Transcript lec3.Pleura &Lung.ppt

By Prof.
Saeed Abuel Makarem
Pleura
‫الغشاء الرئوي‬
•
•
•
•
Double-layered serous
membrane enclosing the
lung.
Has two layers:
– Parietal layer, which
lines the thoracic walls.
– Visceral layer, which
covers the surfaces of
the lung.
The two layers continue with
each other around the root
of the lung ‫انظر الصوره‬,
where it forms a loose cuff
hanging down called the
pulmonary ligament.
The space between the two
layers, the pleural cavity,
contains a thin film ‫دقيق جدا‬
of pleural fluid ( 5-10 ml.).
Root of the lung:
‫منطقه دخول الشرايين واالوعيه‬
‫والقصبات للرئه وفي هذه المنطقه‬
‫يتم التحم طبقتي الغشاء الرئوي‬
‫بطبقه واحده‬
Pulmonary
ligament
Parietal Pleura
• Divided according to the region in which it lies
and the surfaces it covers, into:
1- Cervical ‫عنقي‬
2- Costal
3- Mediastinal
4- Diaphragmatic
‫تشرح مفصال بالشرائح القادمه‬
Parietal Pleura
• Cervical Pleura:
• Projects up ‫ تبرز‬into the neck
about 1-1.5 inches above the
medial1/3rd of clavicle.
• It lines the under surface of
the suprapleural membrane
‫غشاء فوق الغشاء الرئوي‬.
• Costal pleura:
• lines, the back of the:
• 1- sternum,
• 2- Ribs & costal cartilages,
• 3- Intercostal spaces &
• 4- Sides of vertebral bodies
Parietal Pleura
• Mediastinal pleura:
covers the mediastinum
‫انظر الصوره‬.
• At the hilum ‫منطقه دخول‬
) ‫االوعيه ( سبق شرحها‬, it is
reflected on to the
vessels and bronchi, to
become continuous
with the visceral pleura
• Diaphragmatic pleura:
covers the thoracic
(upper) surface of the
diaphragm
Pleural Recesses
‫تجويفات‬:
• 1- Costodiaphragmatic:
• Slit ‫ تجويف دقيق عميق‬like
space between costal
and diaphragmatic
pleurae. The inferior
border ‫ ياتي الحقا‬of the
lung descends ‫ ينزل‬into it
during deep inspiration
• 2- Costomediastinal:
• Slit like space between
costal and mediastinal
pleurae, is filled by the
anterior border of the
lung during deep
inspiration
‫الصوره حاله‬
‫مرضيه الن الزايه‬
‫ال يصلها هواء‬
‫‪Costophrenic‬‬
Pleura: Nerve Supply
•
Parietal pleura:
•
is sensitive to pain, temperature,
touch & pressure and is supplied
as follows:
 Costal pleura segmentally
supplied by the intercostal
nerves.
 Mediastinal pleura supplied by
phrenic nerves.
 Diaphragmatic pleura supplied
over the domes by phrenic
nerves, around the periphery by
lower six intercostal nerves.
Visceral pleura sensitive to
•
stretch only and is supplied by the
autonomic fibers from the
pulmonary plexus
Lungs
Lungs
• Located in the thoracic
cavity, one on each
side of the
mediastinum
• Each lung is:
 Conical in shape.
 Covered by the
visceral pleura.
 Suspended ‫معلقه‬
free in its own
pleural cavity.
 Attached to the
mediastinum only
by its root.
Borders
‫معناها حدود‬
‫الرئه يعني‬
‫اطرافها‬
• Each lung has:
1- A thin anterior
‫ امامي‬border that
overlaps the heart.
 The left lung shows
cardiac notch along
this border.
2- A thick posterior
‫ خلفي‬border that lies
beside the vertebral
column.
3- A thin inferior ‫سفلي‬
border, that is
related to diaphragm
cardiac notch
Surfaces ‫سطوح الرئه يعني‬
‫االجزاء الباقيه غير الحدود‬
Each lung has:
• An apex ‫قمه‬, which
projects upward into
the neck for about 1
inch ‫تذكر الغالف يتمد‬
‫ النش ونصف‬above the
clavicle.
• A concave base,
which rests on the
diaphragm.
• A convex costal
surface, which
corresponds to the
concave chest wall.
• A mediastinal surface,
which is molded ‫تطبع‬
‫عليها ( مثل الصوره واللي‬
) ‫ ورونا بالعملي‬to the
mediastinal structures.
• At bout ‫ نوبه‬- ‫ مرض‬the
middle of this surface is
a depression ‫تنضغط‬, the
hilum, where the
structures enter the
lung:
• (bronchi, bronchial &
pulmonary arteries) or
leave (bronchial &
pulmonary veins,
nerves & lymphatics)
‫‪1‬‬
‫الرئه اليمنى بها ثالث فصوص‬
‫كما في الدوائر المرقمه‬
‫‪4‬‬
‫‪1‬‬
‫‪2‬‬
‫‪Right‬‬
‫‪atrum‬‬
‫‪3‬‬
‫‪Mediastinal‬‬
‫‪surface‬‬
‫االجزاء‬
‫المجاوره للرئه‬
‫اليمنى والتي‬
‫تطبع عليها كما‬
‫في المربعات‬
‫‪ of‬المرقمه‬
‫‪the right‬‬
‫‪lung‬‬
‫‪3‬‬
‫مهمه تحفظ‬
‫‪2‬‬
‫‪1‬‬
‫الرئه اليسرى لها‬
‫فصين فقط‬
‫‪3‬‬
‫‪Mediastinal‬‬
‫‪surface of‬‬
‫‪the left lung‬‬
‫‪1‬‬
‫كارديك نوتش ‪ :‬يوجد‬
‫بالرئه اليسرى فقط‬
‫بسبب وجود القلب‬
‫اللسان ‪ :‬يوجد‬
‫بالرئه اليسرى فقط‬
‫بسبب وجود القلب‬
‫‪2‬‬
‫‪Left‬‬
‫‪ventricle‬‬
‫‪2‬‬
Fissures ‫& الخط الفاصل‬
Lobes ‫الفصوص‬
• Right Lung:
• Divided by two
fissures, the oblique &
horizontal, into:
• 1- Superior,
• 2-Middle and
• 3- Inferior
• Left lung:
• Divided by only one
oblique fissure into:
• 1- Superior and
• 2- Inferior
Fissures
• Oblique fissure:
• Runs from the
inferior border
upward and
backward across the
medial and costal
surfaces until cuts
the posterior border
about 2½ inches
below the apex
• Horizontal fissure:
runs horizontally
across the costal
surface at the level of
right 4th costal
cartilage to meet the
oblique fissure in the
midaxillary ‫الخط‬
‫ الفاصل االبطي‬line
Blood Supply ‫للرئه‬
• Arterial supply:
• By bronchial arteries,
branches of the
descending thoracic
aorta.
• Venous Drainage
‫االورده‬:
• By bronchial veins,
which drain into
azygos & hemiazygos
veins.
Nerve Supply
• Through pulmonary
plexuses located at
the root of each lung,
and composed of:
– Sympathetic
fibers from the
sympathetic trunk
– Parasympathetic
fibers from the
vagus nerve
Root of the Lung
• Formed by the structures
entering or leaving the lung:
bronchi, pulmonary vessels,
lymphatics, bronchial vessels
and nerves.
• Surrounded by a tubular sheath
of pleura which hangs down to
form pulmonary ligament.
• The pulmonary ligament
provides a potential space for
the movement of pulmonary
vessels and large bronchi
‫‪Surface Anatomy of Pleurae‬‬
‫‪& Lungs‬‬
‫اقرا الكتاب للرئه‬
‫صفحه ‪68‬‬
‫وللغشاء الرئوي اقرا‬
‫صفحه ‪72‬‬
‫صوره توضح‬
‫اماكن سماع النفس‬
‫للرئه والصورة‬
‫تشرح نفسها‬
‫مهمه‬
‫تابع‬
Bronchopulmonary segments:
‫عندما تدخل الشعب للرئه‬
‫تتفرع حتى ترتبط بالرئه عندما ترتبط بالرئه تكون هذه السيقمينت فائدتها ان لكل سيقمنت شريان‬
‫وعصب خاص به فعند حدوث مشكله به يمكن ازالتها وال تؤثر على عمل الرئه‬
• Definition: Are the smallest
anatomic, surgical, and
functional units of the
lung.
Each segment is pyramidal in shape
with its apex directed medially
toward the lung root, and its base
toward the lung surface.
Each segment receives segmental
bronchus, branch of pulmonary
artery, its own lymphatic vessels,
and autonomic nerve.
The branch of pulmonary vein lie in
the connective tissue between the
segment.
• Pleural effusion
• Pleuritis, pleural rub,
pleural adhesions
• Pneumothorax
• Empyema
• ‫قال الدكتور باشرحها الدرس‬
‫الجاي‬
Clinical Notes