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RESPIRATORY SYSTEM(Basic Anatomy)
DR TINKU JOSEPH
DM ResidentDepartment of Pulmonary Medicine
AIMS, Kochi
Email: [email protected]
Respiratory System starts at the nares
Major Functions
Upper respiratory system:1. Air conditioning (warming)2. Defense against pathogens3. Gas Transport
Lower respiratory system:1. Speech & other
respiratory sounds2. Gas exchange (ventilation)3. Maintenance of
homeostasis, e.g. pH
Respiratory Epithelium
• Histology? Pseudo…
• Mucus produced by numerous goblet cells
• Defense by means of
• filtering hairs
• turbinates
• ciliary escalator
(mucociliary blanket)
• sticky mucus
Respiratory Muscles
Diaphragm: depresses on contraction inhalation
External intercostals: elevate ribs inhalation
Internal intercostals: depress ribs active exhalation
(Accessory muscles - serratus anterior, scalenes, pectoralisminor, sternocleidomastoid, internal and external obliques, transverse abdominus, rectus abdominus)
Upper Respiratory System
1. Nose
2. Nasal Cavity
3. Paranasal sinuses
4. Pharynx
Upper Respiratory System
1) Nose External and internal nares =
Nostrils Nose Hairs = vibrissae Alar cartilages on the nose Paranasal Sinuses
Upper Respiratory System
• 3) Nasal Cavity
• Nasal Conchae:
– Superior, middle and inferior
– Other name: “Turbinate bones” because they create
– Advantage ?• nasal septum• hard palate, soft palate
Upper Respiratory System
3)Paranasal Sinuses
• Named after their bones
– Frontal
– Ethmoid
– Sphenoid
– Maxillary
Upper Respiratory System
4) Pharynx
Shared passageway for respiratory and digestive systemsNasopharynx - part above uvula and posterior to internal
naresOropharynx – portion visible in mirror when mouth is wide
openfauces = the openinguvula - posterior edge of soft palate
Laryngopharynx – between the hyoid bone & the esophagus
Lower Respiratory System = Anything inferior to the Pharynx
Larynx: Cartilaginous cylinder (from C4- C7)
Made up of 9 cartilages– 3 large unpaired (know
these!) Thyroid, Cricoid, and Epiglottis
– 3 small paired (involved in
construction of voice box)
Larynx (voice box)
Hyoid Bone
Epiglottis
Thyroid Cartilage
Adam’s Apple
Cricoid Cartilage
Vocal Folds
Larynx, cont’d
The pitch of sound is from tension of the elastic fibers of the vocal folds
Resonance from shape of pharynx and mouth
The glottis is the opening between the vocal folds
Innervation via laryngeal nerves
Branches of CN X
Left recurrent laryngeal nerve loops around aorta
From Bronchi to Lungs: The Bronchial Tree
1 bronchi (enter lungs at hilus, complete cartilage rings)
2 bronchi (from now on cartilage plates)
3 bronchi
Bronchioles
Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveolar sacs
Conducting portion
Respiratory portion
Lungs
Light, soft, spongy
Conical in shape, apex, base, costal surface, medial surface, hilus. Note various impressions
Right lung
Three lobes; superior, middle and inferior
Oblique and horizontal fissure
Left Lung
Two lobes; superior and inferior also Lingula and Cardiac notch, oblique fissure
Right Lung
Right Lung
Right Lung
Left Lung
Left Lung
Left Lung
Surface Anatomy
Surface Anatomy
Surface Anatomy
Airways
Trachea, primary bronchi, secondary bronchi, tertiary bronchi out to 25 generations
All comprised of hyaline cartilage
Trachea
Begins where larynx ends (about C6)
10 cm long, half in neck, half in mediastinum
20 U-Shaped rings of hyaline cartilage – keeps lumen intact but not as brittle as bone
Lined with epithelium and cilia which work to keep foreign bodies/irritants away from lungs
Airways
Primary Brochi
One to each lung – continuation of trachea Right bronchus is wider and shorter 2.5 cm as opposed to
5 cm and branches from the trachea at a greater angle
Secondary bronchi – one to each lobe, three in right, two in left
Tertiary – one to each bronchopulmonary segment –approximately 10 per lung
All of the above are hyaline cartilage with no ability to change diameter
Bronchoscope
Tumor
Tumor
Tumor
In and Out
Bronchopulmonary Segments
Bronchopulmonary Segments
Bronchopulmonary Segments
Bronchioles
First level of airway surrounded by smooth muscle; therefore can change diameter as in brocho-constriction and broncho-dilation
Terminal
Respiratory
3-8 orders
alveoli
Bronchioles
Bronchioles
Gas Exchange
Pulmonary arteries carry deoxygenated blood to aleoli
Gas exchange occurs via diffusion through the capillary beds
Returned to heart via pulmonary veins
Gas Exchange
Innervation
Pleura via intercostal (thoracic) nerves
Tracheobronchial tree
Parasympathetic via CN X efferent function = broncho-constriction via smooth mm., also to epithelial cells in trachea; afferent = responsible for cough reflex
Sympathetic from T1-T5 efferent = brocho-dilation
Intercostal to Pleura
Innervation
Pleural Cavities and Membranes
Two cavities separated by mediastinum
Lining of cavities
– Parietal Pleura
– Visceral Pleura
– Pleural Cavity
Pleurisy
Pneumothorax, (hemothorax, pyothorax, pleural effusion)