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RESPIRATORY SYSTEM

Erial Bahar
Lecture Outline
1. Anatomy of the respiratory system.
2. Overview of physiology of the respiratory
system.
3. Some common respiratory disorders.
Functions of the Respiratory
System
1. Provides oxygen.
2. Eliminates carbon dioxide.
3. Regulates the blood’s hydrogen-ion concentration
(pH).
4. Forms speech sounds (phonation).
5. Defends against microbes.
6. Influences arterial concentrations of chemical
messengers by removing some from pulmonary
capillary blood and producing and adding others to
this blood.
7. Traps and dissolves blood clots.
External and internal respiration.
During external respiration in the lungs, CO2 leaves blood and O2 enters blood. During
internal respiration in the tissues, O2 leaves blood and CO2 enters blood.
Mader: Human Biology, 7th Ed.
The respiratory system
A. Nasal cavities—filter, warm, and moisten air
B. Pharynx (throat)—carries air into respiratory tract and food into
digestive tract
C. Larynx (voice box)—contains vocal cords
1. Glottis- space between the vocal cords
2. Epiglottis—covers larynx on swallowing to help prevent food from entering
D. Trachea (windpipe)
E. Bronchi—branches of trachea that enter lungs and then subdivide
1. Bronchioles—smallest subdivisions
F. Lungs
1. Organs of gas exchange
2. Lobes: three on right; two on left
3. Alveoli
1. Tiny air sacs where gases are exchanged
2. Surfactant—reduces surface tension in alveoli; eases expansion of lungs
4. Pleura—membrane that encloses the lung
1. Visceral pleura—attached to surface of lung
2. Parietal pleura—attached to chest wall
3. Pleural space—between layers
5. Mediastinum—space and organs between lungs
Respiratory tracts
1. Nasal cavities
2. Pharynx Upper respiratory tracts
3. Glottis
4. Larynx
5. Trachea
6. Bronchi Lower respiratory tracts
7. Bronchioles
8. Lungs
The organs of respiration.

Anatomy and Physiology in Health and Illness


The branching bronchi and the lobes of the lungs.

Delmar’s Fundamental Anatomy and Physiology


Sagittal view of the nasal cavity and pharynx
Delmar’s Fundamental Anatomy and Physiology
The pathway of air from the nose to the larynx.

Anatomy and Physiology in Health and Illness


Anatomy and Physiology in Health and Illness
Tracheal cartilage

Anatomy and Physiology in Health and Illness


The trachea and some of its associated structures.
Anatomy and Physiology in Health and Illness
The trachea, bronchi, and bronchioles.
(A) Anatomy of trachea and bronchial tree.
(B) End of bronchial tree showing terminal bronchioles, alveolar duct, and alveoli.
Delmar’s Fundamental Anatomy and Physiology
Lower respiratory tract.
Anatomy and Physiology in Health and Illness
Anatomy of a lobule of a lung
Delmar’s Fundamental Anatomy and Physiology
The anatomy of an alveolus
Delmar’s Fundamental Anatomy and Physiology
Relationship between the bronchial and pulmonary circulations.
The pulmonary artery supplies pulmonary capillary network A. The bronchial artery
supplies capillary networks B, C, and D. Dark-colored areas represent blood of low
O2 content.
ANATOMY OF THE LUNG
Anatomy and Physiology , 7th ed.
Moore, Clinically Oriented Anatomy, 5th Ed.
1 Thyroid gland
2 Internal jugular vein
3 Right common carotid artery
4 Right axillary vein
5 Right brachiocephalic vein
6 Superior lobe of right lung
7 Right atrium
8 Right coronary artery
9 Middle lobe of right lung
10 Right ventricle
11 Diaphragm
12 Liver (left lobe) and falciform
ligament
13 Left internal jugular vein
14 Trachea
15 Left brachiocephalic vein
16 Superior lobe of left lung
17 Cut edge of pericardium
18 Ascending aorta
19 Pulmonary trunk
20 Inferior lobe of left lung
21 Left ventricle
22 Costal margin
23 Right pulmonary artery
24 Esophagus
25 Descending aorta
26 Pericardium
27 Aortic valve
28 Thymus
29 Diaphragm
I Sphenoid sinus 17 Frontal sinus
2 Pharyngeal opening of 18 Superior nasal concha
auditory tube 19 Middle nasal concha
3 Spinal cord 20 Inferior nasal concha
4 Dens of axis 21 Hard palate
5 Oropharynx 22 Soft palate with uvula
(oropharyngeal 23 Tongue
isthmus) 24 Vocal fold
6 Epiglottis 25 Larynx
7 Entrance of larynx 26 Trachea
8 Esophagus 27 Upper lobe of left
9 Upper lobe of right lung lung
10 Azygos vein 28 Left pulmonary artery
11 Branches of pulmonary 29 Left main bronchus
artery 30 Left pulmonary veins
12 Right main bronchus 31 Lower lobe of left
13 Bifurcation of trachea lung
14 Tributaries of right
pulmonary veins
15 Middle lobe of right
lung
16 Lower lobe of right
lung
Moore, Clinically Oriented Anatomy, 5th Ed.
The medial surface of the right lung.
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
The medial surface of the left lung.
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
Moore, Clinically Oriented Anatomy, 5th Ed.
Moore, Clinically Oriented Anatomy, 5th Ed.
Roots and hila of the lungs
Right Lung
Major structures related to the right lung
The trachea and main bronchi viewed from the front

Clinical Anatomy, Ellis


The respiratory tree
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
The named divisions of the main bronchi

Clinical Anatomy, Ellis


Moore, Clinically Oriented Anatomy, 5th Ed.
Moore, Clinically Oriented Anatomy, 5th Ed.
(a) The segments of
the right lung.

(b) The segments of


the left lung.

Clinical Anatomy, Ellis


Moore, Clinically Oriented Anatomy, 5th Ed.
Clinical Anatomy, Ellis
Clinical Anatomy, Ellis
A resin corrosion cast of the adult
human lower trachea and bronchial
tree photographed from the anterior
aspect. The segmental bronchi and
their main branches have been
coloured :
• brown = apical;
• grey/blue = posterior;
• pink = anterior;
• dark blue = lateral (middle lobe)
and superior lingular;
• red = medial (middle lobe) and
inferior lingular;
• dark green = superior (apical) of
inferior lobe;
• yellow = medial basal;
• orange = anterior basal;
• blue = lateral basal;
• light green = posterior basal.

Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed


• brown = apical;
• grey/blue = posterior;
• pink = anterior;
• dark blue = lateral (middle
lobe) and superior lingular;
• red = medial (middle lobe)
and inferior lingular;
• dark green = superior (apical)
of inferior lobe;
• yellow = medial basal;
• orange = anterior basal;
• blue = lateral basal;
• light green = posterior basal.

Corrosion cast of the bronchial tree of the right lung


Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
• brown = apical;
• grey/blue = posterior;
• pink = anterior;
• dark blue = lateral (middle
lobe) and superior lingular;
• red = medial (middle lobe)
and inferior lingular;
• dark green = superior (apical)
of inferior lobe;
• yellow = medial basal;
• orange = anterior basal;
• blue = lateral basal;
• light green = posterior basal.

Corrosion cast of the bronchial tree of the left lung

Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed


Cells of the respiratory tract
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
CELLS OF THE LOWER RESPIRATORY TRACT
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
Bronchopulmonary segments. Right lung.
(Bronchopulmonary segments are numbered and named)
Bronchopulmonary segments.Left lung.
(Bronchopulmonary segments are numbered and named)
Pulmonary circulation. Although the intrapulmonary relationships are accurately demonstrated,
the separation of the vessels of the root of the lung has been exaggerated in the hilar region to show them as they
enter and leave the lung. Note that the right pulmonary artery passes under the arch of the aorta to reach the
right lung and that the left pulmonary artery lies completely to the left of the arch.
Moore, Clinically Oriented Anatomy, 5th Ed.
OVERVIEW OF THE PHYSIOLOGY
OF THE RESPIRATORY SYSTEM
Phases of Respiration
A.Pulmonary ventilation
B.External gas exchange
C. Internal gas exchange
The process of respiration
A. Pulmonary ventilation
A. Inhalation—drawing of air into lungs
• Compliance—ease with which lungs and thorax can be expanded
B. Exhalation—expulsion of air from lungs
C. Lung volumes—used to evaluate respiratory function
B. Gas exchange
A. Gases diffuse from area of higher concentration to area of lower concentration
B. In lungs—oxygen enters blood and carbon dioxide leaves (external exchange)
C. In tissues—oxygen leaves blood and carbon dioxide enters (internal exchange)
C. Oxygen transport
A. Almost totally bound to heme portion of hemoglobin in red blood cells
B. Separates from hemoglobin when oxygen concentration is low (in tissues)
• Carbon monoxide replaces oxygen on hemoglobin
D. Carbon dioxide transport
A. Most carried as bicarbonate ion
B. Regulates pH of blood
ANATOMY OF BREATHING
• Breathing is a highly coordinated abdominal and thoracic
process.
• The diaphragm is the major muscle of inspiration,
responsible for some 67% of the vital capacity.
• The external intercostal muscles are most active in
inspiration, and the internal intercostals, which are not as
strong, are most active in expiration.
• Increasing the vertical, transverse and anteroposterior
dimensions of the chest increases the volume of the pleural
space, and the resulting decrease in intrapleural pressure
draws air into the lungs.
• During expiration, the diaphragm relaxes and moves
superiorly. Air is expelled from the lungs and the elastic
recoil of the lung creates a subatmospheric pressure that
returns the lateral and anteroposterior dimensions of the
thorax to.
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
Pulmonary ventilation. (A) Inhalation. (B) Exhalation.

Memmler’s The Human Body in Health and Disease,10th ed.


Movement of thoracic wall during breathing
Mader: Human Biology, 7th Ed.
Movements of the ribs during breathing
(A) increase the transverse diameter of the chest by the 'bucket handle' movement
(B) increase the anteroposterior dimension of the thorax by the 'pump handle'
movement.
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
Nervous control of
breathing
• During inspiration, the
respiratory center stimulates
the external intercostal (rib)
muscles to contract via the
intercostal nerves and
stimulates the diaphragm to
contract via the phrenic nerve.
• Should the tidal volume
increase above 1.5 liters,
stretch receptors send
inhibitory nerve impulses to
the respiratory center via the
vagus nerve. In any case,
expiration occurs due to a lack
of stimulation from the
respiratory center to the
diaphragm and intercostal
muscles.

Mader: Human Biology, 7th Ed.


Some of the nerves involved in control of respiration.

Anatomy and Physiology in Health and Illness


ANATOMY OF COUGHING
• Initiation of muscular responses to irritation involves stimulation of sensory
endings by mechanical or chemical stimuli.
• Sensitive areas :
– the laryngeal aditus,
– the primary carina and branching points of the tracheobronchial tree
appear to be the most sensitive areas of the epithelium lining the
airways.
• Vagal afferents stimulate the cough centre in the brain stem.
• Initially there is a deep inspiration, which is followed by forceful contraction
of the expiratory muscle and diaphragm against a closed glottis. This leads to
an abrupt rise in pleural pressure (6.5 to 13 kPa) and intra-alveolar pressure.
Subsequent glottal opening causes a rapid peak expiratory flow of air,
followed by some collapse of the trachea and central airways, which is
responsible for the post peak plateau in flow

Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed


The respiratory pathway of oxygen and carbon dioxide.
Delmar’s Fundamental Anatomy and Physiology
External respiration: exchange of gases between alveolar air and capillary blood

Anatomy and Physiology in Health and Illness


Anatomy and Physiology in Health and Illness
Emphysema.

Anatomy and Physiology in Health and Illness


Collapse of a lung: A. Absorption collapse. B. Pressure collapse.

Anatomy and Physiology in Health and Illness


Gas exchange. (A) External exchange between the alveoli and the blood. Oxygen diffuses into
the blood and carbon dioxide diffuses out, based on concentrations of the two gases in the
alveoli and in the blood. (B) Internal exchange between the blood and the cells. Oxygen diffuses
out of the blood and into tissues, while carbon dioxide diffuses from the cells into the blood.
Memmler’s The Human Body in Health and Disease,10th ed.
Memmler’s The Human Body in Health and Disease,10th ed.
The respiratory system. (A) Overview. (B) Enlarged section of lung tissue showing
the relationship between the alveoli (air sacs) of the lungs and the blood capillaries.
(C) A transverse section through the lungs.
Memmler’s The Human Body in Health and Disease,10th ed.
Memmler’s The Human Body in Health and Disease,10th ed.
A spirogram. The tracing of lung volumes is
made with a spirometer

Memmler’s The Human Body in Health and Disease,10th ed.


Memmler’s The Human Body in Health and Disease,10th ed.
Disorders of the respiratory system
A. Disorders of the nasal cavities and related structures—sinusitis,
polyps, deviated septum, nosebleed (epistaxis)
B. Infection—colds, RSV, croup, influenza, pneumonia, tuberculosis
C. Hay fever and asthma—hypersensitivity (allergy)
D. COPD—involves emphysema and bronchitis
E. SIDS—sudden infant death syndrome
F. Respiratory distress syndrome (RDS)
1. Acute (ARDS)—due to other medical problem or direct injury to lung
2. RDS of newborn—due to lack of surfactant
G. Cancer—smoking a major causative factor
H. Disorders involving the pleural space
1. Pleurisy—inflammation of pleura
2. Pneumothorax—air in pleural space
3. Hemothorax—blood in pleural space
I. Choking : Obstruction of the respiratory tract.
Pneumothorax. Injury to lung tissue allows air to leak into the
pleural space and put pressure on the lung.
Memmler’s The Human Body in Health and Disease,10th ed.
The Heimlich maneuver.
This young man shows how he saved his girlfriend from
choking on a piece of candy by using the Heimlich maneuver.
Memmler’s The Human Body in Health and Disease,10th ed.
A tracheostomy tube in place.

Memmler’s The Human Body in Health and Disease,10th ed.


Mader: Human Biology, 7th Ed.
Lower respiratory tract disorders
Moore, Clinically Oriented Anatomy, 5th Ed.
Moore, Clinically Oriented Anatomy, 5th Ed.
Thoracentesis. A needle is inserted into the pleural
space to withdraw fluid
Memmler’s The Human Body in Health and Disease,10th ed.
Bronchial arteries and veins.
A. The bronchial arteries supply the supporting tissues of the lungs and visceral pleura. Left bronchial arteries
arise from the superior thoracic aorta, but the origin of the right bronchial artery is variable; in order of
frequency, it may arise (1) from a right posterior intercostal artery (usually the 3rd), (2) from a common
trunk shared with the left superior bronchial artery, or (3) directly from the aorta.
B. The bronchial veins drain the more proximal capillary beds supplied by the bronchial arteries; the rest is
drained by the pulmonary veins. The right bronchial vein drains into the azygos vein and the left bronchial
vein drains into the accessory hemiazygos vein or the left superior intercostal vein.
Moore, Clinically Oriented Anatomy, 5th Ed.
Lymphatic drainage of lungs. The lymphatic vessels originate in superficial subpleural and deep
lymphatic plexuses. All lymph from the lung leaves along the root of the lung and drains to the inferior or superior
tracheobronchial lymph nodes. The inferior lobe of both lungs drain to the centrally placed inferior tracheobronchial
(carinal) nodes, which primarily drain to the right side. The other lobes of each lung drain primarily to the ipsilateral
superior tracheobronchial lymph nodes. From here the lymph traverses a variable number of paratracheal nodes
and enters the bronchomediastinal trunks.
Moore, Clinically Oriented Anatomy, 5th Ed.
Nerves of lungs and visceral pleura.
The right and left pulmonary plexuses, anterior and posterior to the roots of the lungs, receive sympathetic contributions
from the right and left sympathetic trunks and parasympathetic contributions from the right and left vagus nerves (CN X).
After contributing to the posterior pulmonary plexus, the vagi continue inferiorly and become part of the esophageal
plexus, often losing their identity and then reforming as anterior and posterior vagal trunks. Branches of the pulmonary
plexuses accompany pulmonary arteries and especially bronchi to and within the lungs.
Moore, Clinically Oriented Anatomy, 5th Ed.
Pulmonary innervation
Pulmonary vessels.
Diagram of an anterior view
Imaging of the lungs
Standard posterior-anterior view of the chest showing tumor in upper right lung
Bronchogram showing the branching
pattern of the trachea and bronchi of the
right lung, in a slightly oblique antero-
posterior view. In this procedure, a
radiopaque contrast medium has been
introduced into the respiratory tract to
coat the walls of the respiratory passages

Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed


Radiograph of chest: A, posteroanterior view of adult female and B, lateral view

Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed


Development of the respiratory tree and diaphragm.
A-C, Development of the endodermal respiratory tree. D, Major
epithelial populations in the early embryo from a left dorsolateral
view. The lung buds are bulging into the laterally placed
pericardioperitoneal canals. E, F, Formation of the diaphragm: E
shows the diaphragmatic components from a left dorsolateral
view, and F shows the diaphragmatic components viewed from
above.
Gray’s Anatomy ; The Anatomical Basis of Clinical Practice,39 th .ed
1. Respiratory Tract
• The respiratory tract consists of the nose (nasal cavities), the nasopharynx, the pharynx, the larynx (which
contains the vocal cords), the trachea, the bronchi, the bronchioles, and the alveoli. The bronchi, along with
the pulmonary arteries and veins, enter the lungs, which consist of the alveoli, air sacs surrounded by a
capillary network.
2. Mechanism of Breathing
• Inspiration begins when the respiratory center in the medulla oblongata sends excitatory nerve impulses to
the diaphragm and the muscles of the rib cage. As they contract, the diaphragm lowers,and the rib cage
moves upward and outward; the lungs expand, creating a partial vacuum, which causes air to rush in. The
respiratory center now stops sending impulses to the diaphragm and muscles of the rib cage. As the
diaphragm relaxes, it resumes its dome shape, and as the rib cage retracts, air is pushed out of the lungs
during expiration.
3. Gas Exchanges in the Body
• External respiration occurs when CO2 leaves blood via the alveoli and O2 enters blood from the alveoli.
Oxygen is transported to the tissues in combination with hemoglobin as oxyhemoglobin (HbO2). Internal
respiration occurs when O2 leaves blood and CO2 enters blood at the tissues. Carbon dioxide is mainly
carried to the lungs within the plasma as the bicarbonate ion (HCO3–). Hemoglobin combines with
hydrogen ions and becomes reduced (HHb).
4. Respiration and Health
• A number of illnesses are associated with the respiratory tract. These disorders are divided into those that
affect the upper respiratory tract and those that affect the lower respiratory tract. Infections of the nasal
cavities, sinuses, throat, tonsils, and larynx are all well known. In addition, infections can spread from the
nasopharynx to the ears. The lower respiratory tract is also subject to infections such as acute bronchitis,
pneumonia, and pulmonary tuberculosis. In restrictive pulmonary disorders, exemplified by pulmonary
fibrosis, the lungs lose their elasticity. In obstructive pulmonary disorders, exemplified by chronic
bronchitis, emphysema, and asthma, the bronchi (and bronchioles) do not effectively conduct air to and
from the lungs. Smoking, which is associated with chronic bronchitis and emphysema, can eventually lead
to lung cancer.
5. Homeostasis
• The respiratory system works with the other systems of the body in the ways described in the illustration
on page 183.
Mader: Human Biology, 7th Ed.