Respiratory system:

ANATOMY
Alicia Yolandra
0910710031
PD-A FKUB 2009
R.201

TASK 1 : Functional division of respiratory system
a. Pembagian fungsional sistem respirasi
Dibagi menjadi 2 :
Bagian konduksi
Terdiri dari rongga hidung, nasopharynx, larynx, trakea, bronchus, bronchioles pre-terminalis dan terminalis.
Berfungsi untuk menjaga udara yg masuk tetap bersih, lembab/ basah, dan hangat. Bagian ini memiliki dinding
yang kaku dan tetap terbuka.
Bagian respirasi
Terdiri dari bronchioles respiratorius, duktus alveolus, atria, saccus alveolus, dan alveolus.
Berfungsi dalam membantu pertukaran gas CO2 dan O2 dalam paru-paru.

b. Korelasi antara sistem respirasi dengan sistem kardiovaskular
Jantung terletak berdekatan dengan paru-paru, terutama dengan paru-paru kiri. Mereka sama-sama berada
pada bagian thorax. Oksigen pada darah yang diperlukan jantung untuk dialirkan ke seluruh tubuh berasal dari paru-
paru. Hubungan ini terjadi dibantu dengan adanya vena pulmonalis. Sedangkan karbondioksida yang terdapat pada
darah yang kotor dibuang ke paru-paru oleh jantung melalui arteri pulmonalis. Setelah itu, karbondioksida dibuang
ke udara melalui sistem pernafasan bagian atas.

c. Pembagian klinis sistem respirasi
Dibagi menjadi 2 :
Upper respiratory system
Berasal dari pharyngeal apparatus. Terdiri dari hidung, nasal cavity, sinus paranasal, dan pharynx. Semuanya
termasuk bagian sistem konduksi.
Lower respiratory system
Berasal dari foregut. Dimulai dari larynx, lalu ke trachea, bronchi, dan berakhir di paru-paru. Sebagian
termasuk bagian konduksi, tapi ada juga yg mencakup bagian respirasi

TASK 2 : Histologi dan fungsi epitel respirasi
- Cavum nasi (vestibulum, cavum nasi, region olfaktorius (1/3 atas), dan sinus paranasalis): epitel pseudostratified
columnar yang bersilia Partikel (debu, bakteri) yang akan masuk ke cavum nasi tersapu ke luar oleh cilia.
- Epiglottis:
Sisi oral/ pharyngeal: Squamous complex non-kornifikasi
Sisi laryngeal: Pseudo kompleks kolumnar bersilia (dgn goblet sel untuk mensekresi glycoprotein) & Skuamus
kompleks non-kornifikasi (sebagian, lebih tipis dari sisi oral)
- Nasopharynx s/d bronchioles preterminal: Dari proximal ke distal, terdiri dari epithel pseudostratified columnar,
columnar, cuboid, dan squamous, diikuti cilia yg makin ke distal makin sedikit. Trachea & bronchus, sebagai jalur
pernafasan yg cukup besar dan penting, didukung oleh unsur-unsur kerangka dalam bentuk cincin yang terbuat
dari tulang rawan, supaya tidak collapse karena tekanan saat proses respirasi.
- Bronchioles terminal: epithel columnar simplex, tapi disertai lapisan otot yg paling tebal.
- Bronchioles respiratorius: Epithel cuboid dgn cilia yg makin ke distal makin sedikit
- Alveoli: epitel squamous simpleks (memfasilitasi difusi oksigen dan CO
2
), & sel cuboidal (mensekresi surfaktan).
Surfaktan ini mengatasi kecenderungan dinding alveolar untuk mengikuti satu sama lain (yang akan melenyapkan
ruang udara)
*Brush cell (modifikasi dari epithel pseudostratified columnar) pada bagian yg cilia nya sedikit. Selain memiliki
microvilli, juga punya ujung saraf sensoris
*Small granule cell memiliki

TASK 3: Cavum pleurae and pleurae
a. Jelaskan tentang tipe pleura, cavum pleura dan pleural fluid
Tipe pleura ada 2 macam:
o pleura visceralis: bagian dari pleura yang membungkus paru dan melapisi fisuranya sehingga paru
terpisah menjadi beberapa lobus yang berbeda. Dipersarafi saraf otonom Peka terhadap tarikan,
tida peka rasa sakit
o pleura parietalis: bagian dari pleura yang melapisi dinding rongga toraks. Dipersarafi oleh
n.intercostalis & phrenicus Peka terhadap rasa sakit
Keduanya terdiri dari sel mesothel yg menempel pada lapisan jar.ikat yg terdiri dari kolagen & serat elastis
Cavum pleura: ruangan yang di bentuk diantara dua lapisan pleura,yang secara normal terdiri dari sedikit
pleural fluid. Thoracocentesis bisa dilakukan pada recessus diaphragmatica setinggi costae 9-10 di mid
axillary line
Pleural fluid: merupakan cairan serosa yang diproduksi secra normal oleh pleura, kebanyakan cairan
tersebut diproduksi oleh sirkulasi pada bagian parietal (arteri intercostals) via bulk flow dan di reabsorbsi lagi
oleh system lymphatic, cairan ini diproduksi dan di rearbsobsi secara continue.

b. Jelaskan tentang bagian pleura parietalis
Pleura parietalis terdiri dari:
pars cervicalis
pars costalis
pars mediastinalis
pars diaphragmatica
c.Jelaskan tentang recessus costomediastinal dan recessus costodiphragmatica
Paru-paru tidak sepenuhnya mengisi rongga pleura anterior, posterior atau inferior. Hal ini mengakibatkan
terbentuknya recessus pada dua lapisan pleura parietal yang berlawanan.
recessus costomediastinalis bagian ventral pada tempat peralihan pleura costalis menjadi pleura mediastinalis.
Pada inspirasi max. tepi ventromedial lobus paru dx akan mengisi seluruhnya sedangkan pada paru sin karena
tumpul dan lebih besar maka tidak pernah mengisi penuh.
recessus costodiaphragmatica terdapat pada peralihan pleura costalis menjadi pleura diaphragmatica dan
merupakan regio antara margin inferior paru dengan margin inferior rongga pleura. Ruangan ini sangat dalam
hingga pada inspirasi max sekalipun pd paru-paru dx-sn tidak akan mengisi penuh (tempat ideal untuk pungsi).
Inspirasi biasa: mid-clavicular line 6, mid axillar 8, T10
Forced inspiration: mid-clavicular line 8, mid axillar 10, T12
TASK 4: the trachea
a. Gambarkan tentang struktur anatomi dari trachea
Trakhea disebut juga pipaudara yang menghubungkan faring dan laring sehingga menuju ke paru. Trakea
mempunyai lingkar diameter dalam sekitar 20-25 millimetres dan panjang sekitar 10-16 centimetres. Trakea
bergabung dengan laring pada level vertebra cervical ke5 dan membentuk cabang bronchi primer pada vertebrae
level T4 atau T5. Disana terdapat bentukan huruf C yang tidak sempurna berjumlah 15-20 ring yang merupakan
tulang rawan sehingga melindungi trachea bagian depan dan samping untuk jalannya udara. Otot2 trakhea
menghubungkan ring C yang tidak sempurna tadi.




b. Describe the structural histology of the trachea


Epitel yang melapisi sebelah dalam ialah epitel silindris semu berlapis bercilia dan bertumpu pada membrane basalis
yang tebal. Di antara sel-sel tersebar sel-sel piala (sel goblet). Dibawah membrane basalis terdapat lamina propria
yang banyak mengandung serabut elastis. Di lapisan dalam lamina propria serabut elastis membentuk anyaman
padat sebagai suatu lamina elastica, maka jaringan pengikat dibawahnya kadang-kadang disebut tunica submukosa.
Di dalam tunica submukosa inilah terdapat kelenjar-kelenjar kecil (seromukosa) seperti pada dinding larynx yang
bermuara pada permukaan epitel. Tracheal cartilage dilapisi perichondrium

c. explain about the function or the benefit of the c-shaped cartilage's structures and its opening.
Ligamen fibroelastis dan berkas otot polos terikat pada periosteum dan menjembatani kedua ujung bebas
tulang rawan berbentuk C. Ligamen tersebut mencegah distensi berlebihan dari lumen, sedangkan otot polos
memungkinkan pengaturan lumen. Kontraksi otot dan penyempitan lumen trakea yang ditimbulkan terjadi pada
refleks batuk (lumen mengecil akibat kontraksi meningkatkan tekanan aliran udara ekspirasi membersihkan
jalan napas).

TASK 5 : The Bronchial Tree

a. explain about bronchus extrapulmonalis and bronchus intrapulmonalis
Bronkus ekstrapulmonal adalah bronkus di luar parenkim paru, yaitu bronkus primer. Terdiri dari:
- cincin kartilago berbentuk c
- otot, khususnya pada bagian posterior. Bagian anteriornya diisi kartilago & ligament annular
- membrane mukosa tidak memiliki lipatan
- Lamina propria terdiri dari jar.ikat kendor yg mangandung serabut elastic. Terdapat infiltrasi dari sel limfosit
Bronkus intrapulmonal bronkus di dalan jaringan paru, yaitu bronkus sekunder (lobaris) dan bronkus tersier
(segmentalis). terdiri dari:
- insular cartilage (mengelilingi bronkus, tetapi berbentuk pulau2)
- Otot mengelilingi seluruh lumen
- Membran mukosa nya melipat secara longitudinal
- Lamina propria nya terdiri dari jar.ikat kendor yg mengandung serabut elastic & retikuler, yg berjalan
longitudinal

b. explain the differences between bronchus primaries dextra et sinistra

The Right Bronchus (bronchus dexter), wider, shorter, and more vertical in direction than the left, is about
1.25 cm. long, and enters the right lung nearly opposite the fifth thoracic vertebra. The azygos vein arches over it
from behind; and the right pulmonary artery lies at first below and then in front of it. About 2 cm. from its
commencement it gives off a branch to the upper lobe of the right lung. This is termed the eparterial branch of the
bronchus, because it arises above the right pulmonary artery. The bronchus now passes below the artery, and is
known as the hyparterial branch; it divides into two branches for the middle and lower lobes. Sudut masuk ke
bronchioles: 20
o
The Left Bronchus (bronchus sinister) is smaller in caliber but longer than the right, being nearly 5 cm. long.
It enters the root of the left lung opposite the sixth thoracic vertebra. It passes beneath the aortic arch, crosses in
front of the esophagus, the thoracic duct, and the descending aorta, and has the left pulmonary artery lying at first
above, and then in front of it. The left bronchus has no eparterial branch, and therefore it has been supposed by
some that there is no upper lobe to the left lung, but that the so-called upper lobe corresponds to the middle lobe of
the right lung. Sudut masuk ke bronchioles: 35
o
(http://education.yahoo.com/reference/gray/subjects/subject/237).

c. Find a picture and explain about the bronchial tree or the branches of bronchus primaries.



Cabang trakea didalam mediastinum berasal kanan dan kiri primary bronci. Internal ridge disebut carina yang
memisahkan dua bronchi tersebut. Seperti trachea primary bronchi memiliki kartilago yang berbentuk C-shape
supporting rings. Primary bronchus sebelah kanan menyuplai paru-paru sebalah kanan dan primary bronchus
sebelah kiri menyuplai paru-paru kiri. Primary bronchus sebelah kanan memiliki diameter yang lebih besar dari
sebelah kiri, dan menurun kebawah dengan sudut yang meninggi. Sehinga memungkinkan benda asing yang masuk
lebih sering masuk ke bronchus kanan dari pada kiri. Sebelum cabang berlanjut, tiap primary bronchus berjalan ke
mengikuti alur dari permukaan medial dari paru-paru. Alur tersebut, merupakan hilum dari paru-paru, jug a
menyediakan akses untuk memasuki pulmonary vessel, nerve, dan lymphatics. Keseluruhan susuan tersebut
tersusun dengan kuat pada meshwork dari dense connective tissue. Kompleksini, cabang paru-paru menempel ke
mediastinum dan menguatkan posisi dari major nerve,blood vessels, dan lymphatic vessels .
Cabang paru-paru : anterior kevertebre T5(kanan) dan T6 (kiri).

d. Explain further about the branches of bronchus segmentalis until saccusalveolaris.
Tiap bronchus primer dibagi menjadi secondary bronchus yang memasuki paru-paru, caabang sekunder
membentuk tertiary bronchi, atau segmental bronchi. Pola cabang berbeda antara ke dua paru-paru, tiap tertiary
bronchus menyuplai udara ketiap-tiap bronchopulmonary segmen, region spesifik dariparu-paru. Paru-paru kanan
mempunyai 10 bronchopulmonarysegmen. Selama pertumbuhan, paru-paru kiri juga memiliki 10 segmen, tetapi
perpaduan dari tertiary bronchi yang berdekatan secara umum akan menguarngi jumlah segmen menjadi 8 atau 9.
Tiap tertiary bronchus bercabang beberapa kali didalam bronchopulmunary segmen, membentuk multiple
bronchioles yang akan berlanjut membentuk cabang yg meruncing yang disebut terminal bronchioles.

e. What is the main difference between the bronchus and bronchiulus?
Dengan bercabangnya bronchus, maka diameternya akan semakin mengecil, yang menyebabkan gambaran
stukturnya akan semakin berbeda karena lempeng-lempeng cartilage yang makin berkurang.
Kalau struktur pulmo disamakan seperti kelenjar, maka bronchus merupakan ductus extraloburalis, sebab
terdapat diluarlobuli.
Cabang bronchus yang memasuki lobules pada puncaknya disebut bronchiolus yang sesuai dengan ductuS
sintra lobularis pada kelenjar.
Biasanya dinding brochiolus berdiameterlebihkecildari 1mm dengan epitel silindris selapis bercilia dan tanpa
cartilago.

TASK 6 : The Lungs

Find a picture and explain about :
a. The division and surface anatomy of the lungs ( includes the lobe, fissures, apex, base, surface, borders)



LOBES
The left lung is divided into two lobes, an upper and a lower, by an interlobular fissure, which extends from
the costal to the mediastinal surface of the lung both above and below the hilus. As seen on the surface, this fissure
begins on the mediastinal surface of the lung at the upper and posterior part of the hilus, and runs backward and
upward to the posterior border, which it crosses at a point about 6 cm. below the apex. It then extends downward
and forward over the costal surface, and reaches the lower border a little behind its anterior extremity, and its
further course can be followed upward and backward across the mediastinal surface as far as the lower part of the
hilus. The superior lobe lies above and in front of this fissure, and includes the apex, the anterior border, and a
considerable part of the costal surface and the greater part of the mediastinal surface of the lung. The inferior lobe,
the larger of the two, is situated below and behind the fissure, and comprises almost the whole of the base, a large
portion of the costal surface, and the greater part of the posterior border.
The right lung is divided into three lobes, superior, middle, and inferior, by two interlobular fissures. One of
these separates the inferior from the middle and superior lobes, and corresponds closely with the fissure in the left
lung. Its direction is, however, more vertical, and it cuts the lower border about 7.5 cm. behind its anterior
extremity. The other fissure separates the superior from the middle lobe. It begins in the previous fissure near the
posterior border of the lung, and, running horizontally forward, cuts the anterior border on a level with the sternal
end of the fourth costal cartilage; on the mediastinal surface it may be traced backward to the hilus. The middle
lobe, the smallest lobe of the right lung, is wedge-shaped, and includes the lower part of the anterior border and the
anterior part of the base of the lung.
The right lung, although shorter by 2.5 cm. than the left, in consequence of the diaphragm rising higher on
the right side to accommodate the liver, is broader, owing to the inclination of the heart to the left side; its total
capacity is greater and it weighs more than the left lung.

APEX
The apex (apex pulmonis) is rounded, and extends into the root of the neck, reaching from 2.5 to 4 cm.
above the level of the sternal end of the first rib. A sulcus produced by the subclavian artery as it curves in front of
the pleura runs upward and lateralward immediately below the apex.
BASE
The base (basis pulmonis) is broad, concave, and rests upon the convex surface of the diaphragm, which
separates the right lung from the right lobe of the liver, and the left lung from the left lobe of the liver, the stomach,
and the spleen. Since the diaphragm extends higher on the right than on the left side, the concavity on the base of
the right lung is deeper than that on the left. Laterally and behind, the base is bounded by a thin, sharp margin which
projects for some distance into the phrenicocostal sinus of the pleura, between the lower ribs and the costal
attachment of the diaphragm. The base of the lung descends during inspiration and ascends during expiration.

SURFACE
The costal surface (faciescostalis; external or thoracic surface) is smooth, convex, of considerable extent, and
corresponds to the form of the cavity of the chest, being deeper behind than in front. It is in contact with the costal
pleura, and presents, in specimens which have been hardened in situ, slight grooves corresponding with the
overlying ribs.
The mediastinal surface (faciesmediastinalis; inner surface) is in contact with the mediastinal pleura. It
presents a deep concavity, the cardiac impression, which accommodates the pericardium; this is larger and deeper
on the left than on the right lung, on account of the heart projecting farther to the left than to the right side of the
median plane. Above and behind this concavity is a triangular depression named the hilum, where the structures
which form the root of the lung enter and leave the viscus. These structures are invested by pleura, which, below the
hilus and behind the pericardial impression, forms the pulmonary ligament. On the right lung (Fig. 972), immediately
above the hilus, is an arched furrow which accommodates the azygos vein; while running upward, and then arching
lateralward some little distance below the apex, is a wide groove for the superior vena cava and right innominate
vein; behind this, and nearer the apex, is a furrow for the innominate artery. Behind the hilus and the attachment of
the pulmonary ligament is a vertical groove for the esophagus; this groove becomes less distinct below, owing to the
inclination of the lower part of the esophagus to the left of the middle line. In front and to the right of the lower part
of the esophageal groove is a deep concavity for the extrapericardiac portion of the thoracic part of the inferior vena
cava. On the left lung (Fig. 973), immediately above the hilus, is a well-marked curved furrow produced by the aortic
arch, and running upward from this toward the apex is a groove accommodating the left subclavian artery; a slight
impression in front of the latter and close to the margin of the lung lodges the left innominate vein. Behind the hilus
and pulmonary ligament is a vertical furrow produced by the descending aorta, and in front of this, near the base of
the lung, the lower part of the esophagus causes a shallow impression.

BORDERS
The inferior border (margo inferior) is thin and sharp where it separates the base from the costal surface and
extends into the phrenicocostal sinus; medially where it divides the base from the mediastinal surface it is blunt and
rounded.
The posterior border (margo posterior) is broad and rounded, and is received into the deep concavity on
either side of the vertebral column. It is much longer than the anterior border, and projects, below, into the
phrenicocostal sinus.
The anterior border (margo anterior) is thin and sharp, and overlaps the front of the pericardium. The
anterior border of the right lung is almost vertical, and projects into the costomediastinal sinus; that of the left
presents, below, an angular notch, the cardiac notch, in which the pericardium is exposed. Opposite this notch the
anterior margin of the left lung is situated some little distance lateral to the line of reflection of the corresponding
part of the pleura.

b. The radix pulmonalis


The Root of the Lung (radix pulmonis).A little above the middle of the mediastinal surface of
each lung, and nearer its posterior than its anterior border, is its root, by which the lung is
connected to the heart and the trachea. The root is formed by the bronchus, the pulmonary artery,
the pulmonary veins, the bronchial arteries and veins, the pulmonary plexuses of nerves, lymphatic
vessels, bronchial lymph glands, and areolar tissue, all of which are enclosed by a reflection of the
pleura. The root of the right lung lies behind the superior vena cava and part of the right atrium,
and below the azygos vein. That of the left lung passes beneath the aortic arch and in front of the
descending aorta; the phrenic nerve, the pericardiacophrenic artery and vein, and the anterior
pulmonary plexus, lie in front of each, and the vagus and posterior pulmonary plexus behind each;
below each is the pulmonary ligament.
The chief structures composing the root of each lung are arranged in a similar manner from before
backward on both sides, viz., the upper of the two pulmonary veins in front; the pulmonary artery
in the middle; and the bronchus, together with the bronchial vessels, behind. From above
downward, on the two sides, their arrangement differs, thus:
On the right side their position iseparterial bronchus, pulmonary artery, hyparterial bronchus,
pulmonary veins, but on the left side their position ispulmonary artery, bronchus, pulmonary
veins. The lower of the two pulmonary veins, is situated below the bronchus, at the apex or lowest
part of the hilus.

c. The hillus pulmonalis

The mediastinal surface (facies mediastinalis; inner surface) is in contact
with the mediastinal pleura. It presents a deep concavity, the cardiac
impression, which accommodates the pericardium; this is larger and
deeper on the left than on the right lung, on account of the heart
projecting farther to the left than to the right side of the median plane.
Above and behind this concavity is a triangular depression named the
hilum, where the structures which form the root of the lung enter and
leave the viscus. These structures are invested by pleura, which, below
the hilus and behind the pericardial impression, forms the pulmonary
ligament. On the right lung, immediately above the hilus, is an arched
furrow which accommodates the azygos vein; while running upward,
and then arching lateralward some little distance below the apex, is a
wide groove for the superior vena cava and right innominate vein;
behind this, and nearer the apex, is a furrow for the innominate artery.
Behind the hilus and the attachment of the pulmonary ligament is a vertical groove for the esophagus; this groove
becomes less distinct below, owing to the inclination of the lower part of the esophagus to the left of the middle
line. In front and to the right of the lower part of the esophageal groove is a deep concavity for the extrapericardiac
portion of the thoracic part of the inferior vena cava. On the left lung, immediately above the hilus, is a well-marked
curved furrow produced by the aortic arch, and running upward from this toward the apex is a groove
accommodating the left subclavian artery; a slight impression in front of the latter and close to the margin of the
lung lodges the left innominate vein. Behind the hilus and pulmonary ligament is a vertical furrow produced by the
descending aorta, and in front of this, near the base of the lung, the lower part of the esophagus causes a shallow
impression.

d. Bronchus eparterialis dan hyparterialis

The right bronchus gives off, about 2.5 cm. from the
bifurcation of the trachea, a branch for the superior lobe.
This branch arises above the level of the pulmonary
artery, and is therefore named the eparterial bronchus.
All the other divisions of the main stem come off below
the pulmonary artery, and consequently are termed
hyparterial bronchi. The first of these is distributed to
the middle lobe, and the main tube then passes
downward and backward into the inferior lobe, giving off
in its course a series of large ventral and small dorsal
branches. The ventral and dorsal branches arise
alternately, and are usually eight in numberfour of
each kind. The branch to the middle lobe is regarded as
the first of the ventral series.