238 Partin Bory Systems Introduction “The main function of the respiratory system is 10 provide ‘oxygen to body cells for energy metabolism and to -elimi tate carbon dioxide, a byproduct of metabolism. Because these gases must be carried to and from the cells in the ‘ood, the respiratory system works closely with the ear diovascular system to accomplish gas exchange (Fig. 11+), This activity has rwo phases: + External gas exchange occurs between the outside at mosphere and the blood. ‘+ Incernal gas exchange occurs between the blood andthe External exchange takes place in the lungs, located in the thoracic cavity The remainder of the respirarory tact ‘consists ofa series of passageways that conduct ai 1 and from the lungs. No gas exchange occurs in these eepion. elec to Figure 11-2 as you Fad the following description ofthe respiratory tat Ai sacs (aves oftung Systemic crcut —_| ‘ed cals (head, upper limbs) Body cals (trunk, lower ibs) are moved Into and ou of the uns in ereral exchange gases move In irtrmal exchange gases move between the blood ad body ces. Upper Respiratory Passageways The upper respirator PIBIBEWBYS ON ist ofthe nang ns ebro rat cig end i Ventilation ‘Air sacs (alveot) ‘tungFrontal sinus Nasal cavity * epigatie— Right lung — Aight — bronchus, ry From pulmonary artery Aivoolar oe bronchiole Diaphragm ‘To pulmonary ‘Aveolt voin Capilaries B Section of lung enlarged ETE the respiratory system. A. Overview. Bs Enlarged section of ung tisue showing the relationship between the alveol (ai sacs) and the blood capes. Inthe bones of the skull and face near the nose are ai tales ined with a mucous membrane that drain into ‘eal avi. These chambers lighten the bones and pro- ‘tk esonance for speech production. These cavities, called ‘au, are named specifically for the bones in which they are hd, ach asthe frontal, sphenoidal, ethrnoidal, and max- iy sss. Together, because they are near the nose, these as are referred to as the paranasal sinuses. Figure 11-2 the lation ofthe frontal and sphenoidal sinuses. The tonsils, lymphoid tissue described in Chapter 9, are in the region of the pharynx (Fig. 11-3): + The palatine tonsils are on ether side of the soft palate in the oropharynx, < Pharyngeal oe era | Pharynx Palatine The tonsils, lof the tonsils are located inthe vicinity ofthe phar throat,240 — Partitt Body systems ee Tonsil bactrlinfection of thet hood nem past year sgl reaval ofthe fected 18s ‘aes 2 sandal procedure, 9 tonsilectomy was thought © [revert severe infecbors ike step thro Because tsi wee {ought to have uncon, surgeons fen ene fete {onslleven hel ton n ode to peeves onsite With the dacovery that tol play an important inemune one ton the numberof tonsletomies performed i the United States dropped amatially, reaching an al-time fw in te 19805. Today although treated with appropriate more frequent fact isthe procedure among American chien. Su Fran infection recurs or enlarged tonss tons 2 comeon child many cases of toni are successly Tantei onal tomy i becoming Second most common sug ngery considered ake swallowing “+The single pharyngeal tonsil, commonly known as the adenoids, isn the nasopharyi™: + Thelingual tonsils are small mounds of lymphoid issue atthe posterior of the tongue. 1 advisability of removing the consis Opinions on the fescibed in Box 19-1. have changed ove ime, 28d Lower Respiratory Passageways and Lungs ‘is moves from the pharynx into the larynx, commonly aia he voice box, because contains the vocal folds oF Sane The larynx is atthe top of the trachea, commonly SSIES he windpipe, which conducts ai into che bronchial System toward the lngs. Epigiottis: waa bone ) Thyroid CLINICAL PERSPECT! Tonsillectomy: A Procedure Rec IVES =p onsidered se tenn dct Many tnsHetOnies 3 pear oar geat cbsrctiveseep 2662 2 cnn wy a ops rethngfr 2 Fe Seconds 22 Une dg ec es 996 at TnAeTONY mayan eo ee aden aerin HOM ONS TE egy bene eater tec he 088 My oy trregan fee! gon etamies we peromed By ee ee rates oe CUE 1B the arc 6 th onan 5 bag ay om ors re Seven Me this rn asletomy WS 480 WME 1 ge Sues 10965 hat th eta Me tens COmpACON Geet jedwnvlevcatey down results in 2 aster 2 postoperative pain compa THE LARYNX “The larynx is shaped by nine cartilages, the mos rom aie ef which is the anterior thyroid cartilage that frm the sadam’ apple” (Fig. 11-4). The small lat-shapes cee itage at tbe top of the larynx isthe epilots, Wha carramsilows, the epiglotts covers the Opening of the yn and helps to prevent Food from entering the ep. ratory act “The larynx contains the vocal folds, bands of tse thx are important in speech production (Fig. 11-5). Vibravs produce by ar passing over the vocal fl form th bs Poe voice production, although portions of the throat an mouth are needed for proper speech articulation. The ope Ing between the vocal folds isthe glottis (the epilats » above the glottis). Trachea {inner ining) a 8 The vocal folds superior view. A.The ts!" dosed postion B. Te glotisn open positonr HEA He vo tube reinforced with C-shaped rings of car. he collapse (you can fel these rings if yor alert ato yoni a ag noes van Gent cme Saka fe ging the Seco tse region hace ah The ach consis ofthe space berween the lungs cet pe organs contained inchs space i112 fi your Ghupter11 The Respro system 247 = lobes. The left lung, which is smaller to accommo- date the hear is divided into two lobes. The lobes a fut the subdivided to cocespond to dvisons ofthe Bronchial ne Gosble membrane, the pleura, cover the hangs and Dil ‘thoracic cavity (Fig. 11-6). There are wo pleural + The parca pleura, the outer layer i tached to the wall of the thoracic cavity, “= * The visceral pleura, the inner layer, is attached to the the trachea, the mediastinum comin d seme een meee mam tere : Fe ABS oe TET tom iid ce bern he ro a ayer the pleural space. The most pleural membranes ‘He BRONCHIAL SYSTEM side easly over each other within the chest avi allowing Tomer end the trachea divides ino a right anda left ‘be lungs to expand during breathing. vas lone po, which enter the lungs. The right bron- spt pt and wie vides oo thee secondary coe ight lng. The I bronchur dds mo Breathing Fervni sae.spel he let long Phe dios 4s come sad oto hing by he pose of pace a ieasing numberof emai cubes that SOp- —resthing echnvaly called pulmonsry venation. This a ea tcc’ fend rea mpraon (lion) 2d ys progress through th the cartilage in Cepiration (exhalation), teparated by 2 period of rest Seva lly pve and else by 00% vg noma teultedunconsciouly cee funy) muscle, = the brainstem, These center adjust the rate and chythm of (Spe ala ofthe conduing tbe he rock, Sst cer carr th nd compos, exh microcap a he a oak ss eran ame or ae exchanged between the lings and the | Sti ERTS tet uifandctbon diode dics ot of the lod for | th animation “Pulmonary Ventatin” Inthe Sten | eimination (see Fig. 11-2). Pees se THE LUNGS INSPIRATION The conshaped lungs occupy the major portion of the The breathing cycle begins when the phrenic nerve simu Seem the dah Tung is larger soe divided into ats the diaphragm to contact and fae, enlarging the POSTERIOR ago porta Thoracic vera | - \ . A NE a S X sewn ANTERIOR Jon tough he ngs show he pare and a242. Parti Body Systerns Let ung Diaphragm Internal intercostal muscles During inhalation, the ‘During exhalation, daphagm presses the the diaphragm rises abdominal organs ‘and reais othe ‘ownward and forward, resting postion [A Acton ofrbcage B Action fb cage ‘ninhalaion in exhalation Pulmonary ventlaton A ninhltin.the duphagm loners and the exeralitercostl elevate the rb cage Bi exalt the breathing muscles telothedaphragm ise andthe lungs ping backto the vga se Meena Intec raw he ibs dowrwardin force erhlation chest cavity. At the same te, externa intercostal muscles heeween the nibs elevate and expand the ribcage. A result Jing decease n presure within the thorax causes iro flow ino the lungs (Fig. 11-7). Muscles ofthe neck and thorax are used in addition for forceful inhalation. The measure of how easly the lungs expand under pressures compliance. Fluid produce in the lungs, known surfactant, aids in compliance by reducing surface ren- Sion within the lve EXPIRATION Expiration occurs athe breathing muscles relax and the clastic lngs spring back to their orignal size, Increased presure inthe smaller thorax forces ai ou of che Lungs in forceful exhalation, the internal intercostal muscles to lower the ribcage, andthe abdominal muscles t pressing internal organs upward against the phragm. Gas Transport ‘Oxygen is arid in the blood bound to hemoglobin in ed ‘ood cells. The oxygen i eleaed 10 the elle as ceded Carbon dioxide is cared in several ways but molly converted to carbosic acid. The amount of carbon donde thats exhaled ts imports in regulating the Blood acd. iyo alkali, based onthe amount ofan a at 's formed. Dangerous shits i blood pH can result frm Cxhalanon of too much o 0 litleearbon dowd, egies aes Ll aeppd acted in he espace Paces net ‘exchanged between tbe dh ra anaes ne vse apples tothe bony socket for» to0eh measure of how easly the lang expand under PFESSUS many types of respiratory disorders ack ne ing een Stag ren me PA) cary during ewallowing fo prevent food fom The: “pleakabaped cartage that cover the ‘entering the trachea “The ack of drawing air into the lungs; inhalation eee “gachee that contain the vocal folds (oot: laryng/o) “The enlarged, superior portion ofthe “Tongan ofthe face ued for breathing end housing earors a al naval cavity (foots: aslo, thin) Traludes an external portion and an “Fes ede calls to lease energy fom food using metabo GMM ied on ether side ofthe oropharynx; usually “The paired master © (a deeve loc Moen the ern tonsils is used alone Se eg (continued) meant w! Limonne cnt go) z (rot - (root phrenica) aya pan cal cmorane = pe thoracic cavity (parietal pleura ea ; ceenbrane alin re ieee : he two layers of the pleura: plu LURE ta ar — qoar imo and out of land? uses are located nea the nose and dng 1 des pannel: he paranass : aero = nasal cavity dita i ai = : = Sims - sca cougingor daring the tes: expectoration: wi Te sae apn < a a variety of mater ge _ — race ion win te OL 4 sg —— ne a res : a = Learning Objectives ter study of this chapter you should be able to: 1.» Describe the organs of the digestive tract, and give the function ofeach. p22 2» Describe the acessory organs and explain the toe of each in digestion. p275 15 > entity and use the roots pertaining to the digestive system and accessory organs. p278 ‘A. © Describe the major disorders ofthe digestive system. p282 '5 > Define medical terms used in reference to the digestive system, p28 © > Interpret abbreviations used in referring to the gastrointestinal system. p296 7 > Analyze the medical tems in case studies related to the digestive system. pp271, 302 Case Study: B.F’s Gastroesophageal Reflux Disease (GERD) and Erosive Esophagitis Chief Complaint ' BR. is a St-yearold African American businessman with complaints of epigastric pain, He has a 10-year history of heartburn that he notes has become worse over the last year The heartburn occurs both after reals and at bedtime. His slep has been interupted by nighttime symptoms, and fe fees generally fatigued. Intermittently he says he feels that things come back up into his throat, but he lacks clear signs tf apation into the respiratory tract. He is aware that gastio- tcophgeal refx disease (GERD) is a chronic condition and may be asocated with a risk for complications that include serious intiity and mortality. Due to his required travel for business, he fas put of making a dacto’s appointment but realizes he needs tu ee his physician. The heartburn has increased in frequency (diy now) and severity, so he Finally schedules an office visit. Eamination Bi seen by his primary care physician and describes his aly episodes of discomfort. BF. is 6-foot-Linch and weighs 20 pounds. The physician reviews a colonoscopy from last year th him that was normal. His Blood pressure and other physical ANCILLARIES At-A-Glance ‘examination findings at this visit are within normal ranges. Results| ‘of complete blood count, chemistry profile, and lipid profile are all within normal limits. He describes his self-medication by tke ‘ng over-the-counter (OTC) drugs including antacids, histamine-2 receptor antagonists (H2 blockers), and the OTC proton pump ‘inhibitor (PPI) omeprazole. He notes the latter helped “a ite bit but he discontinued use after two weeks, as noted in the packaging instructions. He has no history of stoking or alcohol abuse, He has an unremarable past medical and family history. Clinical Course The physician explained to BF that he is experiencing classic esophageal symptoms that are highly specific to GERD, heart- burn, and regurgitation. The physician also informed him that GGERD might be associated with erosive esophagitis, whichis best diagnosed on endoscopy via esophagogastroduodenoscopy (€6D). Because B.F. is 51 and has been experiencing heartburn for more than 10 years with daily symptoms forthe past yea, be should be evaluated by endoscopy. He has been refered for the procedure, but the appointment isnot for seven weeks. He is prescribed a PPL and is instructed to return to the office in approximately four weeks while still on therapy for assessment (of symptoms prior to his appointment, iit thePont to access the following resources. For guidance in using the resources most effectively, see Pp. b-xvi, chapter 12 The Digestive System 271 ET272 Part Body Systems nrymes are needed throughout the Introduction Z “Then aampounds ae organic ctalyaty Em pae! “The function of the digestive system isto prepare food for of food's chemical reskdOwr The name of oy, seine body cells: Nuren must be broken down By canbe recognized by he ening se. imecarical and chemical means into molecules that © Small enough to be absorbed ito circulation. Within cell seal enough tobe ahr oe ioreebuidig lel The Digestive Tract the mae ar cites rem avo sors wPES*eS iv rg abo Known a he ak ‘easte materials and then eliminates them from the body. Te all at cela kg fogs wih Sec Ft eg 3 = eeuee {Sines me ste Care aks lace ba she gorse ropes mc, (pends NET IE En te Digestion take Pc pe anus (Fg 120. Pera (per tporting and separating them bdo exc on men 8 Se cnn oe Sesh Se ead te sone mona eo Ne ot Same Digestive system. Some divisions ofthe small and large intestine axe shown The accessor organs ae the salary ean rh ieeaenetenri MOUTH TO THE STOMACH Tea ei in che mouth (Fg. 122}, also called the Diet ee, fod is chewed into smal bits by the tech, Sen a heel te eh Land mar for indng The our sto ra molr tooth andi surrounding tc ae wal nigure 123. The palate isthe roof of the mouth; palais fomed oy bons, ade ee part soft palate) is made of soft tissue. The fleshy a ued in spcch production, hangs from the soft pal eee oes Lap incr of he meh anh Cn om cane nel hye ne i es af chewing, f mation etl, lg dicks, and palate also help to break up food and mix | Soria ings hepa Se Tae mlrey dint es Pig U2) mes Upper lip centalincisor Gingiva (gum) find Hard palate CRIED tenet hn photon andthe the ora cavity are shown. X FOR YOUR REFER [ W organs of the Digestive aes Seceer nays feces secetors han most cgesion and absorption of nations Faieastnex td nna pcan wma saliva into the mouth and are considered to be accessory digestive organs. Portions of moistened food are moved toward the pharyax (throat), where swallowing reflexes push them into the esophagus. Peristalss moves the food through the ssophagus and into the stomach. At is distal end, where it joins the stomach, the esophagus has muscle tissue that contracts to keep stomach contents from refluxing (Sow. ing backward). This lower esophageal sphincter (LES) is also called the “cardiac sphinctee” because it lies above the cardia of the stomach, the region around its upper opening. Inthe stomach, food is further broken down as itis churned and mixed with secretions containing the enzyme Amelar woth, The boy socket igh load GEER espn areshown aswel a portanstihe othcis in the intestinal Lining called ili (Fig. 12-4 Fister has blood capillaries to absorb nutrients into Mba and lymphatic capillaries, or lacteals, to eat ama! molecules of digested fats into the lymph. ‘hee as oin che blood when lymph flows into the blood- soem near the heat. THELARGE INTESTINE ‘uy fod tat has aot been digested, along with water tl ese juices, passes into the large intestine. This tol the digestive tract begins in the lower right region sti abdonen with a small pouch, the cecum, to which ‘i penis is atached. (The appendix does not aid in tut contains lymphatic tissue and may function ‘enon The large intestine continues as the colon, 2 feta is often used alone to mean the large intestine, the colon constitutes such a large portion of that GH colon travels upward along the right side of 45 the ascending colon, erosses below the Seagate transverse colon, and then continues down fee Sie of the abdomen as the descending colon. As Fatal trough the colon, water is reabsorbed, and is formed, This waste material passes into the jigmoid colon and is stored in the rectum until through the anus. per 12 The Digestive System 275, Intestinal vill. A. Microscopic vew ofthe small intestine ning showing vil nd ‘lands that secrete mucus and digestive juices: The lumen s the central opening. 8 An ites vil. Fach villus has blood vessels and alactealOyenphatic capi for ruven absorption. The Accessory Organs ‘The salivary glands, which secrete into the mouth, are the first accessory organs to act on food. They secrete an enzyme (salivary amylase) that begins starch digestion. ‘The remaining accessory organs are in the abdomen and secrete into the duodenum (Fig. 12-5), The liver isa large Cystic duct ‘Common bile duct Duodenum Pancreatic duct ‘Accessory organs of digestion. The organs and duce are shown. The daphragm and spleen ae shown for reference 12