Physiology of pleura

By
Prof.DR soheir helmy

The lungs

The lungs are vital organs.

The main function of the lung is gas exchange.
Other functions of the lung:
Excretory function,waste gases are carried by
blood traveling the veins to the lungs where
respiration takes place.
Homeostatic function ,adjust PH of the blood by
altering the pressure of CO2.
Synthesis of surfactant

The lungs
Metabolic

functions: Activation and inactivation of biological

substances
Conversion of angiotensin
1>>>angiotensin 11 since the lung is rich
in angiotensin converting enzyme.
Inactivation of substances like serotonin,
epinephrine and prostaglandins.
So the lung must be protected by the pleura

pleura

Each lung is enclosed in a double walled sac

called the pleura.

Both layer of pleura is formed of serous
membrane
The portion that adheres to the thoracic
cavity is parietal pleura
The portion which covers the lung is the
visceral layer
Between the two layers of pleura a space
called intra pleural space

Intra Plural fluid

It is the fluid that filled pleural

cavity
It is a lubricant fluid which allow
the pleura to slide easily
against each other during
ventilation.
Normal amount of fluid equals
20-25 ml in each space
It is formed and reabsorbed
continuously.
It is produced by parietal
circulation (intercostal arteries)
It is reabsorbed by lymphatic
system
If formation exceeds
reabsorptions pleural effusion
occurs.

Intra plural pressure

It is the pressure in the

space between the two
layers of pleura
It is usually negative
pressure
Normal value of I.P.P.
-3mm Hg at the end of
normal expiration.
-6mm Hg at the end of
normal inspiration.
-30.mm Hg->forced
inspiration.

Causes of negativity of I.P.P

Lack of air in the pleural cavity
Surface tension of the fluid lining the alveolar wall
Elastic recoil lf the lung which continuously pulls the
visceral pleura away from the parietal pleura
N.B ve force is a suction force.

Significance of -ve I.P.P

It helps expansion of the lung.

Helps venous return to the heart.
Helps blood flow through pulmonary vessels.
Helps lymphatic flow in the thoracic duct

Puemothorax
Presence

of air in the pleural cavity.

Air can enter the pleura through wound in the
chest wall
Types: 1-closed
2- open
3-valvular
4-artificial
Manifestation: sudden occurrence of pleural pain..
Dyspnea.
Patent may be cyanosed

Treatment:-

puemothorax

Treatment

Pleural effusion
Normally,

very small amounts of pleural fluid

are present in the pleural spaces, and fluid is
not detectable by routine methods. When
certain disorders occur, excessive pleural fluid
may accumulate and cause pulmonary signs
and symptoms. Simply put, pleural effusions
occur when the rate of fluid formation exceeds
that of fluid absorption. Once a symptomatic,
unexplained PLEURAL EFFUSION pleural effusion
occurs, a diagnosis needs to be established.

Pleural effusion
Abnormal

accumulation of fluid in pleural

space.
The following mechanism may play a role
in pleural effusion: Altered permeability of pleural membrane
due to inflammatory process or emboli.
Decrease intra vascular oncotic pressure
e.g hypoalbuminemia.
Decrease lymphatic drainage.