Lower Respiratory Tract: Must Know!

Structure Importance
start of trachea lower border of cartilage (c6)
end of trachea (bifurcation to L and R level of sternal angle
bronchi) between T4 and T5
carina Ridge that separates the 2 bronchi
16-20 rings no. of U-shaped cartilaginous rings of trachea
(deficient posteriorly)
Trachealis muscle found posterior and attached to trachea (no cartilage)
lining of trachea (mucus membrane) Pseudostratified ciliated columnar epithelium
lining of bronchioles ciliated columnar epithelium
in expiration Bifurcation rised 1 vertebral level
in deep inspiration As low as T6
Relations:
anterior Thyrpod gland ISTHMUS at 2nd-4th ring
Sternum, thymus
posterior Esophagus
R and L recurrent nerves
laterally Thyroid gland LOBES
Carotid sheath (and its contents)
Right side Azygos vein
Right vagus nerve
Pleura
Left side Arch of aorta
Left CCA
Left subclavian
Bronchi order of division PLS

Principal bronchi
Lobar bronchi
Segmental bronchi
Difference of R and L bronchi:
Right bronchi Wider
Shorter: 1 inch adult/ 0.5 in child
More vertical
***more prone to entry of foreign bodies like coins/bolts
Left bronchi Narrower
Longer: 2 inches
More horizontal
Unique about Right Lung a. Before the hilum (entry to lung), has 1 superior lobar bronchus
branch

b. 3 lobes: Superior, Middle, Inferior

c. Azygos lobe: accessory seen in 1% population superior to hilum of

right lung
Left Lung a. Only 2 lobes: superior and inferior lobes
b. Has cardiac notch: where heart is located
Cardiac notch → a concave indentation of anterior margin of left
lung
Lingula Tongue-like projection inferior to cardiac notch
hilum A depression in the lung middle surface of lung where the lung ROOT
attaches
What’s in the lung root? Bronchi
Pulmonary arteries and veins
Bronchial vessels
Nerves
fissures Divide lungs into unequal lobes
Bronchopulmonary segments (BPS) a. Anatomic, functional, structural unit of lungs
b. Has own lymphatic and nerve supply (meaning in surgery it can be
removed as one segment without compromising other segments)
c. Pyramidal shaped subdivisions of lungs
Bronchioles a. No more cartilage (unlike trachea and bronchi which has incomplete
cartilage rings)
b. Has complete circular smooth muscle fibers instead
Bronchiole branching TR:
Terminal bronchiole
Respiratory bronchiole
Respiratory bronchiole a. outpouchings of terminal bronchiole where gas exchange takes
place
b. branches into ALVEOLAR DUCTS
Alveolar ducts a. End branches of terminal bronchioles
b. Has outpouchings called ALVEOLAR SACS (gas exchange)
Alveolar sacs a. Consist of several ALVEOLI
b. Surrounded by rich capillary network for gas exchange
Nonrespiratory circuit blood supply Bronchial arteries and veins
Respiratory circuit blood supply Segmental arteries
Intersegmental veins
In a lung there are 2 pulmonary veins
Bronchopulmonary nodes Drain into superficial (subpleural plexus)
Pulmonary nodes Drain into deep plexus
From deep plexus 1. To tracheobronchonchial nodes
2. To bronchomediastinal lymph trunks
In inspiration a. Root of lungs and bifurcation descends
b. Bronchi elongate and dilate
c. Diaphragm descends
d. Anterior abdominal muscles relax
In expiration a. Root of lungs and bifurcation ascends
b. Bronchi shorten and constrict
c. Diaphragm ascends
d. Anterior abdominal muscles toned
Normal respiratory rate 16-20 beats per minutes
RR in children Faster
RR in adults Slower
Muscles involved in forced inspiration 1. Raises the ribs: scalenius ant and medius, SCM
(labored breathing) 2. Fixes scapula: trapezius, levator scapulae, rhomboid
3. Pull ribs up: serratus anterior, pectoralis minor
Types of respiration 1. Infants: abdominal respiration (ribs are more horizontal)
2. Adult female: thoracic respiration (ribs more oblique, starts at 2
years old)
3. Adult male: both abdominal and thoracic and predominantly
abdominal respiration
Pleura Serous membrane that folds back on itself to forms 2 layers (parietal and
visceral)
Serous fluid In pleural cavity (10-20 mL) to protect lungs and for smooth gliding motion
during respiration
Visceral pleura Covers the lung surface
No pain sensation (sensory)
Supplied by ANS (autonomic nervous system)→ motor only
Parietal pleura Can sense pain (especially costal part)
CLINICAL NOTES:
Pneumothorax a. Air in pleural cavity
b. Causes: lung injury (bullet, stab) or lung dss
c. Open pneumothorax → pleural cavity open to outside air
d. Tension pneumothorax → a dangerous condition where air
pressure in increased in injured lung and the other lung is pushed to
mediastinum

hydrothorax Excessive serous fluid in pleural cavity due to pleural effusion

hemothorax Blood in pleural cavity due to lacerated lung or damage to lung blood vessels
empyema Pus in serous fluid
atelectasis Collapsed lung air sacs (congenital or dss)
pleuritis Inflammation of pleura which makes the surface rough and cause abnormal
sounds during chest auscultation
Chest tube insertion To remove air, blood, pus, excess serous fluid
Where to insert needle In 5th or 6th intercostal space
LUNG DEVELOPMENT
foregut Origin of lower respiratory tract (trachea, bronchi, bronchioles)
Laryngotracheal tube Gives rise to: R and L lung buds, larynx and trachea
Lung buds Develop laterally to become lungs; grows laterally into 2-3 lobes
Why babies survive being born on 7th The capillary loops connected to pulmonary circulation are sufficiently well -
month developed to support breathing
When lungs become fully expanded 3-4 days after birth