FAF 141 Lungs and pleura 2024 part 2 [Autosaved].pdf

FAF 141: Respiratory Anatomy Lungs & pleura Jodie Lemphane [email protected] Acknowledgements:...

FAF 141: Respiratory Anatomy Lungs & pleura Jodie Lemphane [email protected] Acknowledgements: B Bastiaanse and K Keet Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe 2 Copyright notice Material which is made available by way of an electronic database may be subject to certain licensing conditions. These conditions normally entail that you may only use the material for your own private study and research at the University and not for any other purpose. It is expected of you to adhere to these conditions at all times. Printed material is also only made available for class discussion, private study and research purposes. Further reproduction of such material is prohibited Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe 3 Important notice These PPP are supplied to you as a brief outline and is by NO means a complete set of notes. It is simply a framework Supplement these notes with information obtained during the lectures and the dissections Important : Your prescribed textbook (Moore) is to be used as a constant source of information together with the learning objectives and Netter’s atlas Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Learning Objectives Lungs Describe anatomical structure and appearance of the left and right lungs with respect to: shape, surface and borders lobes and fissures surface anatomy of the lung fissures broncho-pulmonary segments relations with the structures in the thoracic wall and mediastinum Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Learning Objectives Lung (continued) Explain difference between the lung hilum and the root of the lung Describe the relations of the structures of the root of the lung to each other Describe the composition and organization of the bronchopulmonary segments Describe systemic and pulmonary blood supply of the lungs Describe the lymphatic drainage to the lungs Describe the nerve supply to the lungs Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Lungs Organs of respiration Located in the right and left pleural cavities Air enters & leaves via main bronchi – branches of trachea Pulmonary arteries: deliver deoxygenated blood from right ventricle of heart Pulmonary veins: returns oxygenated blood to left atrium Right lung is larger than left Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe The Lungs Apex projects above rib 1 and into root of neck Base Diaphragmatic surface) sits on diaphragm Surfaces Costal: adjacent to ribs & intercostal spaces Mediastinal: against mediastinum anteriorly & vertebral column posteriorly, contains hilum Diaphragmatic: sits on diaphragm Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe The Lungs Borders Ant: separate the costal from medial surface Inf: separates base from costal surface Post: separates costal from medial surface Lobes and fissures Right 3 lobes (Sup, Middle &Inf) 2 fissures (Horizontal & Oblique) Left 2 lobes (Inf & Sup) 1 fissure (Oblique) Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  The lungs (cont.) Right lung Left Lung https://www.anatomy.tv/anatomytv/html5ui_2019/#/product/har_ thorax_2014/type/Text%20articles/id/44311/layer/1/angle/9/struct ureID/1329256 Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Surfaces Costal surface Mediastinal surface Diaphragmatic surface Large, smooth & convex Concave, rel. to Concave, base of lung mediastinum Rel. to costal pleura Rest diapraghm Hilum, receives root of the Post.part Throacic lung RHS= deeper, liver vertebra= vertebral Costodiaphragmatic Embalmed RHS- surface of costal pleura recess impressions for oesophagus & cardiac Cardiac impression LHS larger LHS impressions- arch of aorta & oesophagus (small) Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Borders Anterior border Costal & mediastinal surfaces meet ant Cardiac notch LHS- indent Inferior border Diaphragmatic surface Separates costal & mediastinal surfaces Posterior border Costal & mediastinal surfaces meet post Broad & rounded Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Right lungs Right lung Two fissures= 3 lobes Fissures are invaginations of visceral pleura Oblique: separates inf lobe from sup. And middle lobes Horizontal fissure: separates sup lobe from mid. lobe Wider, shorter (diaphragm) Larger & heavier than L Impressions Heart Inferior and superior vena cava Azygous vein esophagus Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Left lungs Left lung Smaller than the right- why? 1 fissure= 2 lobes Oblique fissure: separates sup and inf lobes Cardiac notch (heart) Lingula The ant. Border of the superior lobe projects over the heart Impressions Aortic arch & thoracic aorta Oesophagus Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Lungs Surface markings (impressions)- Grants dissector Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Hilum Wedge-shaped area on medial surface of lung, structures forming the root enters and leaves the lung. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Lungs- hilum relations Relations R.hilum of the lung Relations L.hilum of the lung Ant: VCS and n. phrenicus Ant: N. phrenicus Post: V. azygos, n. vagus and esophagus Post: N. vagus and aorta Sup: Arch v. azygos Sup: Arch aorta Inf: Pulmonary lig. Inf: Pulmonary lig. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Right and left lung relations at the hilum Right Left Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Root of lung Attachment of lung to mediastinum Parietal and visceral layers of pleura are continuous Pulmonary ligament - fold of parietal & visceral pleura extending beyond root M7; 112 fig. 1.34 B downwards M8; 332 fig. 4.34 B Contents (at hilum) Pulmonary a.: superiormost. Main bronchus: posterior Pulmonary vv.: inferiormost https://www.anatomy.tv/anatomytv/html5ui_2019/#/product/h Nerves and lymphatics ar_thorax_2014/type/Text%20articles/id/44310/layer/4/angle/2 5/structureID/1322160 Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Bronchopulmonary segments Usually 10 R & 8-10 for L lung Largest subdivision of a lobe Characteristics Pyramidal-shaped segments of the lung Separated by connective tissue septa. Supply: segmental bronchus and a tertiary branch of the pulmonary artery. Drained by intersegmental parts of the pulmonary veins Found In CT between segments Named according to the segmental bronchi supplying them. Surgically ressectable. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Arterial & Venous Supply Pulmonary arteries – Carry Deoxygenated blood to Lung & Alveoli Pulmonary Veins – Carry Oxygenated blood from lungs to heart Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Lungs & pleura Lobar arteries Each lung has a Divide into tertiary segmental arteries. Pulmonary artery supplying blood to it and two The arteries and bronchi: paired & branching pulmonary veins draining blood from it simultaneously and running parallel courses- serving Right and left pulmonary arteries (pulmonary trunk) a lobe Level: sternal angle; Likewise, a paired tertiary segmental artery and bronchus supply each bronchopulmonary segment of Carry low-oxygen (“venous”) blood to the lungs for the lung. oxygenation. Usually colored blue, or bluish-purple like veins,. Usually, the artery is located on the anterior aspect Becomes part of the root , divides secondary lobar of the corresponding bronchus arteries. Right and left superior lobar arteries to the superior lobes arise first, before entering the hilum. LHS: Descends posterolateral to the main bronchus as the inferior lobar artery RHS: Intermediate artery divide into middle and inferior lobar arteries of the right lung. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Pulmonary arteries Right and left pulmonary arteries originate from pulmonary trunk Bifurcation point: left of midline, vertebral level T4/T5, anteroinferior to left of tracheal bifurcation Carries deoxygenated blood from right ventricle of heart to lungs Left pulmonary artery: shorter than the right Anterior to descending aorta Posterior to superior pulmonary vein Passes through hilum & branches within lung Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Right pulmonary artery: longer than left Passes horizontally across mediastinum Passes anterior and slightly inferior to tracheal bifurcation & anterior to right main bronchus Posterior to ascending aorta, superior vena cava & upper right pulmonary vein Gives off branch to superior lobe of lung before entering hilum Gives off 2nd (recurrent) branch to superior lobe Divides to supply middle & inferior lobes Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Venous drainage Pulmonary veins, two on each side. Oxygenated blood from lungs to the heart RHS middle lobe →RHS sup. Pulmonary vein Start at hilum, pass through root of the lung and drain into the left atrium of the heart Bronchial veins: right bronchial vein → v. azygos, and left bronchial vein → acc. hemi-azygos or left sup. intercostal vein Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Lymphatic drainage of lungs Superficial plexus & deep lymphatics drain into Tracheobronchial nodes Located around the lobar and main bronchi Lymph passes sup along trachea to parasternal and brachiocephalic nodes Forms rhs and lhs bronchomedistinal trunks Drain into Deep veins of neck or R lymphatic duct or Thoracic duct Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Innervation of lungs Ant. and post. pulmonary plexuses, ant. and post. to root of lung Branches of this plexus originate from the sympathetic trunks (T2-T5) and parasympathetic from vagus nn. Plexus contains parasympathetic, sympathetic and visc. aff. fibers Distributed along branches of the airways and vessels Vagus: Constricts bronchioles Sympathetic system: Dilates bronchioles Visc. afferent. fibers of plexus: reflexes and pain Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Right vagus Left vagus Enters mediastinum ant. to Enters mediastinum between right subclavian artery left comm. carotid artery & L R recurrent laryngeal n. subclavian artery Runs posteroinf. on R side L recurrent laryngeal n. trachea, post. to R Passes post to root left lung brachiocephalic v., SVC and root R lung Divides into branches for L Divides into branches for pulmonary plexus for R pulmonary plexus Leaves plexus as single nerve Leaves plexus as single → esophageal plexus. nerve → esophageal plexus. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Nerve supply lungs Phrenic nerve Between subclavian artery and brachiocephalic (origin) vein Ant. to root lung Right - Passes along right side R brachiocephalic vein, SVC., RA, IVC Left - Crosses left surface of arch aorta, superficial to LA and LV Supply: Diaphragm: Motor and sensory Pericardium and mediastinal pleura: Sensory Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Surface anatomy Pleural markings Lung markings Cardiac notch Oblique fissure Spinous proc. of T2 posteriorly to 6th costal cartilage anteriorly Horizontal fissure Level of 4th costal cartilage and rib, meets oblique fissure in MAL Trachea Recesses Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Surface anatomy Vertebra prominens = C7 Spine T1 Oblique fissure T2 spinous process (post), 6cc (ant) Lung markings T10 Pleural markings T12 Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Relationship between the lungs & pleura Line Mid-clavicular Mid-axillary Scapular Median posterior Skeleton Rib Rib Rib Vertebra Margin of parietal 8 10 12 T12 pleura Margin of lungs 6 8 10 T10 Parietal pleura extends approximately two ribs inferior to the lung Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe