Pleura_Student_2016

What is pleura? Has two layers that are continuous with one another 1. ___ layer-lines the thoracic cavity Possible to separate from thoracic wall 2. ___ layer-lines the outer surface of the lungs Inseparable from the lung surface Begins at the root of the lung

Parietal Visceral

Development of the Pleura As a result, the lungs become covered by two layers of pleura. @ ___-lines the heart Peritoneum-lines the ___ cavity Parietal layer-derived from ___ mesoderm Visceral layer-derived from ___ mesoderm

Pericardium abdominal somatic splanchnic

pleural friction rub

Pleuritis

Mesothelioma Aggressive cancer that arises from the ___ Often due to ___ exposure

pleura asbestos

Blood Supply As a general rule, blood and lymphatics to serous membranes(pleura, pericardium, & peritoneum) are supplied by the organs that they line -Parietal pleura-___ arteries and veins -Visceral pleura-___ arteries and veins* @Superior left bronchial artery-arises from the aorta ___ to the left main bronchus Inferior left bronchial artery- arises from the aorta, ___ to the left main bronchus Right bronchial artery-arises from the aorta and has a common origin with the ___ right posterior intercostal artery

intercostal bronchial posterior inferior 3rd

Development of the Pleura Developing ___ buds push into the pericardioperitoneal canals (spaces). Pericardioperitoneal canals are already lined with ___ that become the inner (visceral) and outer (parietal) walls of the pleura. @ Expansion of the lung buds into the pericardioperitoneal canals. At this stage, the canals are in communication with the peritoneal and pericardial cavities. A. Ventral view of lung buds. B. Transverse section through the lung buds showing the pleuropericardial folds that will divide the thoracic portion of the body cavity into the pleural and pericardial cavities.

lung mesoderm

Position of the Pleural Cavities @ The pleural cavities are located to the left and right of the ___, above the diaphragm.

mediastinum

How much fluid is in the pleural cavity? Normally, no more than ___ per side

15ml

Borders of the pleura Superior-Neck of the ___ rib Midclavicular line-Rib ___ Midaxillary line-Rib ___ Posterior-___ Medial- mediastinum Inferior- diaphragm

1st 8 10 T12

Pleural Injury Areas that are more susceptible to traumatic injury -___ pleura-not covered by bony structures -3 areas where pleura extends below the ribs #3 A puncture of the pleura may lead to ___

Cervical 1. Right infrasternal angle 2. Right costovertebral angle 3. Left costovertebral angle pneumothorax

Recesses of the Pleura -Spaces that allow for lung expansion during respiration -___-between the visceral and mediastinal pleura bilaterally* -Costodiaphragmatic-between inferior border of the ___ pleura and inferior border of the ___ pleura @ The costomediastinal recess on the left is larger due to the position of the heart on the left side. Costodiaphragmatic recess may be referred to as the ___ angle by radiologists

Costomediastinal costophrenic visceral parietal

Important Fascial Components -___ fascia-connective tissue layer that attaches the costal portion of the parietal pleura to the thoracic wall -Suprapleural membrane(___ fascia)-thick fascial layer that covers the ___ portion of the ___ pleura and attaches to the inner margin of the first rib and transverse process of ___ -___ fascia-attaches the diaphragmatic portion of the parietal pleura to diaphragm

Endothoracic Sibson's cervical parietal C7 Phrenicopleural

What is pleura? The pleura is a 2-layered serous membrane that develops as a sac around the lung. ___-simple squamous epithelium that lines body cavities & produces serous fluid ___ ___-pale yellow and transparent, composed of proteins and water Also includes a layer of supportive connective tissue @ From text: (b) Both layers are similar histogically and consist of a ___ squamous mesothelium (M) on a thin layer of connective tissue, as shown here for visceral pleura covering ___ (A). The connective tissue is rich in both collagen and elastic fibers and contains both blood vessels (V) and lymphatics (L). X140.

Mesothelium Serous fluid simple alveoli

Tension Pneumothorax Complicated pneumothorax where air can enter, but cannot escape ___ builds inside the affected pleural cavity, pushing the trachea & mediastinal contents away from the affected side. This compresses the ___ lung & is a life-threatening medical emergency.

Pressure contralateral

___ Performed to draw fluid out of the plural cavity for analysis and to remove excess fluid Needle is inserted in ___ intercostal space(between ribs 9 &10) at the ___ line -Superior enough to avoid damaging intercostal nerves -Angled up to avoid the ___ -During ___ to avoid lung tissue

Thoracentesis 9th midaxillary diaphragm exhalation

Pneumothorax When ___ enters the pleural cavity, this is known as pneumothorax. This causes loss of ___ pressure within the pleural cavity and may cause the lungs to collapse (___). When a lung collapses, it occupies less volume within the pleural cavity. -Loss of volume in the affected side may cause the trachea to shift towards the ___ side on chest X-ray.* @___ volume in the ipsilateral lung may cause tracheal deviation towards the affected side if the pneumothorax is large enough

air negative atelectasis ipsilateral Decreased

Parts of the Parietal Pleura Cervical- ___-shaped and extends above the anterior portion of the 1st rib Costal- associated with the ribs and intercostal spaces Diaphragmatic- covers the diaphragm Mediastinal- covers the mediastinum

dome

Development of the Pleura The lungs develop as an outpocketing from the floor of the endodermally lined gut tube, specifically from the ___ region. @ A. Embryo of approximately 25 days' gestation showing the relation of the respiratory diverticulum to the heart, stomach, and liver. B. Sagittal section through the cephalic end of a 5-week embryo showing the openings of the pharyngeal pouches and the laryngotracheal orifice. ___ becomes lungs When the foregut expands its called the pharynx. Mesoderm for the 2 layers covering and endoderm for the respiratory system

foregut diverticulum

Pleural Effusion Excessive fluid accumulates in the ___ space, which leads to lung compromise. Can be due to many etiologies -___-pleural fluid -___-blood -___-lymph -___-pus (empyema)

pleural Hydrothorax Hemothorax Chylothorax Pylothorax

What is the pleural cavity? The space between the two layers of pleura is known as the ___ cavity. -The pressure in the pleural cavity is normally ___ than atmospheric pressure, what is referred to as ___ pressure. -Loss of ___ pressure can lead to lung compromise. This space contains a thin layer of ___ fluid produced by the ___ cells of the pleura. -Provides lubrication to allow for smooth expansion and contraction of the lungs -Surface tension 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. @The space is important to maintain, but understand that it is more of a potential space.

pleural less negative intrapleural serous mesothelial

Pleuritis Pleuritis is inflammation of the pleura (also known as ___). Instead of gliding smoothly during ___, the pleural layers rub against each other. This can cause sharp pain when breathing referred to as ___ chest pain. May be detectable with the stethoscope (sound is described as a pleural friction rub).

pleurisy respiration pleuritic