2. 1 Anatomy of The Trachea

3. 2 The trachea is a cylindrical tube that projects onto the spine from C6 to the level of T5. As it passes downwards, it follows the curvature of the spine, and courses slightly backward. Near the tracheal bifurcation, it deviates slightly to the right. length: 10-12 cm ； 16-20 cartilage ring Cervical trachea ： Cricoid cartilage - suprasternal fossa ， 7- 8cartilage rings Thoracic trachea: suprasternal fossa - tracheal Long ridge ， 9-12cartilage rings Tracheobronchial tree

4. 3 Cricoid Cricoid Cartilage Cricothyroid membrane Thyroid gland Thyroid cartilage Cricoid cartilage

5. 4 气管支气管 气管 1. Tracheal lung ridge 2. Tracheal branches of a tree

6. 5 Tracheobronchial anatomy Bronchial 1. Principal bronchus(left and right) 2. lobar bronchi. （ L2 、 R3 ） 3. segmental bronchi → 4. Bronchiole 5. Terminal bronchiole 6. Respiratory bronchiole 7. Alveolar

7. 6 When a patient aspirates (breathes in a strange object, mostly food) in which lung do you think the object will normally be found and why? Right lung Steeper bronchus Gray, Anatomy of the Human Body (1918)

8. 7 physiological function 1. respiratory regulation passage to inhale Ｏ 2 and to exclude ＣＯ 2 ， smooth muscle contraction,to stretch, to regulate respiration. to change the resistance and pressure. 2.clean function mucus cilia 3.immune function IgAd ， IgG 、 IgM 、 IgE 。 4.defensive cough reflex vagal afferent nerve ending The Trachea & Bronchi sensitive to mechanical irritation Receptor of inferior lobar bronchi sensitive to chemical irritation

9. 8 Esophageal Anatomy

10. 9 Fibromuscular tube about 25cm long: C6–T10 Esophageal plexus (vagus + sympathetics) Vagal trunks (anterior & posterior) Esophageal hiatus in diaphragm Right crus of diaphragm forms a sphincter-like sling

11. 10 Esophageal Anatomy Superiorly: level of cricoid cartilage, juncture with pharynx Middle: crossed by aorta and left main bronchus Inferiorly: diaphragmatic sphincter 4 physiological stenosis

12. 11 食管的应用解剖 食管的四个狭窄： ①第一狭窄：即入口处，由环咽肌收缩所致，距上 切牙约 16cm ，是食管最狭窄之处。此段后壁咽下 缩肌与环咽肌连接处有肌肉薄弱区，易在食管镜 检查时造成穿孔。 ②第二狭窄：由主动脉弓压迫食管左侧而成，位第 一狭窄下方 7cm （距上切牙 23cm ）处。在管腔内 可见主动脉产生的搏动。

13. 12 食管的应用解剖 ③第三狭窄：为左主支气管压迫前壁而成， 位第二狭窄下方 4cm （距上切牙 27cm ）处。 时常把第二、三狭窄合称为第二狭窄。 ④第四狭窄：为食管通过膈肌裂孔而成，距 上切牙约 40cm 。

14. 13 Esophageal Anatomy Inner circular & outer longitudinal muscle coats All the muscle fibers are actually helical: outer loose helix, inner tight helix Not all smooth muscle Inferior third smooth Superior third skeletal Middle third mixed

15. 14 Esophageal Anatomy Mucosa stratified squamous, usually non- keratinizing muscularis mucosae prominent Submucosa: mucous glands Muscularis externa Adventitia loose conn. tissue no serosa

16. 15 Esophageal Anatomy Esophageal Veins Esophageal vv. drain into SVC via inferior thyroid vein Esophageal vv. drain into azygous Esophageal vv. drain into portal v.

17. 16