OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY

FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
• Internal Respiration – At the systemic
capillaries, absorption of oxygen from blood to
tissues and release of carbon dioxide from the
cells.

COMPARISON OF INTERNAL AND EXTERNAL

RESPIRATION
• External Inspiration
➢ Inspiration of oxygen from the external
atmosphere.
➢ Removal of carbon dioxide from lungs
and into the atmosphere.
• Internal Respiration
➢ Absorption of Oxygen from blood to
tissues.
➢ Cellular release of carbon dioxide.

FUNCTIONAL ANATOMY: RESPIRATORY SYSTEM

• Conducting Zones or Dead Space
➢ Respiratory passages from the nose to
the terminal bronchioles.
• Respiratory Zone
➢ Actual sites of gas exchange.
➢ Composed of respiratory bronchioles,
FUNCTIONS OF THE RESPIRATORY SYSTEM
alveolar ducts, alveoli
1. Gas exchange or Respiration – Supply body with
oxygen and dispose of carbon dioxide RESPIRATORY PASSAGES
2. Regulation of pH
• Conducting Passages
3. Voice Production
➢ Nose
4. Olfaction
➢ Pharynx
5. Innate Immunity
➢ Larynx
➢ Trachea
PROCESSES OF RESPIRATION
➢ Bronchial Tree
• Pulmonary Ventilation (Inspiration) - • Respiratory Passages
Movement of air in and out of the lungs. ➢ Bronchioles
• External Respiration – Gas exchange (O2 ➢ Alveolar Ducts
loading and CO2 unloading between the blood ➢ Alveoli
and alveoli).
• Transport of Respiratory Gases – O2 and CO2
must be transported to and from the lungs and
tissue cells of the body. This uses blood as the
transporting fluid. Perfusion (oxygenated blood
supplied to tissues).

RESPIRATORY SYSTEM 1
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
NOSE AND NASAL CAVITY INTERNAL NOSE (NASAL CAVITY)
• Nasal vestibule
➢ Sweat glands
➢ Sebaceous glands
➢ Vibrissae
➢ Limen nasi
• Nasal cavity proper
➢ Upper olfactory
➢ Lower respiratory
➢ Internal nares (Choanae) – Opening
from the nasal cavity leading to the
nasopharynx

WALLS OF THE NASAL CAVITY

• Superior (roof)
• Inferior (floor)
• Medial (septum)
• Lateral (labyrinth)

SUPERIOR WALL OF THE NASAL CAVITY

EXTERNAL NOSE
❖ Composed of bones.
• Root • Nasal
• Apex/Tip • Frontal
• Dorsum (Alae Nasi) - Bridge • Ethmoid
• Nostrils (Anterior Nares) • Sphenoid
• Septum Mobile Nasi (Columella)
INFERIOR WALL OF THE NASAL CAVITY
❖ The superior wall of the oral cavity makes up
the inferior wall of the nasal cavity.
• Hard Palate
➢ Palatine process of maxilla bone
➢ Horizontal plate of palatine bone

MEDIAL WALL OF THE NASAL CAVITY

• Nasal septum
➢ Perpendicular plate of ethmoid
➢ Vomer
➢ Septal cartilage

RESPIRATORY SYSTEM 2
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
LATERAL WALL OF THE NASAL CAVITY PARANASAL SINUSES: FUNCTIONS
• Conchae or Turbinate – 3 rolled up bones: • Lightens the bones of the skull.
➢ Superior turbinate – Part of ethmoid • Provides mucus for the nasal cavity.
bone • Resonant chambers for production of sound.
➢ Middle turbinate – Still part of ethmoid
bone PARANASAL AIR SINUSES
➢ Inferior • Maxillary sinus – Opens into middle meatus
• Meatus – Spaces below and between each • Frontal sinus – Opens into the middle meatus
concha. • Ethmoid sinus – Opens into superior and middle
➢ Superior meatus – Posterior ethmoidal meatus
air sinus • Sphenoid sinus -Opens into sphenoethmoidal
➢ Middle meatus recess.
▪ Anterior ethmoidal air sinus
▪ Middle ethmoidal air sinus
▪ Maxillary air sinus
▪ Frontal air sinus
➢ Inferior meatus – Nasolacrimal duct
• Sphenoethmoidal Recess – Sphenoidal air
sinus.

CLINICAL CORRELATIONS: SINUSITIS

• Cause: Inflammation in the air sinuses, causing
mucous buildup.
• Symptoms: Heaviness of the head (headaches),
PARANASAL AIR SINUSES: OVERVIEW nasal congestion, nasal pitch of voice (ngongo)
• Air containing spaces
• Asymmetrical
• Paired sinuses:
➢ Maxillary
➢ Frontal
➢ Ethmoid
➢ Sphenoid

RESPIRATORY SYSTEM 3
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
PHARYNX • Palatoglossal arch
• Musculo-membranous tube • Palatopharyngeal folds
• Common pathway for food and air
• Base of skull to level of C6 vertebra or cricoid
cartilage
• From choanae to esophageal inlet

LARYNGOPHARYNX/HYPOPHARYNX
• Common passageway for food and air.
• Continuous inferiorly with the larynx.

CLINICAL CORRELATIONS: NASAL AND PHARYNGEAL

• Allergic Rhinitis – An allergic condition
characterized by continuous sneezing, itchy
nose and eyes, coughing and headaches.
• Nasopharyngeal Tumor - Cancer that occurs in
the nasopharynx, which is located behind your
NASOPHARYNX nose and above the back of your throat. Usually
• Exclusive air passageway starts at the pharyngeal tonsils.
Features: • Acute Exudative Tonsillopharyngitis – Acute
• Pharyngotympanic tube (eustachian tube) infection of the pharynx, palatine tonsils, or
➢ Torus tubarius both. Symptoms may include sore throat,
➢ Tubal tonsils dysphagia, cervical lymphadenopathy, and
• Salphingopharyngeal fold fever.
• Pharyngeal recess
• Pharyngeal tonsils

OROPHARYNX: FEATURES
• Posterior third of the tongue
• Valecula
• Lingual tonsils
• Palatine tonsils
• Uvula

RESPIRATORY SYSTEM 4
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
• Cricoid Cartilage
➢ Signet ring shaped cartilage, below the
thyroid cartilage.
• Epiglottis
➢ “Guardian of the Airways”
➢ Spoon shaped, elastic cartilage.
➢ Projects upward when air is flowing in
the larynx.
➢ During swallowing, tips to cover the
laryngeal inlet, preventing food from
entering the laryngeal cavity.

LARYNX
• Upper expanded part of the trachea
• Production of voice “voice box”
• Lower respiratory tract inlet (sphincter)
• Has a cartilaginous framework
➢ 3 paired
➢ 3 unpaired
• Extends 5 cm from C4-C6 vertebra.
• Attached superiorly to the hyoid bone.
• Opens into the laryngopharynx.
LARYNX: PAIRED CARTILAGES
• Inferiorly continuous with trachea
• Total cartilages: 9 • Arytenoid Cartilage
➢ The most important, anchors the vocal
cords to the larynx.
• Corniculate Cartilage
➢ Found in aryepiglottic fold.
• Cuneiform Cartilage
➢ Found in apices of arytenoid.

LARYNX: UNPAIRED CARTILAGES

• Thyroid Cartilage
➢ Shield shaped, with ridge like laryngeal
prominence (Adam’s Apple)

RESPIRATORY SYSTEM 5
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA

VOCAL CORDS VOCAL CORDS: VOCAL FOLDS

• Found along the laryngeal mucosa.
• On each side are the vocal ligaments which
support a pair of horizontal mucosal folds call
the vocal folds or true vocal cords.
• Vocal cords vibrate and air passes through the
cords from the lungs to make the sound of your
voice.
• AKA true vocal folds
• Medial to the false vocal cords.
• It vibrates as air passes through, producing
sound.
• Chief agent in production of voice.
SUMMARY: LARYNGEAL CAVITY

2 Pairs of elevated folds of mucous membrane:

1. Vestibular folds (false vocal cords)
➢ Fixed
➢ Rima vestibuli – Space in between
vestibular folds
2. Vocal folds (true vocal cords)
➢ Movable
➢ Chief agents in production of voice
➢ Rima glottidis – Space in between vocal
folds

Laryngeal Cavity Regions

VOCAL CORDS: VESTIBULAR FOLDS 1. Vestibule
• AKA Ventricular fold, superior or false vocal ➢ Between the laryngeal inlet and the
cord. vestibular folds
• One of two thick folds of mucous membrane, 2. Middle Region
enclosing the vestibular ligament. ➢ Found between the vestibular and vocal
• Attached in front to the angle of the thyroid folds called laryngeal ventricle
cartilage below the attachment of the epiglottis, 3. Lower Region
and behind to the arytenoid cartilage, above the ➢ Found below vocal folds
vocal process. ➢ Site of Laryngotomy
• Plays no part in sound production.

RESPIRATORY SYSTEM 6
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
BRONCHI
• Trachea divides into the bronchus at the level of
the sternal angle.
• Bronchial tree (Right & Left):
➢ Primary (pulmonary)
➢ Secondary (lobar)
▪ 3 in right lung
▪ 2 in left lung
➢ Tertiary (segmental)
▪ 10 in each lung
• Each primary bronchus subdivides to the
secondary/lobar bronchi, this then branches to
form tertiary/segmental bronchi.
• Bronchioles: air passages under 1 mm in
diameter

TRACHEA
• “Windpipe”
• Cylindrical tube
• Length: 4 -5 inches or 10-12 cm
• Diameter: 2.5 cm
• 16 TO 20 “U” shape cartilages (hyaline cartilage)
• Passage of air
• From level of C6 vertebra to T5 vertebra
• Divides inferiorly into 2 primary bronchi
• Non-cartilaginous flattened posterior wall is in
contact with esophagus

COMPARISON OF RIGHT AND LEFT BRONCHI

Right Bronchi Left Bronchi

Diameter Wider Narrower
Length Shorter Longer
Direction More vertical Oblique

RESPIRATORY SYSTEM 7
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
RIGHT BRONCHUS
• Give off a branch:
➢ Eparterial bronchus
➢ Hyparterial bronchus
• Foreign body more likely to be dislodged into
the right bronchus.

BRONCHOPULMONARY SEGMENT LEFT BRONCHUS

• Terminal Bronchioles • Arch of aorta passes backward and over it.
➢ These bronchioles contain club (Clara) • Descending thoracic aorta at its back.
cells, columnar, nonciliated cells
interspersed among the epithelial cells. RESPIRATORY ZONE
➢ Club cells may protect against harmful
effects of inhaled toxins and
carcinogens, produce surfactant
(discussed shortly), and function as
stem cells (reserve cells), which give rise
to various cells of the epithelium.
• Respiratory Bronchioles
➢ They have alveoli budding from their
walls.
➢ Alveoli participate in gas exchange, and
thus respiratory bronchioles begin the
respiratory zone of the respiratory RESPIRATORY ZONE STRUCTURES
system. • Respiratory bronchiole: branch into alveolar sac
and alveoli (where gas exchange takes place).
• Alveoli: expansions in the walls of the alveolar
sacs: open into the atrium of the alveolar duct.

CELL TYPES OF THE RESPIRATORY MEMBRANE

• Type 1 pneumocytes – Walls of the alveoli
composed of simple squamous epithelium
• Type 2 pneumocytes – Secrete a fluid
containing surfactant that coats the gas
exposed alveolar surfaces. Surfactant decreases
the surface tension on the alveolar walls
contributes to the elastic properties of the lungs
• Alveolar macrophages (dust cells) – Provide
their primary line of defense against inhaled
dust, bacteria and other foreign particles.

RESPIRATORY SYSTEM 8
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
LUNGS AND PLEURAL COVERINGS
Pleura – 2 layered serous membrane covering the lungs.

1. Parietal pleura – Lines the thoracic wall and

superior aspect of the diaphragm.
2. Visceral pleura – Cover the external lung
surface, dipping into and lining the fissures.

PLEURAL CAVITY: RECESSES

• Phrenicocostal Recess
➢ Costodiaphragmatic recess
➢ Where costal pleura extends into
groove between the diaphragm and
chest wall.
• Costomediastinal Recess
➢ Where costal and mediastinal pleurae
meet.

PARIETAL PLEURA: SUBDIVISIONS CLINICAL CORRELATIONS: PLEURAL CAVITY

• Costal pleura • Pneumothorax - A collapsed lung. A
• Cervical pleura/Cupula pneumothorax occurs when air leaks into the
• Diaphragmatic space between your lung and chest wall. This air
• Mediastinal pushes on the outside of your lung and makes it
collapse. The collapsed lung can change the
orientation of the heart, resulting to
complications.
• Pleural effusion (tubig sa baga) – Increased
accumulation in the pleural cavity, obstructing
the costodiaphragmatic recess .
• Hemothorax – Accumulation of blood in the
pleural cavity.

PLEURAL CAVITY
• Slit like space.
• The space between outside the lungs and inside
the chest wall.
• Contain serous lubricating fluid.

RESPIRATORY SYSTEM 9
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA

LUNGS
• Vital organs of respiration
• Main function – To oxygenate the blood
• Situated on either side of the heart.
• Suspended in its pleural cavity via its root.
• Healthy lungs are light, soft and spongy
• Spongy, elastic-pinkish in infant but patchily
mottled dark gray in adults
• Fetal lung: solid & sink in water

LUNGS: SURFACES
• Apex - Narrow superior portion of the lung.
• Mediastinal surface – Medial surface of the
lung
• Costal surface – Surface of the lung lying
against the ribs.
• Base – Posterior surface that lies on the
diaphragm.
HILUS OF THE LUNGS
• Found in the medial surface of each lung
through which blood vessels of the pulmonary
and systemic circulation enter and leave the
lungs
• Primary bronchus also passes through
RIGHT LUNG: SUMMARY
• 3 lobes (superior, middle, inferior)
• 2 fissures (horizontal and oblique
• Features:
➢ Larger, heavier, shorter, and wider than
left.
➢ Deeper diaphragmatic surface due to
the liver.
• Eparterial and hyparterial bronchi (10
bronchiopulmonary segments(
LEFT LUNG: SUMMARY
• 2 lobes (superior and inferior)
• 1 fissure (oblique)
• Cardiac notch in anterior border.
• Lingula (between cardiac notch and oblique
fissure)

RESPIRATORY SYSTEM 10
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)
 OUR LADY OF FATIMA UNIVERSITY - COLLEGE OF PHYSICAL THERAPY
FOHA111 HANDOUT
LECTURE BY: EMMA C. MIRANDA, MD, FPSA
• Hyparterial bronchi ONLY (8-10
bronchiopulmonary segments)

BLOOD SUPPLY OF THE LUNGS

• Pulmonary artery
• Pulmonary vein

CLINICAL CORRELATIONS: LUNGS

• Pneumonia – A bacterial, viral, or fungal
infection of the lungs that causes the air sacs, or
alveoli, of the lungs to fill up with fluid or pus.
• Bronchogenic Carcinoma - A malignant lung
tumor characterized by uncontrolled cell
growth in tissues of the lung. This growth can
spread beyond the lung by the process of
metastasis into nearby tissue or other parts of
the body.
• Pulmonary tuberculosis - A chronic respiratory
disease common among crowded and poorly
ventilated areas. An acute or chronic infection
caused by Mycobacterium tuberculosis,
tuberculosis is characterized by pulmonary
infiltrates, formation of granulomas with
caseation, fibrosis, and cavitation.

RESPIRATORY SYSTEM 11
ENCODED BY: RALPH ANDREI ALEXANDER B. HADAP (BSPT 1-Y1-1)