Pleura Anatomy and Functions

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Questions and Answers

Which part of the pleura lines the thoracic wall?

  • Costal pleura (correct)
  • Mediastinal pleura
  • Cervical pleura
  • Diaphragmatic pleura

What is the primary role of the pleural recesses?

  • To facilitate gas exchange
  • To provide structural support to the lungs
  • To serve as a storage site for excess pleural fluid
  • To allow the lungs to expand during deep inspiration (correct)

Which of the following correctly describes the blood supply to the parietal pleura?

  • Aorta and inferior vena cava
  • Bronchial vessels
  • Pulmonary veins and arteries
  • Intercostal vessels and internal thoracic artery (correct)

What kind of nerve supply does the visceral pleura receive?

<p>Autonomic nerves (C)</p> Signup and view all the answers

Which recess is the most dependent part of the pleura where fluid collects if present?

<p>Costodiaphragmatic recess (C)</p> Signup and view all the answers

Which term describes the condition where air fills the pleural cavity?

<p>Pneumothorax (D)</p> Signup and view all the answers

What is the mechanism primarily responsible for increasing the vertical diameter of the thoracic cavity during quiet inspiration?

<p>Diaphragm contraction (D)</p> Signup and view all the answers

At which gestational week does the development of the respiratory tract begin?

<p>Week 4 (A)</p> Signup and view all the answers

Which structure separates the developing laryngeotracheal tube from the esophagus?

<p>Tracheoesophageal septum (B)</p> Signup and view all the answers

What anatomical change occurs during the bucket handle mechanism of respiration?

<p>Ribs are raised laterally (A)</p> Signup and view all the answers

Flashcards

Pleural Cavity Fillings

The pleural cavity can contain various substances, including air (pneumothorax), fluid (hydrothorax), blood (haemothorax), lymph (chylothorax), and pus (pyothorax).

Needle Thoracostomy

A procedure to drain fluid from the pleural cavity using a needle.

Preferred Insertion Site (Needle)

Two spaces below the upper level of pleural effusion.

Quiet Inspiration

The normal, everyday breathing process, the diaphragm contracts and the rib cage expands.

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Forced Inspiration

Deep or rapid breathing that involves the use of accessory muscles.

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Quiet Expiration

Breathing out, using only the elastic recoil of the lungs and relaxation of intercostal muscles and diaphragm to push the air out.

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Forced Expiration

Active pushing of air out, with the help of accessory muscles in the abdomen and back.

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Respiratory System Development

Originating from endoderm (inner layer) of the developing embryo and forming the larynx, trachea, and lungs, starting around week 4 of gestation.

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Pseudo-glandular stage

The first stage of lung development, lasting from the first to the fourth month.

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Pleura Definition

A serous membrane enveloping the lung, extending medially.

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Parietal Pleura Parts

Parts of the pleura lining the thoracic cavity: Cervical, Costal, Mediastinal, Diaphragmatic.

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Cervical Pleura

Part of parietal pleura covering the lung apex.

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Costal Pleura

Part of parietal pleura lining the thoracic wall.

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Mediastinal Pleura

Part of parietal pleura lining the mediastinum.

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Diaphragmatic Pleura

Part of parietal pleura lining the diaphragm.

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Pleural Recesses

Extensions of pleural cavity; allow lung expansion during deep breathing.

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Costomediastinal Recess

Recess between costal and mediastinal pleura, filled by lung during deep breathing. In front.

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Costodiaphragmatic Recess

Recess between costal and diaphragmatic pleura; most dependent part, fluid collects here.

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Parietal Pleura Blood Supply

Supplied by intercostal, internal thoracic, and musculophrenic vessels.

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Visceral Pleura Blood Supply

Supplied by bronchial vessels.

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Parietal Pleura Nerve Supply

Somatic innervation via intercostal and phrenic nerves - painful.

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Visceral Pleura Nerve Supply

Autonomic innervation.

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Pleural Lymphatic Drainage

Drainage through parasternal, intercostal, and diaphragmatic lymph nodes.

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Pleural Pain Radiation

Pain in the pleura can radiate, often following nerve pathways to other areas.

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Study Notes

Pleura

  • Pleura is a serous membrane, originating from the medial side of the lung.
  • Visceral and parietal pleura are continuous.
  • Parietal pleura lines the thoracic wall, mediastinum, and diaphragm.
  • Visceral pleura covers the lungs.
  • The pleural cavity is a potential space between the visceral and parietal pleura.
  • There are recesses in the pleural cavity called costomediastinal and costodiaphragmatic recesses.

Parts of Parietal Pleura

  • Cervical pleura: Covers the apex of the lung.
  • Costal pleura: Lines the thoracic wall.
  • Mediastinal pleura: Lines the mediastinum.
  • Diaphragmatic pleura: Lines the diaphragm.

Pleural recesses

  • Costomediastinal recess: Located between costal and mediastinal pleura. Filled with the anterior border of the lung during deep inspiration.
  • Costodiaphragmatic recess: Located between costal and diaphragmatic pleura. Filled with the inferior border of the lung during deep inspiration. It's the lowest part of the pleural cavity and fluid collects there if found in the cavity.

Blood supply, Nerve supply and Lymphatic drainage

  • Parietal pleura:
    • Blood supply: Intercostal vessels, internal thoracic, and musculophrenic vessels.
    • Nerve supply: Somatic (intercostal nerves for costal pleura and peripheral diaphragmatic pleura, phrenic nerves for mediastinal and central diaphragmatic pleura)
    • Lymphatic drainage: Parasternal, intercostal and diaphragmatic lymph nodes.
  • Visceral pleura:
    • Blood supply: Bronchial vessels.
    • Nerve supply: Autonomic (nerves of pulmonary plexus, vagus and sympathetic).
    • Lymphatic drainage: Bronchopulmonary lymph nodes.

Aspiration of pleural fluid

  • Needle thoracostomy is the procedure used to aspirate pleural fluid.
  • Preferred insertion site is two spaces below the upper level of effusion.
  • Upper border of the rib is the insertion site to avoid injury to intercostal nerves.

Surface Anatomy of Pleura

  • Landmarks like mid-clavicular line, mid-axillary line, and paravertebral muscles are mentioned within the reference image.

Mechanism of Respiration

  • Quiet inspiration: Increased vertical, transverse, and anteroposterior diameters of the thorax due to diaphragm and rib muscle contractions.
  • Types of inspiration: Quiet and forced inspiration
  • Quiet expiration: Elastic recoil of lungs and the relaxation of the diaphragm and intercostal muscles.
  • Forced expiration: Contraction of accessory muscles

Development of Respiratory System

  • Origin: Endodermal tissue from the floor of the pharynx, beginning around week 4 of gestation.
  • Laryngeal groove forms, and the edges fuse to form the laryngotracheal tube.
  • The laryngotracheal tube separates from the developing esophagus during development.
  • Larynx, trachea, and lungs develop from separate endodermal tissue of the laryngotracheal tube.
  • During development, the lower end of the laryngotracheal tube divides into two lung buds (right and left). The right bud divides into three, and the left bud divides into two, which give rise to bronchopulmonary segments.
  • Other coats develop from the adjacent splanchnic mesoderm.

Stages of lung maturation

  • Pseudo-glandular (1st-4th month): Bronchi and terminal bronchioles form.
  • Canalicular (4th-6th month): Terminal bronchioles divide into respiratory bronchioles and alveolar ducts. Primitive alveoli develop.
  • Terminal sac (6th month-birth): Many more terminal sacs develop, and capillaries bulge into their walls.
  • Alveolar (birth-8 years): Type I pneumocytes become very thin and form the alveo-capillary membrane for efficient gas exchange.

Development of pleura

  • Pleura formation occurs when each lung bud invaginates the ipsilateral pericar-dioperitoneal canal.

Congenital Anomalies

  • Agenesis of the lung (failure of the primitive lung bud to develop).
  • Laryngeal web (failure of complete canalization of the laryngeal cavity).
  • Congenital subglottic stenosis (due to defect in cricoid cartilage canalization).
  • Esophageal atresia with or without tracheoesophageal fistula (TEF) (results from abnormal division of the tracheoesophageal septum). Neonates show vomiting or choking after breastfeeding.
  • Respiratory distress syndrome (failure of alveoli ventilation due to insufficient surfactant production).
  • Congenital cysts of the lung (formed by dilation of terminal or larger bronchi).
  • Accessory lung lobe (arises from trachea or esophagus).

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