Pleurae, Trachea & Principal Bronchi By Dr Rabia Inam Gandapore.pptx

Pleurae. Trachea and Principal Bronchi

1. Pleurae Dr. Rabia Inam Gandapore Assistant Professor Head of Department Anatomy (Dentistry-BKCD) B.D.S (SBDC), M.Phil. Anatomy (KMU), Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),CHR (KMU), Dip. Arts (Florence, Italy)

2. Teaching Methodology LGF (Long Group Format) SGF (Short Group Format) LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams) SGD (Short Group) SDL (Self-Directed Learning) DSL (Directed-Self Learning) PBL (Problem- Based Learning) Online Teaching Method Role Play Demonstrations Laboratory Museum Library (Computed Assisted Learning or E-Learning) Assignments Video tutorial method

3. Goal/Aim (Main Objective) Describe the gross features of pleura . Describe the major components of the ( upper and lower) respiratory system. Describe the general and anatomical features of trachea and bronchi. Describe the anatomical features of lungs .

4. Specific Learning Objectives (cognitive) At the end of the lecture the student will able to: Describe the gross features of pleura . Describe the major components of the ( upper and lower) respiratory system. Describe the general and anatomical features of trachea and bronchi. Describe the anatomical features of lungs .

5. Psychomotor Objective: (Guided response) A student to draw labelled diagram of Histology of Respiratory System (Trachea & its layers)

6. Affective domain To be able to display a good code of conduct and moral values in the class. To cooperate with the teacher and in groups with the colleagues. To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time in the class. To be able to perform well in the class under the guidance and supervision of the teacher. Study the topic before entering the class. Discuss among colleagues the topic under discussion in SGDs. Participate in group activities and museum classes and follow the rules. Volunteer to participate in psychomotor activities. Listen to the teacher's instructions carefully and follow the guidelines. Ask questions in the class by raising hand and avoid creating a disturbance. To be able to submit all assignments on time and get your sketch logbooks checked.

7. Lesson contents Clinical chair side question: Students will be asked if they know what is the function of Outline: Activity 1 Describe the gross features of pleura . Activity 2 Describe the major components of the ( upper and lower) respiratory system. Activity 3 Describe the general and anatomical features of trachea and bronchi. Activity 4 Describe the anatomical features of lungs

8. Recommendations Students assessment: MCQs, Flashcards, Diagrams labeling. Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy , Netter’s Atlas , BD Chaurasia’s Human anatomy, Internet sources links.

9. Pleurae Serou s m e mbran e s t hat l in e l u n gs & t ho r ac i c ca v i t y P e rmi t s eff i cient & eff o r t l e s s respira t i o n Structur e o f Pleurae 2 pleurae in body – one covering each lung They consist of a serous membrane – this is a layer of mesothelial cells , s u pporte d b y connec t i v e t issue Each pleura can be divided into 2 parts : Viscer a l pleu r a – co v ers l u n gs . Parietal pleura – covers internal surface of thoracic cavity . These 2 parts are continuous with each other at hilum of each lung There is a potential space between the viscera and parietal pleura, known a s p l e u ral ca v i t y

10. Diaphragm

11. Parietal Pleura It covers internal surface of thoracic cavity Thicker than visceral pleura & subdivided according to part of body that it is contact with: 1. Me d ia s ti n a l ple u r a – Cov ers l at e r a l aspec t o f medi a s t in u m 2. Cervical pleura – Lines extension of pleural cavity into neck 3. Costal pleura – Covers inner aspect of ribs, costal cartilages , & in t ercos t a l m u sc l e s . 4. Diap h r a gmat ic pleu r a – Co v ers t ho r ac i c ( s u pe r i o r ) s u r f ac e of diaphragm

12. Visceral Pleura C overs outer surface of lungs & extends in t o in t er l obar f i ss u res It is continuous with parietal pleura at hilum of each lung (this i s wher e s t ru c tures en t er & l ea v e l u n g)

13. Surface marking of pleurae

14. Surface marking of pleurae

15. Pleural cavity S pace between parietal & v iscera l p l e u ra It contains a small volume of serous fluid , which has two major functions 1. I t l ubri c at e s surf a ces o f p l e u r a e , al l o win g t hem t o s l i d e o v er each o t he r 2. serous fluid also produces a surface tension , pulling parietal & v iscer a l p l e u ra t o g e t her This ensures that when thorax expands , lung also expands, f i ll in g wi t h air

16. Pleural cavity

17. Pleural Cuff 2 layers continuous with one another by me a ns of a c u f f of p leura C uff surrounds structures entering & leaving lung a t h i lu m of each lung Pleural c u f f han g s down a s a loose fold c alle d the pulmon a ry l i ga m ent

18. Pleural Recesses Anteriorly & posteroinferiorly, pleural cavity is not completely f i l l ed b y lung s. This gives rise to recesses – where the opposing surfaces of the par i et a l pleur a touch T here ar e 2 r e c esses p r esent i n each pl e ural c a v ity: Costodiaphragmatic – located between costal pleurae & diaphragmatic pleura Costomediastinal – locate d b etween c os t al pleurae & med i a s t i n a l pleurae , beh i nd stern um .

19. Pleural Fluid P leura l spac e normally conta i ns 5 to 1 ml of clear fluid It lubricates opposing surfaces of the visceral & par i et a l pleura e dur i ng resp i rat i on The formation of fluid results from hydrostatic and osmotic pressures between capillaries P leural fluid is normally absorbed into capillaries of v i scera l pleura

20. Neurovascular supply Parietal Pleura S en si t i v e t o pres s ure, pain , an d t e m p er a t u re P r o duces a w e l l l ocalized pain Two nerves responsible for innervation of the parietal pleura: Intercostal nerves – innervates the costal and cervical pleura. Visceral Pleura Not sensitive to pain, temperature or touch S ensory f i bre s o nl y d e t ect s t r e tch Receives autonomic innervation from the pulmonary plexus (a network of nerves derived from the sympathetic trunk and vagus nerve) Arterial supply is via bronchial circulation ( internal thoracic ar t erie s ) , whic h al s o s u pp l ie s t he parenchym a of t he l u n gs.

21. Clinical Relevance

22. Clinical Relevance: Pneumothorax Pneumothorax (commonly referred to a collapsed lung ) occurs when air or gas is present within the pleural space . This removes the surface tension of the serous fluid present in the space, reducing lung extension Clinical features: Chest pain , and shortness of breath , and asymmetrical chest expansion Upon percussion, the affected side may be hyper-resonant (due to e xc e s s a i r w it h i n t h e c h e s t ) There are two main classes of pneumothorax Spontaneous Traumatic Traumatic: Occurs as a result of blunt or penetrating chest trauma, such as a rib fracture (often seen in road traffic collisions). Treatment depends on identifying the underlying cause Primary pneumothoraces tend to be small and generally require minimal intervention Secondary and traumatic pneumothoraces may require decompression to remove the extra air/gas in order for the lung to reinflate (this is achieved via t h e i n s e r t i on of a ch e s t dra i n )

23. Collapsed lung

24. Pleural Effusion

25. Pleural effusion

26. Applied features Pleurisy Inflammation of pleura (pleuritis or pleurisy), secondary to inflammation of the lung (e.g., pneumonia ) Results in pleural surfaces becoming coated with inflammatory exudate, causing the surfaces to be roughened This roughening produces friction, and a pleural rub can be heard wi t h t he s t e thosc o p e o n insp i r a t i o n an d expi r at i o n Often, the exudate becomes invaded by fibroblasts, which lay down collagen and bind the visceral pleura to the parietal pleura, forming p l e u ral adhesions.

27. TRACHEA

28. T rac h ea Anatomical position: M a rks t h e b e g i nn i n g of t r a c h e o b ro n c h i a l t r e e Arises at lower border of cricoid cartilage in neck continuation of larynx Travels inferiorly into superior mediastinum , bifurcating at level of sternal angle ( forming right & left main bronchi ) As it descends, trachea is located anteriorly to oesophagus , and i n c l i n e s s l i g h t l y t o r i g h t . Structure: T r a c h e a , l i ke a l l of l a rg e r r e s p i r a t ory airways, is held open by cartilag e (C- shaped rings ) - Hyline T h e fr e e e n d s of t h e s e r i n gs a re su p p o r t e d b y t h e t r a c h e a l i s mu s c l e

29. Neurovascular Supply R eceives sensory innervation from recurrent laryngeal nerve A r t eri a l supp l y c o mes f r o m t r ac h ea l b r an ches o f infer ior thy r oid artery in upper part & branches of bronchial arteries in thoracic region Venous drainage i brachiocephalic, azygos & accessory hemiazygos veins Lymph Drainage pretracheal and paratracheal lymph nodes & dee p cervica l nodes

30. Relations of trachea in Superior Mediastinum Anteriorly: Sternum Thymus L eft brach i ocepha l i c v ein O r i g i ns of brach i ocepha lic & l eft common car o t id arteries A rch of ao r t a Posteriorly: Esophagus L eft rec u r r en t l ar y ngeal ne r v e

31. Left side: A r c h o f ao r t a Left common car o t id & l eft s u bc l avia n ar t erie s , L eft v agu s & l eft phre n i c ne r v es Pleura Righ t side: A z y g o s v ein R i ght v agu s ne r v e Pleura

32. Clinical Relevance

33. Normal X-rays AP and Lateral views

34. Applied features Tracheal Displacement Due to Goiter

35. Tracheal wall with bronchoscopy Trachealis muscle overlies esophageal muscle and epithelium

36. Morphologic Normal Variants U-shaped trachea (27%) C - sha p ed t rac h ea ( 4 9 %) H or s e s h oe t r a c h e a

37. Principal Bronchi

38. Principal Bronchi At the level of sternal angle , behind arch of aorta , trachea bifurcates into right & left main bronchi They undergo further branching to produce the secondary bronchi supplies a lobe of the lung, and gives rise to se v er a l segmen t a l br o nchi Along with branches of pulmonary artery and veins, the main br o nchi make up t he r o o t s of t he l u n gs Bronchi divide dichotomously, giving rise to several million terminal bronchioles that terminate in one or more respiratory bronchioles that divides into 2 to 11 alveolar ducts that en t er al veolar sacs

39. Structu r e Right main bronchus – wider, shorter , and descends more vertically than its l e f t - s i d e d c o u n t e r p a rt Left main bronchus – passes inferiorly to arch of aorta , and anteriorl y t o t h e t h or a c i c a or t a a n d o e s o p h a gus i n ord e r t o r e a ch t h e h i l um o f t h e l e ft lung

40. Neurovascular Supply B ronchi derive innervation from pulmonary branches of vagus nerve (CN X) Blood supply Branches of bronchial arteries V e n o u s dra i n a ge i s i n t o br o n c h i a l v e i n s Sympathetic (A) and parasympathetic (B) supply to the structures in superior mediastinum (Sympathetic: Yellow, Parasympathetic: Blue, Mixed: Green)

41. Clinical Relevance

42. Applied features At bifurcation of primary bronchi , a ridge of cartilage called the carina runs anteroposteriorly between openings of 2 bronchi This is most sensitive area of trachea for t r i gge r i n g cou gh r e f l e x , a n d c a n be seen on bronchoscopy Because right bronchus is wider & more d i r e ct con t i n u a ti on of t r a c h e a , for e i gn b o d i e s tend to enter the right instead of the left bronchus From there, they usually pass into the middle or lower lobe bronchi Clinically, this results in a higher incidence of foreign body inhalation .

43. Carina on bronchoscopy From the head From the front