Bronchial arteries travel with ...?
the main bronchus
The innervation of the parietal pleura is the same as ...?
the surface it covers
Bronchial arteries arise from what?
the thoracic aorta
Pulmonary plexuses also innervate what along with the lungs?
the visceral pleura
The blood supply of the parietal pleura is the same as what other structure?
thoracic wall
What is it called when a needle is inserted through an intercostal space into the pleural cavity to obtain a fluid sample?
thoracocentesis
Elevation & depression of the diaphragm significantly alters the vertical dimensions of what?
thorax
What does the lower respiratory tract consist of?
trachea, bronchial tree, lungs
True or false: each lung has similar features
true
Both phrenic nerves or complete __________ __________ _________ __________ damaged: both sides of the diaphragm are paralyzed, mechanical ventilation required for severe cases
upper cervical spinal cord
Each lung is invested & enclosed in a serous pleural sac that consists of 2 continuous membranes, called what?
visceral and parietal pleura
The portion of the serous membrane pulled with the growing lungs is ...?
visceral pleura
What closely covers the lung & adheres to its surfaces?
visceral pleura
Which pleura invests all surfaces of the lungs forming their shiny outer surface?
visceral pleura
Visceral pleura innervation:
visceral sensory fibers for pain travel retrograde with sympathetic fibers to T1 - T6
What are the attachments of the diaphragm?
xiphoid process, costal margin, ribs 11 & 12, lumbar vertebra
What is the route of parasympathetic innervation of the lungs?
•Preganglionic parasympathetic cell bodies located in dorsal vagal motor nucleus in the brainstem •Preganglionic parasympathetic fibers contribute to the Vagus nerve (CN X) •Travels through the mediastinum in the thorax •Passes posterior to the root of the lung •Synapse on postganglionic parasympathetic cell bodies along the branches of the bronchial tree •Visceral motor to the smooth muscle (bronchoconstrictor) & glands of the bronchial tree (secretomotor) and to the pulmonary vessels (vasodilator)
What is the route of sympathetic innervation of the lungs?
•Preganglionic sympathetic cell bodies located in IML of T1 - T6 •Preganglionic sympathetic fibers travel through the ventral root to the white ramus communicans to the sympathetic trunk •Synapse in the sympathetic trunk on postganglionic sympathetic cell bodies within a paravertebral ganglion •Postganglionic sympathetic fibers leave the sympathetic trunk via cardiopulmonary splanchnic nerves •Visceral motor to the smooth muscle (bronchodilator) & glands of the bronchial tree (inhibitory) and to the pulmonary vessels (vasoconstrictor)