Anatomy and Physiology of Respiration

RESPIRATORY SYSTEM
 Consists of - Nose

- Nasal Cavity - Pharynx - Larynx - Trachea - Bronchi - Lungs  the lungs have the terminal air sacs (or) alveoli

RESPIRATION is the sum of processess by which an organnism meets its requirement of oxygen and eliminates carbondioxide Multicellular organs needs 2 systems to get enough O2 1.blood circulatory system - to carry O2 & CO2 2.respiratory system to load the blood with O2 - to remove excess CO2 TYPES OF RESPIRATION 1. External respiration (pulmonary ventilation) exchange of air between the external environment and the pulmonary alveoli 2. Internal respiration (cell respiration, enzymatic oxidation) - consumption of O2 by cells and the formation and liberation of CO2 RESPIRATORY RATE Varies with age at birth : 40-60/min 1st year : 25-35/min 2-4yrs : 20-30/min 5-14 yrs : 20-25/min normal adult : 10-18 times/min

RESPIRATORY SYSTEM 1.Lungs the gas exchanging organs 2.A pump that ventilates the lungs i .chest wall & respiratory muscles ii .respiratory centres in the brain stem
that control the respiratory muscles -nerves that connect the brain to the muscles

FUNCTIONALLY the system consists of two zones

1.Conducting zone

2.Respiratory zone Conducting zone - trachea to terminal bronchioles - nose to terminal bronchioles is known as dead space - no gaseous exchange take place Respiratory zone - the actual site of gas exchange take place - composed of respiratory bronchioles - alveolar ducts and alveoli

THORACIC WALL(CHEST WALL) AND RESPIRATORY MUSCLES Consists of posteriorly = 12 thoracic vertetbrae laterally = 12 pairs of ribs anteriorly = sterum and costal cartilages superiorly = supra pleural membrane inferiorly = diaphragm INTERCOSTAL SPACES spaces between adjacent ribs and each contain 3 intrinsic muscles 1.external intercostal muscles 2.internal intercostal muscles 3. inner most intercostal muscles (intercostalis)

 MUSCLES OF CHEST WALL arranged in 3 layers for each intercostal space: 1.external intercostal muscle external layer 2.internal intercostal muscles middle layer 3. inner most intercostal, subcostal, transversus thoracic internal layer Other muscles sub costalis - sternocostalis - levatores costarum

1.External internal muscle directed forward and downward - extends from the tubercle of the ribs posteriorly to the costochondral junction anteriorly where the muscles is replaced by an aponeurosis called anterior intercostal menbrane Action elevation of the ribs (inspiratory mscles) Nerve supply corresponding intercostal nerves or thoracoabdominal nerves 2.Internal intercostal muscles directed downward and backward from the subcostal groove of rib above to the upper border of rib below -extends from the medial end of the intercostal spaces to the angles of the ribs where the muscles is replaced by the posterior or internal internal costal membrane Action muscles of expiration Nerve supply - corresponding intercostal nerves or thoraco abdominal nerves

INNERMOST INTERCOSTAL MUSCLES (INTERCOSTALIS INTIMI) Directed downward and backward Lies within the lateral wall of thorax Arises from the inner lip of the costal groove above to the upper margin of the rib below Nerve supply and action same as internal intercostal muscle OTHER MUSCLES 1.SUBCOSTALIS - arises from the lower margin of the ribs near their angles - Inserted to the upper margins of 2nd or 3rd rib below Action elevates the ribs Nerve corresponding intercostal nerve 2.STERNOCOSTALIS (TRANSVERSUS THORACIC) Arises from posterior surface of xiphoid process, body of sternum Inserted into the internal surface of the 2nd to 6th costal cartilages Action expiratory function. Nerve corresponding intercostal nerves

 3.LEVATORES COSTARUM - arises from the transverse processes of the 7th cervical to 11th thoracic vertebeae Each is inserted into the external surface of the subajacent rib, between the tubercle and angle Action elevates the ribs Nerve supply dorsal rami of 8th cervical,1st to 11th thoracic nerves BLOOD SUPPLY ARTERIAL SUPPLY - intercostal arteries anterior and posterior intercostal arteries VENOUS DRAINAGE intercostal veins LYMPHATIC DRAINAGE - anterior intercostal, - posterior intercostal, - phrenic (diaphragmatic nodes)

RESPIRATORY MUSCLES INSPIRATORY MUSCLES- QUIET INSPIRATION 1.diaphragm (most important m/s) 2.Internal intercostal muscle 3.External intercostal muscle DEEPER INSPIRATION 1.above muscles 2.Scalena muscles raise the 1st and 2nd ribs 3.Sternal head of sternomastioid 4.Levatores costarum 5.Serratus posterior superior and serratus posterior inferior 6.Quadratus lumborum FORCED INSPIRATION (Shortness of breath from exertion or disease) 1.Above muscles plus 2.pectoralis major & minor 3.trapezius, levator scapulae, rhomboideus 4.Erector spinae , deep muscles of back 5.Nostrils and glottis dilate rhythmically to easier entrance of air

EXPIRATORY MUSCLES
QUIET EXPIRATION recoil of lungs and costal cartilages DEEP EXPIRATION contraction of internal intercostal muscles DEEPER EXPIRATION aided by abdominalmuscles - oblique and transverse abdominal muscles - iliocostalis and latissimus dorsi

DIAPHRAGM
Principle muscle of respiration dome shaped, fibro-muscular partation between the thorax and abdomen Right dome overlies the liver ,at the level of 5th rib Slightly higher than the left Pierced by structures passing between the thorax and abdomen Composed of 2 parts muscular part and central part muscular part is again divided into 3parts a. sternal b. costal part c. lumbar or vertebral part

Central part -Muscular fibres converge radially to a strong, sheet like tendons or aponeurosis called central tendon which is fused to fibrous pericardium - No bony attachment - Divides into 3 leaves-right, anteromedial and left - Openings 3 major openings 1.vena caval opening (T8) 2.oesophageal (T10) 3.aortic opening(T12) - 6 small openings NERVE SUPPLY 1.phrenic nerve (C345) 2.lower 6 intercostal nerves

TRACHEA

Trachea

Rt: bronchus (p bronchus)

Lt: bronchus

TRACHEA
Commencemnent Cricoid cartilage (lower border) C6.vertebra Ending Sternal angle (angle of Louis) T4 lower border. Carina - keel shaped cartilage at the bifurcation of trachea (useful landmark in Bronchoscopy)

Angle of Louis

Primary (Main/Principal) Bronchus

Rt.Primary bronchus Wider, Shorter & more Vertical gives off 3 i. Superior lobar (secondary) bronchus before entering the hilum of lung ii. Middle iii. Inferior lobar Lt.Primary bronchus gives off 2

Clinical application
Inhaled Foreign body - tends to enter the right primary bronchus Carina
In case of Ca. involvolving

tracheobronchial lymph node Widening of Carina can be

seen during Bronchoscopy

Secondary (Lobar) bronchus

Right 3 lobar bronchi i.Superior lobar ( b/f entering the hilum) On entering the hilum ii.Middle iii.Inferior

Left 2 lobar bronchi (on entering hilum) i. Superior ii.Inferior

Tertiary (Segmental) bronchi and Broncho pulmonary segments Right side

Upper lobe -3 Segmental or
Tertiary bronchi Middle lobe - 2 Segmental bronchi Inferior lobe - 5 Segmental bronchi

Left side
Upper lobe - 3 Seg. bronchi
- +Lingular - 2 seg. bronchi

Inf.lobe
- 5 segmental bronchi

Bronchopulmonary segments
Right
Upper lobe
i. apical ii. post. iii. ant.

Left upper lobe

Apical post anterior Lingular

Middle lobe i. lat. ii. medial Lower lobe i. superior

(apical)

superior inferior

Lower lobe

ii. ant.basal iii.medial basal iv.lat.basal v.post.basal

Clinical applications
1.Knowledge of branching of bronchial tree is needed i. for appropriate posture of patient to promote the postural drainage ii. to locate the segment involved by radiography & bronchoscopy 2.Bronchopulmonary segment is the smallest segment which can be removed surgically

Clinical application
3. Aspiration pneumonia 4. Lung abscess
(In comatose or anaesthetized patient) more common in

apical segment of right lower lobe

LUNGS
 pair of respiratory organs situated in the pleural cavities separated by

mediastinum  conical in shape  each lung has an apex at the upper end  each lung has an apex at the upper end  right lungs weigh 625 gms  left lungs weigh 575 gms

 3 borders - anterior - posterior - inferior  2 surfaces costal fits the parts of thoracic wall - medial a ) vertebral part applied on each side of the vertebral bodies b ) mediastinal related to mediastinum

Right lung (hilum)

Vertebral surface

Mediastinal surface

Left lung (hilum)

Mediastinal surface Vertebral surface

apex

Ant. border

Diaphragmatic surface Inferior border

Oblique fissure

Pulmonary artery

Superior pul vein Main bronchus Inferior pul. vein

Pulmonary ligament

upper upper

Transverse fissure mid lower Oblique fissure lower

Oblique fissure

FISSURES AND LOBES OF THE LUNGS

 right lung is divided into 3 lobes superior, middle, inferior by 2 fissures oblique and horizontal  left lung is divided into 2 lobes by oblique fissure

BRONCHIAL TREE trachea bifurcates at the level of T4 into right and left main (primary) bronchi main bronchus gives off a branch to each lobe of the lung, known as lobar or secondary bronchi 3 for the right and 2 for the left each lobar bronchus subdivides into segmental or tertiary bronchi, which supply the broncho pulmonary segments

BLOOD SUPPLY
Bronchial arteries
2 on Lt. originate from Aorta 1 on RT. from .3rd right posterior intercostal artery Run along bronchi Supply - the bronchial tree from Carina to Respiratory bronchiole - visceral pleura

Bronchial veins drain from hilar region & visceral pleura Into Azygos (Rt.) & Accessory hemiazygos (Lt.)

Lymphatic drainage
From superficial part 1.Superficial plexus (beneath visceral
pleura)

Clinical application
-Bronchogenic CA. most common CA. in men may metastasize to pleura, hilum of lung & mediastinum via Lymph. Common sites of metastasis

to Bronchopulmonary nodes (at the hilum) & Tracheobronchial nodes (at bifurcation)

From deeper part 2.Deep plexus (in submucosa)

drain along the bronchi & pulmon vessels to Bronchopulmon.nodes From .Bronchopulmonary to -i. Tracheobronchial -ii.Bronchomediastinal lymph trunks Finally into junction of subclavian.& internal jugular veins at root of the neck - Rt.lymph.trunk or Thoracic duct

Brain, Bone,Lung & Adrenal Supraclavicular Node - often becomes enlarged in CA.bronchus

NERVES SUPPLY OF THE LUNGS

Sympathetic From T1 T5 segment of spinal cord relay in upper thoracic ganglia bronchodilator & vasoconstrictor Parasympathetic From vagus nerve bronchoconstrictor, secretomotor & vasodilator afferent fibres are responsible for cough reflex

PLEURA
-serous membrane covering the lungs - two pleural sacs (one on each side) - each pleural sac is invaginated by the lung -2 layers - outer parietal - inner visceral pleura -in between two layers is the potential space called pleural cavity, contains a film of serous fluid -parietal layer lines the thoracic wall and mediastinum - visceral pleural applied to the lung substance, covers the surfaces and lines the fissures

 PARIETAL PLEURA costal pleura - mediastinal pleura - diaphragmatic pleura - cervical pleura COSTAL PLEURA lines the sternum, ribs, intercostal spaces and sides of the bodies of the vertebrae Anteriorly and posteriorly continous with the mediastinal pleura Inferiorly - with the diaphragmatic pleura MEDIASTINAL PLEURA lines the mediastinal surface of the lungs DIAPHRAGMATIC PLEURA covers most of the diaphragm except the central tendons CERVICAL PLEURA rounded extension of the parietal pleura which passes through the superior of the thorax into the root of the neck

PLEURAL RECESS parts of the pleura cavity which are not occupied by lung tissue except in inspiration 1.costo mediastinal recess : along the anterior margin of pleura 2. costo diaphragmatic recess : along the inferior margin of pleura 3.retro oesophageal recess : the reflexion of mediastinal pleura behind the oesophagus 4. infra pericardial recess : behind the inferior venacava BLOOD SUPPLY AND NERVE SUPPLY Parietal pleura - branches from posterior intercostal, internal thoracic, musculophrenic and superior phrenic arteries its veins join the systemic veins in the neighbouring parts of chest wall Nerve supply costal and peripheral parts of diaphragmatic pleura are supplied by intercostal nerves - mediastinal and central part of diaphragmatic pleura phrenic nerves Visceral pleura bronchial artery - venous drainage is by pulmonary vein Nerve supply sympathetic through pulmonary pleuxus

PLEURA

c.cevical

Costal

a.
mediastinal

b.

diaphragmatic

d.

VISCERAL PLEURAL
Covers the lung closely except around the hilum
It extends into the depth of fissures of the lung Where does the parietal and viscera meet ? Two layers b/c continuous with one another at the hilum What is the Pulmonary ligament ? Extension of pleural reflexion like a cuff below the hilum

Clinical Applications
When the Pleural cavity is filled with Fluid - Hydrothorax Air- Pneumothorax; Blood - Haemothorax Pus - Empyema Irritation of parietal pleura - painful From Costal & peripheral diaphragmatic pleura Chest or Abdominal wall (intercost.n) Fr.Mediasti.& central diaphragmatic pleura (phrenic) - Neck & shoulder Costo diaphragmatic recess may get involved in surgical operation around kidney (esp.left upper pole)

MECHANICS OF RESPIRATION
Study of mechanicals factors involved in ventilation Study of movements of diaphragm and thoracic cage during respiration When chest cavity expands the air pressure inside is lowered, the greater pressure outside causes a flow of air into the lungs When the chest cavity shrinks the increased pressure inside causes some contained air to flow out RESPIRATION Is the sum of processes by which an organism meets its requirement of oxygen and eliminates carbon dioxide PULMONARY VENTILATION movement of gases in and out of lungs.

 The lungs and chest wall are elastic structures and have a tendency to recoil There is a thin layer of fluid between the lungs and chest wall, the pressure in that space is known as intrapleural pressure subatmospheric Intra pulmonary pressure pressure inside the lungs

INSPIRATION
- active process - When the inspiratory neurones discharge, - the nerve to inspiratory muscles are excited - Contraction of the inspiratory muscles (diaphragm & external intercostal) causes an increase in the intrathoracic volume - The intrapleural pressure which is about -2.5mm Hg at the start of inspiration decreases to -6mm Hg - The lungs are expanded so that the intrapulmonary pressure decreases - When intrapulmonary pressure becomes lower than the atmospheric pressure, air enters the lungs causing a rise in intrapulmonary pressure - Intrapulmonary volume increases during inspiration - When the inspiration neurone discharge stops, it is the end of inspiration

EXPIRATION
When the inspiratory neurone discharge stops, it is the end of inspiration The lung recoil pulls the chest back to expiratory position ,where the recoil pressures of lungs and chest wall balance each other Expiration is a passive process, that no expiratory muscles are working There is some contraction of the inspiratory muscles in the early part of expiration This contraction exerts a braking action on the recoil forces slows expiration During expiration, intrapleural pressure rises from -6mmHg to-2.5 mmHg Intrapulmonary pressure also rises ,as the lungs recoil When it exceeds the atmospheric pressure ,air moves out of the lungs causing a fall in intrapulmonary volume and intrapulmonary pressure