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"Life is not the amount of breaths you

take; it's the moments that take your


breath away."
Will Smith,
Embriologi paru
Fase pembentukan paru

• Pembentukan paru terdiri atas 5 tahap


mnemonics nya
Every Pulmonologist Can See Alveoli.
Embrional Pseudoglandular canalicular saccular Alveolar
Fase pembentukan paru
Fase pembentukan paru
Kelainan Fase pembentukan paru

• Defisiensi surfaktan  ↑ tekanan


 alveoli kolaps (terdapat
gambaran ground glass
appereance)
• Faktor resiko : prematuritas, C-
section (↓pelepasan
glukokortikoid),
• Terapi : pemberian steroid
Anatomi paru
1. nares anterior
2. Cavum nasi
3. Nares posterior
4. Nasofaring Sal napas atas
5. Orofaring
6. Laringofaring
Zona konduksi
7. Laring
8. Trakea
9. Bronkus principalis/primer
10. Bronkus lobaris/sekunder
11. Bronkus segmentalis/tersier Sal napas
12. Bronkiolus terminalis bawah
13. Bronkiolus respiratorius
14. Ducktus alveolaris
Zona respirasi
15. Saccus alveolaris
16. alveoli

• zona konduksi : tidak mengandung alveoli, tidak ambil bagian pada pertukaran gas,
sebagai ruang rugi anatomi
• zona respirasi : mengandung alveoli, terjadi proses pertukaran gas
hidung

Nose
Terdiri atas 2 bagian yaitu:
1) Hidung Luar (external nose)
2) Cavum Nasi yang terbagi atas kana dan Nasal
kiri oleh septum nasi. septum
Hard
Fungsi :
External plate
I) Olfaction (smelling)
nose
II) Air passage
III) Filtration of dust
IV) Humidification & warming of inspired air
V) Reception & elimination of secretions
from paranasal sinuses & nasolacrimal
ducts.
Different regions of Nasal
cavities have different functions

Olfactory regions

Respiratory regions

Nasal vestibules
anterosuperior
Ophtalmic
A.
posteroinferior

1)Anterior ethmoidal A. Maxillary


A.
&
2)Posterior ophthalmic A.

1)Sphenopalatine artery ( from


maxillary artery)

2)Greater palatine artery (from


maxillary artery)
faring

*
Faring
Organ yang dibentuk
jaringan fibromuskuler.
Panjang 15 cm
Terbagi 3 :
•Nasofaring
•Orofaring
•Laringofaring

Faring terbentang dari


basis cranii sampai bag.
Bawah cricoid laring
setinggi C6
Nose

Oropharynx

Larynx
Larynx
Position:
Anterior neck at the level of C3-C6 vertebrae, Connect oropharynx with trachea.
Function:
1) Organ produksi suara (voice box)
2) Sebagai katup dari saluran pernapasan bawah , terutama saat menelan
Kerangka laring dibentuk oleh kartilago yang dihubungan oleh membran dan
ligamentum dan digerakkan oleh otot

Median MRI of head

C3
epiglottis

C6 epiglottis
Sagittal section
of head & neck
1) Thyroid
2) Cricoid Laryngeal skeleton consists:
3) Epiglottic 9 cartilages
4) Arytenoid
5) Corniculate
6) Cuneiform 3

3
3

1
1
1 5
4 4

2
2 2

Lat Pos

Ant
Thyroid cartilage

•The largest, single


•Superior border : opposite 4 vertebra

Superior horn
Thyroid notch Superior horn

Laryngeal
prominence
(Adam’s apple)
Oblique line
inferior horn
Lamina
inferior horn

Anterior posterior lateral


view view view
Cricoid
&
anterosuperior view
Arytenoid cartilages:
paired, 3-sided pyramidal cartilages
corniculate
cartilage

Arytenoid articular
surface of cricoid
cartilage

muscular process of
lamina of cricoid arytenoid cartilage
cartilage

Arch of cricoid
cartilage

Vocal process of
arytenoid cartilage

anterosuperior
Anterior view
Cricoid cartilage
For articulation
with arytenoid
cartilage

anterosuperior view
For articulation
with arytenoid
cartilage
For articulation
with thyroid
For articulation cartilage
with arytenoid lamina
cartilage

cricothyroid

For articulation arch


with thyroid
Posterior
cartilage Anterior
cricoarytenoid
Posterior aspect Left lateral aspect
Epiglottic cartilage

Arytenoid cartilages
Anterolateral view of the laryngeal
cartilages and ligaments

1. Thyrohyoid membrane(superior
Hyoid
border & suprior horn attach to
Thyrohyoid
hyoid) membrane Lateral
2. Median cricothyroid thyrohyoid
ligament(inferior margin of lig.

thyroid to cricoid)

3. Cricotracheal ligament(cricoid Thyroid


cartilage
to first tracheal ring)
Median cricothyroid lig.

Cricoid
cartilage
Cricotracheal Cricothyroid joint
Lig
Lateral view of the laryngeal
cartilages and ligaments
Cartilages of larynx
Sagittal section
epiglottis

Hyoid bone Hyoepiglottic


ligament

Thyrohyoid
membrane

Corniculate
posterior
Thyroid
cartilage cartilage lamina
arytenoid
cartilage

Muscular
process Thyroepiglottic
Vestibular ligament
ligament Vocal
process
Vocal
ligament
Cricoid
cartilage

Trachea
Cartilages of larynx
Sagittal section
Sagittal section
of head & neck

Epiglottis,
Cartilago elastis terletak di
belakang radix lingua.
Valekula adalah cekungan
pada membran mukosa
kanan kiri plica
glossoepiglotika
posterior anterior

Sagittal section showing the interior aspect of the left half of the larynx
Fibroelastic membrane of the larynx
Quadrangular + Cricovocal (Conus elasticus)

epiglottis

Thyroepiglottic Laryngeal Hyoid bone


ligament vestibule
Quadrangular Thyrohyoid
Thyroid
membrane membrane
cartilage
Quadrangular
Vestibular Conus elasticus
membrane
ligament Cricovocal membrane
Vocal
Vestibular
ligament
fold
Rima Laryngeal
Corniculate glottidis
cartilage Infraglottic ventricle
Arytenoid cavity
cartilage Vocal fold

Conus elasticus Cricoid


Cricovocal membrane cartilage

Coronal section through the larynx and the


cranial end of the trachea: posterior aspect.
Superior view

Vestibular fold
Vocal fold
Rima Glottidis

posterior
posterior

Inervasi laryng : saraf sensorik di atas plica vocalis -> n. Laryngeus internus
di bawah plica vocalis -> n. Laryngeus superior

vaskularisasi laryng : di atas plica vocalis ->r. Laryngeus sup a thyroidea sup
di bawah -> r. Laryngeus inferior a thyroidea inf
Trakea

trachea,
Terletak dari anterior esophagus
sampai setinggi angulus sterni.
Bercabang jadi bronkus principalis
dex et sin
Bifucartio trachea dinamakan
carina
Lateral view

Superior mediastinum

Sternal angle

Vaskularisasi : a. Thyroidea inf


Inervasi : cabang n. Vagus, n.
Laryngeus reccurens, truncus
symphaticus
Thoracic
apertures
T1
superior thoracic aperture(thoracic inlet)
•pos: T1
•Lat: 1st rib
•Ant: superior border of manubrium)

Inferior thoracic aperture(thoracic outlet)


•Pos: T12
•Pos lat: 11th &12th ribs
•Ant lat: costal cartilages of ribs 7-10,
forming costal margins
•Ant: xiphisternal joint
anterior view Posterior view

Right main
bronchus:
wider,shorter,
runs more vertically

left main bronchus:


Inferior to arch of aorta
runs more horizentally
Anterior
Horizental section of trachea

posterior
Bronchoscopic view of
distal trachea and carina
Cadaveric lungs:firm to Healthy lungs: light, soft, spongy &
touch, discolored in appearance, fully occupy pulmonary cavities
shrunken (approximately 1/3
their size).
Right lung(larger,heavier,shorter, wider) left lung

Oblique
fissure
Superior
lobe

horizental Oblique
fissure fissure

inferior
lobe
Lungs
•Are separated from each other
by the mediastinum.

Lungs
•Are attached to mediastinum
by the roots of lungs.

mediastinum
Roots of lungs:
1. Bronchi
2. Pulmonary arteries
3. Superior & inferior pulmonary veins
4. Pulmonary plexus of nerves(sympathetic,
parasympathetic, visceral afferent fibers)
5. Lymphatic vessels

L.pulmonary
artery
R. pulmonary
artery R. Pulmonary
veins
R. Pulmonary
veins

Right & left


main bronchus
Right bronchus
(middle of posterior boundary)

Right pulmonary artery


(superiormost)
superior right
pulmonary vein
(anteriormost)

Inferior right
pulmonary vein
(inferiormost)

The mediastinal surface of the right lung


pulmonary artery
(superior most)

Left principle bronchus


(middle of posterior boundary)

Left pulmonary veins(anteriormost


& inferiormost)

Pulmonary ligament

The medial surface of the left lung.


Mediastinal & diaphragmatic surfaces of right lung

Groove for brachiocephalic vein Area for trachea


Area for esophagus
Groove for azygos vein
Groove for superior vena cava

Area for thymus

Cardiac impresion
Mediastinal & diaphragmatic surfaces of left lung

Groove for subclavian artery

Area for esophagus

Groove for arch of aorta

Area for thymus

Cardiac impression

Area for esophagus

Groove for
descending of aorta
Each lung is enclosed
in a serous sac,
named:

pleura
Pleurae & lungs Visceral
To visualize the relationship of pleura & lungs: pleurae
root

Parietal lung
pleurae

Parietal pleura (lines pulmonary cavities,adhering


to thoracic wall,mediastinum, diaphragm)

Visceral pleura (Adherent to all surfaces including


surfaces within horizontal & oblique fissures)

Pleural cavity
Pleura consists of two continuous membranes.
Visceral pleura: invest all surfaces of lungs
Parietal pleura: lines pulmonary cavities
Pleural cavity: potential space between layers of pleura,
contains serous pleural fluid, allows the layers of pleura to slide
smoothly over each other during respiration

6
Plural
ligament
Pleura consists of 2 layers:
1) Visceral

2)Parietal
•Cervical(2-3 cm superior to the level of clavicle)
•Mediastinal
•Costal
•Diaphragmatic

Cervical part

Mediastinal
part

Costal part

Diaphragmatic
part

Endothoracic fascia covered internal surface of thoracis wall(sternum,ribs,costal


cartilages, intercostal muscles,sides of thoracic
Visceral pleura vertebrae),diaphragm,aspects of mediastinum.
Parietal pleura changes directions as it passes from one wall of pleural cavity to another
Lines of pleural reflection:
•Sternal line(costal pleura…mediastinal pleura)
•costal line(costal pleura…diaphragmatic)
•vertebral line(costal pleura…mediastina pleura)

vertebral

Sternal

costal
Sternal line passes
inferiorly in median plane

Right:
Posterior aspect of
xiphoid process(6th
costal cartilage)
2
Left:
At the level of 4th
costal cartilage
4 passes left,
Cardiac creating notch, then
notch continuous inf
eriorly to the 6th
6 costal cartilage
6

Sternal
line Cardiac notch allows a part of
pericardium(heart sac) to be in direct
contact with anterior thoracic wall.this is
important for pericardiocentesis.
Diaphragmatic
borders of pleurae
MCL &
lungs

Both pleural reflections &


diaphragmatic border of
lungs pass laterally at 6th
2 costal cartilages.
Pleural reflections reach
MCL(midclavicular line) at
the level of 8th costal
4 cartilage.
Cardiac
notch
But inferior margins of lungs
6 reach MCL at the level of 6th
6 rib.
6
Sternal
line

8
MAL
SL Pleural reflections
reach 10th rib at
MCL(midaxillary line) &
12th rib at SL(scapular
line) & spinous process
of T12.

inferior margins of lungs reach


the MAL
at 8th rib and SL at 10th rib,
proceeding T10
10
8 10
12
10 12
Vertebral line of pleural
reflection:
T1-T12
T1

Costal line of pleural


reflection:
T12---rib12---rib10

T12
Injuries to the pleura and lung

Lungs & pleural sacs may be injured in:


1) wounds to the base of neck(especially
during first few years after birth).
2) Fracture of ribs
3) Abdominal incisions(eg,exposing a kidneyor
liver)

Results?

Pneumothorax:
presence of air in pleural cavity.
(Pneumo: presence of air)

Results?
Lungs are comparable to Remains distended only as long as its outlet is closed.

When outlet is opened,their inherent elasticity will cause them to collapse.

Normal lungs in situ remain distended even when their outlet (airway) is open. Why?
endothoracic
Thoracic wall………………………...parietal pleura………
Surface tension consequent Visceral pleura.
..…….…………………..…………
fascia to pleural fluid

•Pressure in pleural cavity is sub-atmospheric


If a hole(penetrating wound) opens through the thorax. What
happens?
Air will be sucked into pleural cavity(- pressure)
What happens?
Breaking of surface tension
Inherent elastisity of lungs
Pulmonary collapse
Pleural cavity(normally a potential space) becomes a real space.

Pulmonary
collapse
Trachea &
major bronchi
(anterior view)

Superior lobar
bronchus
Superior lobar
bronchus
To superior
lobe

To superior
Middel lobar bronchus lobe
Right & left
main bronchi
To middle
lobe
inferior lobar
bronchus To inferior
To inferior lobe
lobe
Bronchopulmonary segments

•Pyramidal-shaped, apices facing lung roots,bases at pleural surface


•Separated from adjacent segments by connective tissue septa
•Supplied independently by a segmental bronchus & a tertiary branch of pulmonary artery
•Drained by intersegmental parts of pulmonary veins that lie in connective tissue between and
drain adjacent segments
•Surgically resectable
•Usually (10 in right lung;8-10 in left lung)
•Trachea
•Main bronchus
•Lobar bronchus(secondary b.)
•Segmental bronchus (tertiary b.)
Nerves of lungs & pleurae
Anatomi rongga thorax
Otot respirasi
Otot ekspirasi