The Respiratory

System
Dr. Katelyn Wood, PhD
katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson you will be able to…

• Describe the pathway air takes to travel from the atmosphere to enter your lungs
to faciliate gas exchange

• Differentiate between the conducting and respiratory zones in terms of structures

and function
The Respiratory
System
The Respiratory System
Series of passages conducting air from environment to alveoli
to facilitate gas exchange
The Respiratory System
Structural Divisions:
• Upper = Nose & Pharynx
• Lower = Larynx, Trachea, Bronchioles, Alveoli

Functional Divisions:
• Conducting = Nasal Cavities  Terminal
Bronchioles
• Cleanse, warm and humidify air
• Respiratory = Respiratory Bronchioles 
Alveoli
• Gas Exchange
https://www.lung.ca/lung-health/lung-info/respiratory-system
The Conducting Zone
Nose  Terminal Bronchioles
The Conducting Zone Nasal cavity

Naso
Oro Pharynx
Laryngo
Larynx
Trachea

Bronchi
Nasal Cavity Cribriform plate

• Mucous Linings
• Olfactory Mucosa (smell – CN I,
olfactory N; on cribriform plate)
• Respiratory Mucosa (cleaning)
Inferior
meatus
• Bony Protrusions = Conchae Hard palate
• Increases surface area
• Covered in epithelium + Highly vascular
• Superior + middle = ethmoid bone
• Inferior conchae is a bone
• Meatus = space under conchae
 Nasopharynx
Oropharynx
Pharynx
nasal cavity
Laryngopharynx with conchae
uvula

• Connects Nasal Cavity with Larynx

• Made of skeletal muscle, lined with
mucous membrane
• Three sections:
• Nasopharynx = air only hard palate
• Oropharynx = air + food
• Larygopharynx = divides air + food esophagus
• Bottom = esophagus + larynx
hyoid bone
larynx
 hyoid
thyroid epiglottis

Larynx
cuneiform
• Functions:
• Prevent food from entering
trachea
• Permit passage of air corniculate
• Produce vocalization

• 9 Cartilages (mostly hyaline) Tracheal

Cartilage
• Thyroid
• Cricoid arytenoid
• Epiglottis (elastic cartilage)
• 2x Arytenoid (anchor vocal cords) cricoid
• 2x Cuneiform
• 2x Corniculate
 Glottis Rima Glottidis

Speech Production (opening)

Vocal fold
• Vocal Ligaments/fold (cords)
superior view
• Arytenoid to Thyroid
• Intrinsic laryngeal muscles
control tension and length of
cords (tension = pitch)
Vestibular fold

• Vestibular Fold
• Superior to vocal folds
• No role in voice production
• Important for holding pressure
within lungs (e.g. valsalva)
HIGH and LOW pitch
Trachea + Bronchial Tree
• Held open by “c”-shaped cartilages

• Divides into Primary bronchi @ carina

• Left = longer, more horizontal
• Right = shorter, more vertical, wider

• Secondary (Lobar)
http://license.umn.edu/technologies/20180250_central-airway-stent-removal-device

• Left = 2
• Right = 3

• Tertiary (Segmental)
• Bronchopulmonary Segments
(segmental bronchus + vessels)
The Respiratory Zone
Respiratory Bronchi  Alveoli
The Respiratory Zone
Alveolar duct
Respiratory bronchiole
Alveoli

Tertiary
bronchiole

Alveolar sac
 Histology An Essential Textbook, 1st ed. Lowrie Jr. Thieme 2020

Alveoli Structure
• Two Cell Types:
• Type I Pneumocyte Junquiera’s Basic Histology, 14th Ed, Mescher, 2016

• Long and flat shaped

• Make up walls of alveoli +
interface with pulmonary
capillaries

• Type II Pneumocyte
• Cuboidal
• Secrete surfactant to reduce
surface tension
• Allows alveoli to remain
popped open
A = Alveolus; I = Type I Pneumocyte
II = Type II Pneumocyte; C = Capillary
 Airway branching

branches # of tubes
Trachea 1

Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.
Main bronchi 1

Lobar and segmental

bronchi
Bronchial Tree

Conducting zone Lobar = 2–3

Segmental = 10

Bronchioles and terminal

11–16
bronchioles
Divisions

Respiratory
17–19
bronchioles

Respiratory zone
Alveolar ducts 20–22

Alveolar sacs 23

(b) Airway branching

To Summarize…
• Respiratory system consists of 2 zones:
• Conducting (passage of air + moistening & cleaning)
• Mouth/Nose  Terminal Bronchi
• Respiratory (gas exchange)
• Respiratory Bronchi  Alveoli

• Bronchial tree progressively divides into smaller and smaller tubes as

you progress from the nose to the alveoli

• Gas Exchange occurs via alveoli

• 2 main cell types:
• Type I Pneumocyte = diffusion
• Type II Pneumocyte = pulmonary surfactant
 ©

katelyn.wood@uwo.ca
Lung + Pleura
Anatomy
Dr. Katelyn Wood, PhD
katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson you will be able to…

• Understand the composition of the lungs

• Describe the location of the lungs within the thoracic cavity

• Label hilum structures, lobes and fissures of the lungs

• Describe the structure and function of pleura

 Superior Mediastinum

Thoracic Compartments
Middle Mediastinum
Anterior Mediastinum
Posterior Mediastinum
L + R Pleural Cavities

Middle
mediastinum

Anterior Superior Lateral

Pleural Cavities
Contents:
• Lungs
• Pleura

Hilum:
• Pulmonary Arteries
• Pulmonary Veins
• Primary Bronchi
• Bronchial Arteries
 Airway branching

branches # of tubes
Trachea 1

Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.
Main bronchi 1

Lobar and segmental

bronchi
Bronchial Tree

Conducting zone Lobar = 2–3

Segmental = 10

Bronchioles and terminal

11–16
bronchioles
Divisions

Respiratory
17–19
bronchioles

Respiratory zone
Alveolar ducts 20–22

Alveolar sacs 23

(b) Airway branching

The Lungs
 Trachea

Lungs in Situ Right lung Left lung

Carina
Right main bronchus

Right lobar bronchi

Right segmental
bronchus
Right bronchiole

Anterior view of bronchial tree in lungs

Copyright © 2017 by John Wiley & Sons, Inc. All rights
reserved.
What is the lung made of?
• Space between 2 adjacent
alveoli = Interalveolar Septum

• Contents:
• pulmonary capillaries (gas
exchange)
• Interstitium (fibroblasts for
elastic tissue production +
macrophages for protection)

Netter’s Essential Histology by Ovalle and Nahirney 2008

 right

Lungs
• Each lung has 3 surfaces:
• Costal surface (against the ribs)
• Diaphragmatic surface (against the diaphragm)
• Mediastinal surface (against the mediastinum)
left
• Apex = top of lung
• Root/Hilum = mediastinal surface

• Separated into lobes by fissures

• Connected to the heart via pulmonary (gas

exchange) + bronchial (systemic) circulation
Right Lung
Lateral View
Left Lung
Lateral View
Hilum Structures
• Bronchi (air)
• Have cartilaginous rings surrounding lumen
• Pulmonary Arteries (deoxygenated blood)
• Anterior to bronchi, thicker walled than veins
• Pulmonary Veins (oxygenated blood)
• Inferior
• Lymphatics
• Bronchial Arteries (systemic circulation) Number of divisions
depends upon location
• Pulmonary Ligament (pleural reflection) of X-section
R. Hilum
Root of the Lung

Pulmonary lig
Double layer of pleura
transitioning from visceral to
parietal
Pleura
Pleural Cavities
• Pleura are 2-layered sacs
surrounding the lungs
• Visceral = next to lung
• Parietal = next to thoracic wall
Pleural Cavities
• Pleura are 2-layered sacs
surrounding the lungs
• Visceral = next to lung
• Parietal = next to thoracic wall
• Costal = ribs
• Diaphragmatic = diaphragm
• Mediastinal = heart/mediastinum
• Cervical = neck

Figure 4.30C – Clinically Oriented Anatomy (Moore et al)

Lungs within Pleura

Figure 4.31B-D – Clinically Oriented Anatomy (Moore et al)

Pleural Reflections + Recesses
• 2 clinically significant recesses within
the pleura:
• Costomediastinal
• Costodiaphragmatic

• Potential areas where

What muscles
fluid can collect are these?
To Summarize…
• Lung consists of alveoli + interstitium
• 2 lungs, divided into lobes by fissures
• Left lung = 2 lobes
• Right lung = 3 lobes
• Pleural cavities exist to the right and left of the mediastinum
• Contain lungs + pleura
• Pleura = 2 layered sac, in which the lungs are situated
• Visceral layer = next to lung; parietal layer = next to chest wall
• Space between pleural layers = intrapleural space
• Opening in pleura at the hilum of the lung
• A key passageway for neurovasculature + pulmonary structures into the lungs
 ©

katelyn.wood@uwo.ca
Breathing + Gas
Exchange
Dr. Katelyn Wood, PhD
katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson you will be able to…

• List the thoracic muscles which contribute to inspiration/expiration

• Describe how changes in thoracic cage volume and intrapleural pressure allow for
lung inflation/deflation

• Describe how a pneumothorax occurs

Thoracic MSK Review
Bony Anatomy
• Thoracic Cage
• Sternum, ribs, costal
cartilage, thoracic vertebrae

• Costotransverse +
Costovertebral Joints
• Articulation @ posterior
aspect between ribs +
vertebrae
Thoracic Muscles
• External Intercostals
• Elevates ribs (inspiration)
• Superolateral to Inferomedial
• “hands in your pockets”

• Internal + Innermost Intercostals

• Depresses ribs (forced expiration)
• Superomedial to Inferolateral
• “grab your collarbones”

• Diaphragm
• Contraction lowers domes
Mechanics of Breathing
Pressure Changes  Respiration
Sternum:
• Breathing is all about pressure Exhalation
changes Inhalation
• Dependant upon the volume of
the thoracic cage Diaphragm:

• Increasing volume = inspiration Exhalation

• Decreasing volume = expiration Inhalation

Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.

Changes in size of thoracic cavity

during inhalation and exhalation
Fundamental Mechanics
• Lungs are under tension (interstitium is primarily elastic)
• Naturally want to collapse
• Stuck to visceral pleura
• Alveolar Pressure = atmospheric pressure

• Pleura has parietal & visceral layers creating a sac

• Intrapleural pressure = ~4mmHg below atmosphere

• When the thoracic cage expands (muscle contraction), so does the

parietal pleura decreasing the intrapleural pressure
• The lungs follow suit, decreasing the alveolar pressure
• Air flows in
Air
Pressure = A

lower
A

A-4
lower
Pneumothorax
• Puncture to pleural membrane causes air (pneumo) in pleural
space
Essentials of Clinical Examination Handbook. Ed. 8. Shi et al. Thieme 2018

• Intrapleural pressure = atmospheric pressure

• Doesn’t change with thoracic cage expansion
• Lung is no longer under tension + collapses

• If blood is involved called a hemothorax

 Air Pressure = A
Pneumothorax

AA - 4
Gas Exchange
Pulmonary vs Bronchial Circulation

From aorta or
intercostal As)

Pulmonary Bronchial (systemic)

Gilroy A, MacPherson B, Johnson A et al., ed. Atlas of Anatomy. 4th Edition. Thieme; 2020
Pulmonary vs Bronchial Circulation

System Origin Location Features Goal

A: center of
bronchopulmonary
deoxygenated High flow, low
segment Oxygenate
Pulmonary blood from the pressure, low
V: outside of blood
right ventricle resistance
bronchopulmonary
segment
A: center of
oxygenated bronchopulmonary
Bronchial High pressure, Perfuse
blood from the segment
(systemic) high resistance lung tissue
left ventricle V: drains into
pulmonary vein
 Bronchial Artery
Vasculature of the drains via pulmonary vein
Pulmonary
Artery
Trachiobronchial Tree respiratory
bronchiole

• Arteries in Centre of
Bronchopulmonary
segment Pulmonary
Vein

Capillary bed
on Alveolus

• Veins in the
periphery alveoli

Gilroy A, MacPherson B, Johnson A et al., ed. Atlas of Anatomy. 4th Edition. Thieme; 2020
Gas Exchange outside air

• Goal = oxygenate blood +

remove carbon dioxide

• Diffusion of oxygen + carbon

dioxide between alveoli +
pulmonary capillaries
O2 CO2

BLOOD CO2 O2 BLOOD

Pulmonary Circulation
 Netter’s Essential Histology by Ovalle and Nahirney 2008

Gas Exchange
• Goal = oxygenate blood +
remove carbon dioxide

• Diffusion of oxygen + carbon

dioxide between alveoli +
pulmonary capillaries

• Gas has to pass through 3

zones:
Pulmonary Capillary
O2 Fused Basement Membrane CO2
Alveoli
Ventilation vs Perfusion
• Gas exchange depends upon the relationship
between ventilation (air in alveoli) + perfusion (blood
flow through capillaries)

VA/Q = alveolar ventilation/ cardiac output

• Shunt = adequate perfusion, but no ventilation

• Causes: pulmonary edema, asthma, COPD, pneumothorax,
gas trapping

• Dead Space = adequate ventilation, but no perfusion

• Causes: hemorrhage, dehydration, pulmonary embolism
 Essentials of Clinical Examination Handbook. Ed. 8. Shi et al. Thieme 2018

Pulmonary Edema
• Usually secondary to heart failure
• Blood not effectively pumped from L ventricle leads
to back up in pulmonary veins + lungs

• Swelling, and eventual leaking of pulmonary capillaries = Fluid

accumulation + increased pressure in interstitium
• Increases pressure around alveoli + respiratory bronchioles, which may lead
to collapse + shunting because air becomes trapped
• Diffusion (and thus oxygenation) becomes more difficult

• Fluid may leak into the pleural cavity (pulmonary effusion) or

mediastinum
• Alveolar flooding is possible (very problematic)
To Summarize…
• Breathing depends upon changes in pressure within the thoracic cavity
• Lungs always want to collapse, but are held open by the intrapleural pressure
• Thoracic cage expansion  intrapleural pressure decrease  lungs expand
• When pressure drops within the lung tissue, air is inspired
• Pneumothorax = disruption in pleura  loss of pressure differential + lung
collapse

• Diffusive gas exchange occurs between alveoli + pulmonary capillaries

• Goal = Remove CO2 from body, Add O2 to blood
• Mismatch between perfusion and ventilation causes problems
• Shunt = perfusion, ventilation
• Dead space = ventilation, perfusion

• Lungs receive both systemic circulation (bronchial A) + pulmonary

circulation (pulmonary A)
 ©

katelyn.wood@uwo.ca
Breathing + Gas Exchange - Captions
Slide 2:
In this last module we'll talk about breathing and gas exchange.

Slide 3:
By the end of this session, you will be able to list the thoracic muscles which contribute to inspiration and
expiration. Describe how changes in the thoracic cage volume and intrapleural pressure, allow for lung
inflation and deflation. And describe how a pneumothorax occurs.

Slide 5:
So we've talked about this a lot already, but because we're talking about volume changes in the thoracic
cage, it's important for you to recall now, the bony anatomy that forms the thoracic cage. So of course,
we've got our sternum, ribs, costal cartilage, and thoracic vertebra, which are going to form this bony shell
within which the lungs reside. There are of course, a couple articulations that are key here. So ribs join to
the sternum on the anterior aspect via costal cartilage, but also join to the vertebrae on the posterior
aspect via two joints that we talked about much earlier in the course. These consists of the
costotransverse join, which is an articulation between the costal tubercle and the transverse process of a
thoracic vertebra, and the costovertebral joints which consists of an articulation between the head of the
rib and the vertebral body

Slide 6:
There are also a number of thoracic muscles that are going to act on the ribs to allow for a change in the
size of the thoracic cage. Specifically, here we're looking for a change in volume. The first muscle we'll talk
about is external intercostals. These elevate the ribs and are key for inspiration. They move in a
superolateral to inferomedial direction. So I like to think about this as putting my hands in my pockets.
These are on the most exterior aspect of the thoracic cage. Deep to this then we'll find two muscles, the
internal and innermost intercostals. These are going to depress the ribs and are important for forced
expiration. They run in the opposite direction, superomedial to inferolateral. So I think about this as
grabbing my collarbones. Again, these are internal to the external intercostals so we see internal there
and purple, and on the most interior aspect, we'll see our innermost intercostals Lastly, we have the
diaphragm. The main thing to remember here is that when you contract your diaphragm, it lowers and
this is going to increase the volume of the thoracic cavity and be important for inspiration.

Slide 7:
Breathing is all about changes in pressure. Let's go through how that works now.

Slide 8:
So as I just mentioned, pressure changes lead to respiration. So, this is dependent fully upon the changes
in volume of the thoracic cage. When you increase the volume you inspire, and when you decrease the
volume you expire. What we're showing here on the right is how the thoracic cage is going to move when
you breathe in. So the colored diagram is in expiration. The grayed out diagram is demonstrating
inspiration. And what I want you to realize here is that ribs are a fixed shape. So it's almost like they swing
outwards a little bit, much like the handle on a bucket when you want to inspire. At the same time you
contract your diaphragm and those domes lower and overall that increases the volume of the thoracic
cage.

Slide 9:
So a few fundamental mechanics you should be aware of. First lungs are under tension. Remember, the
interstitium is primarily elastic tissue, which means they're constantly wanting to collapse. Lungs are also
stuck to visceral pleura. You can think about the pressure in the alveoli, as being equivalent to atmospheric
pressure, or essentially the air that's around you in the room. Pleura, we've already discussed, has both a
parietal and visceral layer, and this creates a sac. Inside this sac, we have the intrapleural space. And this
has a pressure of about four millimeters of mercury below the atmosphere. And so this is going to create
an oppositional force to the lungs that are wanting to contract. Essentially, when the thoracic cage
expands, due to muscle contraction we've just spoken about, so does the parietal pleura and this increases
the volume of the intrapleural space. Since we aren't changing the contents, this is going to decrease the
pressure and cause the visceral pleura, which is attached to the lungs to pull on the surface of the lungs,
which allows them to expand. Overall this will decrease the pressure inside the alveoli, as again we've
increased the volume but not change the contents. This is going to allow air to move inside

Slide 10:
Let's now go through a diagram to explain how breathing works. So there's our trachea, which leads to
both lungs. The lungs here are outlined in a layer of visceral pleura, and there's the parietal pleura. That
exists inside the rib cage and remember, the chest wall is actually stuck to that layer of parietal pleura.
And there's our diaphragm. Pressure inside the lungs, specifically the alveoli, is equivalent to atmospheric
pressure or the pressure in the space around you. Pressure in the intrapleural space is about four
millimeters of mercury less than that of the lung, or the atmospheric pressure. This creates an oppositional
force to the lung wanting to contract and helps it stay open. When you breathe in, your rib cage expands,
this pulls on that parietal layer of pleura. Your diaphragm drops and does the same. Ultimately, this means
that the pressure in the intrapleural space is going to decrease. This causes the lungs to expand. This then
drops the pressure in the lungs and allows air from the periphery to flow in. When you want to breathe
out, everything happens in reverse. So the chest wall moves back in. That increases the pressures and the
lungs will collapse in

Slide 11:
A pneumothorax represents a clinical circumstance where air exists in the thorax where it shouldn't be.
Essentially, what happens here is there's a puncture to the pleural membrane and air is allowed into the
intrapleural space. Now, you can see in this image here that the lung is deflated. And here's why that
happens. When you puncture the pleural membrane, the pressure inside the intrapleural space changes.
And in fact, when it equals atmospheric pressure, you no longer get that opposition between the
intrapleural space and the lungs, which are wanting to contract. Because the lungs are no longer under
that tension, then they collapse inward as they want to do. And you can see in this radiologic image, that
the lung here is much smaller on the right side than it is on the left. Now, the other issue that results is
when you puncture this membrane, you're allowing air to move in and out of the intrapleural space. So
when you expand your thoracic cage and you pull on that parietal layer, air is actually sucked in through
whatever hole exists, and you don't get that change in pressure that would allow the lung to re inflate. If
however, you have blood in this space, we refer to it as a hemothorax. Treatment options here include
resealing the hole and getting the lung to expand. But this can be a little bit dangerous, because if you
don't make sure that the pressure in the intrapleural space returns to normal, that can actually shift the
position of organs in the thorax which can be really problematic. In general, this is a medical emergency
for which you're going to want to seek attention

Slide 12:
Let's go through a diagram now to demonstrate exactly what happens in a pneumothorax. So there's our
trachea in black and our two lungs in green, our plural membranes and blue forming the intrapleural
space. The costal area or rib cage in yellow, and our diaphragm and red. Remember, pressure inside the
alveoli is the same as atmospheric pressure under normal conditions. Pressure inside the intrapleural
space is four millimeters of mercury less than that, and that creates an oppositional force that helps to
keep the lungs open. If you disrupt a pleural membrane, you're going to disrupt the pressures. So what
happens here is air can flow in and now the pressure inside the intrapleural space is the same as it is inside
the lungs. Because of this, we no longer have that oppositional force. And the lung, which wants to recoil
under normal circumstances, can do so and it collapses

Slide 13:
Gas exchange is the whole point of breathing. It talks about how we get oxygen into the blood and how
we get carbon dioxide out of the blood. In the next few slides, I want to talk about the interface between
the lungs and the capillaries that make this possible.

Slide 14:
Remember first though, that the lungs receive two forms of circulation, pulmonary circulation, which I like
to think of as the lungs superpower. The lungs oxygenate blood. And so pulmonary circulation allows them
to do that. Bronchial circulation on the other hand is systemic circulation that supplies the lung tissue. So
this is that ordinary form of circulation that every cell in your body needs

Slide 15:
Le'ts compare and contrast the pulmonary and bronchial circulation and terms of their origin, the location,
the features and their goal. So pulmonary circulation consists of deoxygenated blood moving from the
right ventricle out to the lungs. Arteries in this system move down the center of the bronchopulmonary
segment, and veins return via the outside area of the bronchopulmonary segment. And I'll show you what
this looks like in a second. Critically, these vessels contain high flow, low pressure, and low resistance. The
goal here is to oxygenate blood. So high flow means we can get a lot of blood through the lungs, low
pressure, because they're right next to the heart. And low resistance means it's easy for the blood to flow
through. By contrast, the bronchial circulation is an extension of systemic circulation. In this system, we
see oxygenated blood traveling from the left ventricle out to supply the lung tissue itself. These arteries
also start off going down the center of a bronchopulmonary segment, and most of them drain into a
pulmonary vein. These vessels have high pressure and high resistance. The goal here is to perfuse the lung
tissue. They have high pressure because coming off of the systemic system, which needs to travel to the
whole body, they're going to be under high pressure leaving the aorta. High resistance results from them
being conventional arteries, and that is there to oppose the high pressure that's present in them.

Slide 16:
So here's what the vasculature of the tracheobronchial tree looks like. And this is what I was talking about.
So essentially here, this is one bronchopulmonary segment, and we can see there's our respiratory
bronchiole, and we know what's a respiratory bronchiole because we can see alveoli appearing on it, and
that leads all the way down through the alveolar ducts into alveolar sacs to get to eventually all of these
pockets of alveoli -- this is where the gas exchange is going to occur. So arteries from both the bronchial
and the pulmonary circulation are going to travel down the center of the bronchopulmonary segment.
And remember, bronchopulmonary segments just refer to a tertiary segment of the bronchi and the lung
tissue it supplies. So here we have the bronchial artery, and it's looking pretty small in comparison, and
it's going to drain via a pulmonary vein, especially when we get down to this level. There's our pulmonary
artery, also traveling down the center of the bronchopulmonary segment. This is going to go on to form a
capillary bed on top of the alveoli through which gas exchange will occur. This blood is then going to return
via the pulmonary veins. These veins you can see now are on the periphery. So blood comes in down the
center of the bronchopulmonary segment and returns via the periphery

Slide 17:
So when we talk about gas exchange, we're really interested in our ability to oxygenate the blood and
remove carbon dioxide from it. This occurs via passive diffusion of these two gases between the alveoli of
your lungs and the pulmonary capillaries carrying blood. Here's a diagram to walk us through this process.
So there's an alveolus and there's our pulmonary capillary containing blood. Essentially what happens
here is when you breathe in, oxygen moves into the alveoli and then diffuses across the membrane to get
into the capillary. At the same time, carbon dioxide present in the capillary is going to move into the alveoli
and be breathed out

Slide 18:
So in the previous module, we talked about alveoli as being a single cell thick, formed of those type I
pneumocytes, and how they interface with pulmonary capillaries to allow for gas exchange. In the top
right image here, this is a scanning electron micrograph of that region. So we can see on the bottom part
that type I pneumocyte of the alveolus, interfacing with a capillary, where we see an RBC, or a red blood
cell existing on the top left. These two sets of cells kind of abut each other, and they will fuse in this
instance, which is very specific to cases where you have diffusion occurring. So what's going to happen
here is we're going to see gas passing through three zones in order for exchange to happen. We're going
to see our pulmonary capillary, this fused basement membrane of the two cells, and then our alveoli.
Oxygen is going to move from the alveoli of the lungs, up through these two other areas to reach the
blood. Carbon dioxide is going to move in the opposite direction. It's important that you realize here that
movement through the zones has implications for physiology. If for some reason, this movement is
impaired, either by swelling, a thickening in the membrane, or a resistance to that passive diffusion, gas
exchange is going to be impaired

Slide 19:
So now that we understand that gas exchange is dependent upon an interface between alveoli and a
capillary, we can now recognize that it is a balance between ventilation, or the air coming into the alveoli,
and perfusion, or the blood flowing through the capillaries. We need to make sure that these two aspects
are well matched, so that there's enough air to contain oxygen to diffuse into the blood that's passing by.
Mismatches between the two can actually be quite problematic. And let's talk about them now. We refer
to this as the Va, so the ventilation in the alveoli over Q, which is cardiac output. So alveolar ventilation,
air coming into the alveoli. Cardiac output determines the amount of blood flowing through the capillaries.
Under normal circumstances, we have a pretty good match. We have just the right amount of blood and
just the right amount of air that we get an appropriate amount of diffusion happening across those
membranes. If however, we do not have ventilation entering the alveoli, we enter this circumstance that
we refer to as shunt. So we have adequate perfusion, blood is flowing through the capillary, but we don't
have ventilation for some reason. And this can happen in a number of clinical circumstances. So
pulmonary edema, which we'll talk about in a second, asthma, COPD, which is chronic obstructive
pulmonary disorder, and pneumothorax, which we've already talked about, and gas trapping all lead to a
shunt. Essentially, blood is flowing past, but there's no oxygen and no air for it to interface with to allow
diffusion to occur. The opposite to this we refer to as dead space. What's happening here is there's lots
of air in the alveoli. But blood isn't flowing through the capillaries. Causes of this could be hemorrhage,
dehydration, or a pulmonary embolism, essentially preventing the blood from getting to the capillaries.
Again, in terms of gas exchange, this is really problematic. You've got the air but you don't have the blood
to put it into

Slide 20:
Pulmonary edema is one of those clinical circumstances I just mentioned, that can lead to a shunt. This is
usually occurring secondary to heart failure. When heart failure occurs, blood is not effectively pumped
from the left ventricle. And this leads to a backup in the pulmonary veins and lungs. What happens next
is swelling and eventual leaking of the pulmonary capillaries. And this results in fluid accumulation in the
interstitium, along with increased pressure. This results in a couple of things. One, this increased pressure
around the alveoli in the interstitial space and the respiratory bronchioles can lead to collapse. And this
leads to shunting because air can become trapped in the alveoli. And when you're not exchanging the air,
you're not creating that pressure gradient that you need for oxygen or new oxygen to be present and
carbon dioxide to be taken away. This means that diffusion and thus oxygenation of the blood becomes
more difficult. If this progresses to an extreme fluid can actually leak into the pleural cavity. And this is a
problem, we refer to this as pulmonary effusion, and this can result into circumstances similar to a
pneumothorax. It can also lead into the mediastinum. Lastly, if it becomes really progressed, alveolar
flooding is possible. So usually the type I pneumocytes are really tightly adhered to each other and are
resistant to fluid moving into the alveoli. But if the pressure in the interstitium becomes too great, you
can get leaking of fluid into the alveoli. And this becomes super problematic for gas exchange, because
the gases simply can't diffuse that far or through the fluid.
Slide 21:
So to summarize everything we talked about today, breathing depends upon changes in pressure within
the thoracic cavity. Lungs always want to collapse -- they're elastic in nature, but they're held open by an
opposing pressure in the intrapleural space. When the thoracic cage expands, the intrapleural pressure
decreases, and this pulls on the lungs to cause them to expand. When the pressure then drops within the
lung tissue and alveoli, air is inspired. A pneumothorax results in the disruption of the pleura -- you get a
loss in this pressure differential between the lungs and the intrapleural space, and the lung can collapse.
Diffusive gas exchange occurs between alveoli and pulmonary capillaries. The goal here is to remove CO2
from the body and add oxygen back into the blood. A mismatch between perfusion, so the blood flow,
and ventilation, the airflow, can cause problems. Specifically, we talked about conditions of shunt where
we see adequate perfusion but not enough ventilation, and dead space where we see adequate
ventilation, but not enough perfusion. Remember, lungs receive both systemic circulation, via the
bronchial arteries, and pulmonary circulation to allow for gas exchange, via the pulmonary arteries.

Slide 22:
That's all for now. Take care.
Lungs + Pleura Anatomy - Captions
Slide 2:
Let's talk about the anatomy of the lungs and pleura.

Slide 3:
By the end of this lesson, you will be able to understand the composition of the lungs describe the location
of the lungs within the thoracic cavity, label hilum structures lobes and fissures of the lungs and describe
the structure and function of pleura.

Slide 4:
So as we've previously discussed, the thoracic cage can be divided into six compartments. Specifically the
superior mediastinum, middle mediastinum, anterior mediastinum, posterior mediastinum and left and
right pleural cavities. Today we're going to focus on the pleural cavities and their contents.

Slide 5:
When we talk about pleural cavities, we're interested in knowing more about what they contain including
the lungs and the pleura. And of course the transition zone between the middle mediastinum and the
pleura which we refer to as the hilum. This is going to be a transition zone, where we see the entrance or
exit of pulmonary arteries and veins, primary bronchi and bronchial arteries.

Slide 6:
We also spoke about the bronchial tree divisions in the last lecture, it's important that you realize that to
get from the external environment down deep into your lungs, air needs to traverse through a variety of
tubes that progressively become smaller as we move from your trachea down towards the alveoli.
Essentially, for gas exchange to occur, you need to get to an area where you have a single cell of alveoli
juxtaposed with a single cell of a capillary. And the way that we do this is we subdivide these tubes coming
off of your trachea progressively as we get further and further away.

Slide 7:
So now we're going to talk about the lungs. So what happens and what exists when we get to the bottom
of those tubes and we're working with alveoli

Slide 8:
So this is what the lungs look like in situ. So they're in your chest. We've already talked about them being
the left and right pleural cavities, but they actually kind of wrap around the front of the heart a little bit
as demonstrated in the bottom left image. In the right image there, we see some of the lung has been
dissected away so you can see some of the bronchial tree. Let's go through and try and identify some of
these key structures we've already talked about. First up, there's your right lung, and your left lung.
Remember, a key difference between them is the number of lobes. The left lung has two, the right lung
has three. There's your trachea, moving right down the midline. Remember, it's held open by a series of
C-shaped cartilages, where the cartilage is open on the posterior aspect. The trachea divides at the carina
to form the main bronchus on both the left and the right sides. This main bronchus is then going to divide
to form the lobar bronchi with one of them heading to each of the lobes of the lungs. That means on the
right side, you have a superior, middle and inferior so three of them and on the left side you only have
superior and inferior because there are only two lobes. After this, we're going to divide into segmental
bronchi. These correspond with the bronchopulmonary segments that we spoke about last week. Finally
we'll get into bronchioles and terminal bronchioles before we get down into the respiratory zone that we
can't actually see here because it's becoming progressively smaller.

Slide 9:
So the question becomes then what is the lung made of? Once we get through these tubes, what makes
that sponge like exterior of the lung? Well, it turns out that between alveoli, we have a space that we
refer to as the interalveolar septum. And this space here contains pulmonary capillaries, which are
important for gas exchange via pulmonary circulation, and a space that we refer to as interstitium. And
this space contains fibroblasts, which basically make the elastic tissue that is what your lungs are primarily
composed of, as well as macrophages, which are part of the immune system and are there for protection

Slide 10:
So here's a lateral view of the left and the right lungs. And you can see from this image, the difference in
the lobe number. So the right is going to have three lobes, the left is only going to have two. Each lung
has three surfaces, a costal surface against the ribs, which you can see here on the lateral aspect, a
diaphragmatic surface, which is on the inferior aspect against the diaphragm, and mediastinal surface,
which is against the mediastinum, and this is going to be towards the midline. We refer to the tip of the
lung as being the apex. And the root, or the hilum, of the lung is on the mediastinal surface. And we talked
about that as being a region of transition from structures within the middle mediastinum out towards the
lungs and back again. Lungs are divided into lobes via fissures. And they're connected to the heart via two
forms of circulation: the pulmonary circulation, which is there for gas exchange, which allows you to
oxygenate your blood and remove carbon dioxide and the bronchial circulation, which is part of systemic
circulation. I like to think of the bronchial circulation as being very similar to the coronary circulation of
the heart. It's there to supply the tissue themselves. So because the lungs are a form of tissue in your
body, it needs a blood supply. And its special feature is gas exchange. So that's why it has the pulmonary
circulation. Kind of like the heart. The heart has tissue that needs blood supply. So that's what the coronary
system is for, but its special feature is contraction. Same thing with muscles. They get systemic blood flow,
but their special feature is contraction as well.

Slide 11:
So here's the right lung, on a lateral view. Let's go through naming some of the key parts. So there are the
main landmarks I just talked about. We have the apex at the top, and this comes out very close to your
neck at the, the root of the neck. We have our costal surface. So this is a lateral view that's going to be
right against the ribs. And then the base. The base of the lung is just the bottom part. Right here, it's being
identified on the costal surface. But we could also look at the diaphragmatic surface which you can't see
in this view, as being the base. There's the anterior border, the inferior border. Lungs tend to be a little
bit more rounded posteriorly. So that's one way to know. And then also the direction that the fissures are
traveling in which we'll talk about in a second. Speaking of fissures, there are two fissures in the right lung,
there's the oblique fissure. Remember, an oblique line is on an angle, so that's that angled fissure. There's
the horizontal fissure. And it's the presence of these two fissures together that are going to form the three
lobes: superior, middle, and inferior.

Slide 12:
Let's contrast what we just learned about the right lung with the left lung. Again, we have an apex and a
costal surface. And there's our anterior border. And we've identified the inferior border here. So you can
see that kind of curved area moving from the apex down towards the base of the lung, as being on the
posterior aspect. Here, we only have one fissure, the oblique fissure, because we only have two lobes,
superior and inferior. The left lung also has an additional feature that the right lung doesn't and we call
this the lingula. You can see it a little bit better on an anterior view, but it's a little piece of the superior
lobe that actually wraps around the front of the heart and looks a little bit like a tongue, which is why it's
called the lingula

Slide 13:
As I mentioned earlier, the hilum is a place of transition. This is where tubes and vessels are going to
transition from the mediastinum out into the lungs. Here we'll see bronchi, which are carrying air, and
they're easiest to identify in my opinion, because they have cartilaginous rings surrounding their lumen.
Lumen is just a term for the inside of the hole. We'll also see pulmonary arteries and these are going to
carry deoxygenated blood. These are usually anterior to the bronchioles and slightly more superior and
they have slightly thicker walls because they're arteries. We then have pulmonary veins, these are going
to carry oxygenated blood back to the heart. These are generally more inferior within the hilum. We'll see
some lymphatics because your lungs have some lymphatic drainage and bronchial arteries. And remember
this is from systemic circulation to supply the lung tissue itself. Lastly, we have the pulmonary ligament
and this is a reflection of pleura and I'm going to show you what this is in a second. One key thing to note
here is that I didn't really make reference to a certain number of bronchi or pulmonary arteries or veins
existing at the hilum -- it's because the number of divisions that you see actually depends upon the
location in which the cross section is taken.

Slide 14:
So let's look at the right lung here to identify the structures we just spoke about. To get you oriented.
There's the apex, the base, the anterior border and the inferior border. We're looking at the mediastinal
surface here. And you can also see the diaphragmatic surface on the bottom. We can also see a little bit
of the costal service, specifically the vertebral part on the posterior aspect of the lung. Right here on the
mediastinal surface, we see an area that we'd refer to as the cardiac impression. This is where the heart
presses up against the lung. And when you take lungs out post mortem, you can actually see this
impression from where it's been pressed up against the heart throughout the lifetime. We can see the
two fissures here of the right lung, the oblique fissure and the horizontal fissure. And of course, divisions
into the superior, middle and inferior lobes. When it comes to the hilum in specific, there are a few
features we want you to know about. So there's the hilum, we've got a superior and then the inferior and
middle are still together. There's our branches of the right pulmonary artery looking a little bit more
superior, and conveniently colored in purple here, because they're containing deoxygenated blood from
the heart that's going to be oxygenated within the lung. We can also see some branches of the pulmonary
veins. These are pink, to try and demonstrate that it's carrying oxygenated blood back to the heart. The
smaller vessels which we haven't labeled here, so those pink and purple dots that are much smaller, that's
your bronchial circulation. So that's going to be the systemic circulation that's headed out from the heart
to supply the lung tissue proper. The last thing I want to point out is the pulmonary ligament, that's an
extension in white on the inferior aspect of the right hilum there. Now what this is, is a double layer of
pleura, which is transitioning from its visceral layer, which is against the lung to the parietal layer, which
is against the rib cage. We'll talk about pleura in a second. But what I want you to realize here is you get
this double layer coming off of the lung, and that's what forms the pulmonary ligament

Slide 16:
So the pleura itself is a sack in which the lung resides. They have two layers: a visceral layer, which I just
mentioned is right next to the lung and is actually adhered to it, and the parietal layer which is right next
to the ribs. When I think about forming a pleural cavity, it's very similar to the way that the pericardium
is formed around the heart. So we get that visceral pleura there in purple shown in my diagram below,
and then the parietal pleura, in red. So I think about blowing up a balloon with just a little bit of air and
then sticking my fist inside. What this represents then is the continuous nature of the pleura between
both the parietal and visceral layers, the lung, which would be my fist, and then the hilum which would
be my wrist. The area just inferior to my wrist formed of that transition zone between visceral and parietal
pleura would be where the pulmonary ligament was.

Slide 17:
So when we talk about pleura, and specifically parietal pleura, we can actually name the pleura based on
which surface it's against. So we already talked about visceral pleura being adhered to the lung. And if we
look at a lung from a cadaveric specimen, you'll notice that the lung appears shiny and smooth. And if that
is the case, it's because the visceral pleura is still on there, she can't actually take it off. The parietal pleura
is what's next to the rib cage. So if you've ever cooked ribs, and you've taken the silver skin off of the
inside of ribs, what you've done is removed parietal pleura. So, in human lungs, we also have that same
type of pleura on the parietal surface, and so naming it based on what it's adhered to, is what we're going
to do next. So on the mediastinal surface, we've got the mediastinal pleura, which is pictured there in
purple. On the cervical region up towards your neck, we have the cervical pleura, right at the apex. We
have costal pleura right next to the ribs, and we have diaphragmatic pleura which is right down there at
the base of the lung.

Slide 18:
So here's an image of the lungs within the pleura. And you'll note here that the lungs don't actually fill the
entire space. And this is important, especially when we talk about mechanics of breathing. And so that
space there means that there's a gap between the two layers of parietal and visceral pleura. And that
there is actually really key for maintaining a pressure difference, which we capitalize on in order to be
able to breathe. So you'll notice here that the lungs are ending a little bit short of the pleura. And that's
going to be really important so that the lungs have space to move within the pleura when you breathe,
and that we can alter the pressures of the intrapleural space to allow breathing to occur. And we'll talk
about that in the next module.

Slide 19:
Also because we have reflections in the pleura we have spaces where fluid may accumulate. And so I
wanted to bring that up here for you. There are two clinically significant recesses or spaces within the
pleura. We refer to these as the costomediastinal and costodiaphragmatic. So this should tell you what
they're between. and ideally here, we want to remember that these are potential areas where fluid can
collect. So if we look at this diagram here, we can see one space here between the costa or the anterior
chest wall and the mediastinum and that's going to be the costomediastinal recess. And then we've got
the costodiagphragmatic recess, and that's going to be inferior there between the ribs and the diaphragm.
Here's a zoomed in picture of that costodiaphragmatic recess. And so you can see there's the lung --
doesn't quite extend all the way down as far as the pleura does, until we get this extra space. And so if
you have a pleural effusion, or an accumulation of fluid within the pleural or intrapleural space, and you're
seated, fluid can collect here,. So we can see a couple other landmarks. Here, we see the intercostal vein,
artery and nerve which we've previously talked about, we can see the diaphragm, the right lung, both
layers of pleura and a series of muscles here. Do you remember which ones these are? Those are going to
be your intercostals. So external, internal and innermost

Slide 20:
So to summarize everything we spoke about today, the lung consists of alveoli, which are those air pockets
that are a single cell thick and interstitium, which is the area in between them. That interstitium is going
to contain elastic fibers which allow the lungs to contract back down to their normal size after inflation,
as well as the pulmonary capillaries, which are important for gas exchange. You have two lungs, and
they're divided into lobes by fissures. The left lung has two lobes. The right lung has three. Pleural cavities
exists to the right and the left with the mediastinum. They contain the lungs and the pleura. Pleura are
two-layered sacs in which the lungs are situated. We have a visceral layer which is right next to the lung.
In fact, it's adhered to it and the parietal layer which is adhered to the chest wall. This creates a space
between the pleural layers which we refer to as the intrapleural space. Physiologically, this space is really
important for maintaining a pressure differential between that space and the lungs, which allows you to
breathe -- we'll talk about that in the next module. Finally, the opening that exists in the pleura at the
hilum allows for transmission of vessels and vasculature, as well as the bronchi from the mediastinum out
to the lungs and back again.

Slide 21:
That's all for this one. We'll see you in the next lecture.
Respiratory System Overview - Captions
Slide 2:
Today we're going to talk about the respiratory system.

Slide 3:
By the end of this lesson, you'll be able to describe the pathway that air takes to travel from the
atmosphere to enter your lungs and facilitate gas exchange and differentiate between the conducting and
respiratory zones of the respriatory system in terms of structure and function.

Slide 5:
So the respiratory system consists of a series of passages conducting air from your environment, into
alveoli at the base of your lungs. And ultimately this is going to facilitate gas exchange. So essentially it
has two components. It has all the tubes that air needs to travel through to get from your mouth down
into your lungs, and then the lungs themselves which is where gas exchange occurs.

Slide 6:
So the respiratory system can be divided in a couple of ways. So the first way would be structurally
between the upper and lower segments. So your upper respiratory system consists of your nose and
pharynx. And then your lower respiratory system is larynx down: so larynx, trachea, bronchioles, and
alveoli. But more importantly than structural divisions, we have functional divisions. And this is what I'd
like you to focus your attention on. So we have conducting airways, and we have respiratory airways. The
conducting airways are your nasal cavities to your terminal bronchioles. And we'll talk about those in some
more detail in a second. But the whole point here is to cleanse warm and humidify the air that you're
breathing in from your environment. The respiratory division is responsible for gas exchange, and this is
going to occur in your respiratory bronchioles all the way down to your alveoli.

Slide 8:
So as I just mentioned, that conducting zone consists of everything from your nose, all the way down to
your terminal bronchioles. So this image here is just an overview of all of that. So we have our nasal cavity,
and that's going to be where some air comes in, but it can also travel in through your mouth. We've got
the pharynx, which has three portions, the nasopharynx, the oropharynx, and the laryngopharynx. The
larynx, the trachea, and then that will subdivide to form your bronchi and eventually your terminal
bronchi, which are covered in this picture by lungs.

Slide 9:
The nasal cavity is a primary area through which air can get into the respiratory system. And it starts off
at your nostril, which is sometimes referred to as the nares. This space is bounded by a couple of
landmarks that I'd like you to know. Superiorly we have the cribriform plate, and this is part of your skull
through which your olfactory nerve is going to travel. Your olfactory nerve is responsible for your sense
of smell. Inferiorly we have the hard palate, and this is the roof of your mouth. So if you run your tongue
along the roof of your mouth, you'll feel a hard bony surface. That's the hard palate. And when you get
back a little bit further, it will get softer and we refer to that as the soft palate. The entirety of the nasal
cavity is lined by mucus. This here serves two purposes. On the superior aspect, we have olfactory mucosa.
And this is where that olfactory nerve, cranial nerve I, is going to embed its fibers so that it can pick up on
smell. Everything else within your nose, or nasal cavity is respiratory mucosa. And its primary purpose is
cleaning. So if there is particulate or anything else in the air that you don't want to breathe in, it's going
to stick to the respiratory mucosa on its way through. Within the nasal cavity, we also have a few bony
protrusions that we refer to as conchae or conchae. And these are there to increase surface area. So
they're also covered in epithelium and they're highly vascular. So if you have a nosebleed that's why it
bleeds a lot. The superior and middle conchae come from the ethmoid bone, whereas the inferior conchae
is a bone itself that we talked about way back in the second week, when we talked about the axial
skeleton. We refer to the space underneath a conchae as the meatus. So I've identified here the inferior
meatus for you

Slide 10:
So once the air passes through your nasal cavity it enters the pharynx, which has three parts nasopharynx,
oropharynx, and laryngopharynx, which are in yellow, blue and red respectively. The pharynx connects
the nasal cavity with the larynx, which is ultimately where air is going to travel through to get to your
lungs. It's made of skeletal muscle and it's lined with a mucous membrane. And those three sections the
nasopharynx contains only air. The oropharynx at the back of your mouth is going to contain both air and
food if you happen to be eating. And then the laryngopharynx is going to divide the air in food. So we've
got that larynx anteriorly headed to your lungs. So it's going to have air. And the esophagus is posterior.
And that's going to be where all the food goes to get to your stomach. A few other landmarks here, there's
your hard palate, which we talked about on the previous slide. And there's your uvula which is the end of
your soft palate. I also wanted to point out the hyoid bone. This here is right at the base of your mouth.
And it's a key attachment point for muscles as you transition from your mouth into your neck. And I bring
it up here because it's actually important in our next slide.

Slide 11:
So once we are through the pharynx, we enter the larynx and this area here is going to perform three
functions. It's going to prevent food from entering the trachea. It's going to permit passage of air. And it's
going to allow you to produce vocalization, so your vocal cords live here. It consists of nine pieces of
cartilage, most of which are formed from hyaline cartilage. You have three unpaired pieces of cartilage
and three paired. The larynx itself starts off at the hyoid bone and ends at the tracheal cartilage both of
which I've identified for you here. Starting off with the unpaired cartilage, you have three of them, is the
thyroid cartilage, which exists looking a bit like a shield on the anterior aspect. The cricoid cartilage, which
some say looks like a signet ring, with the thick part at the back. And the epiglottis which is an ovoid
shaped piece of cartilage that is actually going to cover up the trachea and prevent food from getting into
it. The epiglottis is actually formed from elastic cartilage, so it's the exception to the hyaline comment
earlier. In terms of paired cartilages on the posterior aspect, here we have the arytenoid cartilages and
this is what's going to anchor your vocal cords. Interior to them we have the cuneiform cartilages and on
the tips of the arytenoid cartilages, superiorly, we have the corniculate cartilages
Slide 12:
Speaking of speech production, let's talk about how that works. So we have our vocal folds here, or vocal
ligaments or chords, all those terms are interchangeable. And they run from your arytenoid cartilage,
which we just identified to your thyroid cartilage. Now, they look a little bit different here, because they're
covered in mucosa. Intrinsic laryngeal muscles are going to control the tension and length of the chords.
And so I'm not going to talk about the muscles themselves here, but essentially, they pull on the arytenoid
cartilages, and that changes the shape of the vocal folds. Essentially, as you increase the tension, you're
going to get a higher pitch. And as you decrease the tension, you're going to get a lower pitch. And that's
what's pictured down here in these two images of vocal folds. Lateral to the vocal folds, we have vestibular
folds, and these are superior and a little bit lateral, as I just mentioned, and they don't have a role in terms
of voice production, but they are important for holding pressure within the lungs. So if you want to hold
your breath or perform a valsalva maneuver, the vestibular folds are going to come into play here. This
whole area we refer to as the glottis and the hole passing through is referred to as the rima glottidis

Slide 13:
We're then going to enter the trachea which is going to subdivide to form the bronchial tree. So the
trachea itself is held open by a series of "C"-shaped cartilages, where the opening is at the posterior
aspect. The trachea itself will divide into the primary bronchi, left and right, at a landmark referred to as
the Carina. So this carina, I've identified with that black star. And so we have our left primary bronchi, and
it's going to be slightly longer and more horizontal. And we have our right primary bronchi, which is more
vertical and slightly wider. And I bring this up because it has implications for choking. Think for a second,
if you swallowed a foreign body, which bronchi is it more likely to end up in? I'm hoping you said right. It's
a little bit wider, a little more vertical. Most often if someone is choking on a foreign body, it's going to be
in the right bronchi, though it could also be in the left. From here we're going to divide into secondary
bronchi, which are sometimes referred to as lobar bronchi. On the left side, you have two and on the right
side you have three. These correspond to the number of lobes that exist in each lung. So the left lung has
two lows, and thus two lobar bronchi and the right lung has three. Lastly, we're going to divide into our
tertiary or segmental bronchi. And these correspond to bronchopulmonary segments. So a
brochopulmonary segment consists of a segmental bronchus, which I've identified here in these colors,
and all of the vessels that are going to go with it. And clinically, this is important because if you need to
perform a lung resection, you can actually just remove a full bronchopulmonary segment and not impact
the rest of the lung, because each bronchopulmonary segment much like groupings, or compartments of
muscles, is supplied by its own neurovascular bundle.

Slide 15:
So when we transition into the respiratory zone, we're now getting into the capability to have gas
exchange occur. So we just left off at the tertiary bronchiole, and from there we're going to move into
respiratory bronchioles. And the major change here is we start to see the presence of alveoli, which are
these little air sacs in which gas exchange is actually going to occur. These respiratory bronchioles then
are going to go down and form alveolar ducts, which are going to have alveolar sacs on the end of them,
which is just a clustering of alveoli. Basically, air needs to get all the way down to this zone before gas
exchange can occur. So we need to make sure that we've got clear passage through all of those tubes to
make it down here, so that gas can eventually interface with a capillary network.
Slide 16:
Once we get here though, this is what an alveoli looks like. And these are those tiny tiny sacs right at the
end of your bronchial trees. So alveoli are formed of two cell types, in particular, type Iand type II
pneumocytes. And I bring this up here because it has implications in terms of function, but also gas
exchange. So type I pneumocytes are what for most of the alveolar wall, these are long and flat shaped
cells. And these are what are going to interface with the pulmonary capillaries to allow for gas exchange
within the pulmonary circulation. Type two pneumocytes are more cuboidal in shape. And these are going
to secrete surfactant on to the alveoli themselves. And this reduces surface tension. The whole point of
pulmonary surfactant is to allow these alveoli to remain popped open, even when pressure drops in the
lung. And in an upcoming lecture, we're going to talk about how breathing occurs and ventilation. And
you'll learn there that it's all based around pressure. And so at some points, the pressure gets quite low
in the alveoli, but you'd want them to stay open instead of collapsing and pulmonary surfactant helps with
that. So in these two images here, we can see sort of a schematic diagram of what these might look like.
But then we can also see the histological view. And again, I don't expect you to be able to identify these
cells on a histological slide, but rather be able to explain the function of them and why they're shaped the
way that they are.

Slide 17:
So here's a summary here of our bronchial tree. And so it looks like a tree because we start out with kind
of a trunk at the main stem, and we progressively branch till we get into smaller and smaller airways all
the way down to the alveolar sacs. And so we mentioned here that we've got divisions occurring along
the way. And so I'm hoping you'll be able to take away from this that we just get a further and further
branching as we get further away from the trachea and closer to the alveoli.

Slide 18:
So to summarize everything we talked about today, the respiratory system consists of two zones, a
conducting zone for the passage of air, moistening, and cleaning. And this runs from your mouth and your
nose to the terminal bronchi. We also have a respiratory zone and this is for gas exchange, and this is from
your respiratory bronchi to your alveoli. The bronchial tree progressively divides into smaller and smaller
tubes as you progress from the nose to the alveoli. And gas exchange is going to occur at the alveoli, which
are a single cell thick. There are two main cell types that are exist here, type I pneumocytes which are
important for diffusion and type II pneumocytes, which secrete pulmonary surfactant

Slide 19:
That's all for this lecture. We'll see in the next one
Kin 3222B / HS 3300B

Week 6: Lungs + Respiration

Pressures & Gas Exchange
OBJECTIVES:
By the end of this lab, you should be able to:
• Describe the pathway air takes to travel from the atmosphere to enter your lungs
• Differentiate between conducting and respiratory zones of the respiratory system
• Describe the composition, and anatomy of the lungs and pleura relating this to function
• Describe how changes in thoracic cage volume allow for respiration
• Explain how gas exchange occurs at the level of the alveoli and pulmonary capillary

Respiratory Overview
1. Complete the following table to summarize the functional divisions of the respriatory system

Conducting Respiratory
Nasal Cavities --> Terminal Respiratory Bronchioles --> Alveoli
Bronchioles (Respiratory bronchiole, alveolar duct,
Contents (Nasal cavity, pharynx, larynx, alveolar sacs, alveoli)
trachea, bronchi, terminal
bronchioles)

Function Cleanse, warm and humidify air Gas exchange

2. Label the following diagram of the respiratory conducting zone

Nasal cavity

Naso
Oro Pharynx
Laryngo
Larynx
Trachea

Bronchi

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 3. List the 2 types of mucosa found in the nasal cavity + their function:
Olfactory
a) _____________________________, _____________________________
Smell
Respiratory Cleaning
b) _____________________________, _____________________________
Ethmoid bone
4. Which two bones form the conchae of the nose? _________________ Inferior conchae
& __________________

5. List the 9 cartilages of the Layrnx:

UNPAIRED PAIRED
Thyroid
a) _______________________ d) Arytenoid
_______________________
Cricoid
b) _______________________ Cuneiform
e) _______________________
c) _______________________
Epiglottis f) Corniculate
_______________________

Epiglottis
6. Which laryngeal cartilage is made of elastic cartilage (as opposed to hyaline)? _______________
Arytenoid
7. Which laryngeal cartilage attaches to the vocal cords/folds? _______________
Epiglottis
8. Which laryngeal cartilage covers the entrance to the trachea? _______________
increased
9. To produce sounds of a higher pitch, tension is ________________ on the vocal cords. To
decreased
produce sounds of a lowe pitch, tension is __________________.

10. Draw & label a diagram of the bronchial tree, starting with the trachea and ending at the tertiary
(segmental) bronchi. Be sure to identify any differences between the left and right sides.
Larynx
Primary bronchi
Trachea

Secondary bronchi

Tertiary bronchi Carina

Bronchioles

Cardiac notch

11. What is the definition and clinical significance of a bronchopulmonary segment?

Definition: one of the smaller divisions of a lobe of a lung supplied by its own segmental
______________________________________________________________________________
______________________________________________________________________________
bronchi and neurovascular bundle. It is clinically significant when performing a lung resection
______________________________________________________________________________
as you can remove a full bronchopulmonary segment without affecting the other segments.
12. Alveoli are made of two primary cell types, type I and type II pnemocytes. Describe their shape
and function:
long & flat shaped
a) Type I: ______________________________, interfaces with pulmonary capillaries to allow for gas exchange
______________________________
cuboidal
b) Type II: ______________________________, ______________________________
secretes surfactant to reduce surface tension allowing alveoli to
remain open when lung pressure decreases

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Lung & Pleural Anatomy
Right lung
13. Label the following diagram of a lung. Which lung is it? _________________________________

Apex

Superior Lobe

Anterior Border

Horizontal fissure
Costal
surface

Middle lobe

Inferior
lobe

Oblique fissure

Base
Inferior
border

14. Describe the following structures of the hilum.

Consider what travels in them, where it’s located, or what it’s made of.

Structure Description
Bronchi Carries air; have cartilagenous rings surrounding the lumen

Pulmonary Arteries Carries deoxygenated blood; located anterior & slightly superior to bronchi and have
thicker walls than veins
Pulmonary Veins Carries oxygenated blood; located inferior within the hilum

Bronchial Arteries Are used for systemic circulation to supply the lung tissue itself

Pulmonary Ligaments Pleural reflection

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 15. Where would you find the cardiac impression on a lung? What is it the result of?
The cardiac impression on a lung is found in the HILUM and is a result of the heart
______________________________________________________________________________
pressing up against the lung
______________________________________________________________________________

16. Draw and label a diagram of the hilum.

Branches of right
pulmonary artery

Superior lobar bronchus

Inferior and middle lobar
bronchi (common origin)

Branches of right
pulmonary vein

17. Complete the following paragraph to describe the structure/function of pleura:

visceral
Pleura consist of 2 layers: _______________________ parietal
and _______________________ which creates a
intrapleural space
cavity/space we refer to as _________________________. This space typically has a pressure that is
4mmHg
____________ less than atmospheric pressure. Its this pressure differential between the intrapleural
atmosphere
space and the _______________ open
that allows the lungs to remain ______________. 2 clinically significant
costomediastinal
recesses, the ___________________________ ribs
recess (between the ________________ and
________________ costodiaphragmatic
mediastinum ) and the _____________________ recess (between the ________________ ribs and
________________
diaphragm ), are areas where fluid may pool within the pleura.

Respiration
18. Respiration is entirely dependant upon pressure changes, which are linked to changes in the
inspiration
volume of the thoracic cavity. Increased volume results in ____________________ while
decreased volume results in ____________________
expiration

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 19. Complete the following chart to detail how each muscle acts upon the thoracic cage to change
it’s volume:

Muscle Action
External Elevate the ribs to allow for inspiration, increasing the volume within
Intercostals the thoracic cage
Internal/Innermost Depresses the ribs during forced expiration, decreasing the volume within the
Intercostals thoracic cage
Through contracting the diaphragm,the diaphragm lowers and increases the
Diaphragm volume of the thoracic cage
20. Lungs naturally want to collapse. Why?
The interstitium is primarily elastic and are under tension, causing them to naturally want to collapse
______________________________________________________________________________
______________________________________________________________________________

21. Explain why inspiration occurs when the chest wall expands. Be sure to include references to the
lungs, pleura and intrapleural space.
When an individual breathes in, the rib cage expands and pulls on the parietal pleura layer. This
______________________________________________________________________________
causes your diaphragm to drop. Ultimately, the pressure within the intrapleural space decreases causing the
______________________________________________________________________________
lungs to expand. This drops the pressure in the lungs and allows air from the periphery to flow in.
______________________________________________________________________________
______________________________________________________________________________

22. What is a pneumothorax?

A puncture to the pleural membrane causing air (pneumo) to move into the pleural space
______________________________________________________________________________
______________________________________________________________________________

Gas Exchange
23. Complete the following chart to compare/contrast features of the pulmonary and bronchial
circulation.

System Origin Location Features Goal

A: center of
High flow
bronchopulmonary
deoxygenated segment Oxygenate
Pulmonary blood from the Low pressure blood
right ventricle
V: outside of
bronchopulmonary Low resistance
segment
A: center of
bronchopulmonary
oxygenated segment High pressure
Bronchial Perfuse
blood from the
(systemic) V: drains into lung tissue
left ventricle High resistance
pulmonary vein

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24. Label the vessels on the diagram of a a bronchopulmonary segment
Bronchial
Artery
Pulmonary
Vein Pulmonary Artery

Pulmonary Vein

Capillary Bed
on Alveolus

25. Define the following terms in relation to ventilation/perfusion :

adequate perfusion, but no ventilation
a) Shunt: __________________________________________________________________
________________________________________________________________________
adequate ventilation, but no perfusion
b) Dead Space : _____________________________________________________________
________________________________________________________________________

26. Which of the following clinical conditions may lead to shunt (circle) vs dead space (underline)

Pulmonary edema COPD Pneumothorax

Asthma Pulmonary embolism Hemothorax

Hemorrhage Dehydration Gas trapping

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