Respiratory System (p. 233-251)

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Respiratory System

Provides the means for gas exchange required by living cells. Supplies oxygen and takes carbon dioxide away.

Conduction Portion

Functional division of the respiratory system which transports air. It includes the nose, nasal cavity, pharynx, larynx, trachea, and other smaller airways.

Respiratory Portion

Functional division of the respiratory system where gas exchange with the blood occurs. It includes small airways called respiratory bronchioles, alveolar ducts, and alveoli.

Inhalation or Inspiration

Draws gasses into the lungs.

Exhalation or Expiration

Forces gasses out of the lungs.

External Respiration

Involves the exchange of gases between the atmosphere and the blood.

Internal Respiration

Involves the exchange of gases between the blood and the cells throughout the body.

Conditioning of Gases

As inhaled air passes though airways it is warmed, humidified, and cleaned by mucous which captures particles.

Sound Production

As air is forced out of the lungs and moves through the larynx it makes sound. The nasal cavity, paranasal sinuses, teeth, lips and tongue, are some of the structures that help with sound.

Olfactory Epithelium

Covers the superior region of the nasal cavity and contains chemoreceptors for the sense of smell.

Chemoreceptors

Detect inhaled molecules that dissolve in the mucus overlying the olfactory epithelium.

Respiratory Protection against Airborne Infection

Entrance of the nose has hairs, twisted passages trap insects and microbes, and mucus destroys microbial walls and traps everything.

Clinical: Cystic Fibrosis

Clinical: Inherited disease which affects the chloride channels in the membrane. This causes unusual osmotic flow and increase in mucus production in the respiratory passageways and pancreas. This leads to problems breathing and increased chance of infection.

Clinical: Cystic Fibrosis

Clinical: The most common serious genetic disease in Caucasians. It is inherited and causes mucus build up in the respiratory system, salty skin, and back up of enzyme juices in the pancreas. Antibiotics and agents to break up mucus are usually needed. They are currently trying to transmit a good gene into the epithelial cell via a modified adenovirus.

Upper Respiratory Tract

Composed of nose and nasal cavity, paranasal sinuses, pharynx(throat), and associated structures. They are all part of the conducting portion of the respiratory tract.

Nose

The main conducting airway for inhaled air.

Nasal Bones

Form the bridge of the nose.

Nostrils or External Nares

Openings on the inferior surface of the nose.

Nasal Cavity

Connects to the nasopharynx via the internal nares. Helps sound resonant.

Roof of Nasal Cavity

Made up of the frontal bones, nasal bones, cribriform plate of the ethmoid and sphenoid bone.

Floor of the Nasal Cavity

Horizontal plate of the maxillae, and horizontal plate of the palatine bones.

Vestibule

Anterior portion of the nasal cavity near the nostrils. Contains vibrissae.

Vibrissae

Coarse nose hairs in the vestibule.

Olfactory Epithelium

The most superior portion of the nasal cavity when has numerous chemoreceptors for the sense of smell.

Nasal Septum

Divides the nasal cavity into left and right.

Septal Cartilage

Anterior portion of nasal septum.

Perpendicular Plate of the Ethmoid

Contributes to the superior portion of the nasal septum.

Vomer Bone

Contributes to the posterior portion of the nasal septum.

Conchae or Tubinates

Help form the lateral walls of the nasal cavity. They also act to create turbulence in the nasal cavity so air can be humidified longer and so particles can be trapped.

Superior Nasal Conchae

Part of the ethmoid bone.

Middle Nasal Conchae

Part of the ethmoid bone.

Inferior Nasal Conchae

Independent facial bone. Note: the nasolacrimal ducts empty just inferior to this bone.

Paranasal Sinuses

Four bones in the skull contain these paired air spaces which together decrease skull bone weight and help condition air. They are lined by ciliated epithelium with overlying mucus. They include the frontal sinus, ethmoidal sinus, sphenoidal sinus, and maxilary sinus.

Article: Antenna Pierces Brain

Article: The antenna went up his nose and through his sinus and hit his pituitary gland. He lost a pint of blood.

Article: Balloon Sinusplasty

Article: The procedure that lest doctors snake a balloon up the noses of chronic sinusitis sufferers, stretching their sinus passages to help them breathe easier.

Article: Sinusitis

Article: An inflammation or infection of the straw-sized passages that drain each of he sinuses that surround the nose and eyes. It can cause swelling and facial pain, debilitating headaches, and sometimes pus-like nasal congestion.

Article: Acute Sinusitis

Article: Triggered by colds or bad allergies, usuallly clears up within a month.

Article: Chronic Sinusitis

Article: Symptoms of sinusitis last longer than two months or regularly occur.

Article: Polyps

Article: Growths in the sinus passageways that the balloon can't get rid of.

Pharynx

Commonly called the throat. Its funnel shaped and is a common pathway for both inhaled and exhaled air and for ingested food. It is lined with mucosa and contains skeletal muscles used for swallowing.

Nasopharynx

The superiormost region of the pharynx. It is lined with ciliated epithelium and normally only air passes through it.

Uvula and Soft Palate

Responsible for preventing food from entering the nasal cavity though the nasopharynx.

Auditory or Eustachian Tubes

Tubes that connect the inner ear with the nasopharynx in order to equalize pressure in the ear.

Pharyngeal Tonsil or Adenoids

Single tonsil housed in the nasopharynx.

Oropharynx

The middle pharyngeal region which is immediately posterior to the oral cavity. Bounded by the soft palate and the hyoid bone. It has no cilia and is tough to withstand swallowed food. Both air, food and drink pass though it.

Palatine tonsils and Lingual Tonsils

Two lymphatic tonsils in the oropharynx.

Laryngopharynx

The inferior portion of the pharynx. It extends from the hyoid bone to the top of the esophagus. Contains strong epithelium with no cilia since it allows passage of both air and food. When things get lodged in the throat it is usually in the laryngopharynx.

Larynx or Voice Box

Bounded superiorly by the laryngopharynx and posteriorly by the esophagus and inferiorly by the trachea. The superior aspect of the larynx is lined with a stratified squamous epithelium and the portion below the vocal cords is lined with ciliated epithelium.

Functions of the Larynx

Prevents swallowed materials from entering the lower respiratory tract, conducts air into the lower respiratory tract, and produces sound.

Thyroid Cartilage

The largest cartilage in the larynx which forms only the anterior and lateral walls of the larynx. Formed with hyalin cartilage.

Laryngeal Prominence or Adam's Apple

The V-shaped anterior projection of the thyroid caritlage.

Cricoid Cartilage

Ring-shaped and forms the inferior base of the larynx and connects to the trachea. Composed of hyaline cartilage.

Cricothyroid Ligament

Dense connective tissue band which attaches the cricoid cartilage to the inferior edge of the thyroid cartialge. Its 4 fingers width from the sternal notch.

Cricothyrotomy

Emergency airway which is sometimes opened in the larynx by making an incision though the cricothyroid ligament. A vertical incision is followed by a horizontal incision to allow air into the respiratory tract. Tubes are then inserted.

Clinical: Tracheotomy

Clinical: Done when the patient has upper airway obstruction, difficulty breathing(pneumonia, pmphysema, or chest wall injury) or respiratory paralysis. Performed by making an incision between the third and forth tracheal rings to allow the insertion of a trachotomy tube.

Clinical: Tracheostomy

Clinical: Opening created by a tracheotomy.

Clinical: Tracheal Stenosis

Clinical: A narrowing of the trachea at the incision site due to scar tissue formation.

Clinical: Cricothyrotomy

Clinical: Procedure performed by EMT's where an incision is make in the neck inferior to the thyroid cartilage and then another is made transversly through the cricothyroid ligament.

Clinical: Heimlich Maneuver

Clinical: Performed by creating pressure in the remaining air in the lungs by pushing in and upwards on the abdomen. It can also be performed on oneself. If not succesful a cricothyrotomy is necessary.

Clinical: Right Bronchus

Clinical: Most smaller aspirated foreign bodies end up here because of the straight shot down into the lower lobe of the right lung.

Clinical: Bronchoscopy

Clinical: Procedure where a bronchoscope (either flexible or rigid, preferable rigid) is used to find and remove the foreign body.

Epiglottis

Large, spoon or leaf shaped elastic cartilage that covers the opening of the larynx. It attaches to the thyroid cartilage and moves down as the larynx moves up during swallowing. After swallowing it returns to its normal superior position.

Article: Tubes into Tubes

Article: Endotracheal tube into windpipe, laryngoscope=L-shaped, IV Catheter, IO line (interosseous line), Emergency IV in umbilical catheter.

Laryngoscope

L-shaped endoscope used for visualizing the larynx.

Vestibular Folds or False Vocal Cords

The superior ligaments along with the mucous membrane covering them. They have no function in sound production.

Vestibular Ligaments

The superior ligaments and part of the vestibular folds.

Vocal Folds or True Vocal Cords

The inferior ligaments along with the mucous membrane covering them. They produce sound when air passes between them.

Vocal Ligaments

The inferior ligaments and part of the vocal folds.

Rima Glottidis

The opening between the vocal folds. This opening widens if the vocal folds are abducted and becomes more narrower if the vocal folds are adducted.

Glottis

Refers to the rima glottidis plus the vocal folds.

Range of Voices

Determined by the length of the vocal folds. Longer vocal folds equal lower range and shorter equals higher range.

Pitch of Voices

Determined by the amount of tension or tautness on the vocal folds by the intrinsic laryngeal muscles. Tighter equals higher sound and loose equals lower sound.

Loudness of Voices

Depends on the force of the air passing across the vocal folds. A lot of air forced throuth the rima glottidis produces a loud sound, a little equals a soft sound. Note: Whispering only uses the most posterior portion of the rima glottidis and the vocal cords do not vibrate. This is why a whisper is all the same pitch.

Cracking of the Voice

When a male goes through puberty, his laryngeal cartilages and vocal folds grow rapidly, producing this sound which eventually leads to a deeper voice at maturity.

Structures Involved in Speech

Pharynx, nasal and oral cavities, paranasal sinuses, lips, and tongue.

Clinical: Laryngitis

Clinical: Inflammation of the larynx that may extend to the surrounding structures. Viral or bacterial infection is the most common cause but can also be caused by overuse in yelling. In children the epiglottis can also become swollen and obstruct the airway making a medical emergency.

Trachea

A flexible, slightly rigid tubular organ often referred to as the windpipe. It is lined with cilia which help move debris up to the larynx and pharynx to be swallowed or expelled.

Tracheal Cartilages

15-20 C-shaped rings that keep the trachea open. The trachealis muscle covers the open part of the C.

Trachealis Muscle

The open end of each C-shaped piece are bound together by this muscle. During swallowing this muscle bulges into the trachea to allow for swallowing of large objects and it is contracted in coughing in order to increase pressure and help expel foreign objects.

Primary Bronchi

Two smaller tubes which bifurcate from the trachea at the level of the sternal angle. They have incomplete rings of hyaline cartilage. Note: The left Bronchi is at a more acute angle to get over the heart and the right is straight down. As a result stuff tends to go into the right bronchi.

Carina

The most inferior tracheal cartilage separates the primary bronchi at their origin and forms an internal ridge.

Bronchial Tree

A highly branched system of air-conducting passages that originate from the left and right primary bronchi and progressively branch into narrower tubes as they diverge throughout the lungs before ending int eh terminal bronchioles.

Hilum

The medial surface of the lung.

Secondary Bronchi

Branch from the primary bronchi. The right lung has 3 for the 3 lobes and the left has 2 for the two lobes.

Tertiary Bronchi

The secondary bronchi divide into these even smaller bronchi which in turn divide into even smaller bronchi. They have ciliated epithelium and have cartilage and smooth muscle.

Bronchioles

No longer lined with cilia, don't contain cartilage. However, they contain muscle that helps regulate air flow. Where bronchoconstriction and broncodilation occur.

Bronchoconstriction

Smooth muscle contraction narrows bronchioles.

Bronchodilation

Smooth muscle relaxation dilates bronchioles.

Terminal Bronchioles

The final segment of the conducting pathway. They conduct air into the respiratory portion of the respiratory system.

Clinical: Bronchitis

Clinical: Inflammation of the bronchi caused by viruses or bacteria, or by inhaling vaporized chemicals, matter, or cigarette smoke. Divided into acute and chronic.

Clinical: Acute Bronchitis

Clinical: Develops rapidly and only lasts for about 10-14 days.

Clinical: Chronic Bronchitis

Clinical: Results from long-term exposure to irritants. Defined by the large amounts of mucus and a cough to last up to 3 months. Permanent changes can occur such as thickening bronchial walls and narrowing o lumens, or overgrowth (hyperplasia) of the mucin cells of the bronchi, and accumulation of lymphocytes within the bronchial walls.

Respiratory Bronchioles

Branch from the termialbronchiles and continue to divide. Alveoli can come off of it.

Alveolar ducts

Smallest airway before the alveolus.

Alveolus (plural alveoli)

Specialize to promote diffusion of oxygen from the alveoli into the pulmonary capullaries, and diffusion of carbon dioxide out of the pulmonary capillaries and into the alveoli.

Alveolar Macrophages

Migratory cells that continually crawl within the alveoli, engulfing microorganisms or particulate material that has reached the alveoli.

Pleura

Serous membrane on the outside of the lung. Made up of the visceral and parietal pleura which are continuous at the hilum of the lungs.

Visceral Pleura

Pleura that tightly covers the outer surface of the lung.

Parietal Pleura

Covers the internal thoracic walls, the lateral surfaces of the mediastinum, and the superior surface of the diaphragm.

Pleural Cavity

The potential space between the two serous membranes. The pressure in this space is lower than that of the lungs which makes them stick together.

Clinical: Pneumothorax

Clinical: A condition that occurs when free air gets into the pleural cavity, the space between the parietal and visceral pleura. Results from a penetrating injury or from a broken rib puncture.

Clinical: Treatment for Pneumothorax

Clinical: Insertion of a tube into the pleural space to suck out the free air. After the air has been removed, an airtight bandage is placed over the entry site to prevent air from reentering the pleural space.

Clinical: Tension Pneumothorax

Clinical: A hole in the chest or lung allows air to enter and acts as a one-way valve. As the patient struggles to breath, air is pulled in through the wound but can't escape. Can cause atelectasis of both lungs and death.

Clinical: Atelectasis

Clinical: Collapsed lung.

Clinical: Hemothorax

Clinical: Condition where blood fills the pleural cavity.

Clinical: Hydrothorax

Clinical: An accumulation of serous fluid in the pleural cavity.

Clinical: Empyema

Clinical: Accumulation of pus, as occurs with pneumonia, in the pleural cavity.

Base of the Lung

Wide, concave portion that rests inferiorly upon the muscular diaphragm.

Apex of the Lung

Blunt superior region which projects superiorly to a point that is slightly superior and posterior to the clavicle.

Subdivisions of the Right Lung

Superior, middle, and inferior lobe.

Subdivisions of the Left Lung

Superior and inferior lobe.

Bronchopulmonary Segments

The left and right lungs may be partitioned into these segments each with their own tertiary bronchus, surrounded by connective tissue, and each with ts own arterial and venous blood supply.

Clinical: Pneumonia

Clinical: An infection of teh alveoli of the lung. Commonly caused by bacteria and viruses. Results in tissue swelling and accumulated leukocytes in that area and decreased capacity to exchange gas. Contagious.

Clinical: Sputum

Clinical: Expelled with pheumonia. Consists of mucus and other matter, and is usually rust- or green-tinged.

Pulmonary Circulation

Conducts blood to and from the gas exchange surfaces of the lungs to replenish its depleted oxygen levels and get rid of excess carbon dioxide.

Bronchial Circulation

A component of the systemic circulation and consists of tiny bronchial arteries and veins that supply the bronchi and bronchioles of the lung.

Bronchial Arteries

3 or 4 of them branch from the anterior wall of the decending thoracic aorta to supply the bronchial tree.

Bronchial Veins

Collect venous blood from these same structures and drain them into the azygous system of veins.

Lymphatic Drainage of Lungs

The lymphatic drainage of the right lung drains into the right lymphatic duct, and the lymphatic drainage of the left lung drains into the thoracic duct.

Pulmonary Ventilation

Also known as breathing, it is the movement of air into and out of the respiratory system.

Clinical: Asthma

Clinical: A chronic condition characterized by episodes of bronchoconstriction and wheezing, coughing, shortness of breath, and excess pulmonary mucus. The person becomes hypersensitive to an airborne agent and upon exposure the bronchioles constrict. Treatment included inhaled steroids(cortisone-related compounds), bronchodilators, and other measures.

Autonomic Nervous System

Responsible for innervating the trachea, bronchial tree, and lungs.

Sympathetic Innervation

Its main function is to open and dilate the bronchioles (bronchodilation).

Parasympathetic Innervation

Its main function is to decrease the airway diameter of the bronchioles (bronchoconstriction).

Medulla Oblongata

Regulates the rate and depth of breathing.

Pons

Can also influence the breathing rate.

Aging of the Respiratory System

There is a decrease in elastic connective tissue which results in a decrease in the ventilation rate.

Chronic Obstructive Pulmonary Disease (COPD)

Encompasses emphysema and chronic bronchitis. Characterized by lung structural abnormalities resulting from inflammation, the resulting airflow obstruction makes it hard for the patient to exhale.

Clinical: Emphysema

Clinical: TYPE OF COPD! An irreversable loss of pulmonary gas exhange surface area due to inflammation of the terminal bronchioles and alveoli. There is a decrease in the number of alveoli which leads to greater spaces in the alveoli. A larger chest is characterized by this. No cure.

Clinical: Lung Cancer

Clinical: Originates in the epithelium, and if metastasis occurs it will most likely move to the brain. Pulmonary symptoms include chronic cough, coughing up blood, excess pulmonary mucus, and increased likelihood of pulmonary infections.

Clinical: Squamous Cell Carcinoma

Clinical: Cancer that changes the pseudostratified ciliated columnar epithelium lining in the lungs to a sturdier stratified squamous epithelium to withstand the chronic inflammation and injury caused by tobacco smoke. These then are genetically damaged and become malignant.

Clinical: Adenocarcinoma

Clinical: Arises from the mucin-producing glands. DNA injury causes these cells to become malignant.

Clinical: Small-Cell Carcinoma

Clinical: Fastest to metastasis of the lung cancers. Originates in the primary bronchi and eventually invades the mediastinum.

Clinical: Sudden Infant Death Syndrome (SIDS)

Clinical: Also known as Crib Death, it is the sudden and unexplained death of an infant yougner than 1 year of age. Babies that sleep on their stomachs are more likely to die so "back to sleep" campaign has helped.

Article: Cystic Hygroma

Article: A tangled mass of lymph vessels mos often seen in young children. IT is not cancerous but the abnormal growth can encroach on otherwise normal organs. In a fetus, excess amniotic fluid can diagnose this condition.

Article: Intubation

Article: The process of inserting a tube down the trachea, usually using a laryngoscope. In the article the doctor looked for bubbles in order to know where to put the tube in between the growths.

Article: Bruit or Carotid Bruit

Article: A blockage in an artery can cause this noise made by turbulant flow.

Article: Arteriovenous Malformations or AVMs

Article: Complex tangles of abnormal arteries adn veins that can be located in almost any organ in the body, including the brain. Movement of blood through an AVM is rapid, turbulent, and high-volume.They also have a defective layer that makes them prone to stroke.

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