FAF_141_Lungs_and_pleura_part_1[1] PDF.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 outcomes Pleura Describe the different parts of the pleura, namely the parietal layer, visceral layer and pleural space. Describe the different parts of the parietal pleura. Describe the relation of the pleural space to the lungs. Describe the position of the pleural reflections and recesses. Describe the nerve supply of the parietal and visceral pleura. Describe the surface anatomy of the left and right pleural reflection lines and pleural recesses. Identify these on a person’s chest. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Thoracic cavity Kidney shaped Divided into 3 compartments: Left and right pulmonary cavities, contain lungs and pleurae Mediastinum: (central): Mass of tissue that extends from sternum and costal cartilages ant. to bodies of thoracic vertebrae post., and from sup. thoracic aperture to diaphragm Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Pulmonary cavities Lined by serous membrane Pleural membrane (pleura) Pleura Outer parietal pleura (PP), Lines pulmonary cavities Inner layer - visceral pleura (VP), Covers lung surface and extends into fissures Layers continuous with each other around hilum of lung Pleural cavity: Potential space between PP and VP – serous fluid Contains thin layer of fluid Hilum of lung Where the parietal and visceral pleura meet Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Parietal pleura Parietal pleura consists of: Cervical Costal Mediastinal Diaphragmatic *Extrapleural Intrathoracic Surgical Access Fixation makes it difficult to appreciate in the embalmed cadaver, but in surgery the relatively loose nature of the thin endothoracic fascia provides a natural cleavage plane, allowing the surgeon to separate the costal parietal pleura lining the lung cavity from the thoracic wall. This allows intrathoracic access to extrapleural structures (e.g., lymph nodes) and instrument placement without opening and perhaps contaminating the potential space (pleural cavity) that surrounds the lungs. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Parietal pleura Parietal pleura consists of: Cervical Covers apex Cupola (cup-like dome) Reinforced by Suprapleural membrane Lung apex extends 2-3cm above clavicle (med) & 1st rib (neck) Costal Separated from thoracic wall by endothoracic fascia * Mediastinal Diaphragmatic Sup. Surface of diaphragm *Extrapleural Intrathoracic Surgical Access Cont. phrenicopleural fascia Fixation makes it difficult to appreciate in the embalmed cadaver, but in surgery the relatively loose nature of the thin endothoracic fascia provides a natural cleavage plane, allowing the surgeon to separate the costal parietal pleura lining the lung cavity from the thoracic wall. This allows intrathoracic access to extrapleural structures (e.g., lymph nodes) and instrument placement without opening and perhaps contaminating the potential space (pleural cavity) that surrounds the lungs. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Parietal pleura Nerve supply Innervated by somatic afferent fibres Costal: branches from intercostal nerves pain referred to thoracic wall Diaphragmatic & mediastinal: phrenic nerves Pain referred to C3, C4, C5 dermatomes: lateral neck & supraclavicular region Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Additional lining of the thoracic wall Endothoracic fascia Fascial layer thoracic cavity Posterior to the ribs & costal cartilages Suprapleural memberane Cervical region Separates the neck region and thoracic region Extension of endothoracic fascia- Sibson fascia First rib (int.border) and C7 Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe 11 Parietal pleura (cont.) http://www.humananatomychart.us/wp- content/uploads/2015/11/serous-membrane- diagram-pleurae-pleural-cavity-pericardial- http://images.medicinenet.com/images/app membrane-root-of-lung-at-hilum-1024x718.jpg ictures/pleurisy-pleuritis-s4-how-pleura- works.jpg Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Pleural reflection lines change in the direction of parietal pleura, Reflects from one wall of pleural cavity to another Asymmetrical (heart-Lhs) Sternal 2, 4 & 6 Costal 6, 8, 10 & 12 Vertebral 12 Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Visceral pleura Continuous with parietal pleura at hilum Attached to surface of lung Extends into fissures Innervated by visceral afferent nerves accompanying bronchial vessels Insensitive to pain Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Nerve supply: pleura Visceral pleura Part Nerve supply insensitive to pain – Lungs and visceral pleura N. Vagus (parasympathetic) receives no nerves of (Pulmonary plexus) Bronchoconstrictor (smooth general sensation muscle) Vasodilator (pulmonary vessels) Parietal pleura (especially Secretomot. (glands) costal part) – extremely Sympathetic trunks (inhibitory & vasoconstrictive) sensitive to pain Visceral afferent (reflex & pain in response to eg. excessive stretch)) Parietal pleura Intercostal nerves (costal & peripheral part diaphragmatic) Phrenic nerves (mediastinal & central part diaphragmatic) = touch and pain Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe 19 Pleural recesses Lungs do not occupy pulmonary cavities completely during expiration – potential pleural spaces Costodiaphragmatic Peripheral diaphragmatic pleura contact with lowermost costal pleura Costomediastinal Posterior to sternum Costal pleura meets mediastinal pleura Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Pleural margins Pleural cavity extends below inferior Inferior border of lung is two ribs above border of lungs: pleural margin: T10 at posterior midline Inferior margin of pleura: Rib 8 at midaxillary line T12 at posterior midline Rib 6 at midclavicular line Rib 10 at midaxillary line Anteriorly, lungs & pleural margin meet near Rib 8 at midclavicular line xiphisternal joint Xiphisternal joint at anterior midline Moore’s Clinically Oriented Anatomy Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Blood supply of the pleura Arterial supply & venous drainage Parietal pleura: Intercostal (ant. and post.) arteries and veins Visceral pleura: Bronchial arteries (1 right and two left) Right bronchial vein → v. azygos Left bronchial vein → acc. hemi - azygos or left sup. intercostals vein Pulmonary veins, two on each side Pleural effusion: https://youtu.be/fUj HM4_IhFc?si=6hOg8Db PlKlBpXgL Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe