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DIAGNOSTIC AND

THERAPEUTIC PROCEDURE
OF CHEST DIS ORDER

compiled by: firaol r.

4/17/2019 BY: Firaol R. 1


Over view of thoracic cavity
• “Chest wall” composed of ribs, sternum,
thoracic vertebrae interlaced with intercostal
muscle
• This space is defined by;
–Sternum anteriorly
–Thoracic vertebrae posteriorly
–Ribs laterally
–Diaphragm inferiorly
The diaphragm is the “floor” of the thoracic
cavity
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Overview …
• Right lung
• Left lung LUNG
• Mediastinum
– Heart
– Aorta and great vessels
– Esophagus
– Trachea
– Thymus

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OVERVIEW ….
 Respiratory system is composed of the upper
and lower respiratory tracts
The two tracts are responsible for ventilation.

 Upper airways warms and filters inspired


air.

 Lower airways accomplish gas exchange

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UPPER RS
Consists of:
Nose
Para nasal sinus
Pharynx
Tonsils
Larynx and
Trachea
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Lower RS
 Bronchi
 Lung
 alveoli and etc…

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Respiratory muscle
Inspiratory muscle (diaphragm muscle &ICM
Other accessory muscle that (to produce large
changes in the volume of the thoracic cavity
during both inspiration and expiration)
Sternocleidomastoid muscle
Scalene muscle & other abdominal muscle

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Ctd…

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Trachea
Left Lung
Right Lung

Mediastinum

Diaphragm
Pericardium

Intrapleural Intrapleural
space space
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Intrapleural Space

Visceral
pleura Chest
wall
Lung

Parietal
Zoom pleura

4/17/2019 BY: Firaol R. Intrapleural space10


Term defn
Ventilation: Movement of air into and out of
airways

External respiration: Gas exchange between air in


lungs and blood

Internal respiration: Gas exchange between the


blood and tissues

Gas exchange: entry of O2 and exit of CO2 to


and from the blood
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Mechanism of breathing
• Brain signals the phrenic nerve
• Phrenic nerve stimulates the
diaphragm (muscle) & ICM to
contract
• When diaphragm contracts, it moves
down, making the thoracic cavity
larger
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• When the volume increases, the
pressure inside decreases
• Air moves from an area of higher
pressure, the atmosphere, to an area of
lower pressure, the lungs
• Pressure within the lungs is called
intrapulmonary pressure
INSPIRATION

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• Exhalation occurs when the phrenic nerve
stimulus stops
• The diaphragm& intercostal muscle
relaxes and moves up in the chest
• This reduces the volume of the thoracic
cavity
• When volume decreases, intrapulmonary
pressure increases
• Air flows out of the lungs to the lower
atmospheric pressure
EXPIRIRATION

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• Remember, this is normally unconscious
process
• Lungs naturally recoil, so exhalation
restores the lungs to their resting position
• However, in respiratory distress,
particularly with airway obstruction,
exhalation can create increased work of
breathing as the abdominal muscles try
to force air out of the lungs

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PLEURAL ANATOMY
Lungs are surrounded by thin tissue
called the pleura, a continuous
membrane that folds over itself
–Parietal pleura lines the chest wall
–Visceral pleura covers the lung
(sometimes called the pulmonary
pleura)
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CTD…

Normally, the two membranes are


separated only by the lubricating
pleural fluid
Fluid reduces friction, allowing the
pleura to slide easily during
breathing
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PLEURAL PHYSIOLOGY
• The area between the pleurae is called the pleural
space (sometimes referred to as “potential
space”)
• Normally, vacuum (negative pressure) in the
pleural space keeps the two pleurae together and
allows the lung to expand and contract
• During inspiration, the intrapleural pressure is
approximately -8cmH20 (below atmosphere)
• During exhalation, intrapleural pressure is
approximately -4cmH20

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PRESSURE
• Intrapulmonary pressure (the pressure in the
lung) rises and falls with breathing
• Equalizes to the atmospheric pressure at end-
exhalation (defined as 0 cmH2O because other
pressures are compared to it as a baseline)
• Intrapleural pressure also fluctuates with
breathing ~ 4mmHg less than the
intrapulmonary pressure
• The pressure difference of 4 mmHg across the
alveolar wall creates the force that keeps the
stretched lungs adherent to the chest wall
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Pressure….
• In between breathing, there is equal
atmospheric pressure(760mmhg) of
inspiration & expiration( zero pressure)
• During inspiration there is negative pressure
• During expiration it is positive pressure

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Pressure…
Pleural pressure is always negative & it used
as suction to keep the lung inflated.
• Generally, breathing system is determined
by:
Pressure
Lung compliance( stretchablity and
alveolar surface tension)
Resistance ( Air flaw=pressure/resistance)
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pressures are disrupted;
• If air or fluid enters the pleural space between
the parietal and visceral pleura, the -4mmHg
pressure gradient that normally keeps the lung
against the chest wall disappears and the lung
collapses
• Air between the pleurae is a pneumothorax
• Blood in the pleural space is a hemo thorax
• Transudate or exudate in the pleural space is a
pleural effusion
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