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

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)

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

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.

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

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

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.

Lesson contents
Clinical chair side question: Students will be asked if they know
what is the function of Outline:
 Activity 1Describe 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

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.

Pleurae
• Serous membranes that line lungs & thoracic cavity
• Permits efficient & effortless respiration
Structure of Pleurae
• 2 pleurae in body – one covering each lung
• They consist of a serous membrane – this is a layer of mesothelial
cells, supported by connective tissue
• Each pleura can be divided into 2 parts:
• Visceral pleura – covers lungs.
• 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 as pleural cavity

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

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. Mediastinal pleura – Covers lateral
aspect of mediastinum
2. Cervical pleura – Lines extension of
pleural cavity into neck
3. Costal pleura – Covers inner aspect
of ribs, costal cartilages, & intercostal
muscles.
4. Diaphragmatic pleura – Covers
thoracic (superior) surface of

Visceral Pleura
• Covers outer surface of lungs & extends into interlobar fissures
• It is continuous with parietal pleura at hilum of each lung (this is
where structures enter & leave lung)

Pleural cavity
• Space between parietal &visceral pleura
• It contains a small volume of serous fluid, which has two
major functions
1. It lubricates surfaces of pleurae, allowing them to slide
over
each other
2. serous fluid also produces a surface tension, pulling parietal
& visceral pleura together
• This ensures that when thorax expands, lung also expands,
filling with air

Pleural Cuff
• 2 layers continuous with
one another by
means of a cuff of
pleura
• Cuff surrounds structures
entering & leaving lung
at hilum of each lung
• Pleural cuff hangs
down as a loose fold
called the
pulmonary
ligament

Pleural Recesses
• Anteriorly & posteroinferiorly, pleural cavity is not
completely filled by lungs.
• This gives rise to recesses – where the opposing surfaces
of the parietal pleura touch
• There are 2 recesses present in each pleural cavity:
• Costodiaphragmatic – located between costal
pleurae & diaphragmatic pleura
• Costomediastinal – located between costal pleurae
& mediastinal pleurae, behind sternum.

Pleural Fluid
• Pleural space normally contains 5 to 10 ml of clear
fluid
• It lubricates opposing surfaces of the visceral &
parietal pleurae during respiration
• The formation of fluid results from hydrostatic and
osmotic pressures between capillaries
• Pleural fluid is normally absorbed into capillaries of
visceral pleura

Neurovascular supply
Parietal Pleura
• Sensitive to pressure, pain, and temperature
• Produces a well localized 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
• Sensory fibres only detect stretch
• 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
arteries), which also supplies the parenchyma of the

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 excess air within the chest)
• 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 the insertion of a chest drain)

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
with the stethoscope on inspiration and expiration
• Often, the exudate becomes invaded by fibroblasts, which lay
down collagen and bind the visceral pleura to the parietal pleura,
forming pleural adhesions.

Trache
a
Anatomical position:
• Marks the beginning of tracheobronchial tree
• 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
inclines slightly to right.
Structure:
• Trachea, like all of larger respiratory
airways, is held open by cartilage(C-
shaped rings)- Hyline
• The free ends of these rings are
supported
by the trachealis muscle

Neurovascular Supply
• Receives sensory innervation
from recurrent laryngeal nerve
• Arterial supply comes from
tracheal branches of inferior
thyroid 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 & deep cervical
nodes

Relations of trachea in Superior
Mediastinum
• Anteriorly:
• Sternum
• Thymus
• Left brachiocephalic vein
• Origins of brachiocephalic
& left common carotid
arteries
• Arch of aorta
• Posteriorly:
• Esophagus
• Left recurrent laryngeal
nerve

• Left side:
• Arch of aorta
• Left common carotid & left
subclavian arteries,
• Left vagus & left phrenic
nerves
• Pleura
• Right side:
• Azygos vein
• Right vagus nerve
• Pleura

Normal X-rays AP and
Lateral views

Applied features
Tracheal Displacement Due to Goiter

Tracheal wall with bronchoscopy
Trachealis
muscle
overlies
esophageal
muscle
and
epithelium

Morphologic Normal Variants
U-shaped trachea
(27%)
C-shaped trachea
(49%)
Horseshoe
trachea

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
several segmental bronchi
• Along with branches of pulmonary artery and veins, the main
bronchi make up the roots of the lungs
• 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
enter alveolar sacs

Structur
e
• Right main bronchus – wider, shorter, and descends more vertically than
its
left-sided counterpart
• Left main bronchus – passes inferiorly to arch of aorta, and anteriorly to
the thoracic aorta and oesophagus in order to reach the hilum of the left
lung

Neurovascular Supply
• Bronchi derive innervation from pulmonary branches of vagus nerve
(CN X)
• Blood supply
• Branches of bronchial arteries
• Venous drainage is into bronchial veins
Sympathetic (A) and parasympathetic (B) supply to the structures in
superior mediastinum (Sympathetic: Yellow, Parasympathetic: Blue,
Mixed: Green)

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
triggering cough reflex, and can be
seen on bronchoscopy
• Because right bronchus is wider & more
direct continuation of trachea, foreign bodies
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.

Carina on bronchoscopy
From the head From the
front

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

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