RESPIRATORY SYSTEM

Respiration is usually considered as a mechanical process of breathing, the exchange of air between the lungs and the external environment. This exchange of air at the lungs is called the external respiration. Simultaneously another form of respiration occurs between the individual body cells and the tiny capillary blood vessels, this is called internal cellular respiration.

ANATOMY AND PHYSIOLOGY OF RESPIRATION: NOSE: Air enters the body via the nose through the two opening called nostrils or nares NASAL CAVITY: Lined with mucous membrane and fine hairs called cilia, the air is filtered of foreign bodies and moistened

PARANASAL SINUSES: Hollow, air containing spaces within the skull that communicate with the nasal cavity, and lined with mucous membrane. Produces a mucus and help produce sound. PHARYNX: After passing through the nasal cavity, air then passes through the pharynx (throat). There are 3 divisions of pharynx, NASOPHARYNX contains pharyngeal tonsils or adenoids OROPHARYNX contain palatine tonsils LARYNGOPHARYNX common passageway for food from the mouth and air from the nose, it divides into larynx (voice box)and the esophagus TRACHEA: - Air passes from the larynx to the trachea (wind pipe) - its a vertical tube about 4 inches long and 1 inch in diameter - it is kept open by 16 to 20 C-shaped rings of cartilages BRONCHI: - In the mediastinum, the trachea divides into 2 branches called bronchial tubes or bronchi (singular bronchus) - they are tubes composed of delicate epithelium surrounded by cartilage rings and a muscular wall. BRONCHIOLES: - Smaller branches of the bronchi are called bronchioles ALVEOLI: - each terminal bronchiole narrows into alveolar ducts, which end in collection of air sacs called alveoli - there are about 300 million alveoli in each lung - its lined with one cell thick layer of epithelium - very thin wall permits the exchange of O2 and CO2 between the capillaries and the alveoli. PLEURA: - Each lung is covered by a double-folded membrane called pleura - parietal pleura, outer layer of the pleura near the ribs - visceral pleura, inner layer lies closer to the lung - the pleural fluid between these two layers, moistens the pleura and facilitates the movement of the lungs within the chest

LUNGS: - the right lung has 3 lobes whereas the left lung has 2 lobes - the uppermost part of the lung is the apex - the lower area of the lung is the base - the hilum of the lung is the midline region in which blood vessels, nerves, lymphatic tissue, and bronchial tubes enter and exit - the lung extends from the collarbone to the diaphragm

DIAPHRAGM: - its a muscular partition separating the thoracic from the abdominal cavity and aiding in the process of breathing - it contracts and descends with each inhalation or inspiration, the downward movement of the diaphragm decreases the internal air pressure so air flow into the lung to equalize the pressure - when the lungs are full, it relaxes and elevates, increases the internal air pressure and thereby air is expelled out of the lungs, this is exhalation or expiration

PATHWAY OF AIR FROM THE NOSE TO THE CAPILLARIES OF THE LUNG: NOSE NASAL CAVITIES AND PARANASAL SINUSES PHARYNX LARYNX TRACHEA BRONCHI BRONCHIOLE ALVEOLI LUNG CAPILLARIES PATHOLOGY DIAGNOSTIC TERMS Auscultation Percussion Pleural rub Rales (crackles) Rhonchi Sputum Stridor DESCRIPTION Listening to sounds within the body Tapping on a surface to determine the difference in the density of the underlying structure Scratchy sound produced by pleural surfaces rubbing against each other Fine crackling sounds heard on auscultation (during inhalation) when there is fluid in the alveoli Loud rumbling sounds heard on auscultation of bronchi obstructed by sputum Material expelled from the bronchi, lungs, or upper respiratory tract by spitting Strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx

Wheezes

Continuous high-pitched whistling sounds produced during breathing

UPPER RESPIRATORY DISORDERS Croup Diptheria Epistaxis Pertussis

DESCRIPTION Acute viral infection of infants and children with obstruction of the larynx, barking cough, and stridor Acute infection of the throat and upper respiratory tract caused by the diphtheria bacterium (corynebacterium) Nosebleed Whooping cough, highly contagious bacterial infection of the pharynx, larynx, and trachea caused by Bordetella pertussis

BRONCHIAL DISORDERS Asthma Bronchiectasis Chronic bronchitis Cystic fibrosis (CF)

DESCRIPTION Chronic bronchial inflammatory disorder with airway obstruction due to bronchial edema and constriction and increased mucus production Chronic dilation of a bronchus secondary to infection Inflammation of the bronchi persisting over a long time; type of chronic obstructive pulmonary disease (COPD) Inherited disorder of exocrine glands resulting in thick mucous secretions in the respiratory tracts that do not drain normally

LUNG DISORDERS Atelectasis Emphysema Lung cancer Pneumoconiosis Pneumonia Pulmonary abscess Pulmonary edema Pulmonary embolism Pulmonary fibrosis Sarcoidosis Tuberculosis (TB)

DESCRIPTION Collapsed lung, incomplete expansion of alveoli Hyperinflation of air sacs with destruction of alveolar walls Malignant tumor arising from the lungs and bronchi Abnormal condition caused by dust in the lungs, with chronic inflammation, infection, and bronchitis Acute inflammation and infection of alveoli, which fill with pus or products of the inflammatory reaction Large collection of pus in the lungs Fluid in the air sacs and bronchioles Clot or other material lodges in vessels of the lung Formation of scar tissue in the connective tissues of the lugs Chronic inflammatory disease in which small nodules develop in lungs, lymph nodes and other organs Infectious disease caused by Mycobacterium tuberculosis; lungs usually are involved, but any organ in the body may be affected

PLEURAL DISORDERS Mesothelioma Pleural effusion Pleurisy (pleuritis) Pneumothorax

DESCRIPTION Rare malignant tumor arising in the pleura Abnormal accumulation of fluid in the pleural space (cavity) Inflammation of the pleura Collection of air in the pleural space

CLINICAL PROCEDURES X-RAY TESTS Chest x-ray (CXR) Computed tomography (CT) scan of the chest DESCRIPTION Radiographic image of the thoracic cavity (chest film) Computer-generated series of x-ray images show thoracic structures cross section and other planes

MAGNETIC IMAGING MRI of the chest

DESCRIPTION Magnetic waves create detailed images of the chest in frontal, lateral, and crosssectional (axial) planes

RADIOACTIVE TESTS PET scan of the lungs Ventilation-perfusion (V/Q) scan

DESCRIPTION Radioactive glucose is injected and images reveal metabolic activity in the lungs Detection device records radioactivity in the lung after injection of a radioisotope or inhalation of small amount of radioactive gas (xenon)

OTHER PROCEDURES Bronchoscopy Endotracheal intubation Laryngoscopy Lung biopsy Mediastinoscopy Pulmonary function tests (PFTs)

Thoracocentesis Thoracotomy Thoracoscopy (thorascopy) Tracheostomy Tuberculin test Tube thoracostomy

DESCRIPTION Fiberoptic endoscope examination of the bronchial tubes Placement of a tube through the mouth in to the pharyn, larynx, and trachea to establish an airway Visual examination of the voice box Removal of lung tissue followed by microscopic examination Endoscopic visual examination of the mediastinum Tests that measure the ventilation mechanics of the lungs (airway function, lung volume, and capacity of the lungs to exchange oxygen and carbon dioxide efficiently) Surgical puncture to remove fluid from the pleural space Large surgical incision of the chest Visual examination of the chest via small incisions and use of an endoscope Surgical creation of an opening into the trachea through the neck Determines past or present tuberculous infection based on a positive skin reaction Chest tube is passed through an opening in the chest to continuously drain a pleural effusion

EXERCISE I FILL IN THE BLANKS 1. The apical part of the lung is the ---------

2. The gas that passes into the blood stream at the lungs is --------3. Breathing in air is called ---------4. Divisions of the lungs are known as ---------5. The gas produced by cells and exhaled through the lungs is --------6. The space between the visceral and parietal pleura is the -----------7. Breathing out air is called ----------8. The essential tissues of the lung that perform its main function are pulmonary --------9. The exchange of gases in the lung is ---------------- respiration 10. The exchange of gases at the tissue cells is ------------- respiration II COMPLETE THE FOLLOWING WITH THE APPROPRIATE MEDICAL TERM 1. Removal of lymph tissue in the oropharynx ---2. Surgical puncture of the chest to remove fluid from the pleural space ------------3. Surgical repair of the nose -----------4. Incision of the chest --------5. Removal of the voice box ---------6. Removal of a region of a lung -----------7. Endoscopic examination of the chest --------------8. Pulmonary resection ---------------III IDENTIFY THE CORRECT MEDICAL TERM WITH THE GIVEN DESCRIPTION 1. Excessive carbon dioxide in the blood: hyper----2. Breathing is easiest or possible only in an upright position: -----------pnea 3. Difficult breathing: ------------pnea 4. Condition of blueness of skin: -------------osis 5. Spitting up blood: hemo---------6. Deficiency of oxygen: hyp----------

7. Condition of pus in the pleural cavity: pyo---- or em---8. Hoarseness; voice impairment: dys------9. Blood in the pleural cavity: hemo-------10. Nosebleed: epi-------