Pulmonary Anatomy Notes

Pulmonary Anatomy

• Prepared by Jennifer Ellsworth, M.S.

Lungs

• Ventilation moves air into and out of the body.
• Respiration moves gasses into and out of the blood and tissues.
  • Gases move from high concentration to low concentration.
  • Gases cross a layer of epithelium into Aveoli: spaces to allow air move in or out

Upper Respiratory Functions

• Warm air
• Humidify air
• Filter out foreign matter

Paired Choanae (AKA Internal Nares)

• Open into the nasopharynx.
• Paired oval openings formed by vomer (medially) and horizontal plate of palatine bone (inferiorly)

Fauces

• Open into Oropharynx.
  • palatoglossal arch
  • palatopharyngeal arch
  • palatine tonsils

Choanae & Fauces

• Expose inspired air to the lymphocyte filled tonsils cleansing air before it reaches the lungs.
• Oral cavity proper
• Oral vestibule
• Oropharynx
• Internal nares choanae
• Fauces
• Esophagus

Insults to the Bronchial Epithelium

• Normal Bronchial Epithelium can be damaged by:
  • Carcinogens
  • CO
• This can lead to Smoker's Epithelium and eventually Carcinoma

Lower Respiratory Functions

• Speech
• Gas Exchange
  • O_2 in
  • CO_2 out
• Homeostasis
  • pH

Chemoreceptors

• IX, GLOSSOPHARYNGEAL
• AORTIC BODIES
• X, VAGUS NERVE
• Alveolus

Anatomy of the larynx

• Body of hyoid bone
• Laryngeal prominence (Adam's apple)
• Cricoid cartilage
• Sternal head
• Clavicular head
• Clavicle
• Jugular notch
• Sterno-cleidomastoid

Valsalva maneuver

• Used for straining but can cause nausea and fainting in patients struggling with hemodynamic instability.
• Phases:
  • I
  • II
  • III
  • IV
• Closed glottis
• Larynx
• Chest
• Muscles
• Valsalva (10 sec)
• Mean
• Lungs
• Aortic
• Pressure
• Diaphragm
• Heart
• Rate
• Abdominal Muscles
• Abdominal Cavity
• Rectal Muscles

Beginning of the Lower Respiratory Anatomy: Larynx

• Swallowing
• Sound Production
  • Sound quality
• Cricoid Cartilage
• Arytenoid Cartilage
  • ↑ tension in vocal folds.
  • ↑ pitch
  • Bigger larynx→ deeper voice
• Phonation occurs here: "buzzing sound"
• Articulation
  • tongue, teeth, lips
• L.Chorda Vocalis
• Rima Glottidis

Larynx

• Innervated by the Recurrent laryngeal nerves.
• They are branches of the Vagus.
• Right vagus nerve
• Thyroid cartilage.
• Right common carotid artery
• Right recurrent laryngeal nerve
• Right subclavian artery
• Hyoid bone
• Left vagus nerve
• Left common carotid artery
• Thyroid gland
• Inferior laryngeal nerve
• Left subclavian artery
• Aortic arch
• Left recurrent laryngeal nerve

Slide 13 Trachea

• Cilia-
  • Ciliated cell (mucus transport)
• Goblet cell (mucus production)
• Connective tissue

Trachea

• Esophagus
• Trachealis muscle
• Lumen of trachea
• Thyroid gland
• Respiratory epithelium
• lumen
• Tracheal cartilage
• muscle
• glands
• cartilage

Bronchial Tree

• trachea
• main bronchus
• Secondary
• Tertiary or segmental bronchus
• bronchioles
• terminal bronchioles
• respiratory bronchioles
• To 1 lung
• To 1 lobe
• To 1 bronchopulmonary segment
• To 1 lobule
• To alveolar sac.
• Where gas exchange occurs
• conducting portion
  *ANS cause bronchodilation.

Structures of the respiratory zone

• Respiratory bronchiole
• Alveolar duct
• Alveolar pores
• Alveoli
• Alveolar sac
• ~400 million alveoli participate in gas exchange.
• Surface area of alveoli is 1500 square feet! (~140 square meters)

Bronchopulmonary Segments

• Right lung
  • Anterior [S3] segment (right superior lobe)
  • Posterior [S2] segment (right superior lobe)-
  • Superior [S6] segment (right inferior lobe)-
  • Apical [S1] segment (right superior lobe)
  • Lateral basal [S9] segment (right inferior lobe)
  • Anterior basal [S8] segment (right inferior lobe)
  • Lateral [S4] segment (right middle lobe)
  • Medial [S5] segment (right middle lobe)
• Left lung
  • Apicoposterior [S1+2] segment (superior division [culmen] of left superior lobe)
  • Superior [S6] segment (left inferior lobe)
  • Inferior [S5] segment (lingular division of left superior lobe)
  • Lateral basal [S9] segment (left inferior lobe)
  • Anteromedial basal [S7+8] segment (left inferior lobe)
  • Superior [S4] segment (lingular division of left superior lobe)

The Respiratory Muscles

• Primary Muscle of Inhalation
  • Diaphragm
  • External intercostal muscles
• Accessory Muscle of Inhalation (active when needed)
  • Sternocleidomastoid muscle
  • Scalene muscles
  • Pectoralis minor muscle
  • Serratus anterior muscle
• Accessory Muscles of Exhalation (active when needed)
  • Transversus thoracis muscle
  • Internal intercostal muscles
  • Rectus abdominis and other abdominal muscles (not shown)

The peripheral chemoreceptors:

• Carotid and Aortic bodies respond to changes in oxygen and hydrogen levels in blood.
• Brain
• Sensory nerve fiber in cranial nerve IX (pharyngeal branch of glossopharyngeal)
• External carotid artery
• Internal carotid artery
• Carotid body
• Common carotid artery
• Cranial nerve X (vagus nerve)
• Sensory nerve fiber in cranial nerve X
• Aortic bodies in aortic arch
• Aorta
• Heart

Chronic Bronchitis

• Mucus with PMNs - acute inflammation
• Respiratory epithelium - a lot of goblet cells and thicker

Alveolar changes in emphysema

• (a) SEM of alveoli from a normal lung (250)
• (b) SEM of alveoli from the lung of a patient with emphysema (250)

Chronic Obstructive Pulmonary Disease (COPD)

• BLUE BLOATER (BRONCHITIS)
  • CYANOSIS
  • CRACKLES
  • WHEEZE
  • OBESITY
  • CHRONIC PRODUCTIVE COUGH
  • PURULENT SPUTUM
  • PERIPHERAL OEDEMA
  • CO_2 RETENTION (INSENSITIVE TO IT)
• PINK PUFFER (EMPYSEMA)
  • TACHYPNEA
  • PINK SKIN
  • PURSED-LIP BREATHING
  • ACCESSORY BREATHING MUSCLES
  • MINUTE VENTILATION
  • BARREL-CHEST
  • DECREASED BREATH SOUNDS
  • CO_2 RESPONSIVE
  • CACHECTIC APPERANCE
  • COMPENSATORY HYPERVENTILATION

The Respiratory System Throughout Life

• Surfactant secreted after 26 weeks gestation.
• At birth, only one-sixth of alveoli are present.
• In people who begin smoking as teenagers:
  • Lungs never fully develop
  • Additional alveoli never form
  • Lungs loose elastance