1. 1 RESPIRATORY SYSTEM dr. SOENANTO ROEWIJOKO, MS, SpA

2. 2 THE RESPIRATORY SYSTEM LUNGSSYSTEM OF TUBE A.VENTILATION MECHANISM -Thoracic cage -Intercostal muscle -Diaphragm -Elastic & collagen (of the lungs)

3. 3 NASOFARING PLICA VOCALIS CONUS ELASTICUS Tonsil

4. 4 2 PRINCIPLES REGION A CONDUCTING PORTION A RESPIRATORY PORTION

5. 5 Nasal cavity Nasal cavity Nasopharynx Nasopharynx Larynx Larynx Trachea Trachea Bronchi Bronchi Bronchioles Bronchioles Terminal bronchioles Terminal bronchioles Gas exchange: Gas exchange: - Resp. bronchioles - Alveoli ducts - Alveoli

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7. 7 2 MAIN FUNCTIONS OF THE CONDUCTING PORTION To provide a conduit through which air can travel to and from lungs To provide a conduit through which air can travel to and from lungs To condition the inspired air To condition the inspired air –Cleansed –Moistened and warmed by: –Respiratory ephitelium –Mucous and serous glands –A rich vascular network

8. 8 RESPIRATORY EPHITELIUM Ciliated pseudostratified Columnar ephitelium with Goblet cells 5 Cells (with EM): Ciliated columnar cells Ciliated columnar cells Mucous goblet cells Mucous goblet cells Columnar brush cells Columnar brush cells Basal cells Basal cells Small granule cells Small granule cells

9. 9 NASAL CAVITY VESTIBULENASAL FOSSAE Nares (nostril) Vibrissae Sebaceous & sweat glands Nasal septum Conchae: - sup, mid, inf. Venous plexuses (of Kiesselbach)

10. 10 OLFACTORY EPHITELIUM ORGANIZATION Modified pseudostratified columnar epith. Bipolar neurons cells Bipolar neurons cells Sustentacular cells Sustentacular cells Basal cells Basal cells

11. 11 MUCOUS SECRETION

12. 12 Mechanism of smell Odor molecules stimulate receptors  Transduction process  Toward the central nervous system OLFACTORY EPHITELIUM ORGANIZATION

13. 13 PARANASAL SINUSES Frontal Frontal Maxillary Maxillary Ethmoid Ethmoid Sphenoid Sphenoid Thinner resp. epithelium Thinner resp. epithelium Few goblet cells Few goblet cells Few small glands Few small glands Thinner lamina propia  periost Thinner lamina propia  periost –Sinusitis :  Inflammatory process of the sinus Acute Chronic

14. 14 PHARYNX Nasopharynx Nasopharynx –Respiratory type epithelium Oropharynx Oropharynx –Squamous type epithelium

15. 15 LARYNX Laryngeal cartilages Hyaline cartilages : Hyaline cartilages : -Thyroid -Cricoid -Arytenoid Elastic cartilages : Elastic cartilages : -Epiglottis -Cuneiform, corniculate

16. 16 Epiglottis Lingual surface Lingual surface –Stratified squamous epith. Laryngeal surface Laryngeal surface –Respiratory epith. –Mixed mucous and serous glands

17. 17 EPIGLOTTIS

18. 18 2 Pairs of Mucous Folds The upper pair: The upper pair: –False vocal cords: (vestibular folds) The lower pair: The lower pair: –True vocal cords: Vocal ligament (elastic fiber) Vocal ligament (elastic fiber) Stratified squoamous epith. Stratified squoamous epith.

19. 19 TRACHEA Respiratory epith. Respiratory epith. C-shape rings of hyaline cartilage (pars. cartilaginea) C-shape rings of hyaline cartilage (pars. cartilaginea) Pars membranacea: Pars membranacea: –Fibroelastic ligament –Smooth muscle –Mixed mucous-serous glands

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21. 21 Bronchial tree Bronchi extra pulmonal Bronchi extra pulmonal Bronchi intra pulmonal Bronchi intra pulmonal Bronchioli Bronchioli (terminal bronchioles) (terminal bronchioles)

22. 22 Bronchi Folded appearance of the bronchial mucous (observed in histologic section) Folded appearance of the bronchial mucous (observed in histologic section) Respiratory epith. Respiratory epith. Mucous and serous gland Mucous and serous gland Spirally arranged smooth muscle Spirally arranged smooth muscle Rings / isolated plate of hyaline cartilage Rings / isolated plate of hyaline cartilage

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24. 24 Bronchiole Diameter of 5 mm/less Diameter of 5 mm/less Ciliated pseudostratified columnar  ciliated simply columnar / cuboidal epith. Ciliated pseudostratified columnar  ciliated simply columnar / cuboidal epith. Smooth muscle + elastic fiber in the lamina propria Smooth muscle + elastic fiber in the lamina propria Have neither cartilage nor glands in their mucous layer Have neither cartilage nor glands in their mucous layer

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26. 26 Bronchiale Asthma The musculatur (both the bronchi and the bronchioles)  is under the control of the vagus nerve and the sympathetic N.S. The musculatur (both the bronchi and the bronchioles)  is under the control of the vagus nerve and the sympathetic N.S. Stimulation of The vagus  contraction The vagus  contraction The parasympathetic  relaxation The parasympathetic  relaxation

27. 27 Asthma Attacks Dispnoe (increased airway resistance) Dispnoe (increased airway resistance) Wheezing sounds Wheezing sounds –Decreases the diameter of the lumen –Hypersecretion of the mucous / serous glands + goblet cells

28. 28 Respiratory Bronchioles Respiratory portion Respiratory portion Their walls  numerous saccular alveoli Their walls  numerous saccular alveoli Ciliated cuboidal epith. Ciliated cuboidal epith. Smooth muscle + elastic C.T. Smooth muscle + elastic C.T.

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30. 30 Alveolar Ducts Squamous alveolar cells Squamous alveolar cells Smooth muscle cells Smooth muscle cells Matrix of elastic and collagen Matrix of elastic and collagenAtria Alveolar sac.

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32. 32 ALVEOLI Terminal portions of the bronchial tree Terminal portions of the bronchial tree Inter alveolar septum: Inter alveolar septum: –Capillaries –Fibroblast –Elastic and collagen fibers –Macrophages Blood: Blood: –Air barrier –Cytoplasm of the alveolar cells –Fused basal laminae –Cytoplasm of the endothelial (continuos type)

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34. 34 2 TYPE OF ALVEOLAR CELLS Type I cells (squamous alveolar/ Pneumocyte type I) Type II cells (Septal cells/ Pneumocyte type II)  Thin/squamous Permeable to gases  Cuboidal Vesicular cytoplasm Secretory cells  Pulmonary surfactant (to lower alveolar surface tension)

35. 35 ALVEOLAR PORES 10-15  m in diameter 10-15  m in diameter Connecting neighboring alveoli Connecting neighboring alveoli Equalize pressure in the alveoli Equalize pressure in the alveoli Enable the collateral circulation Enable the collateral circulation

36. 36 PLEURA Serous membrane covering the lung Serous membrane covering the lung Parietal and visceral layer Parietal and visceral layer Mesothelial cells Mesothelial cells Connective tissue (collagen + elastic) Connective tissue (collagen + elastic) Pleural cavity + lubricant Pleural cavity + lubricant Pleuricy Pleuricy Pneumothorax Pneumothorax Pleural effusion / haemothorax Pleural effusion / haemothorax

37. 37 DEFENSE MECHANISM Vibrissae (screen) Vibrissae (screen) Mucous-coated ciliated epith. (traped) Mucous-coated ciliated epith. (traped) Cough reflex (expectoration) Cough reflex (expectoration) Alveolar macrophages Alveolar macrophages Lymphoid tissues Lymphoid tissues