vincent van gogh – skull with cigarette (1886)
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ANATOMY OF THE RESPIRATORY SYSTE M . Vincent Van Gogh – Skull with Cigarette (1886). 25.10.2013 Friday. Kaan Yücel M.D., Ph.D . Nose is divisible into : E xternal nose N asal cavity. External Nose. E xtends the nasal cavities onto the front of the face P yramidal in shape . - PowerPoint PPT PresentationTRANSCRIPT
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Vincent Van Gogh – Skull with Cigarette (1886)
ANATOMY OF THE RESPIRATORY SYSTEM
Kaan Yücel M.D., Ph.D.
25.10.2013 Friday
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Nose is divisible into :External nose Nasal cavity
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Extends the nasal cavities onto the front of the face
Pyramidal in shape
EXTERNAL NOSE
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External nose has bony & cartilaginous parts.
Bones Cartilages Nasal bones Lateral cartilages (paired)Frontal process of maxilla Alar cartilages (paired)Nasal part of frontal bone Septal cartilage (single)
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NASAL CAVITIES
separated from:each other by a midline nasal septumoral cavity below by the hard palatecranial cavity above by parts of the frontal, ethmoid, &sphenoid bones.
uppermost parts of the respiratory tract
olfactory receptors
Posteriorly, each nasal cavity communicates with the nasopharynx through two openings choana.
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Each nasal cavity consists of 3 regions.
1) nasal vestibule internal to the naris 2) respiratory region largest , rich neurovascular
supply 3) olfactory region @ apex of each nasal cavity,
olfactory receptors
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the most anterior part of the nasal cavity.
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Olfaction (sense of smell)RespirationFiltration of the dust in the inspired air Humidification and warming of the inspired air (cooling the internal carotid artery for brain)Reception of the secretions from the paranasal sinuses and nasolacrimal ducts
FUNCTIONS OF THE NOSE & NASAL CAVITIES
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2. PARANASAL SINUSES
lined by respiratory mucosa. open into the nasal cavitiesinnervated by branches of the trigeminal nerve [V].
air filled spaces lying within the bones around the nasal cavity
1) Frontal sinuses2) Ethmoid sinuses3) Sphenoid sinuses4) Maxillary sinuses
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3. LARYNXorgan of phonation
(vocalization)
CartilageMuscles Connective tissue
continuous below with the tracheaabove opens into the pharynx immediately posterior & slightly inferior to the tongue
between C3- C6
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Unpaired cartilages1) Thyroid cartilage (biggest)2) Cricoid cartilage3) Epiglottic cartilage
SKELETON OF LARYNX LARYNGEAL CARTILAGES
Paired cartilages1) Arytenoid2) Corniculate3) Cuneiform
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THYROID CARTILAGElargest cartilage of the
larynx2 laminae which fuse anteriorly at the thyroid angle & form laryngeal prominence (Adam’s apple)
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CRICOID CARTILAGE
Inferiorly attaches to 1st tracheal ring via cricotracheal ligament. Completely encircles the airway
Broad lamina of cricoid cartilage posteriorlyNarrower arch of cricoid cartilage anteriorly
a ring shaped cartilage, most inferior of the laryngeal cartilages
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ARYTENOID CARTILAGES
3 processesApex (superior) articulation w/corniculate cartilageVocal process (anterior) vocal ligament attaches hereMuscular process (lateral)
pyramidal in shape
posterior & lateral crico-arytenoid muscles
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EPIGLOTTIC CARTILAGE (EPIGLOTTIS)a leaf-shaped cartilage
attached by its stem to the posterior aspect of the thyroid cartilage
@ the angle
Most superior end is free.
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CORNICULATE & CUNEIFORM CARTILAGES
lie in the posterior part of the aryepiglottic fold.
corniculate cartilages two small conical cartilagesLocated on the arytenoid cartilagescuneiform cartilages small cartilages anterior to corniculate cartilages
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between lower border of cricoid cartilage & upper border of 1st tracheal cartilage
EXTRINSIC LIGAMENTS OF THE LARYNXThyrohyoid membraneBelow superior margin of the thyroid cartilage, above hyoid bonelateral thyrohyoid ligament (posterior thickening), triticeal cartilagemedian thyrohyoid ligament (midline thickening)
Hyo-epiglottic ligamentfrom the midline of the epiglottis to the body of hyoid bone
Cricotracheal ligament
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. INTRINSIC LIGAMENTS OF THE LARYNXFibroelastic membrane of the larynx
lies under the mucosa of the larynxlinks together the laryngeal cartilages completes the architectural framework of the laryngeal cavityforms some of the ligaments between the cartilages.
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2 parts1) lower conus elasticus 2) upper quadrangular membrane
INTRINSIC LIGAMENTS OF THE LARYNXFibroelastic membrane of the larynx
Conus elesticus cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Free upper margin thickens & forms vocal ligament vocal foldopening between the 2 vocal folds
(rima) glottis
median cricothyroid ligament anterior midline thickening of conus elasticus
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Each vocal ligament free upper margin attaches to anterior part of inner surface of thyroid cartilage
@ thyroid angleposteriorly attach to vocal processes of the arytenoid cartilages.
Conus elasticus cricothyroid ligament, cricovocal membrane,
cricothyroid membrane
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InspirationWidens
PhonationNarrows- 2 vocal fold come together
Pitch increases with tensing, decreases by relaxation. Intensity of expiration determines the loudness of sound.
Rima glottis
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vestibular ligament attached posteriorly arytenoid cartilage anteriorly thyroid angle superior to the attachment of the vocal ligament.
Quadrangular membrane
lateral margin of epiglottis
anterolateral surface
free lower margin is thickened
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vestibular ligament attached posteriorly arytenoid cartilage anteriorly thyroid angle superior to the attachment of the vocal ligament.
Quadrangular membrane
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architectural support fibro-elastic membrane of the larynx laryngeal cartilages.
LARYNGEAL CAVITYtubular
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1) opens into anterior aspect of pharynx
just below and posterior to the tongue
continuous with the lumen of tracheacompletely encircled by cricoid cartilage
superior aperture (laryngeal inlet) V.S. inferior aperture
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2) oblique and points posterosuperiorly into the pharynx
horizontal in position
superior aperture (laryngeal inlet) V.S. inferior aperture
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superior aperture (laryngeal inlet) V.S. inferior aperture
3) can be closed by downward movement of the epiglottis.
continuously open
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LARYNGEAL CAVITYvestibular and vocal folds divide into three major regions
Vestibulebetween laryngeal inlet & vestibular folds
Middle partbetween vestibular folds & vocal folds Infraglottic space between the vocal folds & inferior opening of the larynx
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.Rima glottidis
between vocal foldsseparates middle chamber from infraglottic cavity.
base formed by interarytenoid fold @ bottom of interarytenoid notch.
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FUNCTIONAL ANATOMY OF THE LARYNXRespiration
Quiet: laryngeal inlet, rima glottidis open arytenoid cartilages abducted
Forced: rima glottidis widens arytenoid cartilages rotated laterally, vocal folds abducted
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Rima glottidis is completely closed.Completely and forcefully shut the airway
FUNCTIONAL ANATOMY OF THE LARYNXEffort closure
occurs when air is retained in the thoracic cavity to stabilize the trunk
increasing intra-abdominal pressure
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arytenoid cartilages & vocal folds adducted rima glottidis closed
FUNCTIONAL ANATOMY OF THE LARYNXPhonation
Air is forced through the closed rima glottidis Vocal folds vibrate against each other and produce sounds.
Tension in the vocal folds adjusted by vocalis & cricothyroid muscles
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Larynx moves up & forward – opens the esophagusattached to the posterior aspect of the lamina of cricoid cartilage
Epiglottis goes down toward the arytenoid cartilages laryngeal inlet narrowed or closed
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FUNCTIONAL ANATOMY OF THE LARYNXSwallowing
Rima glottidis closed.Laryngeal inlet narrowed
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from the inferior end of larynx to the level of T5-T6
Terminates by dividing into right & left main bronchi @ sternal angle. Main bronchi give branches inside the lungs & form bronchial tree.
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formed of tracheal rings which are incomplete posteriorlyPosterior parts of the tracheal rings closed by
smooth muscle trachealis muscle.
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5. PLEURA
visceral pleura invests all surfaces of the lungs parietal pleura lines the pulmonary cavities & thorax’s inner surface
covers the pulmonary cavities and external surfaces of the lungs in these cavities
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Visceral pleura insensitive to pain
Parietal pleura extremely sensitive to pain
Irritation causes local pain or referred pain projecting to the dermatomes supplied by the same spinal
nerve.
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contains a capillary layer of serous pleural fluid lubricates the pleural surfaces allows layers of pleura slide smoothly over each other during respiration.
lung surface in contact with thoracic walllung expands fills with air when thorax expands
pleural cavitypotential space between the layers of pleura
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5. LUNGSorgans of respiration
lie on either side of the mediastinum surrounded by right & left pleural cavities
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5. LUNGS
Air enters and leaves the lungs via main bronchi branches of trachea
Inspired air into close relation with venous bloodin pulmonary capillaries.
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5. LUNGSApex upper pole3 surfaces costal, mediastinal and diaphragmaticRoot of the lung 2 lobes in the left lung oblique fissure3 lobes in the right lung horizontal & oblique fissures
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TRACHEOBRONCHIAL TREEsublaryngeal airway
Trachea @ superior mediastinum TRUNK OF THE TREE Bifurcation @ sternal angle Main bronchi
Right main bronchus & Left main bronchus enter hilum of the lungBranches of the tracheobranchial tree
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TRACHEOBRONCHIAL TREEMain (primary) bronchus
Secondary (lobar) bronchi 2 on the left, 3 on the right
Tertiary (segmental) bronchi
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o Pyramidal-shaped segments of the lungapices facing the root of the lung.
o Separated from adjacent segments by connective tissue septa.
BRONCHOPULMONARY SEGMENTSlargest subdivisions of a lobe
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o Segmental bronchus & Tertiary branch of pulmonary artery
o Drained by intersegmental parts of the pulmonary veins
BRONCHOPULMONARY SEGMENTSlargest subdivisions of a lobe
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o Named according to the segmental bronchi supplying them.
o Usually 18-20 in number
o Surgically resectable.
BRONCHOPULMONARY SEGMENTSlargest subdivisions of a lobe
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tertiary segmental bronchi
conducting (lobular) bronchioles end as terminal bronchioles
respiratory bronchioles
pulmonary alveolus basic structural unit of gas exchange in the lung
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Branching of the bronchial tree • Trachea• Principal bronchus • Lobar bronchi (secondary bronchi)• Segmental bronchi (tertiary bronchi)• Terminal bronchiol• Respiratory bronchiol• Alveolar duct• Alveolar sac• Alveolus
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root of the lungT5 to TV7
mediastinal pleura reflects off mediastinum a sleeve-like covering forairway, vessels, nerves, lymphatics which pass between
the lung and mediastinum
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hilum of lung
The root of the lung joins medial surface of the lung here!mediastinal pleura continuous with visceral pleura @ hilum of the lung.
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VASCULATURE OF PLEAURA & LUNGS1 LUNG
1 pulmonary artery (venous blood)2 pulmonary veins (arterial blood)
Each lobe and segment its own arteryBranching of the arteries follow the bronchial tree Terminate as capillaries around the alveols.
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VASCULATURE OF PLEAURA & LUNGS
Veins of the parietal pleura drain into systemic veins mainly through the intercostal veins.
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BRONCHIAL ARTERIESfollow bronchial tree as far as respiratory bronchioles.Left bronchial arteries from thoracic aortapaired Right bronchial artery usually arises from 3rd posterior intercostal arterysingle artery.
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BRONCHIAL VEINSRight bronchial vein into azygos vein
Left bronchial vein into accessory hemiazygos vein.
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pulmonary plexuses
parasympathetic innervation vagus nerve bronchoconstrictor, vasodilator to the lung vessels, secretomotor to the glandssympathetic sympathetic trunk bronchodilator, vasoconstrictor to the lung vessels, inhibitor to glandsparietal pleura intercostal & phrenic nerves