The Respiratory System

1. The Respiratory System

2. The General Description The respiratory system includes the res- piratory tract and lungs. The primary function of this system is to supply the body with oxygen and get rid of excess carbon dioxide resulting from cell metabolism.

3. Composition • Respiratory tract • Nose • Pharynx upper respiratory tract • Larynx • Trachea lower respiratory tract • Bronchi • Lungs-paired organs of respiration Function: supply the body with oxygen and to get rid of excess carbon dioxide resulting from cell metabolism

4. The Nose External nose: • Root of nose • Back of nose • Apex of nose • Alae of nose Nasal cavity –divided into two halves by nasal septum

5. Two parts of nasal cavity: • Divided by limen nasi Nasal vestibule • Proper nasal cavity Boundaries • Roof－cribriform plate of ethmoid , Sphenoid, Frontal bone and nasal bone • Floor－hard palate • Medial wall－nasal septum • Lateral wall • Nasal conchae: superior, middle and inferior • Nasal meatus: superior, middle and inferior • Sphenoethmoidal recess

6. Remove the middle nasal conchae Semilunar hiatus Ethmoidal infundibulum Ethmoidal bulb Nasolacrimal canal

7. The formation of the nasal septum 2 Bones, 1 Cartilage, Nasal mucous membrane: olfactory region respiratory region The longitudinal plate of ethmoid bone The cartilage of nasal septum The vomer back

8. Mucous membrane of nose • Olfactory region: located upper nasal cavity, above superior，nasal conchae，contains olfactory cells • Respiratory region : its function is to warm, moisten, and clean the inspired air

9. The paranasal sinuses and their site of drainage into the nose

10. Frontal sinus Ethmoidal sinuses Sphenoid sinus Maxillary sinus

11. The openings of the paranasal sinuses • 3.Paranasal Sinuses— • frontal sinus • middle nasal meatus • maxillary sinus • middle nasal meatus • sphenoidal sinus • recessus sphenoethmoidalis • ethmoidal sinus • Anterior and middle -middle nasal meatus • Posterior- superior nasal meatus • 4, nasolacrimal duct • inferior nasal meatuses

12. The Larynx Position－situated in the anterior part of the neck (below the hyoid bone), and extends from vertebral level of C4 to C6

13. Layngeal cartilages Thyroid cartilage • Shield-shaped cartilage • Laryngeal prominence at base of thyroid notch • Superior thyroid notch, superior and inferior cornua Cricoid cartilage • Complete ring of cartilage (shaped like a signet ring) • Arch of cricoid cartilage－at level of C6 • Larmina of cricoid cartilage

14. Arytenoid • Paired, pyramid shaped, articulate with lamina of cricoid cartilage • Vocal process anteriorly, site of posterior attachment of vocal fold • Muscular process Epiglottic cartilage leaf-shaped elastic cartilage situated behind the root of the tongue

15. Thyroid cartilage sup. cornu Laryngeal prominence sup. thyroid notch lamina anterior angle Laminae of thyroid cartilage inf. cornu Anterior view posterior view

16. Arytenoid cartilages Muscular process Vocal process Muscular process Vocal process Cricoid arch Cricoid cartilage Cricoid lamina Anterior view posterior view

17. Epiglottic cartilage Anterior view posterior view

18. Quadrangular membrane • Between epiglottic, thyroid and arytenoid cartilages • Lower free border forms vestibular ligament • Conus elasticus • Between arytenoids, thyroid, and cricoid cartilages • Upper free border forms vocal ligament • Median cricothyroid ligment：may be site of circothyrotomy during acute respiratory obstruction • Cricotracheal ligament －between cricoid cartilage and first ring of trachea

19. 5 4 2 1 3 • Articulation: 1. cricothyroid joint:rotate around the coronary axis 2. cricoarytenoid joints:rotate around the vertical axis 3. conus elasticus:free and thicked upper border formed the vocal ligament 4. quadrangular membrane:free lower border formed vestibular ligament 5. thyrohyoid membrane

20. Laryngeal joints • cricothyroid joint • cricoarytenoid joint Laryngeal ligaments and membrane • Thyrohyoid membrane －extending from hyoid bone to thyroid cartilage

21. Thyrohyoid membrane Quadrangular membrane Conus elasticus Lateral view Lateral view

22. Muscles of larynx • Increasing tension on the vocal ligament－cricothyroid • Decreasing tension on the vocal ligament－thyroarytenoid • Opening the glottis－posterior cricoarytenoid • Closing the glottis－ lateral cricoarytenoid, transverse arytenoid and oblique arytenoid.

23. 3. Laryngeal cavity 3 parts: laryngeal vestibule intermediate cavity of larynx infraglottic cavity by 2 fissures— vestibular fissure fissure of glottis laryngeal inlet vestibular fold vocal fold ventricle of larynx

24. Laryngeal cavity Aperture of larynx －bounded by upper border epiglottic cartilage, aryepiglottic folds and interarytenoid notch

25. Structure features • Two pairs of shelf like folds : • Vestibular folds • Vocal folds • Two fissures • Rima vestibuli • Fissure of glottis • Inter membranous part－anterior 3/5, between vocal-folds • Inter cartilagrnous part －posterior 2/5, between arytenoids cartilages

26. Three parts • Laryngeal vestibule • Extends from the aperture of larynx to the rima vestibuli • Tubercle of epiglottis Intermedial cavity of larynx • Extends from the level of the rima vestibuli to the level of the fissure of glottis • Ventricle of larynx －a small recess between vestibular and vocal folds on each side • Infraglottic cavity • extends from the level of the vocal folds to the lower border of the cricoid cartilage

27. The Trachea • Position: extends from the lower border of cricoid cartilage to the level of sternal angle (between T4－T5 vertebrae) where it divides into right and left principal bronchi • Structure features • Consists of about 16－20 C-shaped incomplete tracheal cartilages for patency connected by smooth muscle and connective • Carina of trachea －ridge of cartilage at bifurcation into principal bronchi

28. Bronchi Right principal bronchus • Shorter, wider, and more vertical than the left , is about 2.5cm long, Leaves the extend line of the middle line of trachea at 22～25o angle • Foreign bodies are therefore more likely to lodge in this bronchus or one of its branches Left principal bronchus • Narrower, longer, and more horizontal than the right is about 5cm long, leaves the extend line of the middle line of trachea at about 35～36o angle

29. Ⅳ.The trachea and main bronchus: Bifurcation of trachea

30. Ⅴ. Lung: • Position:located in the thoracic cavity, both sides of the • mediastinum, above the diaphragm

31. The Lungs Position: located in the thoracic cavity by both sides of mediastinum General features • Cone-shaped, the right lung is shorter and broader, the left one is longer and narrower • Apex of lung－rises 2 ～3 cm above the medial third of clavicle into neck • Base－concave, related to diaphragm, also called diaphragmatic surface • Costal surface－large, convex, related to thoracic wall

32. External features: • an apex • a base • 2 surfaces— • mediastinal and • costal surfaces • 3 borders– • anterior border, • inferior border, • posterior border

33. Borders • Posterior－blunt • Inferior－ sharp • Anterior－sharp • cardiac notch • lingual in left lung Lobes and Fissure • Right lung • Two fissures : horizontal an oblique • Three lobes : superior, middle, inferior • Left lung • One fissure : oblique • Two lobes : superior and inferior

34. Fissures and lobes of the lungs: • left lung – 2 lobes ( by oblique fissure) • superior lobe (lingula) • inferior lobe • right lung – 3 lobes • (by oblique and • horizontal fissures): • superior lobe • middle lobe, • inferior lobe

35. Hilum of lungs (medial view of the lungs) It is the center part of mediastinal surface. The arrangement of main structures as follows: from anterior to posterior--- pulmonary v., pulmonary a., main bronchus (both sides) from superior to inferior--- rightlung– bronchus of sup. lobe, leftlung– pulmonary a., pulmonary a., main bronchus, bronchus of inf. lobe, pulmonary v. pulmonary v.

36. Medial surface－concave, related to mediastinum and vertebrae • Hilum of lung：area on medial surface where structures in root enter or leave lung • Root of lung • Contents • Principal bronchus • Pulmonary artery and vein • Nerves and lymphatics • Surrounded by connective tissue • Order of structures in the root of lung • From before backward: V.A. B. • From above downward: • R.－B. A. V. • L.－A. B. V.

37. Bronchial tree Each principal bronchus divides into lobar bronchi (two on the left, three on the right), each of which supplies a lobe of lung. Each lobar bronchus then divided into segmental bronchi, which supply specific segments of the lung.

38. The structures of the lung: two parts • ---bronchial tree: • principal bronchus--- • lobar bronchi---segmental • bronchi--- bronchioles--- • terminal bronchioles • --- alveoli of the lung:

39. Bronchopulmonary segments • Wedge shaped, with the base lying peripherally and the apex lying towards the root of lungs, ten in each lung • Each with a segmental bronchus and branches of pulmonary artery • The veins lie both in and between segments

40. The Segments of the lung: bronchopulmonary segments • Bronchopulmonary segments of right lung • superior lobe • apical • posterior • anterior • middle lobe • lateral • medial • inferior lobe • superior • medial-basal • anterior-basal • lateral-basal • posterior-basal • Bronchopulmonary segments of left lung • superior lobe • apico-posterior (merger of "apical" and "posterior") • anterior • lingula of superior lobe • inferior lingular • superior lingular • inferior lobe • superior • anterior medial basal (merger of "anterior basal" and "medial basal") • posterior basal • lateral basal

41. The Pleura General features • Serous membranes forming closed sacs • Two layers • Visceral pleura－adheres to lung, continuous with parietal pleura at root of lung • Parietal pleura－lines the thoracic cavity

42. Two pleural layers continue with each other at root of lung forming closed potential space－pleural cavity • Contains a small amount pleural fluid • Subatmospheric pressure in it

43. Named parts of parietal pleura • Cupula of pleura －extends up into the neck, over the apex of lung, 2～3cm above the medial third of clavicle • Costal pleura －lines the inner surface of the wall of the chest • Mediastinal pleura • Lines mediastinum • Pulmonary ligament －redundant pleura at root of lung, which extends downward, allows movement of structures forming root of lung • Diaphragmatic pleura －Lines diaphragm

44. Pleural recesses －potential spaces of pleural cavity which lungs are not occupied in quiet respiration • Costodiaphragmatic recesse－are the slit-like intervals between costal and diaphragmatic pleurae on each side, the lowest point of pleural cavity • Costomediastinal recess －on the left side between the mediastinal pleura and costal pleura

45. The surface projection of lower border of lung and pleurae

46. The Mediastinum Concept－all of organs between the left and right mediastinal pleurae is called mediastinum. It extends from the sternum in front to the vertebral column behind, and from the thoracic inlet above to the diaphragm below.

47. Subdivisionsof mediastinum • Superior mediastinum • sternal angle • Inferior mediastinum • heart and pericardium • Anterior mediastinum • Middle mediastinum • Posterior mediastinum

48. Left subclavian a. Thoracic duct Aortic arch Left vagus n. Left recurrent n. Thoracic aorta Phrenic n. & pericardiacophrenic a. Sympathetic trunk Root of lung Pericardium Esophagus Greater splanchnic n Left side of mediastnum

49. Trachea Superior vena cava right vagus n. Arch of azygos v. Phrenic n. & pericardiacophrenic a. Azygos v. Root of lung Sympathetic trunk Pericardium Esophagus Inferior vena cava Right side of mediastnum

50. Superior mediastinum Locating－from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posteriorly Contents • Superficial layer • Thymus • Three veins • Left brachiocephelic v. • Right brachiocephelic v. • Superior vena cava