Respiratory System

Dr Mutiara Budi Azhar, SU MMedSc

Learning Objectives
After careful study of this block, you should be able: Describe the purpose of the respiratory system. Differentiate between external and internal respiration. Name all of the structures of the respiratory system. Explain how food and foreign materials are kept out of the respiratory tract. Explain the mechanism for pulmonary ventilation. List and define five breathing volumes. List the ways in which oxygen and carbon dioxide are transported in the blood. Explain how carbon dioxide serves to regulate the pH of the blood. Describe the ways in which respiration is regulated
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Introduction
1. The respiratory system is the most important of the various systems 2. Not breathing (apnea) for more than 3-4 minutes usually causes irreversible brain damage. 3. The respiratory rate is one of the four vital signs. 4. Respiration is an integral part of cardiopulmonary resuscitation (CPR). 5. This block deals with external respiration. 6. Internal respiration, is discussed in Block . .
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The Organs of Respiratory System

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The nose and nasal cavity

The external nose is composed mostly of cartilage, with two small hard nasal bones forming the upper part, or bridge. The tip of the nose is the apex, and the nostrils are the nares. The nasal cavity consists of two parts, the nasal fossae, separated by a cartilage and bony wall (septum). The roof is is formed by a small portion of the frontal bone, the ethmoid and sphenoid bones; the floor by the hard palate, consisting of the maxillae and palatine bones. The portion of nasal cavities just inside the nares, the vestibule, contains stiff hairs (vibrissae). Three thin curled bones, the turbinates (conchae), project inward from the two outer walls. The spaces above and below each turbinate are the meatuses; the lower oneSystem Respiratory receives the nasolacrimal duct. 5

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The nose and nasal cavity Cont.

A mucous membrane (mucosa) consisting of epithelium, glands and connective tissue. Respiratory glands secrete a slimy substance called mucous, which, along with small, fine, undulating hair-like processes (cilia) in the pharynx, larynx, trachea, bronchi and bronchioles trap particles such as dust, and remove them. The cilia of the trachea and bronchi move upward, in contrast to those of the pharynx which move downward, towards the esophagus.
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The nose and nasal cavity Cont.

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The nose and nasal cavity Cont.

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The nose and nasal cavity Cont.

Nerve endings for the olfactory nerve lie on the upper third of both sides of the nasal septum, the olfactory areas. Olfactory nerve fibers pass through small holes in the ethmoid bone (os ethmoidale) to the olfactory bulb (bulbus o;factorius), and then to the cortex, where the impulses are interpreted as smell.
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The nose and nasal cavity Cont.

The function of nasal cavities is to warm, filter, and moisten incoming air. If this function is bypassed, as in patients on mechanical ventilators, drying of the lungs can create discomfort and infection. Consequently, a vapor mist is often added to a ventilator
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The nose and nasal cavity Cont.

Venous areas called swell bodies are located on the turbinates (conchae nasales). About every half-hour, the swell bodies on one side of the nasal cavity engorge with blood, resulting in decreased air flow on that side, with good flow in the other side. Then in reverse.

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These periodic changes permit recovery

from drying.
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The nose and nasal cavity Cont.

The structure of nasal cavity above the vestibule permits the implantation of a wide variety of objects by children, such as peanuts, beans and a diversity of insects, often leading to purulent infections.
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Supralaryngeal structure

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The nose and nasal cavity Cont.

The septum is richly supplied with sensory nerves and blood vessels. Most nosebleeds (epistaxis) originate here; the more common causes being trauma and nose-picking. The irritation of sensory nerve endings often triggers the sneeze reflex the inhalation of air followed by an explosive exhalation, to clear the airway.
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Normal and deviated septum

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A deviated septum
A deviated septum is a condition in which the septal cartilage is bent, usually from a blow, resulting in difficulty in breathing from one side of the nose. In earlier days, some boxers had the septal cartilage removed so that they could breathe easier, resulting in the pug-nosed appearance often seen in older fighters.

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Sinuses (Sinus Paranasales)

Sinuses (sinus paranasales) are spaces in the frontal, ethmoid, sphenoid and maxillary bones that are lined with mucosa and communicate with the nasal cavity They make the skull light, thus making it easier for people to walk in the upright position. Since the sinus mucosa communicates with the nasal cavity, sinuses are prone to the same infection as the nasal cavity.

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Sinuses (Sinus Paranasales) - Cont.

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The nasopharynx
This part of pharynx is the continuation of the nasal cavity into the throat, or pharynx (the pharynx is discussed with the digestive system)

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The larynx
The larynx, or voice box, is the entrance to the trachea, and consists of cartilages, ligaments, mucles, and vocal cords (Fig 5; Fig. 6)). The cartilages provide a rigid structural framework for the larynx and the trachea below it, insuring air passage at all times. The thyroid cartilage is the largest, and can be felt in front of the neck as the adams apple. Directly below it is the cricoid cartilage, which is connected to the thyroid cartilage by a connective tissues membrane, the cricothyroid membrane. Inside the larynx, the epiglottis folds over the vocal cords during swallowing, allowing food to pass into the oesophagus. The glottis is the opening between the Dr MBA 20 two vocal cords. Respiratory System

The larynx Cont.

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The larynx Cont.

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The larynx Cont.

The function of the larynx: permitting air passage to and from the lungs and to produce sound, or phonation. The lips and the tongue create speech. During expiration, the vocal cords vibrate to produce high or low sound, or pitch. In high pitch the glottis is more closed and taut, while in low pitch the glottis is more open and relaxed. Laryngitis results from inflammation of the vocal cords by over use, infection or tumor. Obstruction of the glottic area for any reason can rapidly be fatal.
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The trachea (wind pipe)

The trachea, or windpipe, begins at the glottis and ends at the junction of the two main bronchi (the carina) near the level of the sternal angel (angulus sternalis). The framework of the trachea consists of sixteen to twenty cartilage rings, with connective tissue between them. Internally the trachea is lined with mucosa. When a foreign particle enters the trachea, it is trapped by mucous and cilia, and the cough reflex is initiated: the glottis closes, the respiratory muscles contract, the glottis suddenly opens and the smooth muscle layer of the trachea contracts, making the tube narrower. This increases the velocity of expired air, and an explosive discharge take place.
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The trachea (wind pipe) Cont.

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The right and left of main bronchi

The right and left main bronchi are the continuation of the trachea, and have the same structural framework. Each main bronchus divides into two (left lung) or three (right lung) lobar bronchi. Each lobar bronchus divides into ten segmental bronchi, which again further divide. Gradually, cartilage is lost, and when the tubes become about one millimeter in diameter, they are bronchioles (bronchioli), which terminate in the air sacs, or alveoli. The right main bronchus is the natural continuation of the trachea; thus, the angle is less. If a child inhales (aspirates) a peanut, for example, it is more likely to enter the right main bronchus than the left.
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The right and left of main bronchi

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The lungs

Spongy, highly vascular organs that lie in the left and right pleural cavities. The right lung has three lobes: an upper, middle and lower; the left lung has two lobes: an upper and lower. The upper part of each lung is the apex. The lower curved part is the base and lies on the diaphragm. The medial portion, next to the heart, is the root, or hilum.. The alveoli are surrounded by capillaries, branches of the pulmonary arteries and veins; the exchange of oxygen and carbon dioxide takes place here.
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The lungs - Cont

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The lungs - Cont

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The lungs - Cont

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The alveoli

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The alveoli

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Asthma

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The thorax
The thorax, or chest cavity, is the area enclosed by the sternum, ribs and thoracic vertebrae. It includes the region posterior to the sternum containing the heart and great vessels (the mediastinum), as well as the pleural cavities containing the lungs
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The thorax

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The pleura

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The pleural space, or cavity, a potential space, contains about teaspoon of fluid, providing lubrication against friction. An increase of fluid in the pleural space (pleural effusion): lung cancer and pulmonary edema. The fluid must be drained off (thoracocentesis). Sometimes air enters the pleural space (pneumothorax) from a rupture of a part of a lung, or from a penetrating injury by a knife or bullet. A chest tube (thoracostomy tube) is inserted between the ribs, connected to a pump, and the air evacuated. Blood in the pleural space (hemothorax) is drained in a similar manner.
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The pleura

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Nerves and vessels of the lungs

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The autonomic nervous system supplies the bronchi and bronchioles. Stimulation of the vagus nerve (parasympathetic): (bronchoconstriction). Stimulation of sympathetic nerves: bronchodilatation). The pulmonary arteries and veins participate in the exchange of gases between the capillaries and alveoli. Branches of aorta and upper intercostals arteries, the bronchial arteries, supply most of the lung tissue. Venous drainage is from the azygos vein on the right side of the thorax, and the first intercostals vein on the left.
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Respiratory Physiology

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Thank you very much for your kind attention

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BPD: Prognosis
Medically fragile, decompensate quickly Prone to recurrent respiratory infections About 2/3 gradually recover

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BPD: Treatment
Supplemental O2 Assisted ventilations, as needed Diuretic therapy, as needed

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