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THE RESPIRATORY
SYSTEM
A FIXED LEARNING MODULE

Assoc Prof dr Hamiadji Tanuseputro

HT. JUNE. 2017

 THE RESPIRATORY SYSTEM 1

Nasal cavity RESPIRATORY TUBES

(Nose)
UPPER

Conduct AIR to and from the

lungs
Pharynx
Larynx
Trachea RESPIRATORY MOVEMENTS
LOWER

Bronchus Intake of AIR (inspiration) and

expulsion of Air (expiration)

Lung RESPIRATORY SURFACES

Exchange of GASES and blood
TRANSPORTS the gases

ANATOMICAL FUNCTIONAL
 THE RESPIRATORY
SYSTEM
THE DIVISIONS:
1. UPPER RESPIRATORY – FROM
NARES ANTERIOR TO YHE LARYNX
2. LOWER RESPIRATORY -- FROM
ADITUS LARYNGIS TO THE
ALVEOLUS
3. IN BETWEEN IS THE PHARYNX (THE
CROSSING)

REASONS: EMBRYOLOGICALLY. FUNCTIONALLY, AND

CLINICALLY (PLEASE ELABORATE)
THE NOSE
2
DESCRIBE THE SOMATOTYPES
OF THE NOSE
The best Nose for money:
-A round and fleshy tip
-well concealed nostrils

Bumpy Noses:
-know how to look after their
money
-no-one knows how much they
have
Pointed noses:
-are unreliable as a friend
-rather cruel

Crooked Noses:
-intentions not right
-weak and emotional

Flat Noses:
-hard to accumulate wealth
-have financial problem
 THE NOSE 3
GIVE THE BORDERS OF THE
NASAL CAVITY. THE FUNCTIONS?

Ethmoid bone =
basic skeleton

Note that the roof of the nasal cavity

is made up of the cribriform plate.
Also note that the floor of the nasal
cavity is made up of the palatine
processes of the maxilla.
 THE NOSE 4
DESCRIBE THE FEATURES
OF THE NASAL CAVITY.

Nares –
Vestibule –
Nasal cavity – Choanae
Olfactory
mucosa +
Respiratory
mucosa

Note that the roof of the nasal cavity

is made up of the cribriform plate.
Also note that the floor of the nasal
cavity is made up of the palatine
processes of the maxilla.
 PARANASAL SINUSES 5
GIVE THE OPENINGS OF EACH Frontal sinus Maxillary sinus

PARANASAL SINUSES.

Ethmoid sinus Sphenoid sinus

sphenoid sinus-->sphenoethmoid recess

frontal sinus-->infundibulum of middle
meatus
anterior ethmoid sinus-->middle meatus
middle ethmoid sinus-->ethmoid bulla of
middle meatus
maxillary sinus-->middle meatus
 NASAL CAVITY
6
(LATERAL WALL)
Sphenoethmoidal
DESCRIBE THE LATERAL WALL. recess

Superior concha

sphenoethmoid recess
superior concha --- superior meatus
middle concha --- middle meatus
inferior concha --- inferior meatus

Middle concha

Inferior concha
 THE NASAL CAVITY
7
DESCRIBE THE NASAL SEPTUM.
1. anterior
ethmoidal
(ophthalmic)
2. posterior
ethmoidal
(opththalmic)
3. sphenopalatine
(maxillary)
4. greater
palatine
(maxillary)
5. branch of
superior labial
(facial)
1. anterior
ethmoidal
(V1)
(nasociliary)
2. nasopalatin
e (V2)
(maxillary)
 THE PHARYNX 8
Posterior to the
DEFINE THE PHARYNX. pharynx, you
can identify the
atlas (C1), axis
(C2) and the
remaining
cervical
vertebrae.

The pharynx
functions as part of
the respiratory and
gastrointestinal
systems (a
crossing)
THE PHARYNX 9

The muscles of the pharynx consists

of three pharyngeal constrictors:
superior
middle
inferior
and the stylopharyngeus and
palatopharyngeus muscles.
THE PHARYNX & LARYNX 10

What you should be able to identify are:

nasopharynx (arrow)
oral pharynx (where tongue is seen)
laryngeal pharynx (larynx).
 11

THE LOWER
RESPIRATORY
SYSTEM
THE LOWER RESPIRATORY SYSTEM

THE ADITUS LARYNGIS

IS THE BEGINNING OF
THE LOWER
RESPIRATORY SYSTEM

THE ALVEOLUS IS THE

ENDING (FUNCTIONAL
PART)
THE LARYNX 12

The skeleton of
the larynx is
made up of the
hyoid bone and
several
cartilages.
THE LARYNX 13
Three singles: Epiglottis, Thyroid, Cricoid

Three pairs: Arythenoids, Corniculates,

Cuneiforms, and “Triticeas”
 THE LARYNX 14
(INTRINSIC MUSCLES)

Posterior
cricoarytenoid
(abducting the
Connective
vocal cord)
tissue
membranes:
Thyrohyoid
membrane,
Quadrangular
membrane, Cricothyroid
Cricothyroid (tensing the
membrane (or vocal cord)
Conus
elasticus)
 THE LARYNX 15
(ACTION OF INTRINSIC MUSCLES)

Cricothyroid
Lateral
cricoarythenoid
Posterior
cricoarythenoid

Transvers
arythenoid

Vocalis

Most of the muscles adduct the vocal cord

EXAMINATION OF GLOTTIS 16

Motor innervations
external laryngeal (X)
recurrent laryngeal (X)
Sensory innervations
internal laryngeal (X)
sensory above the
false vocal cords
recurrent laryngeal (X)
sensory below the
false vocal cords

The glottis THE NARROWEST PART is

bordered by Ventricular fold and Vocal
fold
EXAMINATION OF GLOTTIS 17
 THE LUNGS 18
(IN SITU)
STUDY THE LUNGS IN SITU
 THE LUNGS 19
(IN SITU)
Sterno
clavicular

2nd rib
4th rib

6th rib

8th rib

12th rib

Pleural
recess

DRAW THE PARIETAL

PLEURA REFLEXION.
 THE LUNGS 20
DEFINE THE BRONCHOPULMONARY
SEGMENT.
Each lobar bronchus then branches to
WHAT IS ITS SIGNIFICANCE.
form segmental bronchi, each of which
supplies one bronchopulmonary
segment (10 in the right lung and 8 in the
left lung). These segmental bronchi are
actually referred to as first generation
segmental bronchi.

The bronchopulmonary segment is the

anatomical, functional, and surgical
unit/subdivision of the lung and refers to
the portion of the lung supplied by each
segmental/tertiary bronchus and
segmental/tertiary artery.
A surgeon can remove one segment without
seriously disrupting surrounding segments.
 21
BRONCHO-PULMONARY SEGMENTS

The
bronchopulmona
ry segment is the
anatomical,
functional, and
surgical
unit/subdivision
of the lung and
refers to the
portion of the lung
supplied by each
segmental/tertiary
bronchus and
segmental/tertiary
artery.

A surgeon can remove one segment without seriously

disrupting surrounding segments.
ROOT OF THE LUNG 22
(and impressions)

Pulmonary aa & vv

azygos vein and its descending aorta

arch (over the root arch of the aorta
of the lung) over the root of the
phrenic nerve lung, left subclavian
anterior to the root artery
of the lung phrenic nerve
vagus nerve anterior to the root
posterior to the root of the lung
of the lung vagus nerve
esophagus posterior to the root
of the lung
23
LUNG LOBULE 24

Each lung lobule

is supplied by a
single terminal
bronchiole

Each terminal
bronchiole formed
by the dividing of a
segmental
bronchus supplies
a unit of the lung
called a lung
lobule. The lung
lobule is the basic
functional unit of
the lung.
 25

STUDY THE PULMONARY

LOBULE.
 26

Type I Pneumocytes: are very flat

squamous cells that are so thin that
their cytoplasm cannot be seen in
the light microscope. Apart from the
perinuclear region, these cells are
less than 0.2 μm thick which
facilitates the diffusion of gases
across their cytoplasm.
 27

Type II Pneumocytes: are

connected to the type I cells by
tight junctions and are
distinguished by their discernible
cytoplasm and more rounded
appearance. Have a round
nucleus and their cytoplasm
tends to bulge somewhat into the
lumen. These are secretory cells,
whose major product is
pulmonary surfactant.
28
29
THE ALVEOLUS 30

Adjacent alveoli share a common

wall called the interalveolar
septum which contains the
capillary system of the
pulmonary circulation. Adjacent
alveoli also communicate by
small apertures (i.e., <10 μm in
diameter) within the
interalveolar septa called
alveolar pores.

Interalveolar Septum: refers to the

tissue which separates adjacent
alveoli. It contains the extensive
alveolar capillary plexus and thus
represent the site where the
diffusion of gases takes place
between alveolar air and capillary
blood.
 31
MECHANISM OF RESPIRATION

Inspiration (normally active):

Thoracic (intercostal nerves)
- Upper 6 prs ribs – increase a-p diameter – pump handle movements
- Lower 7 to 10 prs ribs – increase lateral diameter – bucket handle movements

Abdominal (phrenic nerves)

- Diaphragm – increases inferior-superior dimension

Expiration (normally passive):

- Due to recoil of lungs and tissues

Note: In forced respiration accessory muscles come into action!!

 Respiratory centres & Reflex centres
32

The Pneumatic
and Apneustic
centres adjust
the output of the Higher centres can
rhythmicity influence
centre, thereby respiration through
modifying the pneumatic centre.
pace of Pyramidal provides
respiration. conscious control to
resp. muscles, but
Pneumatic
centre usually by
extrapyramidal
Apneustic
centre pathways (reticular
The Rhythmicity
formation).
centres set the basic
Inspiratory ctr
pace and depth of
respiration. Exspiratory ctr
 DEVELOPMENT OF THE LUNGS 33
RESPIRATORY DIVERTICULUM : ---- Larynx and Trachea
(endodermal)

LUNG BUDS : ---- primary bronchus, secondary br., tertiary br.,

bronchioles, terminal bronchioles, respiratory
bronchioles, alveolar ducts, alveoli. (20-24 orders).

MATURATION OF THE LUNGS:

- Pseudo glandular Period (5-17 weeks) ---
- Canalicular Period ( 16-25 weeks)
- Terminal Sac Period (24- birth)
- Alveolar Period (Late fetal period)
resemble an exocrine gland
Respiration not possible
--- respiratory bronchioles and alveolar
ducts present.
Respiration possible.
--- thin alveolar epithelium
Type I cells (pneumocytes);
Type II cells (secrete surfactant).
Fetus can survive.
--- alveolocapillary membrane
(respiratory membrane)
Gas exchange possible.
 34
* Characteristics of mature alveoli will develop after birth!!
* Alveoli in the full-term infant is about 1/6 of the adult
* At birth about half the lungs filled with fluid (amniotic fluid, mucus
from trachea, which will be cleared by; pressure (during delivery),
blood capillaries, and lymphatics.
* A thin alveolocapillary membrane (Type I cells) and surfactant
(Type II cells) maintain the alveoli open (thus respiration).
* A deficiency in surfactant causes hyaline membrane disease ---
respiratory distress syndrome.

Note: STUDY THE BRANCHING OF THE BRONCHIAL TREE.

BRONCHOPULMONARY SEGMENT.
CONGENITAL ANOMALIES OF OESOPHAGUS - TRACHEA.
 35

THANK YOU

FOR YOUR PATIENCE

HT JAN 2012