1. 1 Chapter 22 Respiratory System

2. 2 Tale of Two Gases RESPIRATION is Simple- in with the good (O2), out with the bad (CO2) called Pulmonary ventilation Phases of respiration: External respiration- gases exchanged between lungs and blood Internal respiration-gases exchanged between blood and tissues

3. 3 Respiratory System Anatomy- Upper Respiratory System: Nose, Pharynx, Larynx (“X” marks the spot) Lower Respiratory System: Trachea, Bronchi, Lungs (TB of the lungs)

4. 4 Nose The study of the nose, ears and throat is called otorhinolaryngology (oto= ear, rhino= nose, larynx= throat) External nose: Cartilage stuck to the nasal bones creating a wind tunnel with two holes called the external nares or nostrils Function: –filtering air –odors detection –resonating chamber that amplifies the voice (hold your nose) –moisture addition –warming air –FOR Men and Women

5. 5 Anatomy of Nasal Region Note the philtrum

6. 6 Anatomy of Nasal Region Where does the nasal bone end in the nose?

7. 7 The Deep Dark Secret of the Schnoz Internal nose anatomy- nasal cavity divided by nasal septum Nasal septum anatomy- consists of the perpendicular plate of the ethmoid bone (superior), the vomer (inferior) and septial cartilage (anterior) Deviated nasal septum= is a disorder of these nasal septum

8. 8 The Nasal Septum

9. 9 The Path of Air in the Snoot Air enters the nostrils first, Then the vestibule (anterior nasal cavity), Nasal Conchae create the meatuses, –The superior, middle and inferior nasal conchae extend from the lateral nose wall creating shelves in the nose –Between these shelves are spaces called the superior, middle, and inferior meatuses Then air goes to the olfactory epithelium, –CN I meets the air, pseudostratified ciliated epithelium with goblet cells are here moistening the air and trapping dust And then into the Pharynx on the way to the lungs

10. 10 Nasal Cavity - Mucosa Olfactory mucosa lines roof of nasal cavity Respiratory mucosa lines rest of nasal cavity with ciliated pseudostratified epithelium Defensive role of mucosa –mucus (from goblet cells) traps inhaled particles bacteria destroyed by lysozyme Alternate nasal breathing, right side is +, left is - ions

11. 11 Regions of Pharynx The Pharynx (FAIR-inks)- from the internal nose to the cricoid cartilage Naso- Oro- Laryngo- C5C5

12. 12 Pharynx Function: –passage way for food, air, water –resonating chamber –immune function, tonsils Superior portion has an opening for the Eustachian tube Inferior portion connects to the esophagus and the larynx (food and air tubes)

13. 13 Larynx Larynx (LAIR-inks)- voice box, anterior to C4-6, connect the pharynx with the trachea 9 pieces of cartilage, 2 important: THYROID AND CRICOID CARTILAGES Epiglottis (Epi= over, glottis= tongue)- a small tongue-like structure that when we swallow, the epiglottis closes over the larynx so that food will go into the esophagus Houses the vocal cords

14. 14 Larynx

15. 15 Laryngeal Cartilages Thyroid cartilage- also called the Adam’s apple, wedged shaped made of hyaline cartilage, pointing anterior, larger in males but females have one also, lies superior to the thyroid gland Cricoid cartilage- a ring made of hyaline cartilage, great place for a “trach”

16. 16 Emergency Tracheostomy Tracheostomy (Trach)- a procedure where inferior to the thyroid cartilage and superior to the cricoid cartilage of the throat is cut by a small (3/16”) vertical incision and a Bic pen is placed in the hole so that the a person can breath, don’t try this at home! Done only in extreme emergencies

17. 17 Epiglottis Epiglottis (Epi= over, glottis= tongue)- a small tongue-like structure, when we swallow the epiglottis closes over the larynx so that food will go into the esophagus and not into our _______ Laryngoscopic View of Larynx:

18. 18 Action of Vocal Cords The larynx forms two pairs of folds: superior called the ventricular folds or false vocal cords An inferior pair of folds called the vocal folds or true vocal cords Air passes by the vocal cords causing them to vibrate and producing voice

19. 19 Trachea Trachea- Windpipe Anterior to esophagus, goes from C6-T5, at T5 it divides into right and left bronchi Tracheal rings- composed of hyaline cartilage, in the shape of a “C” The “C” opens posterior to allow the esophagus to expand while swallowing

20. 20 Each color is a different tertiary bronchus

21. 21 Terminal Part of the Lungs

22. 22 Review: Path from Nose to Lungs NOSE- FAIR (pharynx) LAR (larynx) TRADES (trachea) BRONCOS (Bronchi) -LUNGS

23. 23 Histology of the Breathing Tube Histology of most of the respiratory system is Pseudostratified ciliated columnar epithelium This covers the nose to the terminal bronchioles in the lungs Pseudo covers the nose to the small holes

24. 24 Lungs- General Anatomy I Paired cone shaped organs, in thoracic cavity, separated by the mediastinum Mediastinum contains the heart and other structures, it separates one lung from the other Each lung is surrounded by the pleural membrane- protects and encloses the lung The pleura doesn’t totally cover the lung at the base so fluid can be drawn at the 7 th intercostals space this procedure is called thoracentesis (thor-a-sen-TEA-sis) The pleural membrane has two layers: –Parietal pleura superficially –Visceral pleura deep, totally covers the lung itself

25. 25 Pleural Layers and Pleural Fluid Pleural cavity- space between parietal and visceral pleura Contains small amount of lubricating fluid Function of pleural fluid: –The two membranes Slide while breathing –Pressure gradient creation lower pressure assists in inflation of lungs –The two membranes Adhere to each other –Compartmentalization prevents spread of infection –Eases friction between the two membranes

26. 26 Pleurisy Pleurisy- Inflammation of the pleural membranes Initially pleurisy can cause pain due to friction between the two membranes If the inflammation persists then fluid may increase causing pleural effusion, pain leaves Which pleural layer does not entirely cover the lungs? The two parts of the pleural membrane do/ do not totally cover the lung.

27. 27 Lungs- General Anatomy II Each lung extends from the diaphragm inferior to the clavicles superior and from anterior ribs to posterior ribs Base- inferior portion Apex- superior portion, narrow Costal surface- surface lying against the ribs Mediastinal surface- medial part of each lung contains these structures: –Hilus- passageway for bronchi, blood vessels, nerves –Cardiac notch- left lung only, for heart Which lung is smaller? Why?

28. 28 Right lung- 3 lobes: Superior Middle and Inferior lobe Left lung- 2 lobes: Superior and Inferior lobe Fissures divide each lung into lobes:

29. 29 Muscles Involved in Breathing INSPIRATION: Diaphragm (dome shaped) Scalenes –fixes ribs External intercostals –elevate ribs Pectoralis minor, sternocleidomastoid and erector spinae muscles Platysma- in respiratory distress EXPIRATION: Internal intercostal muscles –depress the ribs Contract abdominal muscles

30. 30 Breathing Inspiration- also called inhalation, lungs expand and air goes in, diaphragm goes into the abdomen Expiration- also called exhalation, passive process from elastic recoil of the chest wall and lungs, no muscles needed, the diaphragm exits the abdominal cavity, breaks expiration The above is according to Boyle’s law

31. 31 GAS LAWS Boyle’s law- the volume of gas varies inversely with the pressure –For example: a 1 liter volume in a 1 liter beaker equals 1, a 1 liter volume in a ½ liter beaker equal 2 –Dalton’s Law- used to calculate partial pressures of different gases in a mixture, P = partial pressure –Henry’s law- regards gas staying in solution with increased pressure, open a cola can! –Stouder’s law- Never stand behind a patient

32. 32 Lung Volumes/ Lung Capacity Valsalva Maneuver- forced expiration that is stopped, such as straining at stool, if pain results (such as lower back pain) this is a positive VM (not a BM) Tidal Volume (Vt)- volume of one breath Spirometer- (spiro= breath)- measures the volume of air in the lungs

33. 33 Latin: “Dum Spiro Spero” “ While I breathe, I hope.”

34. 34 Respiratory Terms Hyperventilation- rapid and deep breathing, exhales increased CO2 Too much CO2 causes acidosis (acidic blood) called hypercapnia –CO2 diffuses across the blood brain barrier and can acidify the cerebral spinal fluid Hypoventilation- slow and shallow breathing Hypoxia- inadequate oxygen supply –cyanosis - blueness of skin –Primary effect of hypoxia is tissue necrosis Pneumothorax- Presence of air in pleural cavity –loss of negative intrapleural pressure allows lungs to collapse

35. 35 LUNG DIS-EASE I Asthma- Marked by airway hypersenativity, inflammation and obstruction –Symptoms of difficult breathing, wheezing, anxiety COPD- (Chronic Obstructive Pulmonary Disease) 4 th leading cause of death (what’s #1, 2, 3?) Increased airway resistance with recurrent obstruction- smokers –Emphysema- Alveoli destruction, barrel chest, too much air in the lungs prevents gas exchange –Chronic Bronchitis- Excess mucus and cough, symptoms = cyanosis, shortness of breath

36. 36 Lung Disease Affects Gas Exchange  membrane thickness  surface area

37. 37 LUNG DIS-EASE II Pneumonia- Acute inflammation of alveoli, 4 million deaths per year, bacterial infection that usually follows a viral infection Tuberculosis (TB)- Called “consumption” in the old days, caused creation of sanitariums, creates lesions called tubercles in lungs of bacteria

38. 38 TERMS OF INSPIRATION Need a lift? Asphyxia (as-fix-see-a)- oxygen starvation (in carbon monoxide poisoning) Aspiration- inhaling other stuff than air Dyspnea- labored or painful breathing Rales (Lou?)- rattling or bubbling heard in the lungs from auscultation, lung murmurs, caused by turbulence