Pleura

The Parietal Pleura can be divided into..... (4)

-Cervical (cupula) - Costal - Diaphragmatic -Mediastinal

blood supply to the parietal pleura

Intercostal arteries

hemothorax

blood in the pleural cavity

transudate pleural effusion

cause: -congestive heart failure -liver or kidney disease (less common) Clear watery fluid

exudate pleural effusion

cause: -inflammation -pneumonia -TB -asbestosis. Cloudy viscous fluid.

The _____________ is also innervated by the phrenic nerve.

centrally located mediastinal pleura

suprapleural membrane

connective tissue fascia above the cervical pleura. Extends from first rib to transverse process of C7. Helps maintain the integrity of the structures in the thoracic aperture during respiration.

pulmonary ligament

continuation of the parietal and visceral pleurae that extend inferiorly from the root of the lung between the lung and mediastinum Two layered fold of pleura that extends from the hilum of the lung to the diaphragmatic surface. Helps to maintain the lungs in position during respiration.

the lateral part of the diaphragmatic pleura is innervated by....

intercostal nerves

what should be in the pleural cavity?

just the serous fluid in the pleural cavity.. nothing else!!

what parts of the pleura do the intercostal nerves innervate? (2)

lateral part of the diagrammatic parietal pleura costal partiel pleura

Diaphragmatic pleura

parietal pleura located above the diaphragm.

@ A line drawn through the midpoint of the 12th rib (posteriorly) lungs end at ____ costal reflection at______-

10th rib 12th rib

The Lungs end at ______ using the landmarks of

6, 8, 10 midclavicular, midaxillary and middle of 12th rib

@ the mid clavicular line lungs end at ____ costal reflection at______-

6th rib 8th rib

The Visceral Pleura does not have _________

Pain innervation.

________ pleura is very sensitive to pain

Parietal

pleural cavity

Potential space located between the parietal and visceral pleura contains a serous fluid that creates surface tension between the parietal and visceral pleura. The surface tension created helps the lungs stay expanded.

Costomediastinal recess

associated with left lung at the cardiac notch. The lingula of the lung may expand into this potential space Between mediastinal pleura and visceral pleura of lung.

Pleurisy

inflammation of the pleura resulting in a pleural rub that can be heard by auscultation Can be a cause of pleural effusion.

clinical base of the lungs

lowest part rib 10 on posterior side of thoracic cage

base of lung

lowest part of the lung, resting on the diaphragm

Chylothorax

lymph fluid in plural cavity.

Cervical pleura (cupula)

parietal pleura located near cervical region at the apex of the lung. This is near the first rib and is supported by a Suprapleural membrane (Sibson's fascia)

Costal Pleura

parietal pleura that is near the ribs.

the lowest extent of the lung is....

rib 10 in the posterior This is the location of the clinical base of both lungs

at what costal levels do the lungs end?

6,8,10 rib 6 in the midclavicular line rib 8 in the midaxillary line rib 10 using the midline of rib 12 as the landmark posteriorly

The Pleura ends at _____

8,10, 12.

@ the mid axillary line lungs end at ____ costal reflection at______-

8th rib 10th rib

open pneumothorax .

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound. has a connection with the exterior atmosphere

Pleural Reflections

Areas of the parietal pleura where they meet or reflect upon each other

Visceral pleura

Attached to the surface of the lungs. T he visceral pleura is the outer surface of the lung. When the visceral pleura moves , the lung moves. Cannot be dissected during dissection.

Blood supply to the visceral pleura

Bronchial arteries

what is the clinical significance of the pleural recesses?

Clinicians may be concerned with postural drainage of excess fluid in these recesses.

Parietal pleura

Lines the surface of the pleural cavity along the body wall. (Lines the inner surface of the thoracic cage) The body wall includes the ribs and muscles. The structures of the mediastinum medially and the diaphragm inferiorly are also lined by parietal pleura.

what kind of pain comes from the visceral pleura

No pain fibers for visceral pleura.

Thoracentesis

Surgical procedure to remove fluid from the pleural cavity. Best location is to insert needle two intercostal spaces below the fluid level in the midaxillary line. Seventh, eighth, and ninth intercostal spaces are the areas most used. Damage to the lungs, spleen, and diaphragm need to be avoided

costal reflection what level?

Where the costal pleura becomes continuous with the diaphragmatic pleura inferiorly - 8th rib at the midclavicular line -10th rib at the midaxillary line -12th rib at the midpoint of the shaft

Pleural effusion

abnormal accumulation of fluid in the pleural space (hydrothorax) possible causes... -pleurisy -congestive heart failure -liver disease -kidney disease two types... Transudate -caused by congestive heart failure or less commonly liver or kidney disease. -Clear watery fluid. Exudate - inflammation, pneumonia, TB, asbestosis. -Cloudy viscous fluid

tension pneumothorax

air enters during inspiration and is trapped during expiration. The pressure caused by this condition displaces the mediastinum to the opposite side with cardiopulmonary impairment. Emergency situation. creates tension and pressure that can displace the mediastinum and heart creating a emergency situation with the compressed heart.

cardiac notch of left lung

concavity that accommodates the heart

Cupula

dome of Cervical Partial pleura over the apex of the lung. It lies above the first rib and is subject to any trauma at the root of the neck

What is the Pleura of the Lungs

double-layered sac that is formed by fluid secreting membranes The lungs are not contained in the pleural cavity.

pneumothorax

entry of air into the pleural cavity with the subsequent collapse of the lung. The surface tension between the two layers of pleura is necessary to help expand the lungs with movement of the thoracic structures. loss of negative pressure needed to keep the lung

Hydrothorax (pleural effusion)

fluid in the pleural cavity can also prevent lungs from being able to expand (collapsed lung) Different types depending on the cause... Ex Blood= hemothorax Chylothorax- lymph fluid in cavity. Pyothorax- pus. (pleural effusion is another description for fluid) Excess fluid may collect in the lowest part of the pleural cavity, the pleural recesses

Mediastinal pleura

from vertebra to the sternum. has a two layered fold that extends from the hilum to the base (diaphragmatic surface) of each lung that functions in supporting the lungs maintaining position. This fold is called the pulmonary ligament.

The other sections of the parietal pleura (ie not the central diaphragmatic portion) are innervated by the ___________

intercostal nerves

hilum of the lung

midline region where the bronchi, blood vessels, and nerves enter and exit the lungs

The Parietal Pleura is innervated by

nerves that are near it... -intercostal nerves -phrenic nerve.

Central diaphragmatic portion is innervated by the _______. Pain can be referred to the dermatomes of__________

phrenic nerve C3, 4, 5 or shoulder region

Central diaphragmatic pleura is innervated by the _________

phrenic nerve to the diaphragm (Pain can be referred to dermatomes C3,4,5 in the shoulder.)

at what costal levels does the pleura end? aka where are the costal reflections?

pleura generally ends two ribs below the lungs 8, 10, 12 - 8th rib at the midclavicular line -10th rib at the midaxillary line -12th rib at the midpoint of the shaft

costodiaphragmatic recess

potential 2 rib space between the visceral and parietal pleura lungs can expand into this recess! one on each side located between ribs and diaphragm potential space; when it abnormally fills with air or fluid, it compromises lung expansion

Pleural Recesses

potential spaces that are not filled during normal breathing. The lungs can expand into these recesses during full inspiration.

Pleural pain is from the parietal pleura and is________ pain based on the _________ nerves innervating the parietal pleura

somatic somatic

These nerves (phrenic and intercostal) are _________ nerves and the pain can be _________

somatic very sharp and localized compared to visceral pain.

Pyothorax

the presence of pus in the pleural cavity between the layers of the pleural membrane