ST.

XAVIERS CATHOLIC COLLEGE OF NURING, CHUNKANKADAI

ANATOMY OF

RESPIRATORY

SYSTEM

SUBMITTED BY SUBMITTED TO
 J.ASIR DHAYANI Dr.REENA EVANCY Phd(N)

NURSING TUTOR PRINCIPAL

TERMINOLOGIES
1. ANTRUM A cavity or chamber in the maxillary sinus and is the largest of the paranasal sinuses.
2. NASAL CAVITY Two hollow spaces lined with mucous membrane and have a rich blood supply.
3. NASAL SEPTUM Wall of cartilage that divides the nose into two hollow spaces.
4. NOSE Structure in which air enters.
5. SINUSES Cavities on the skull that surround the nasal area.
6. NASAL VESTIBULE The space contained within the flexible tissues of the nose.
7. HARD PALATE The bony part of the roof of the mouth.
8. PLEURAE Covering for lungs and intestinal organs.
9. PLEURAL CAVITY Potential space between the lungs and chest wall.
10. ADAM’S APPLE(LARYNGEAL PROMINENCE)Lump or protrusion that is formed by the
angle of the thyroid cartilage surrounding the larynx.
11. ALVEOLAR DUCTS The part of the respiratory passage beyond the respiratory bronchioles from
which the alveolar sacs and alveoli arise.
12. ALVEOLI (RESPIRATORY UNIT) An air wall of the lungs, formed by the terminal dilation of
tiny air passages.
13. BRONCHIOLES Small airways extending the bronchi into the lobes of the lungs.
14. CILIA Tiny hair like structures that moves mucous and dust through the esophagus.
15. CRICOID CARTILAGE The ring-shaped structure forms the lower portion of the larynx.
16. CARINA The point, at which the trachea splits, causes intense coughing when stimulated by a
suction catheter.
17. DIAPHRAGM The musculomembranous partition separating the abdominal and thoracic cavities.
18. SOFT PALATE A muscular flap that closes off the nasopharynx during swallowing or speaking.
19. MEDIASTINUM It is the area in the chest between the lungs that contains the heart, the aorta, part
of the windpipe and the esophagus.
20. HEMOGLOBIN It is a protein inside red blood cells that carries oxygen throughout the body.
21. HILUM Midline region where the bronchi and blood vessels enter and exit the lungs.
22. SURFACTANT Surface acting material responsible for lowering the surface tension of a fluid.
23. BENDS OR CAISSON’S DISEASE Disease of the divers due to the excessive accumulation of
nitrogen in the blood.
24. OTORHINOLARINGOLOGY It is the branch of medicine that deals with diagnosis and treatment
of the diseases of the ears, nose and throat(ENT)
25. PULMONOLOGIST A pulmonologist is a specialist in the diagnosis and treatment of diseases of
the lungs.

STRUCTURE OF RESPIRATORY SYSTEM

INTRODUCTION
Respiratory system is required for taking in air which contains oxygen and breathing out carbon-di-
oxide which is the waste product of metabolic processes occurring in the body.

PARTS OF RESPIRATORY SYSTEM

The respiratory system is divided into two parts.

 Upper Respiratory Tract

 Lower Respiratory Tract
UPPER RESPIRATORY TRACT

The organs of upper tract are located outside the chest cavity. They include

 Nose
 Pharynx
 Larynx

LOWER RESPIRATORY TRACT

The organs of lower tract are located inside the chest cavity. They include

 Trachea
 Two bronchi(one bronchus to each lung)
 Bronchioles and smaller air passages (small
bronchi,bronchiole,alveoli)
 Two lungs and their coverings(pleura)
 Muscles of Respiration
 The intercostals muscles
 Diaphragm

UPPER RESPIRATORY TRACT

NOSE AND NASAL CAVITY

NOSE
 First respiratory organ.
 Pyramidal shaped structure.
 Apex pointing towards forehead base pointing near mouth.
 Openings of the nose on the face are known as anterior nasal apertures (anterior nares).It
leads to nasal cavities.
 It is divided by a median partition, the nasal septum into two nasal cavities.

EXTERNAL PORTION

 The nose has a prominent ridge separating the right and left halves called the dorsum.
 It is made up of bone and hyaline cartilage.
 It is covered with skin.
 It is lined by mucous membrane.
 It is flexible, external nose has two openings called the nostrils or external nares.The
nares are separated by the septum bone.
 Upper narrow end-root of the nose
 Middle- bridge of the nose
 Lower end-tip of the nose Wings Ala.

INTERNAL PORTION

 It is a large cavity.
 It lies over the roof of mouth.
 The roof of the nose is separated from the cranial cavity by a ethmoid bone called
cibriform plate.
NASAL CAVITY
o Pyramidal in shape.
o Extends from the nostrils (anterior nares to the posterior nasal apenture).
o Divided into right and left halves by a median septum.

SUBDIVISION

 VESTIBULE
 OLFACTORY REGION
 RESPIRATORY REGION
 VESTIBULE

Vestibule-dilated part just inside the anterior nasal opening.

Vibrissae-numerous coarse hairs which help to filter the air.

 OLFACTORY REGION

The upper 1/3 of the nasal cavity has the olfactory receptor cells. The mucosa is
yellowish in color.

 RESPIRATORY REGION

The lower 2/3 of the nasal cavity is lined by thick mucous membrane. It is highly
vascular. It is lined by pseudo stratified ciliated columnar epithelium. Each nasal cavity has a
  Roof
 Floor
 Medial wall
 Lateral wall

 ROOF Formed by nasal bone, frontal bone, cibriform of ethmoid and sphenoid.
 FLOOR Formed by hard palate i.e. Palatine process of maxilla and palatine bone.
 MEDIAL WALL Formed of nasal septum.ie.
o Anteriorly-the hyaline cartilage
o Posteriorly-Superiorly, the perpendicular plate of ethmoid
o Inferiorly-Vomer
  LATERAL WALL

Formed by the maxilla, ethmoid with superior and middle turbinates (conchae) and the inferior
nasal turbinate. A turbinate is a shelf like projection.
 The nasal cavities open into nasopharynx

 Anteriorly through anterior nasal (apertures or nares)

 Posteriorly through posterior nasal (apertures or nares).

There are two anterior and two posterior nasal apertures.

EPITHELIAL LINING OF NASAL CAVITIES

The inner lining of the nose is covered with mucous membrane. The nasal cavities are lined by
pseudo stratified ciliated columnar epithelium with goblet cells. Mucus is secreted by the goblet cells
which trap the foreign particles that have entered nasal cavities.

PARANASAL SINUSES
These are air filled space (air cavities present in the bones around the nose.

Paranasal sinuses are

 Frontal
 Maxillary
 Ethmoidal
 Sphenoidal

FRONTAL SINUS
 o Lies in frontal bone.
o Opens into the middle meatus of nose.
o Average height, width and depth are equal.

MAXILLARY SINUS

o Lies in the body of maxilla.

o Pyramidal in shape.
o Opens into the middle meatus of nose.
o Height, width and depth are not equal.

SPHENOIDAL SINUS

o Lies in the sphenoid bone

o Separated by septum.
o Height, width and depth are not equal.

ETHMOIDAL SINUS

o Lies in the labyrinth of the ethmoid bone.

o Divided into anterior, middle and posterior groups.

Frontal air sinus, Maxillary air sinus, Ethmoidal air sinus- drain in the lateral wall of the nose

Sphenoid air sinus-drain in the roof of the nose

NASOLACRIMAL DUCT
o Extends between the eyes and the nose.
o Opens in the lateral wall of nose.
o Drains tears from eyes to nasal cavity
 PHARYNX

POSITION
o It is a tube 12 to 14 cm long, 3.3 cm width.
o Extends from the base of the skull to the level of 6th cervical vertebra.
o Downward and backward continuation of nasal and oral cavities.
o Wide muscular tube like structure.
o Situated behind the nose, mouth and larynx.
o Wide at its upper end; narrow at its lower end.

STRUCTURES ASSOCIATED WITH PHARYNX

Superiorly Base of the skull, including the part of the sphenoid, occipital and front of
the pharyngeal tubercle.

Inferiorly Esophagus at the level of 6th cervical vertebra.

Posteriorly Areolar tissue, involuntary muscle the pharynx glides freely on the
prevertebral fascia which separates it from the cervical spine.

Anteriorly It is connected with the nasal cavity, oral cavity and the larynx, so the
anterior wall is incomplete.
PARTS OF THE PHARYNX

The Pharynx is divided into three parts

 Nasopharynx(nasal part-lies behind nose)

 Oropharynx(oral part)
 Laryngopharynx(laryngeal part)

NASOPHARYNX (NASAL PART)

 Superior part of pharynx.

 Extends from the posterior nares to the soft palate.
 Five openings in its wall
 Two internal nares
 Two openings that lead into the auditory tubes
 Opening into the oropharynx
 Its wall are rigid and non-collapsible.
 It is lined by ciliated columnar epithelium.
 Anteriorly, it communicates with the nasal cavities through the posterior nasal apertures.
 Inferiorly, it becomes continuous with the oropharynx.
 Lateral wall shows the pharyngeal opening of the auditory tube or Eustachian tube. This
opening is bounded by a tubal elevation. Behind this, there is a narrow vertical slit called the
pharyngeal recess or fossa of Rosenmullar.
  Near the junction of roof and posterior wall of nasopharynx, there is a collection of lymphoid
tissue called pharyngeal or nasopharyngeal tonsil.It is better developed in children.A
pathologically enlarged pharyngeal tonsil is called adenoids.
 Another collection of lymphoid tissue is present in the nasopharynx, behind the opening of
auditory tube. It is called tubal tonsil.

OROPHARYNX (NASAL PART)

o It is the middle part (oral part) of the pharynx below the level of soft palate
o It lies behind the oral cavity at the level of 3rd cervical vertebra.
o It is present between nasopharynx above and laryngopharynx below.
 Superiorly-oropharyngeal isthmus (Isthmus of fauces, soft palate)
 Inferiorly-Laryngopharynx (hyoid bone)
 The lateral wall of oropharynx presents the palatine tonsil, lying between the
palatoglossal and palatopharyngeal arches. The palatine tonsil is one of the mucosa-
associated lymphoid tissues (MALT) Collection of lymphoid follicles between two
vertical folds of mucous membrane called the glassopalatine arches.

Oropharynx is lined by non-keratinized stratified squamous epithelium.

During the act of swallowing the soft palate lifts up to close the nasopharyngeal and
oropharyngeal communication therby preventing the food to come out through nose while swallowing.

WALDEYER’S RING
This is a ring of lymphoid tissue in relation to the oropharyngeal isthmus. The
most important lymphoid tissue are
o Right palatine tonsils
o Left palatine tonsils
Other aggregations forming the part of Waldeyer’s ring are
o Tubal tonsils- 2
o Pharyngeal tonsil
o Lingual tonsil
LARYNGOPHARYNX (LARYNGEAL PART)

o It is the lowest part. It starts from oropharynx at the level of hyoid bone and ends to the
beginning of oesophagus
o It is situated behind the larynx.
o It extends from the upper border of epiglottis to the lower border of cricoid cartilage (C3-C6).
o It is lined by non keratinized stratified squamous epithelium.

Superiorly: It communicates with oropharynx.

Inferiorly: It is continuous with oesophagus at the level of sixth cervical vertebrae.

Posteriorly: The posterior wall is supported by the 4th and 5th cervical vertebra.

Laterally: There is depression in the lateral wall called the piriform fossa.

LAYERS OF THE PHARYNX

The wall of the pharynx is composed of the following three layers from inward to outward

LAYERS OF PHARYNX

Mucous Fibrous Muscle

membrane tissue tissue

MUCOUS MEMBRANE

o It is the innermost lining.

 o Its thickness varies in different parts. It is thick at the level of oropharynx and
laryngopharynx.
o It is continuous with the lining of the mouth and esophagus.
o The epithelial lining of the nasopharyngeal region is pseudo stratified ciliated columnar.
o Oropharynx and laryngopharynx are lined by stratified squamous epithelium.
o Stratified squamous nonkeratinized epithelium protects the deeper down tissues from the
abrasive actions of the bolus of the food during its passage through these parts of pharynx.

FIBROUS LAYER

o It is the middle layer.

o It is the fibrous tissue beneath the mucosa which is thicken in the nasopharyngeal region.
o Fibrous layer is made up of collagen fibres.
o It is thicker in the nasopharynx.It begins thinner towards the lower end.

MUSCLE LAYER

o It is the outermost layer.

o It consists of involuntary or non-striated muscle (not under conscious control).
o It is situated deeper to fibrous layer.
o It is composed of skeletal muscle which has involuntary action while swallowing.

LAYERS OF THE PHARYNX

There are 3 pairs of constrictors

 Superior constrictors
 Middle constrictors.
 Inferior constrictors and a number of
 Longitudinal muscles
 Stylopharyngeus
 Salphingopharyngeus
 Palatopharyngeus

During swallowing the inferior constrictor relaxes to allow the food from pharynx to oesophagus.

RELATIONS OF THE PHARYNX

Superior Inferior surface of body of the sphenoid.

InferiorContinues as Oesophagus at the level of sixth cervical vertebra.

 Anterior Communicates with nasal cavities, oral cavity and larynx from above downwards.

Posterior Constrictor muscles and bodies of first six cervical vertebrae.

Lateral Openings of auditory tube and tonsil on either side along the longitudinal muscles of
pharynx.

BLOOD SUPPLY
Arterial Supply

o Branches of facial and external carotid arteries.

o Carotid artery
o Lingual artery
o Palliative and maxillary artery.

Venous DrainageFacial and internal jugular veins.

NERVE SUPPLY
Parasympathetic Glassopharyngeal, Vagus, Cranial part of accessory nerves.

Sympathetic Superior cervical sympathetic ganglion

Parasympathetic and sympathetic nerves from pharyngeal plexuses.

LARYNX
 It is commonly known as voice box.
 It is a common organ for respiration and phonation (sound production)
 It lies in the anterior midline of the neck, extending from the root of the tongue the hyoid bone of
trachea (pharynx above, trachea below).
 It lies opposite 3 rd to 6th cervical vertebrae.
 Until puberty there is little difference in the size of the larynx between the sexes. Thereafter it
grows larger in the male, which explains the prominence of the Adam’s apple and generally the
deeper voice.
 It is made up of
 Cartilages
 Muscles
 Fibrous tissues
 Membranes
  Glands

 Male larynx is larger than in females.

 The larynx is made up of
 Skeletal framework of cartilages
 Joints, ligaments, and membranes which connect the cartilages.
 Muscles, which move the cartilages and the structures attached to them.
 The cavity of the larynx is lined by respiratory epithelium except the surface of vocal
cord which is lined by stratified squamous epithelium.
 Size: Length-4.3 cm
 Transverse diameter-4.2 cm
 Anteroposterior-3.6 cm
CARTILAGESIt is formed by the cartilages. Three cartilages are unpaired and three
cartilages are paired. In total nine cartilages form the skeleton of larynx. The types of Cartilages are

hyaline and elastic fibro cartilage.

UNPAIRED CARTILAGES

 Thyroid cartilage (hyaline cartilage) which is the largest. It has two laminae meeting each
other in the midline at an angle 900 in males and 1200 in females. The cartilage is made of two
quadrangular plates

.
  ADAM’S APPLE The anterior borders of the two plates are united in their lower parts at
an angle, which forms a prominence in the middle of the neck, called the laryngeal
prominence or Adam’s apple. It is more prominent in males.
 In the upper part, the anterior borders are separated by a thyroid notch.
 The posterior borders extend superiorly as the superior horn or cornu (posterior
border of each lamina projected up), inferiorly as inferior horn or cornu (posterior
border of each lamina projected below).
 To the upper border, the thyrohoid ligament is attached.
 The outer surface of the lamina presents the oblique line which gives attachment to strap
muscles, inferior constrictor muscle of pharynx and pretracheal fascia.
 Cricoid cartilage (ring of hyaline cartilage) which lies below the thyroid cartilage.
 It is signet ring in shape.
 It completely covers the larynx.
 It is connected to the thyroid cartilage by means of ligaments.
 It forms a narrow arch anteriorly and a broad lamina posteriorly.
 It consists of a
 Posterior quadrilateral lamina
 Anterior arch
 The thyroid cartilage is connected to the cricoids cartilage by the cricothyroid ligament.
 Epiglottic cartilage (Elastic fibro cartilage) attached to the top of thyroid cartilage.
 It is a leaf-shaped elastic cartilage.
 It acts like a lid for the inlet of larynx.
 The lower end is attached to the inner surface of the narrow thyroid cartilage by a
ligament.
 The upper end is broad and its anterior surface overhangs the posterior part of the
dorsum of the tongue.
 The posterior surface of epiglottis is covered by mucosa of the larynx.
 During swallowing, the base of the tongue presses epiglottis across and over the
opening of the larynx.Thus, food is prevented from entering into the trachea.
PAIRED CARTILAGES

 Arytenoid cartilage (Hyaline cartilage)at the back of cricoids.

 It has a pyramidal shaped structure.
 These are placed on the upper border of the lamina of cricoids cartilage.
 Its apex points upwards.
 It has two processes
 Vocal
 Muscular
 Vocal process projects anteriorly and gives attachment to vocal cord.
 Muscular process projects laterally and gives attachment to muscles.
 The apical part of the cartilage is formed of elastic cartilage. Its basal part is hyaline in nature.
 A fold of mucous membrane extends from arytenoids cartilage to epiglottis which is known as
aryepiglottic fold.Aryepiglottic fold contains cuneiform cartilage anteriorly and corniculate
cartilage posteriorly.
 Each arytenoid gives attachment to the vocal cords and is lined by ciliated columnar
epithelium.
 Cornicuate cartilage-small cartilages lying within the aryepiglottic fold.
 Cuneiform cartilage-small cartilages lying within the aryepiglottic fold
STRUCTURES ASSOCIATED WITH THE LARYNX
 Superiorly The hyoid bone and the root of the tongue.
 Inferiorly It is continuous with the trachea.
 AnteriorlyThe muscles attached to the hyoid bone and the muscle of the neck.
 PosteriorlyThe laryngopharynx and 3rd to 6th cervical vertebrae.

CAVITY OF LARYNX

 It extends from the laryngeal inlet above to the lower border of cricoids cartilage.
 Superiorly, It opens into the laryngeal part of the pharynx.
 Inferiorly, It is continuous with the bladder.
 The interior is lined by mucous membrane.
 Two pairs of folds project into the cavity from the lateral walls.
 The upper pair of folds are the vestibular folds or the false vocal cords.The gap or fissure between
them is called the rima vestibuli.
 The lower pair of folds are the true vocal cords and the fissure between them is rima
glottis(glotticles)

VOCAL FOLDS(VOCAL CORDS OR TRUE VOCAL CORDS)

o Two wedge shaped pearly white folds of mucous membrane stretching from the angle of
thyroid cartilage (anteriorly)to the vocal processes of the arytenoid cartilage posteriorly.
o Rima glottis-The fissure between the vocal cords.
o They are concerned with voice production.
o Their average length varies in males and females.
 Males-23 mm
 Females-17 mm

Each Vocal cord consists of

  Vocal ligament
 Vocalis muscle
 Mucous membrane

o The muscles controlling the arytenoids cartilage determine opening and closing of the glottis, while
the tension of the vocal cords is regulated by Vocalis and cricothyroid a muscle which elongates the
vocal cords.
o In quiet breathing, the vocal cords are midway between full adduction and full abduction. During
vigorous breathing the folds open further in inspiration.
o During phonation ie when the subject is asked to say ah or ee the cords approximate. The frequency
of a note can be regulated by the tension in the vocal cords.

MUSCLES OF LARYNX

Extrinsic Muscles

o They are attached to the skeleton of the larynx and the bones above it.
o They move the larynx as a whole during respiration, deglutition, etc and support the larynx.
o Examples of Extrinsic Muscles
 Thyrohyoid
 Stylohyoid
 Intrinsic Ornohyoid
 Hypoglossus muscle
 Intrinsic Muscles

They are concerned with the movements of the vocal cords and hence, are also concerned
with the production of voice and respiration. They are

o Cricothyroid
o Thyroarytenoid
o Vocalis
o Posterior cricoarytenoid-the only abductor of vocal cord.
o Transverse arytenoids
o Oblique arytenoids
o Aryoepiglotticus
o Thyroepiglotticus

ARTERIAL SUPPLY

Laryngeal branch of superior and inferior thyroid artery.

VENOUS DRAINAGE

 Sensory Nerves

Above Vocal cord: Internal Laryngeal nerve

Below Vocal cord: Recurrent Laryngeal nerve

 Motor Nerves
Recurrent Laryngeal nerve

LYMPHATIC DRAINAGE

The lymphatics drain into superior thyroid vessels, prelaryngeal and pretracheal nodes.

TRACHEA(WIND PIPE)
o It is a cylindrical (tubular) structure.
o It is 10-12 cm long.
o It is made of C Shaped tracheal rings (16-20) , fibrous and muscular (smooth muscle) tissues.
Tracheal rings are formed of hyaline cartilage, which helps to keep the lumen of trachea patent
under all conditions. These cartilages make up the anterior and lateral walls of trachea.
o The posterior gap between the ends of C shaped tracheal rings is fitted by smooth muscle
trachealis.Fibrous tissue fills up the gap between the adjacent ‘’c” shaped cartilage and present
posteriorly.
o The lumen is lined by ciliated columnar epithelium and contains many mucous and serous glands.
o It is a continuation of the larynx and extends downwards to above the level of 5th thoracic vertebra.
o It divides at the carina into the right and left primary bronchi cone bronchus going to each lung.
o In the neck region it is covered by the isthmus of the thyroid gland and acts as a shield for trachea.
o It is a midline tube which begins at 6th cervical vertebra.
 Length :10 to 15 cm
 Diameter:Males 2 cm ;Females 1.5 cm
WALL OF TRACHEA
The wall of the trachea consists of the following layers

o Mucosa
o Sub mucosa
o Cartilage
o Adventitia(outer fibrous layer)
 MUCOSA
Lined by pseudo stratified columnar epithelium with goblet cells in between.
 SUBMUCOSA
Made of loose connective tissue, blood vessels, nerves and mucous gland.
 CARTILAGE
Forms second layer from luminal aspect. It is a C-shaped hyaline rings (cartilages)
deficient posteriorly, where the smooth muscle, trachealis fills the gap.
 ADVENTITIA(OUTER FIBROUS LAYER)
It also bridges the gap between the adjacent ‘’C’’ Shaped cartilages and the ends of
it.Posteriorly intermingled with the fibrous tissue, smooth muscle is also present. Fibrous
tissue is composed of collagen and many elastic fibres.

RELATIONS
 SUPERIOR Cricoid cartilage (larynx)
 INFERIOR Bifurcates into right and left primary bronchi.
 ANTERIOR Isthmus of thyroid gland below which is arch of aorta.
 POSTERIOR Oesophagus,posterior to which is vertebral column
 RIGHT LATERAL Right Lung and pleura, right lobe of thyroid gland.
BLOOD SUPPLY
 ARTERIAL SUPPLY Inferior thyroid and bronchial arteries
 VENOUS DRAINAGE Inferior thyroid veins.
 NERVE SUPPLY
 Parasympathetic Branches of vagus and recurrent laryngeal nerves
(stimulation produce bronchoconstriction)
 Sympathetic Branches from sympathetic trunk (stimulation produce
bronchodilation)
 LYMPHATIC DRAINAGE Lymph drains into bronchopulmonary lymph nodes.
 CARINA
The last tracheal ring is thick and broad. From its lower border, a hook-like process curves downwards
and backwards between bronchi. This projection is called the carina.

TRACHEOBRONCHIAL TREE
Extensive branching from the trachea through the terminal bronchioles resembles an inverted tree and is
commonly referred to as the bronchial tree.

The air passages between trachea and alveoli are divided about 23 times and form the
tracheobronchial tree. This concept was first introduce by Weibel,a swiss anatomist.

The multiple divisions of tracheobronchial tree increase the cross-sectional area.(cross section of
trachea is 2.5 cm2.

There are about 300 million alveoli(air sacs)in human lungs.The pulmonary capillaries and
alveoli from a blood-gas interface.
Conducting zone

Trachea and the first 16 generations of tracheobronchial tree constitute the conducting zone
where no gas exchange occurs. The smallest airway in the conducting zone is the terminal bronchiole.

Respiratory zone

The last seven generations of tracheobronchial tree constitute the respiratory zone where actual
exchange of gases takes place. This zone consists of respiratory bronchioles, alveolar ducts and alveoli.
The respiratory zone is surrounded by an extensive network of pulmonary capillaries. The alveolar ducts
and the thin-walled alveoli together form the respiratory unit.
 BRONCHI
Bronchi are formed when the trachea divides about the level of the 5th thoracic vertebrae and is
divided into right primary bronchus which goes into the left lung.
 Right bronchus is more in line with trachea. It is shorter and wider than left primary bronchus.
Therefore inhaled foreign bodies tend to obstruct right bronchus more than left one.

DIFFERENCE BETWEEN RIGHT AND LEFT BRONCHI

RIGHT BRONCHUS LEFT BRONCHUS

Wider and shorter Narrower and longer

Length=2.5 cm
More vertical and makes an angle of 250 with
median plane.
It enters hilum at the level of T5 vertebra.
Divides into three secondary bronchi for the three
lobes of lung.
Superior,Middle and Inferior lobar branches
Length=5 cm
More oblique and makes an angle of 450 with
median plane.
It enters hilum at the level of T6 vertebra.
Divides into two secondary bronchi for the two
lobes of lung.
Superior and inferior lobar branches
 Till the level of terminal bronchi hyaline cartilage is seen in the wall of bronchus.
 The primary bronchi divide to form smaller bronchi the secondary (lobar bronchi), one for each
lobe of the lung. The primary secondary bronchi are lined by pseudo stratified ciliated columnar
epithelium.
 The secondary bronchi continue to branch forming still smaller bronchi, called tertiary bronchi
that divide into bronchioles.
 Bronchioles contain clara cells, columnar, non ciliated cells interspersed among the epithelial
cells.
 Extensive branching from the trachea through the terminal bronchioles resembles an inverted
tree and is commonly referred to as the bronchial tree.
 Bronchioles do not have any cartilage in their wall instead their wall contains smooth muscles.
 The epithelial lining of wider tubes is pseudo stratified ciliated columnar which is gradually
replaced by cuboidal epithelium in respiratory bronchioles.
  Exchange of gases starts occurring at respiratory bronchiole. Therefore the structure responsible
for gaseous exchange are
 Respiratory bronchiole
 Alveolar duct
 Alveolar sac
 Alveoli
 Trachea, primary, secondary, tertiary bronchi and terminal bronchioles form the passage for air
conduction.

BLOOD SUPPLY
 ARTERIAL SUPPLY Bronchial arteries
 VENOUS DRAINAGE Bronchial veins.
 LYMPHATIC DRAINAGE Bronchopulmonary lymph nodes.

RIGHT BRONCHUS LEFT BRONCHUS

Wider Narrower
More vertical More angular
Shorter Longer
Supported by C shaped cartilages Supported by C shaped cartilages
20-30 degree angle 40-60 degree angle
First generation First generation

RESPIRATORY BRONCHIOLES
AND
ALVEOLI

The terminal bronchioles divide to form respiratory bronchioles which further divide to form
alveolar ducts and finally alveoli. Each 3 mm of lung tissue, contains 170 alveoli. Total approximately
300-500 million alveoli.

Each alveoli is like a pouch with diameter of 0.2-0.5 mm.

 It is lined by a layer of simple squamous epithelium.

There is a capillary network around the alveoli. The blood in the capillaries and the air in the
alveoli and separated by the columnar epithelium, the capillary endothelium and two layers of basement
membranes in between them.

Respiratory unit is defined as the structural and functional unit of lung. Exchange of gases occurs only
in this part of respiratory tract. Structure of respiratory unit

 Respiratory bronchioles
 Alveolar ducts
 Alveolar sacs
 Antrum
 Alveoli The acinus is the functional respiratory unit of the lungs (all alveoli are contained in
the lungs).Each terminal bronchiole gives rise to an acinus.
 Primary bronchi
Divide

Secondary bronchi (lobar)

Redivide

Tertiary bronchi (segmental)

Further branching
Fine bronchioles (do not possess cartilaginous rings in
their walls)

Bronchioles divide finer and finer till ends into an alveolar

duct.
Terminates

Alveolar sac or air sac or Infundibulum (microscopic sac)

 TYPE OF EPITHELIAL CELLS IN ALVEOLI

 Type I alveolar cells-Numerous cells are squamous cells

 Type II alveolar cells-These cells secrete pulmonary surfactant which reduces surface tension
and prevents collapse of the alveolus during expiration.
 Type III alveolar cells-Exact function not known.

Gas exchange occurs across these alveoli. As the airway gets progressively smaller, cartilage,
muscular tissue and connective tissue disappears. Therefore only flattened epithelium i.e. squamous
epithelium is left in the alveoli. Capillaries surround these alveoli.

Hence, gas exchange occurs across the

 alveolar epithelium,
 their basement membrane,
 endothelial cells of the capillary and
 their basement membrane.

These four structures form the respiratory membrane.

The pores of Kohn (also known as interalveolar connections) are discrete holes in walls of
adjacent alveoli.Cuboidal type II alveolar cell usually forms part of aperture.

LUNGS(PULMONALE)
 Essential organs of respiration.
 Situated in the thorax on either side of middle mediastinum.
 The lungs (right and left present in the thoracic cavity).
 Space between the two is known as mediastinum.
 Each lung is conical in shape
 Enveloped by double layer of serous membrane called as pleura.
 Separated from each other by the heart and the great vessels in the middle mediastinum.
 The right lung is more heavier (larger),broader and shorter than left lung because the diaphragm
rises higher on the right to allow room for the liver.Divided by 2 fissures(oblique and
horizontal)into 3 lobes(upper,middle and lower lobes).
 The lung lung is said to be somewhat smaller in size because it shares its space with the
heart;which is more on the left side of the body than on the right.
  Shape-cone shaped
 Texture-spongy
 Color-Young(brown,light pink or grey),adults(mottled black due to deposition of carbon
particles.
 Weight-
o Right Lung(600 gms)
o Left Lung(550 gms)

o Vertical extent is from the root of the neck to the thoracic surface of the diaphragm.
o Horizontally from the mediastinum to the thoracic wall.
o Attached to the heart and the trachea by the structures in the roots of the lung ie the pulmonary
artery, the pulmonary veins and the main bronchi.

Each lung has an

o Apex at the upper end

o Base resting on the diaphragm.
o Two surfaces-costal and medial (mediastinal)

FEATURES OF THE LUNG

 Lung extend from the diaphragm to just slightly superior to the clavicles and lie against the ribs
anteriorly and posteriorly.It has
o Apex(Upper end)
o Base(Inferior portion)

Apex (Upper end)

 Blunt and rounded

 Lies above the level of anterior end of first rib to about 2.5 cm above the clavicle.
 Covered by cervical pleura and further externally by the suprapleural membrane
Base (Inferior portion)

o Semi lunar and concave.

o Rests on the dome of diaphragm (concave area, thoracic surface).
o Lined by diaphragmatic pleura.

Separates

o the right lung from right lobe of liver.

o the left lung from left lobe of liver.
 On right side, right lobe of liver lies below the diaphragm.
 On left side, left lobe of liver, fundus of stomach and spleen.

BORDERS OF THE LUNG

 Anterior border
 Posterior border
 Inferior border

Anterior border

Thin, shorter than the posterior border.

Posterior border

o Thick and ill defined

o Corresponds to the medial margins of the head of the ribs.
o Extends from the level of seventh cervical spine to the tenth cervical spine (C7-C10)

Inferior border It separates the base from the costal and medial surfaces.
SURFACES OF THE LUNG
Costal surface

o It is large and is convex.

o It is in contact with the costal pleura.
o It lies directly against the costal cartilages, the ribs and intercostals muscles.

Medial surface(Mediastinal surface)

 It is concave.
 It is roughly triangular shaped area, called hilum, at the level of 5th, 6th, 9th thoracic vertebrae.
 From the hilus, bronchi, pulmonary blood vessels, lymphatic vessels and nerves enter and exit.
 Medially, the left lung also contains a concavity, the concavity in which the heart lies.
 The mediastinum is the area between the lungs. There are present heart, great vessels, trachea,
right and left bronchi, oesophagus, lymphnodes, lymphnodes, lymphvessels and nerves.

LOBES AND FISSURES OF THE LUNG

The right lung is divided into three lobes(Upper, middle and lower lobes)by two fissures, the
oblique fissure and horizontal fissure.

Right Lung

o Horizontal fissure-It separates the superior lobe and middle lobe.

o Oblique fissure-It separates the middle lobe and inferior lobe.

Left Lung

o Left lung is divided into two lobes by the oblique fissure.

 o The oblique fissure separates the superior lobe from the inferior lobe.
o It cuts into the whole thickness of the lung, except at the hilum.
o The upper lobe of the lung has a cardiac notch and a tongue-shaped projection called the
lingula.

DIFFERENCE BETWEEN RIGHT AND LEFT LUNG

RIGHT LUNG LEFT LUNG

It is on the right side of the It is on the left side of the respiratory

respiratory system. system.
It has 2 fissures and 3 lobes It has only one fissure and 2 lobes

It consists of two bronchi It consists of single bronchus

Anterior border is straight Anterior border is interrupted by the

cardiac notch.
Larger and heavier weight 625 g Smaller and lighter weight 575 g

Shorter and broader Longer and narrower

Provides space for the liver. Provides space for the heart.
ROOT OF THE LUNG

It is a short,broad pedicle which connects the medial surface of the lung to the mediastinum.

It extends inferiorly as a narrow fold called pulmonary ligament.

Structures of the root

The root is made up of the following structures.Principal bronchus on the left

side,eparterial and hypoarterial bronchi on the right side.

 One pulmonary artery.

 Two pulmonary veins-Superior and inferior
 Bronchial arteries one on right side and 2 on left side.
 Bronchial veins.
 Pulmonary plexus of nerves.
 Lymphatics of the lung
 Bronchopulmonary Lymphnodes
 Areolar tissue.

BRONCHO PULMONARY SEGMENT

o The segment of lung tissue that each tertiary bronchus supplies is called a bronchopulmonary
segment.
o Each bronchopulmonary segment is pyramidal in shape.
o The apex is directed towards the root of the lung.
o The base is directed towards the surface of the lung.
o There are about 10 bronchopulmonary segment in each lung. These include

 Internally each lobe has a complex structure due to the extensive branching of the
primary bronchi.
  Exchange of gases takes place; each of them is surrounded by a network of fine capillaries of
artery and vein.
 Have very thin wall for diffusion of gases.
 Membrane of the air sac does not collapse due to the presence of a very thin film of a substance
called lecithin.
 When this film is lacking due to congenital disorder, there is extreme difficulty in breathing which
may lead to death.
 Bronchial tubes which end into air sacs are called respiratory bronchioles.

BLOOD SUPPLY

ARTERIAL SUPPLY
Lung is supplied by bronchial and pulmonary arteries.

Bronchial Artery

Arise from the thoracic aorta or one of the posterior intercostals arteries.

Supplies the bronchial tree and then anastomoses with pulmonary arteries.

Pulmonary Artery

Pulmonary artery enters the hilum of the lung, carrying deoxygenated blood from the right
ventricle of the heart; it ends in the capillary plexes on the alveolar walls of the lung.

Pulmonary Blood Supply

The pulmonary trunk carries the deoxygenated blood. This trunk divided into right pulmonary
artery and left pulmonary artery. Both of these arteries carry deoxygenated blood. From these arteries
the blood reaches into the right and left lung equally. Within the lungs pulmonary artery divided into
many branches which eventually end in a dense capillary network. The walls of alveoli and capillaries
are made up of epithelial tissue. These are single layer cells. In this the exchange of gases takes place
through the alveoli. The exchange of blood is through capillaries. Now the blood is oxygenated. These
fine capillaries join to form the two pulmonary vein. It pours the blood into the heart. It drains the blood
into left atrium. The small blood vessels and capillaries in the lungs consist of connective tissue.

Venous Drainage

Bronchial and pulmonary veins.

Pulmonary veins-Two veins emerge from the hilum of each lung. They carry oxygenated blood from the
lung and empty into the left atrium.
Lymphatic Drainage

There are two sets of lymphatics, both of which drain into bronchopulmonary nodes.

Nerves

Parasympathetic nerves are derived from vagus.

Sympathetic nerves are derived from 2nd to 5th spinal segments.

PLEURA
It is the outer covering of lungs.

It is a serous membrane lined by mesothelium.

Each lung is enclosed and protected by a double layered serous membrane called the serous membrane.

LAYERS OF PLEURA

o Visceral Pleura
o Parietal Pleura

Visceral pleura (Pulmonary Pleura)

 Inner layer adheres to the lung.

  The serous layer of visceral pleura covers the surfaces and fissures of the lung, except at
the hilum and continuous with the parietal pleura.
 Adherent to the lung, it covers the lobes as well as fissures.

Parietal pleura

 Outermost layer.
 Adherent to the wall of the thoracic cavity, the internal surface of the ribs and the superior
surface of the diaphragm.
 Thicker than visceral pleura and continues with the visceral pleura around the edges of hilum.

It is divided into following four parts

 Costal pleura
 Diaphragmatic pleura
 Mediastinal pleura
 Cervical pleura.

Costal pleura It lines the thoracic wall which comprises ribs and intercostals spaces.

Diaphragmatic pleura It lies the superior aspect of the diaphragm and covers the base of the lung.

Mediastinal Pleura It lines the corresponding surface of the mediastinum.

Cervical Pleura It covers the apex of the lung and is covered by the suprapleural membrane.

PLEURAL CAVITY

It is a potential space between the two layers of pleura (Parietal and visceral pleura)
which are separated by a thin film of serous fluid secreted by the epithelial cells of the membrane.

This fluid

o does not permit the membranes to stick together and reduces friction between membranes.
o Provides space for the expansion of lungs.
o Makes respiration painless
 o Act as a lubricant

If there is any injury to the pleura, the lung will collapse due to its property of elastic recoil.

ARTERIAL SUPPLY

 Intercostal arteries
 Internal thoracic arteries
 Musculo phrenic arteries

VENOUS DRAINAGE

Azygos vein

Internal thoracic vein.

LYMPHATIC DRAINAGE

Intercostal

Internal mammary

Posterior medistinal

Diaphragmatic nerves.

NERVE SUPPLY

The costal and diaphragmatic pleura are supplied by the intercostals nerves.

PLEURAL RECESS
Enlargement of the space between Parietal and visceral pleura takes place in the
regions of pleural reflection on to the diaphragm and mediastinum. Pleural Recesses is the name that is
given to these enlarged regions of the pleural cavity. They play an important role in lung growth and
deep inhalation. Hence, for lungs to enlarge during deep inhalation, pleural recesses act as reservation
spaces of the pleural cavity. Following are the recesses of pleura:

Costodiaphragmatic recesses (left and right)

Costomediastinal recesses (left and right)
Along with the above recesses of pleura, there are 3 more small recesses,

 1. Left and right retroesophageal recesses

  All these are created by the reflection of mediastinal pleura supporting the esophagus. Every
recess is believed to be inhabited by a part of the lung, and leads to the retrocardiac space
viewed in the radiographs of the chest.
 2. Infracardiac recess
 It’s a small recess of right pleural sac which occasionally goes below the inferior vena cava.

COSTODIAPHRAGMATIC RECESS
It’s found inferiorly between the costal and diaphragmatic pleurae. Vertically it measures about 5
cm and is located opposite the 8th-10th ribs along the midaxillary line. The costodiaphragmatic
recesses are the most dependent parts of the pleural cavities, for this reason the fluid of pleural effusion
first accumulate at these sites.
COSTOMEDIASTINAL RECESSES
It’s found anteriorly between the costal and mediastinal pleurae and is located
between sternum and costal cartilages. The right costomediastinal recess is potentially inhabited by the
anterior margin of the right lung even during quiet breathing. The left costomediastinal recess is large
because of the presence of cardiac notch in the left lung.

SITES OF EXPANSION OF PLEURA BEYOND THE THORACIC CAGE

There are 5 sites

 On each side in the root of the neck (as domes of pleura)
 In the right xiphisternal angle
 On each side in the costovertebral angle
The pleura can be punctured accidentally at these sites during surgical procedures.

SURFACTANT
Dr.John.A.Clements and Dr.Mary Elen Avery.Dr.John.A.Clements, Professor of
Pediatrics, University of California, San Fransisco-Discovery of surfactant.
 The alveoli are air-filled structure. But normally the alveoli do not collapse due to the
presence of surface tension lowering agent called surfactant. (25 dyn/cm near at expiration, for water 70
dyn/cm).

Surfactant is a complex of

 Phospholipids (70% to 80%)

o (Dipalmityl phosphatidyl choline) DPCC-60 60%,
o Phosphatidylethanolamine chositol (20%)
 Neutral lipids mainly cholesterol (10%)
 Proteins (10%) SP A, SP D –hydrophilic
 Carbohydrate
 Several ions Calcium ions.

It is secreted by type 11 alveolar epithelial cells(Pneumocytes).

It forms a layer at the fluid-air interface in the alveoli.

Surfactant ;( fluid secreted by the cells of the alveoli)contributes to the elastic

properties of pulmonary tissue.
 It differentiate between 24 and 34 weeks of gestation in the human. By about 35
weeks, most babies have enough naturally produced surfactant to keep the alveoli from
collapsing.(production 24-28 weeks of gestation).

L/S ratio; Predictor of foetal lung maturity.

L-Lecithin

S-Sphyngomyelin.

MUSCLES OF RESPIRATION
Respiration is a process by which gases are exchanged between the atmosphere,lungs,alveoli.

There is a pressure gradient exits.It helps in the exchange of gases.Air moves into the lungs when
the pressure inside the lungs is less than the air pressure in the atmosphere.Air moves out of the
lungs,when the pressure inside the lungs is greater than the atmospheric pressure.

The expansion of the chest occurs during inspiration. It occurs as a result of muscular
activity.This is partly involuntary ie.not under our control. The muscles of neck, shoulders and abdomen
help during forceful breathing.

MUSCLES OF INSPIRATION
 The inspiratory muscles are

Diaphragm

External intercostals.

Diaphragm

Large, dome shaped muscular structure separating the thoracic cavity from the
abdominal cavity.

It forms the floor of the thoracic cavity and the roof of the abdominal cavity.

It consists of a fibrous central part called the central tendon.

When the muscle of the diaphragm is relaxed the central tendon is at the level of 8th
thoracic vertebra.

When it contracts, its muscle fibres shorten and the central tendon is pulled
downwards to the level of 9th thoracic vertebra lengthening the thoracic cavity. This decreases pressure
in the thoracic cavity and increases it in the abdominal and pelvic cavities.

The diaphragm is slightly depressed by the heart, so that on either side, there are 2
domes the right and left domes (cupulae). The right dome is supported by the liver lying slightly higher
than the left. Right dome reaches as high as upper border of fifth rib. Left dome may reach lower border
of fifth rib. Central tendon at the xiphisternal joint level.
 Diaphragm is inserted into a central tendon, which is shaped like three leaves. The
superior surface of the tendon is partially fused with the inferior surface of the fibrous pericardium.
Some of the muscle fibres of the right crus pass up to the left and surround the esophageal orifice I a
single like loop. These fibres appear to act as a sphincter and possibly assist in the prevention of
regurgitation of the stomach contents into the thoracic part of the esophagus.

INHALATION EXHALATION

Relations

SuperiorlyThe diaphragmatic surfaces and the heart.

InferiorlyThe liver, the fundus of the stomach and the spleen.

Foramina in the DiaphragmThe diaphragm has three major openings through which various structure
pass between the thorax and abdomen.

The foramen for the inferior venacava is at the level of T8 vertebra, about 2-3 cm
to the right of the median plane.

The esophageal opening where the esophagus passes through an oval opening at the
level of T10 Vertebra.

The aortic hiatus It is the lowest and most posterior of the large openings. It is at the level of T12
vertebra.

Arterial supply Thoracic aorta,Internal thoracic artery,abdominal aorta.

Venous DrainageInferior vena cava,azygous vein or brachiocephalic veins

Lymphatic DrainagePhrenic lymphnodes.

Nerve SupplyMotor supply by phrenic nerve (C3, C4, C5) and sensory supply by intercostals/subcostal
nerves.

Right dome higher than left

External Intercostals

The external intercostals muscles extend downwards and forwards from the lower
border of rib above to the upper5 border of the rib below.

The muscles occupy the superficial layer,and these fibres run in oblique direction
inferiorly and anteriorly from the rib aboveand to the rib below.They elevate the ribs during inhalation
to help expand the thoracic cavity.

They are involved in inspiration.

MUSCLES OF EXPIRATION

The expiratory muscles are

 Muscles of anterior abdominal wall

 Rectus abdominis.
 Pyramidals
 Internal oblique
 External oblique
 Transversus abdominis.

 Intercostals-Internal Intercostals
Internal intercostals muscles occupy the intermediate layer of the intermediate layer of the intercostal
space.These extend downwards and backwards from the lower border of the rib above to the upper
border of the rib below,crossing the external intercostals muscle fibres at right angles.

The fibres of these muscles run at right angles to the external intercostals in an oblique direction
inferiorly and posteriorly from the inferior border of the rib above to the superior border of the rib
below.

They draw the adjacent ribs together forced exhalation to help decrease the size of the thoracic cavity.

Nerve Supply Supplied by the intercostals nerves.

ACCESSORY MUSCLES OF RESPIRATION

The accessory muscles of respiration are

Scalene-cause elevation of thoracic cage

Sternocleidomastoid –cause elevation of thoracic cage

Serratus anterior-help in fixing thoracic cage so that ribs can move efficiently.

During deep forceful inhalation (during exercise or playing a wind instrument, the
sternocleidomastoid, scalene and pectoralis minor muscles are also used.

During deep forceful exhalation, the external oblique, internal oblique, transverses
abdominis, rectus abdominis and internal intercostals are also used.

Nerve Supply

The spinal accessory nerve(also called accessory nerve)is the eleventh cranial nerve
that supplies the sternocleidomastoid muscles and scalene muscles.

APPLED ANATOMY
DISORDERS OF RESPIRATORY SYSTEM
RESPIRATORY TRACT INFECTIONS

 Common cold(coryza)
 Sinusitis
 Tonsillitis and Pharyngitis
 Diphtheria
 Allergic rhinitis

Common cold (coryza)

It is a viral infection which is generally caused by rhinovirus or adenovirus.It causes

no specific symptoms such as headache,nasal congestion,sneezing,watery discharge from nose and
malaise.

When infecting organism is H.influenzae then the common cold is known as influenza.
Sinusitis

It is a disease which swells up the nasal mucosa as seen in viral or allergic rhinitis. It
tends to block the nasal opening of paranasal air sinuses.Therefore; the paranasal air sinuses cannot
drain properly. This leads to collection of mucopurulent fluid in the paranasal air sinus. The patient will
have headache, blocked nose, facial pain and fever.

Tonsilliitis

Inflammation of the tonsil is known as tonsillitis.Tonsillitis can be caused by a

number of bacterial and viral infections.
Laryngitis

Inflammation of larynx is known as laryngitis. It is caused by either a viral or bacterial

infection. Most common cause of hoarseness of voice is laryngitis.

Diphtheria

Pharyngeal infection by corynaebacterium diphtheriae cause diphtheria.A thick fibrous

membrane is formed in this infection which obstructs the airway.Toxins released by this bacteria can
damage skeletal muscles,cardiac muscle,liver,kidney and adrenal glands.
Allergic rhinitis

Allergic rhinitis also known as hay fever,it is an atopic disease which means that
immediate hypersensitivity develops to foreign particles such as pollens,animal dander,household
dust,mold,spores and dust mites.

Epistaxis

Bleeding from anterior nasal opening is known as epistaxis.Commonest cause of it in

children is nasal picking.Other causes are forign body in nose,forceful blowing of nose and drying of
nasal mucosa because of low humidity.
Tumours

 Benign Nasal Tumours

 Nasal Polyps
These are mucosa covered pale oedematous masses.The symptoms may be decreased
sense of smell and chronic nasal obstruction.

 Inverted Papilloma
Arises in the lateral wall of nose.The presenting complaints are bleeding from nose
and nasal obstruction.

1) Malignant Tumours
Malignant tumours of nose,nasopharynx and paranasal air sinuses are diagnosed at a
very late stage.Their early complaints such as discharge from nose,unilateral nasal obstruction are
misleaqding are misleading and delay the diagnosis.

Diseases of the lung

Acute bronchitis

Inflammation of the bronchi is known as bronchitis.It is usually caudsed by viral or

bacterial infection.It may last from days to weeks.It is then known as acute bronchitis.

Chronic bronchitis

It is defined as persistent cough withsputum production for atleast 3 months in 2

consecutive years.

Its commonest cause is smoking.It is generally a part of Chronic Obstructive

Pulmonary Disease.The signs and symptoms are cough with expectoration,dyspnea,wheezing,chest
pain,fever,malaise,green or yellowish green sputum.Antibiotics,bronchodilators and corticosteroid are
used in the treatment of chronic bronchitis.

Chronic obstructive Pulmonary Disease

Most patients suffering from it have features of chronic bronchitis and

emphysema.Patients with COPD are seen in the 5 th or 6 th decade of life.The patient complains of
cough with sputum production and breathlessness.In late stages of COPD complications like
Pneumonia,Pulmonary hypertension,Cor pulmonale and chronic respiratory failure are seen.In this
disease mucus secreting glands and goblet cells in respiratory passage are overactive.

Asthma

A disease caused by increased responsiveness of the tracheobronchial tree to various

stimuli which results in episodic narrowing and inflammation of the airways.

If the duration of attack continues for a long period it is known as status asthmaticus.

Bronchiectasis

It is a chronic dilation of bronchus or bronchi,usually in the lower portions of the lung

caused by the damaging effects of a long standing infection.

Permanent abnormal dilatation and destruction of bronchial wall is known as

bronchiectasis.
Emphysema

Emphysema is abnormal collection of air in tissue or organ.If the air gets trapped in
the lung tissue then it is known as pulmonary emphysema.

If air gets trapped in subcutaneous tissue then it is known as subcutaneous

emphysema.

If air enters mediastinum then it is known as mediastinal emphysema.

If large amount of air collects in the mediastinum then it may compress heart leading
to cardiac tamponade.
Pneumonia

Inflammation of lung parenchyma and abnormal collection of fluid in the alveoli is

seen in pneumonia.

Lung abscess

In this there is a localized collection of pus,inflammation and destruction of the tissue

of the lung.It is an acute or chronic infection of lung.Majority of infections are due to anaerobic
bacteria(bacteria that can thrive in the absence of air.
Tuberculosis

An infectious disease caused by the tubercle bacillus mycobacterium tuberculosis and

characterized pathologically by inflammatory infiltarion,formation of
tubercles,ceseation,necrosis,abscess,fibrosis and calcification.

Occupational Lung disease

Group of abnormal conditions of the lungs caused by the inhalation of

dust,fumes,,gases or vapours in an environmentwhere a person works.
Pnemoconiosis

Diseases of lung which develop as a a result of inhalation of particles is known as

pneumoconiosis.

Occupational lung diseases are named according to the type of particle inhaled

 Pneumoconiosis-Miners,Welders,iron,tin and barium workers

 Asbestosis-Inhalation of Asbestos

 Black Lung-Coal workers

 Bysinosis-People work with cotton,hemp,jute or flax

 Silicosis-Clay,sand,stone,dust

 Allergic alveolitis-Organic dust

Chemically Induced Lung Disease

2) Reactive airway diseases

 Asthma
 Bronchitis
 Chemical Pneumonia
 Pulmonary Fibrosis
3) Paraquat
Ingestion of quaternary ammonium herbicide can lead to acute respiratory distress
syndrome.
Cytotoxic drugs used in the treatment of cancer to kill cancer cells.
4) Oxygen toxicity(Paul Bert Effect or Lorrain Smith Effect)
It develops when o2 is breathed at an elevated partial pressure.

5) Lung Collapse(Atelectasis)
 It is a condition in which the volume of one or both of the lungs gets reduced because
of an external (eg.pleural mass)or internal pathology(foreign body in the airay).

6) Pneumothorax
Accumulation of air or gas in the pleural cavity is known as pmneumothorax.It is a
medical emergency.It can be of
o Tension Pneumothorax
o Spontaneous Pneumothorax.
7) Pleural Effusion

Accumulation of excess fluid in the pleural cavity is known as pleural effusion.

Depending on the type of fluid accumulated in the pleural cavity it can be

 Hydrothorax-serous fluid in pleural cavity

  Haemothorax-blood in pleural cavity.
 Chylothorax-chyle in pleural cavity
 Pyothorax(Empyema)-Pus in pleural cavity.
8) Cystic Fibrosis
A potentially fatal autosomal recessive disease that manifests itself in multiple body
systems including the lungs, the pancreas, the urogenital system, the skeleton and the skin.
9) Diaphragmatic Hernia
It is a defect or hole in the diaphragm that allows the abdominal content to move into
the chest cavity.

10) Pneumonia
Inflammation of the lungs usually due to infection with bacteria,viruses,or other
pathogenic organisms.

11) Pleuritis
Inflammation of the visceral and parietal pleura that surrounds the lungs and line the
thoracic cavity.
12) Hyaline Membrane Disease or Infant Respiratory Distress Syndrome

This is a serious pulmonary disorder which develops in premature infants due to

deficiency of surfactant.Surface tension of alveoli is high and many of them get collapsed.Also
there can be fluid accumulation in the lungs(pulmonary edema).
 Difference between Empyema and Emphysema

EMPYEMA
DEFINITION An empyema is a collection of
pus within a body cavity.
NATURE Empyema is usually a
complication of an infection.
MAIN CLINICAL FEATURE Fever is a typical feature of
empyema.
EMPHYSEMA
Emphysema is the abnormal
and permanent enlargement of
acini associated with alveolar
wall destruction with no
significant fibrosis.
Emphysema is a result of
persistent chronic
inflammation.
Emphysema is not associated
with a fever unless it is
complicated by a
superimposed infection

SUMMARY
The human body needs o2 to survive. The respiratory system is the system in the human body
that enable us to breathe. The human respiratory system is a series of organs responsible for taking in o2
and expelling co2.

CONCLUSION
The human respiratory system not only provides oxygen to each cell of the body but also
removes body wastes, filters out infectious agents, and provides air needed for speech.

Everyday we breathe about 20,000 times,with each breath take in air through nostrils and
mouth,lungs fill up and empty out.As air is inhaled the mucous membrane of the nose and mouth warm
and humidify the air.

EVALUATION
1. What is surfactant?
2. Differentiate right lung and left lung?
3. What is carina?
4. Define Pneumonia?
5. Describe Atelectasis?
6. Enlist muscles of respiration?
 7. Explain hyaline membrane disease?

BIBLIOGRAPHY
TEXTBOOK
Ashalatha.P.R.Deepa G;’’Textbook of anatomy and physiology for nurses” ;(4thed) India; Jaypee
publication;Page no:25

Wagh Anne; Allison Grant ;( 2007)’’Ross and Wilson; Anatomy and Physiology in health and
illness (10thed), London, Churchill Livingstone publications; Page no:

Randhawa;A textbook of biological science; Anatomy and Physiology;(2nded)India;Pee Vee

Publications, Page no:

JOURNAL
K.Sugunaselvi,R.Rajalakshmi(June 2017)Self changing strategies to Quit Smoking among
current tobacco smokersin General Population.NJOI.Vol.CVIII;No 3.Page no 106-110

Maheswari,Indoor air pollution-the killer in the Kitchen. Nightingale Nursing Times, Page no 12-14.

ELECTRONIC VERSION

https://www.quora.com

https://www.researchgate.net

https://www.coursehero.com

https://www.omicsonline.org

https://www.nchi.nlm.nih.gov

SELF CHANGING STRATEGIES TO QUIT SMOKING AMONG CURRENT

TOBACCO SMOKERS IN GENERAL POPULATION
Tobacco smoking is one of the important health problems in India (second largest) consumer of
tobacco in the world after china, and the prevalence of smoking among adult males is high. Despite
numerous community interventions and government legislation against smoking cessation or prevention
of tobacco smoking is still challengeable. Literatures suggests that strong self-changing behaviors of
smokers,facilitate the process of quit smoking.The aim of this cross sectional study was to explore self-
changing strategies to quit smoking among current smokers in a selected rural population at
Bangalore.A sample size of 35 from general population were conveniently selected to complete a self-
changing strategies of current smokers(SCS-CS questionnaire about commitment to change,taking
control,risk assessment,helping relationship and coping with temptation to quit smoking.Amongst all
the participants(n=35)around 12(34.3%)male study subjects smoked more than 10 times per day.Nearly
three-fourth of current smokers(n=25,71.4%)never had previous quit attempts.Commitment to change
strategy(mean 11.11+-2.73)was high among subjects(80%)often thought to stop smoking,which
facilitated to strengthen their pre contemplation stage of change process.In contrary participants were
weak in coping process.Greater part(n=21,60)of the subjects never keep themselves busy to overcome
the urge to smoke thus failing to achieve the maintenance stage in change process(mean
5.57+2.83).Continuous follow up and frequent cessation programme Would aid to boost up the self-
change strategies to quit smoking.Mental health nurses actively implementing the smoking cessation
intervention in every care settings will increase the successful quiting.

ASSIGNMENT

Abbreviation

DOTS

RNTCP

World TB day,theme

Discovery of Mycobacterium Tuberculosis

Mantoux test.

SHORT ANSWERS
1. What are the neuron centers for respiration.
2. Name the muscles of respiration
3. Name the organs of respiration
4. Name the major openings in the diaphragm
5. Pleuritis
6. What is surfactant
7. Name the structures present in the hilum of a right lung.
8. Define respiratory unit.
9. Define alveoli
10. Draw and label respiratory system.
11. Composition of Inspired and Expired air.
12. Difference between empyema,emphysema
13. Define acinus
SHORT NOTES
1. Trachea-Length,histology,divisions
2. Surfactant
3. Pleural recesses
4. Paranasal sinuses
5. Diaphragm
6. Pleura
7. Explain the structure of lung with the help of diagram

ESSAY
1. Describe different parts of respiratory system.

1.What are the neuron centers for respiration

The respiratory center is located in the medulla oblongata and pons in the brain stem.The
respiratory center is made up of three major respiratory groups of neurons,two in the medulla and
one in the pons.In the medulla,they are the dorsal respiratory group,and the ventral respiratory
group.In the pons,the respiratory group includes two areas known as the pneumotaxic centre and
the apneustic centre.

2.Name the muscles of Respiration

Inspiration

Principal

External Intercostals

Diaphragm

Accessory

Sternocleidomastoid
Scalenes group
Pectoralis major

Expiration

Internal intercostals

Abdominals
 Quadratus lumborum

3.Name the organs of respiration

Nose and nasal cavity

Pharynx

Larynx

Trachea

Bronchi

Lungs

Alveoli

4.Name the major openings in the diaphragm

The diaphragm has three openings

Aortic Hiatus

The most dorsal opening contains the aorta azygous vein and thoracic duct.

Oesophageal Hiatus

It contains the Oesophagus, dorsal and ventral vagal trunks.

Caval Foramen

Lies within the central tendinous region of the diaphragm and contains the caudal venacava.

5. Pleuritis (Pleurisy)

Pleurisy, also known as pleuritis,is inflammation of the membranes that surround the lungs and
line the chest cavity(pleurae).This can result in a sharp chest pain with breathing.

6. Surfactant

The alveoli do not collapse due to the presence of surface tension lowering agent.

Surfactant is complex of

Phospholipids
 Carbohydrate

Several ions (Dipalmityl Phosphatidyl Choline)

It is secreted by type 11 alveolar epithelial cells.

7. Name the structures present in the hilum of a right lung

Pulmonary arteries and veins

Pulmonary bronchi and bronchial arteries

Pulmonary nerve complexes

Lymphatics

8. Define respiratory unit

Respiratory unit is defined as the structural and functional unit of lung. Exchange of gases occurs only
in this part of respiratory tract. Structure of respiratory unit

 Respiratory bronchioles
 Alveolar ducts
 Alveolar sacs
 Antrum
 Alveoli The acinus is the functional respiratory unit of the lungs (all alveoli are contained in
the lungs).Each terminal bronchiole gives rise to an acinus.

9. Define alveoli

Alveoli are an important part of the respiratory system whose function is to exchange oxygen and
carbon dioxide molecules to and from the bloodstream. These tiny, balloon shaped air sacs sit at the very
end of the respiratory tree and are arranged in clusters throughout the lungs.

10.Draw and label respiratory system

11. Composition of Inspired and Expired air

Inspired

20.9%oxygen

0.04%carbon-di-oxide

79%nirogen

Variable amount of water

Expired

16.0%oxygen

4.04% carbon-di-oxide

79%nitrogen

Highly saturated with water vapours.

12.Difference between Empyema,Emphysema

EMPYEMA EMPHYSEMA
DEFINITION An empyema is a collection of
pus within a body cavity.
NATURE Empyema is usually a
complication of an infection.
MAIN CLINICAL FEATURE Fever is a typical feature of
empyema.
13.Define Acinus
Emphysema is the abnormal
and permanent enlargement of
acini associated with alveolar
wall destruction with no
significant fibrosis.
Emphysema is a result of
persistent chronic
inflammation.
Emphysema is not associated
with a fever unless it is
complicated by a
superimposed infection

The word acinus means berry.An acinus is around cluster of cells,usually epithelial
cells,that looks somewhat like a knobby berry(many-lobed berry;resembles raspherry),

A sac like cavity in a gland surrounded by secretory cells.