Lungs & Pleura Anatomy PDF

Lungs& Pleura Upper and lower respirato tracts:  oracic cavity is classi ed into: 1- Middle area (Mediastinum): containing hea and other structures. 2- Two lateral spaces: containing lungs and pleurae. Lungs Def in ition: T he lungs are the organs of respiration. Anatomical Position and Re...

Lungs& Pleura Upper and lower respirato tracts:  oracic cavity is classi ed into: 1- Middle area (Mediastinum): containing hea and other structures. 2- Two lateral spaces: containing lungs and pleurae. Lungs Def in ition: T he lungs are the organs of respiration. Anatomical Position and Relations: T hey are located in the thorax, either side of the mediastinum. Function: T he function of the lungs is to oxygenate blood. T hey achieve this by bringing inspired air into close contact with oxygen- poor blood in the pulmona capillaries. Anatomical Position and Relations: e lungs lie either side of the mediastinum, within the thoracic cavity. Each lung is surrounded by a pleural cavity, which is formed by the visceral and parietal pleura. T hey are suspended from the mediastinum by the lung root – a collection of structures entering and leaving the lungs. T he medial sur faces of both lungs lie Left Lung in close proximity to several Right Lung mediastinal structures: Hea Hea Oesophagus Oesophagus Arch of ao a Inferior vena cava oracic ao a Superior vena cava Azygous vein Anatomical Position and Relations: e left Side Left Lung Right Lung Hea Hea Oesophagus Oesophagus Arch of ao a Inferior vena cava oracic ao a Superior vena cava Azygous vein Anatomical Position and Relations: e right Side Left Lung Right Lung Hea Hea Oesophagus Oesophagus Arch of ao a Inferior vena cava oracic ao a Superior vena cava Azygous vein Lung Structure Lung Structure  e lungs are roughly cone shaped, which has:  an apex, base, three su aces, three borders. T h e left lung is slightly smaller than the right – this is due to the presence of the hea.  Each lung consists of: Apex: T he blunt superior end of the lung. It projects upwards, above the level of the 1st rib into the neck. Base – T he inferior sur face of the lung, which sits on the diaphragm. Lobes (2 or 3):separated by f issures within the lung. TWO: costal, mediastinal.(T he y are named correspond to the area of the thorax they face). THREE Borders: T he edges of the lungs, named the anterior, inferior and posterior borders.  Lobes e right and left lungs do not have an identical lobular structure. e right lung has three lobes; superior, middle and inferior. e lobes are divided from each other by two ssures: Oblique ssure: Runs from the inferior border of the lung in a superoposterior direction, until it meets the posterior lung border. Horizontal ssure: Runs horizontally from the sternum, at the level of the 4th rib, to meet the oblique ssure. e left lung contains superior and inferior lobes, which are separated by a similar oblique ssure. Bronchial Tree  e bronchial tree is a series of passages that supplies air to the alveoli of the lungs. It begins with the trachea, which divides into a left and right bronchus.  Note: e right bronchus has a higher incidence of foreign body inhalation due to its wider shape and more ve ical course.  Each bronchus enters the root of the lung, passing through the hilum. Inside the lung, they divide to form lobar bronchi – one supplying each lobe.  Each lobar bronchus then fu her divides into several te ia segmental bronchi. Each segmental bronchus provides air to a bronchopulmona segment – these are the functional units of the lungs.  e segmental bronchi give rise to many conducting bronchioles, which eventually lead into terminal Ove iew of the tracheobronchial tree. bronchioles. Each terminal bronchiole gives o respirato Key: bronchioles, which feature thin walled outpocketings that Green – upper lobe, extend from their lumens. ese are the alveoli – the site of yellow – middle lobe, gaseous exchange. blue – lower lobe What is the correct order of the bronchial tree?  T he correct order of the par ts of the bronchial tree is:  Trachea,  Prima bronchus,  Seconda bronchus,  Te ia bronchus,  Terminal bronchioles,  Respirato bronchioles,  Alveoli. Pleura Parietal Pleura:  T he parietal pleura is a membrane that covers the internal su ace of the thoracic cavity.  It is thicker than the visceral pleura.  It is a serous membrane consists of a single layer of f lat, cuboidal, mesothelial cells suppor ted by loose connective tissue.  It receives blood & N. supply as chest wall:  It is sensitive to pressure, pain, and temperature.  It can be subdivided according to the par tof the body that it is contact with:  Mediastinal pleura: Covers the lateral aspect of the structures in the mediastinum.  Cer vical pleura: Lines the extension of the pleural cavity into the neck.  Costal pleura: Covers the inner aspect of the ribs, costal ca ilages, and intercostal muscles.  Diaphragmatic pleura: Covers the superior sur face of the diaphragm. Visceral Pleura: e visceral pleura is a thin membrane that tightly adheres to the outer su ace of the lungs and deep in the ssures. It receives the same blood supply and ne e supply as the lung. It is continuous with the parietal pleura at the hilum and also covers blood vessels, ne es, and bronchi associated with the lungs. T he two par ts of the pleurae receive a dif ferent neurovascular supply: Parietal Pleura (As chest wall): T he parietal pleura is sensitive to pressure, pain, and temperature. It produces a well localised pain, and is inner vated by the phrenic and intercostal ne es. T he blood supply is derived from the intercostal a eries. Visceral Pleura (As lung): T he visceral pleura is not sensitive to pain, temperature or touch. Its senso bres only detect stretch. It also receives autonomic inne ation from the pulmona plexus (a network of ne es derived from the sympathetic trunk and vagus ne e). Ar te rial supply is via the bronchial ar te ries (branches of the descending aor ta), which also supply the parenchyma of the lungs (not from pulmona a e ) Pleural Cavity:  e pleural cavity is a potential space between the parietal and visceral pleura.  It contains a small volume of serous uid, which has two major functions. (about 5-10 cc in each side). 1) It lubricates the su aces of the pleurae, allowing them to slide over each other. 2) It produces a su ace tension, pulling the parietal and visceral pleura together. is ensures that when the thorax expands, the lung also expands, lling with air. Inferior border of the lung: 6 –6- 8- 10. Inferior border of the pleura: 6 –8- 10-12. 6 - 6: Sterno-costal junction 6 - 8: Midclavicular line. Purple Numbers: 8 - 10: Mid-axilla line. lung 10 - 12: oracic ve ebra. Red Numbers: pleura Applied anatomy Lung 1- Bronchial Asthma In Normal condition: 1- e lumen is clear and opened. 2- e wall is average thickness. 3- e muscle contract normally. What is an asthma attack? During an asthma attack, three things can happen: Bronchospasm: T he muscles around the airways constrict (tighten). T his makes your airways narrow. Inf lammation: T he lining epithelium of the airways becomes swollen. Make inspiration and expiration di cult. Mucus production: During the attack, more mucus is produced, closing the airways. a sound called wheezing is heard during breathing. 2- Resection all or pa of the lung 3- Regular and Emergency tracheostomy Pleura 1- Pleurisy A pleural friction rub, is characterized by its sound like:  Creaking leather.  Squeaking shoes on wet su aces. is a valuable diagnostic clue for pleural in ammation (pleurisy) 2- Pneumothorax 3- Pleural e usion  A https://www.registerednursern.com/lung-anatomy-and-physiology-quiz/ light cured ac l 1. True or False: T he left lung has three lobes and the right lung has two lobes. 2. e inner layer that surrounds the lung itself is called the? A. Parietal Pleura B. Visceral pleura C. Pleuracardium D. Lobar Bronchi 3. e trachea splits at the _________ to form the ____________. A. Cricoid ca ilage, seconda bronchi B. yroid ca ilage, prima bronchi C. Carina, prima bronchi D. Hilum, seconda bronchi 4. Gas exchange in the lungs occurs in the? A. Bronchioles B. Alveolar sinus C. Alveolar sacs D. Segmental Bronchi 5. ______________ delivers unoxygenated blood to the lungs. A. Pulmona vein B. Ao a C. Left ventricle D. Pulmona a e 6. e right & left bronchus along with the pulmona a e & vein enter into the lungs at the? A. Hilum B. Carina C. Alveolar ducts D. Right middle lobe 7. True or False: During inhalation, the diaphragm contracts upward to create a positive pressure in the chest which allows the body to inhale oxygen. 8. True or False: During gas exchange, carbon dioxide is transpor te d across the capilla membrane to be exhaled while oxygen is transpor te d across the capillar ymembrane to attach to the red blood cells. 9. Eve thing below is pa of the lower respirato system EXCEPT? A. Trachea B. Carina C. Pha nx D. Bronchioles 10. True or False: Inhaled oxygen travels down through the trachea, into the right and left bronchus, then into the segmental bronchi which branches even fur ther into the lobar bronchi. 
 oracic wall https://www.slideshare.net/slideshow/thoracic-inlet-amp-outlet/250515761  oracic wall: 1- Bone& ca ilage (with ligaments) 2- Muscles. 3- veins, a eries, ne es (VAN). T he thoracic wall (the chest wall), is the structure that forms the bounda of the thoracic cavity. It comprises a bony framework made up of twelve thoracic ver tebrae at the back, which are surrounded by ribs, providing protection and suppor tto the thoracic organs. Additionally, it contains super ficial structures such as muscles, skin, and breast tissue. Bones of the orax e bones of the thorax can be split into 3 main groups:  the sternum.  the ribs.  the thoracic pa of ve ebral column.  T he sternum is considered a f lat bone, which itself can be separated into 3 pa s: o e manubrium. o e body. o e xiphoid process.  Originally, these 3 par ts are connected by car tilage but following adulthood the car tilage ossif ies to create a T- shaped bone in the midline of the chest. T h e function of the sternum is to provide protection internal thoracic organs and a iculations for the ribs. Bones of the orax e bones of the thorax can be split into 3 main groups:  the sternum.  the ribs.  the thoracic spine. 2) Ribs: Ribs Classi cation: o True& False: (think about sternum) o Typical& Atypical: ( ink about their shape) 1)o True, False& e upper seven pairs. Floating ribs: o because their costal ca ilages a iculate anteriorly directly with the sternum. o e lower 5 (8-12) are false as their anterior ends attached to the previous rib not the sternum. o Last to false ribs (11& 12) are names Floating as their anterior end not attached to anything. 2) Typical and atypical ribs Typical ribs (3 - 9) have the following anatomical components:  Head: with two a icular facets to a iculate with two successive ve ebra.  Neck: Constriction after the head.  Tubercle: a iculate with transverse process of the ve ebra.  Shaft: cu ed, angulated.  Costal groove: where VAN PRESENT. (Subcostal Vein- A e – Ne e) Other ribs (1, 2, last 3) are atypical BECAUSE: e rst rib:  It is wide and sho ,  It has no shaft twist ( can rest at on the table).  It Has one a icular facet.  It has two grooves on its upper su ace. e second rib: in, long, and has a tuberosity on its superior su ace for the attachment of a muscle (the serratus anterior muscle). e tenth rib: has only one a icular facet. e eleventh and twelfth:  sho  only one a icular facet  no neck.  Pointed anterior end https://www.ncbi.nlm.nih.gov/books/NBK538328/  e costal margin T he costal margin is the lower edge of the rib cage formed by the car tilages of the lower ribs. It is made up of the costal the seventh to car tilages of tenth ribs, which cur ve upwards and meet at the xiphoid process of the sternum. e costal margin  Protecting the related organs  Attachment to diaphragm  Attachment for some abdominal muscles. Applied Anatomy: Flail chest: Multiple rib fractures may allow a segment of the anterior and/or lateral thoracic wall to move freely but paradoxically inward on inspiration and outward on expiration. Flail chest is an extremely painful injur yand impairs ventilation thereby af fecting oxygenation of the blood. A medical student in anatomy exam was asked to identify a rib with 2 grooves on its superior su ace. is rib should be No.? A. 1 B. 3 C. 5 D. 7 E. 9 3) oracic pa of ve ebral column: T h e ver tebral column is a series of approximately 33 bones called ver tebrae, which are separated by inte e ebral discs. T h e column can be divided into f ive dif ferent regions, with each region characterised by a di erent ve ebral structure. 7 ce ical 12 oracic 5 lumbar 5 Sacral 3-5 coccegeal  e ve ebral column has ve main functions:  Axis: forms the central axis of the body.  Suppo body weight: carries the weight of the body above the pelvis.  Protection: protects the spinal cord within the spinal canal.  Movement: Allow movement ( exion extension, Rt.& Lt. rotations).  Contain bone marrow: to form Structure of a Ve ebrae All ve ebrae share a basic common structure. an anterior ve ebral body a posterior ve ebral arch. Ve ebral Body  e ve ebral body forms the anterior pa of each ve ebrae.  It is the weight-bearing component. So, ve ebrae in the lower po ion of the column have larger bodies than those in the upper po ion (to better suppo the increased weight).  e superior and inferior aspects of the ve ebral body are lined with hyaline ca ilage. Adjacent ve ebral bodies are separated by a bro ca ilaginous inte e ebral disc. Ve ebral Arch:  Right and left pedicles  Right and left laminae e two laminae meets together forming the spine. At the site of meetings of pedicles and laminae, 3 processes arise:  Superior a icular process, car superior a icular facet.  Inferior a icular process, car Inferior a icular facet.  Transverse process, car costal facet. A iculation between 2 successive ve ebrae o A iculation between 2 successive ve ebrae: 1- Inte e ebral Disc: 20% of length of ve ebral column. Consists of: 1- An outer circular brous connective tissue ( annulus brosis). 2- An inner gelatinous centre called ( nucleolus pulpous). 2- e joints between the a icular facets  ese are gliding synovial joints & are called facet joints.  ey allow for some gliding motions between the ve ebrae.  ey are strengthened by several ligaments.  3- Ligaments: e anterior longitudinal ligament: ick& strong. e posterior longitudinal ligament: Weaker. Ligamentum avum – attach in between laminae of adjacent ve ebrae. Interspinous ligament: attach in between spinous processes. Supraspinous ligament: attach the tips of spinous processes.  Applied Anatomy: e anterior longitudinal ligament: thick and prevents hyperextension of the ve ebral column. e posterior longitudinal ligament is weaker and prevents hype lexion of the ve ebral column. Applied Anatomy: Inte e ebral Disc Herniation  Herniation of an inte e ebral disc occurs when breaking in annulus brosus occurs allowing nucleus pulposus prolapse.  e rupture usually occurs in a posterior- lateral direction, after which the nucleus pulposis can irritate nearby spinal ne es – resulting in a variety of neurological and muscular symptoms.  Usually occurs in lower ce ical (C5, C6) or lower lumber regions (L4, L5).  Pain and muscle wakness occurs along the site of ne e distribution not at the site of herniation.  ‫‪Shooting pain in the thigh: MRI‬‬ ‫!!!! ﻳﺎﺩﻛﺘﻮﺭ ﺍﻟﻮﺟﻊ ﻓﻲ ﺭﺟﻠﻲ ﻣﺶ ﻓﻲ ﺿﻬﺮﻱ‬ Applied Anatomy: Abnormal ve ebral cord cu ature. Applied Anatomy: Abnormal ve ebral cord cu ature. Kyphosis: excessive thoracic cu ature, (hunchback deformity). Lordosis: excessive lumbar cu ature, (swayback deformity). Scoliosis: lateral cu ature of the spine, (unknown cause). Ce ical spondylosis: decrease size of the inte e ebral foramina due to degeneration of the Intercostal Muscles  ere are ve muscles 1) External intercostal muscle: bres directed downward& forward. 2) Internal intercostal muscle: bres directed downward& backward. 3) Innermost intercostal muscle: bres directed downward& backward. 4) Sternocostalis (Transverse thoracis) 5) Subcostals. ese muscles act to change the volume of the thoracic cavity during respiration. 4) Sternocostalis Muscle: (Transverse thoracis) Origin Posterior su ace of body of sternum and xiphoid process. Inse ion: Internal su ace of costal ca ilages of ribs 2-6 Action: Depresses ribs during forced expiration; Suppo s intercostal spaces and thoracic cage Inne ation: Intercostal ne es 5) e subcostalis: (the subcostal muscle) Consists of thin muscles located on the inner su ace of the posterior thoracic wall.  ey typically bridge two or three intercostal spaces.  ey originate from the internal su aces of the seventh to tenth ribs, near their angles. NB: ere are some other muscles that do not comprise the thoracic wall, but do attach to it. ese include:  the pectoralis major,  the pectoralis minor,  serratus anterior scalene muscles. Diaphragm Diaphragm  Intercostal veins, a eries& ne es (VAN)  Intercostal space is the space between 2 successive ve ebrae.  Intercostal groove is the groove on the lower border of each rib.  Intercostal (vein- a e – ne e) run in order in the subcostal groove (lower border of the rib above).  Collaterals run at the upper border of the rib below. 1- (VAN) N: Ne e supply of intercostal muscles: Intercostal ne es Total 12: 11 intercostal& a subcostal. Applied Anatomy: Intercostal Ne e Block Intercostal Ne e Block is used to treatment various painful conditions of the chest, back, and ank. 2 injections for each space: 1- Near Lower border of the rib above. 2- Near upper border of the rib below. https://www.spineandpainny.com/intercostal-ne e-block Applied Anatomy: Pleural tapping: oracentesis: Used To remove uid from the pleural space.  e needle is introduced in the intercostal space near to the upper border of the lower rib.  2- (VAN) A: A: intercostal a eries Total 12: 11 intercostal& a subcostal. Intercostal ar te ries are located in the intercostal spaces T he re are Anterior and posterior intercostal ar teries which anastomose with each other. Anterior intercostal ar teries : arise from internal thoracic ar teries from 1st par tof subclavian a e. Posterior intercostal ar teries : arise from descending thoracic ao a.  3- (VAN) V: V: intercostal Total 12: 11 intercostal& a subcostal. veins Intercostal veins are a group of veins located in the intercostal spaces. T he y drain blood from chest wall and follow the same course as the intercostal ar teries, mostly emptying into the azygos and hemiazygos venous systems. Superior and inferior hemiazyous cross at T4 to end at azygous vein……. SVC…….Rt atrium oracic inlet  Right& Left phrenic ne es Right C3,4,5 Left C3,4,5 References https://www.youtube.com/watch?v=EL7Mx-hrsZI References: https://www.ncbi.nlm.nih.gov/books/NBK557710/ https://anatomylab.class.virginia.edu/ orax/Lab01/PowerPointHandout_ oraxLab01.pdf https://accesssurge.mhmedical.com/content.aspx? sectionid=71518466&bookid=1202 https://slideplayer.com/slide/10051531/#google_vignette https://www.ncbi.nlm.nih.gov/books/NBK557710/ https://www.slideshare.net/slideshow/thoracic-wall-1/128775533#5 oracic wall: https://www.youtube.com/watch?v=gOSNWST9HIA Applied: Cases: https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=2215&sectionid=169756870 https://www.kenhub.com/en/libra /anatomy/gross-anatomy-through-case-repo s https://www.ncbi.nlm.nih.gov/books/NBK538328/ https://www.youtube.com/watch?app=desktop&v=Nr54xAzEUTc https://www.physio-pedia.com/Ribs