Chapter 23 Respiratory System I. Respiratory System Anatomy The Respiratory System 1.

Consists of the nose, pharynx (throat),larynx (voice box), trachea (windpipe), bronchi, and lungs 2. Structurally, the respiratory consist of two parts :1) upper respiratory system: nose, pharynx, and associated structures and 2) lower respiratory system: larynx, trachea, brochi, and lungs. 3. Functionally, the respiratory system also consists of two parts: 1)conducting zone: consists of a series of interconnecting cavities and tubes both outside and within the lungs-nose, pharynx, larynx, trachea, bronchi, bronchioles, and terminal bronchioles- that filter, warm, and moisten air to conduct it into the lungs and 2)respiratory zone consist of tissues within the lungs where gas exchange occurs -the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli, the main sites of gas exchange between air and blood. 4. Key terms: o Otorhinolaryngology: branch of medicine that deals with the diagnosis and treatment of disease of the ears, nose and throat o pulmonologist: a specialist in the diagnosis and treatment of diseases of the lungs A. Nose (external and internal portions) 1. External Nose: consists of a supporting framework of bone and hyaline cartilage covered with muscle and skin and lined by a mucous membrane.  The cartilaginous framework of the external nose consists of septal cartilage (form the anterior portion of the nasal septum), lateral nasal cartilages inferior to the nasal bones; and the alar cartilages, which form a portion of the walls of the nostrils  Undersuface of the external nose are two openings: external nares or nostrils  External nose functions: 1) warming, moistening, and filtering incoming air, 2) detecting olfactory stimuli and 3) modifying speech vibrations as they pass through the large, hollow resonating chambers. 2. Internal nose: a large cavity in the anterior aspect of the skull that lies inferior to the nasal bone and superior to the mouth; it is lined with muscle and mucous membrane. It communicates with the pharynx through two openings called internal nares or choanae 3. Rhinoplasty: commonly called "nose job" is a surgically procedure in which the structure of the external nose is altered to repair for a fractured nose or deviated nasal septum and often times for cosmetic reasons 4. Nasal cavity: space within the internal nose 5. Vestibule: anterior portion of the nasal cavity just inside the nostrils surrounded by cartilage ;superior part is covered by bone. 6. Nasal septum divides the nasal cavity into right and left sides. Anterior portion of the septum consists of primarily hyaline cartilage and the remainder is vomer, perpendicular plate of the ethmoid, maxillae, and palatine bones 7. Air enters the nostrils, and passes the vestibules, into the conchae-which subdivide each side of the nasal cavity into a series of passageways-superior, middle, and inferior.

8. Conchae and meatuses increases surface area in the internal nose and prevents dehydration by trapping water droplets during exhalation. 9. The olfactory receptors lie in the olfactory epithelium, a region of the membrane lining the superior nasal conchae and adjacent septum. B. Structures of the Respiratory System Diagram (p.848) 1. Respiratory structures in the Head and neck (p.849) C. Pharynx (throat) is a funnel-shaped tube about 13 cm long that starts at the internal nares and extend to the level of the cricoid cartilage, the most inferior cartilage of the larynx (voice box). It functions as a passageway for air and food, provide a resonating chamber for speech sounds, and houses the tonsils, which participate in immunological reactions against foreign invaders.  Divided into three anatomical regions: 1)nasopharynx 2) oropharynx and 3)laryngopharynx  Nasopharynx- the superior portion of the pharynx, lies posterior to the nasal cavity and extends to the palate. Five opening in its wall: two internal nares, two openings that lead into the auditory tube, and opening into the oropharynx  Oropharynx: lies posterior to the oral cavity and extends from the soft palate inferiorly to the level of the hyoid bone. It has one opening: fauces- the opening from the mouth; which has both respiratory and digestive functions, serving as a common passageway for air, food, and drink. It is lined with nonkeratinized stratified squamous epithelium. Tonsils- palatine and lingual tonsils are also found in the oropharynx.  Laryngopharynx begins at the level of the hyoid bone. It opens into the esophagus posteriorly and larynx anteriorly. It is both respiratory and digestive pathway and is lined by nonkeratinized stratified squamous epithelium. D. Larynx (voice box), a short passageway that connects the laryngopharynx with the trachea. It lines in the midline of the neck anterior to the esophagus and the fourth through six cervical vertebrae. - the wall of larynx is composed of nine pieces of cartilage: three occur singly (thyroid cartilage, epiglottis, and cricoid cartilage) and three occur in pairs (arytenoid, cuneiform, and corniculate cartilages). The aryntenoid carilages are the most important because they influences changes in position and tension of the vocal folds. The extrinsic muscles of the larynx connect the cartilages to other structures in the throat; the intrinsic muscles connect the cartilages to one another. Cartilages type Thyroid cartilage Definition consists of two fused plates of hyaline cartilage that form the anterior wall of the larynx and give a triangular shape. A large, leaf shaped piece of elastic cartilage that is covered with epithelium; prevents

Epiglottis

Cricoid cartilage

Arytenoid

Corniculate

Cuneiform

food from entering the larynx A ring of hyaline cartilage that forms the inferior wall of the larynx; connect the larynx and trachea; landmark for making an emergency airway Triangular pieces of mostly hyaline cartilage located the posterior, superior border of the cricoid cartilage. Supported the intrinsic pharyngeal muscles to contract and move the vocal folds to produce sounds. Horn-shaped pieces of elastic cartilage, located at the apex of each arytenoid cartilage. They are supporting structures for the epiglottis Club-shaped elestic cartilages anterior to the corniculate cartilages, support the vocal folds and lateral aspects of the epiglottis.

E. The structures of Voice Production Mucous membrane of the larynx forms two pairs of folds: ventricular and vocal folds Ventricular folds: function in holding the breath against pressure in the thoracic cavity when brought together. When air is directed against the vocal folds, they vibrate and produce sounds and set sound waves in the column of air in the pharynx, nose, and mouth. Pitch depends on the tension creates by the vocal cords. When whispering, the vocal folds does not vibrate but instead abducted sufficiently. 1. Laryngitis and Cancer of the Larynx  Laryngitis: an inflammation of the larynx that is most often caused by a respiratory of the larynx that is most often caused by a respiratory infection or irritants such as cigarette smoke.  Cancer of the Larynx is found almost exclusively in individuals who smoke; characterized by hoarseness, pain on swallowing, or pain radiating to an ear; treatment by radiation and/or surgery. F. Trachea (windpipe) 1. Tracheotomy and Intubation G. Bronchi H. Lungs 1. Pneumothorax and Hemothorax 2. Lobes, Fissures, and Lobules 3. Alveoli 4. Blood supply to the Lungs II. Pulmonary Ventilation A. Pressure Changes During Pulmonary Ventilation 1. Inhalation 2. Exhalation

B. Other Factors affecting Pulmonary Ventilation 1. Surface Tension of Alveoli 2. Respiratory Distress Syndrome 3. Compliance of the Lungs 4. Airway Resistance C. Breathing Patterns and Modified Respiratory Movements III. Lung Volumes and Capacities IV. Exchange of Oxygen and Carbon Dioxide A. Gas Laws: Dalton's Law and Henry's Law 1. Hyperbaric Oxygenation B. External and Internal Respiration V. Transport of Oxygen and Caron Dioxide A. Oxygen Transport 1. Carbon Monoxide Poisoning B. Carbon Dioxide transport C. Summary of Gas Exchange and Transport in Lungs and Tissues (figure 23.23) VI. Control of Respiration A. Respiratory Center 1. Medullary Rhythmicity Area 2. Pneumotaxic Area 3. Apneustic Area B. Regulation of the Respiratory Center 1. Cortical influences on Respiration 2. Chemoreceptor Regulation of Respiration 3. Hypoxia 4. Proprioceptor Stimulation of Respiration 5. The Inflation Reflex 6. Other Influences on Respiration VII. Exercise and The Respiratory system A. The effect if smoking on Respiratory efficiency VIII. Development of the Respiratory System IX. Aging and the Respiratory System X. Disorders: Homeostatic Imbalances

Asthma-Disorder characterized by chronic inflammation, airway hypersensitivity to a variety of stimuli, and airway obstruction. -Partially reversible, spontaneously or with treatment

-Airway obstruction may be due to smooth muscle spasms in the walls of smaller bronchi and bronchioles, edema of the mucosa of the airways, increased mucus secretion, and/or damage to the epithelium of the airways. -Individuals with asthma react to concentrations of agents too low to cause symptoms in people w/o asthma -Allergens (pollen, house dust mites, molds, particular foods) -Emotional upset, aspirin, sulfating agents (in wine/beer, used to keep greens fresh in salad bars), exercise, breathing cold air/cigarette smoke   Early Phase (acute) response- smooth muscle spasm is accompanied by excessive secretion of mucus (may clog the bronchi/bronchioles, may worsen attack) Late Phase (chronic) response- Inflammation, fibrosis, edema, necrosis of bronchial epithelial cells Symptoms- Difficult breathing, coughing, wheezing, chest tightness, tachycardia (heart rated exceeding normal range of resting heart rate), fatigue, moist skin, anxiety Treatment -Acute response- inhaled beta2-adrenergic agonist (albuterol) to relax smooth muscle in bronchioles and open up airways -Long term therapy-strives to suppress the underlying inflammation -Anti-inflammatory drugs- inhaled corticosteroids (glucocorticoids), cromolyn sodium (Intal), leukotriene blockers (Accolate)

Chronic Obstructive Pulmonary Disease (COPD)- Disorder characterized by chronic/recurrent obstruction of airflow, which increases airway resistance. -4th leading cause of death behind heart disease, cancer, cerebrovascular disease -Principal types-emphysema and chronic bronchitis Preventable in most cases- common cause is cigarette smoking/breathing secondhand smoke -other causes- air pollution, pulmonary infection, occupational exposure to dust/gases, genetic factors

Emphysema- Disorder characterized by destruction of walls of the alveoli, producing abnormally large air spaces that remain filled with air during exhaling -Less surface area for gas exchange- O2 diffusion across damaged respiratory membrane is reduced -Blood oxygen level is lowered -Any mild exercise that raises oxygen requirements of cells leaves patient breathless Lung elastic recoil decreases as increasing # of alveolar walls are damaged due to loss of elastic fibers -Over several years, added exertion during inhalation increases size of chest cage, resulting in being “barrel chested” Caused by long term irritation; cigarette smoke, air pollution, occupational exposure to industrial dust Treatment- cessation of smoking, removal of other environmental irritants, exercise training under careful medical supervision, breathing exercises, use of bronchodilators, oxygen therapy  Chronic Bronchitis-Disorder characterized by excessive secretion of bronchial mucus accompanied by a productive cough (sputum is raised) that lasts for atleast 3 months of the year to 2 years Cigarette smoking-leading cause Inhaled irritants-lead to chronic inflammation with an increase in the size and number of mucous gland and goblet cells in the airway epithelium -Thickened/excessive mucus produced narrows the airway and impairs ciliary function -Inhaled pathogens become embedded in airway secretions and multiply rapidly Symptoms-Productive coughing, shortness of breath, wheezing, cyanosis, pulmonary hypertension Treatment-similar to treatment for emphysema  Lung Cancer-Leading cause of cancer death in males/females

-At time of diagnosis-usually well advanced, with distant metastases (cancer that has spread from primary tumor to distant organs/ lymph nodes) present in 55% of patients and regional lymph node involvement in an additional 25%

Cigarette smoke- most common cause -85%-related to smoking, 10-30x more common in smokers Other causes- ionizing radiation/inhaled irritants (asbestos/radon gas) -Emphysema-common precursor to the development of lung cancer Most common type of lung cancer-bronchogenic carcinoma -Starts in the epithelium of bronchial tubes -Bronchogenic tumors named with accordance to where they arise (adenocarcinoma-developed in peripheral areas of the lungs from bronchial glands and alveolar cells) -May be aggressive, locally invasive, and undergo widespread metastasis, depending on type Symptoms- chronic cough, spitting blood from respiratory tract, wheezing, shortness of breath, chest pain, hoarseness, difficulty swallowing, weight loss, anorexia, fatigue, bone pain, confusion, problems with balance, headaches, anemia, thrombocytopenia, and jaundice Treatment- partial/complete removal of lung (Pulmonectomy), radiation therapy, chemotherapy  Tuberculosis (TB)- infectious, communicable disease caused by bacterium mycobacterium tuberculosis

-symptoms may not occur until disease has advanced Increase of HIV is an important factor related to increase of TB cases in the US -other factors- homelessness, drug abuse, immigration from countries with high prevalence of TB, increased housing for the poor, airborne transmission of TB in prisons/ shelters Treatment- isoniazid-Affects the lungs and plurae, may involve other body parts Symptoms- fatigue, weight loss, lethargy, anorexia, low grade fever, night sweats, cough, dyspnea, chest pain, hemoptysis

Croyza-common cold Can be cause by hundreds of viruses, but rhinoviruses are responsible for 40% of all colds in adults Symptoms-sneezing, dry cough, excessive nasal secretion, congestion, usually accompanied by fever

Complications- sinusitis, asthma, bronchitis, ear infections, laryngitis Influenza (flu)-also caused by a virus Symptoms- chills, fever, headache and muscular aches May become life threatening Pneumonia- Acute infection/inflammation of alveoli Most common cause- Bacterium streptococcus pnuemoniae Most susceptible to pneumonia- elderly, infants, immunocompromisedindividials (AIDS/Cancer patients/those taking immunosuppressive drugs), cigarette smokers, individuals with an obstructive lung disease Symptoms- fever, chills, productive or dry cough, malaise, chest pain of dyspnea and hemoptysis Treatment- antibiotics, bronchodilators, oxygen therapy, increased fluid intake, chest physiotherapy (percussion, vibration, postural drainage) Pulmonary Edema-Abnormal accumulation of fluid in the interstitial spaces and alveoli of lungs May arise from increased permeability of the pulmonary capillaries (pulmonary origin) or increased pressure in pulmonary capillaries (cardiac origin) Symptoms-Dyspnea, wheezing, tachypnea, restlessness, feeling of suffocation, cyanosis, pallor, diaphoresis, pulmonary hypertension Treatment-Administering oxygen, drugs that dilate bronchioles and lower blood pressure, diuretics to rid body of excess fluid, drugs that correct acid-base imbalance, suctioning of airways, mechanical ventilation Cystic fibrosis (CF)-Inherited disease of secretory epithelia that affects airways, liver, pancreas, small intestines, sweat glands -Genetic mutation affecting a transporter protein that carries chloride ions across plasma membrane of many epithelium cells -Also disrupts normal functioning of several organs by causing ducts within to become obstructed by thick mucus secretions that do not drain easily -Obstruction of small bile ducts in liver interferes with digestion and disrupts liver function -Clogging of pancreatic ducts prevent digestive enzymes from reaching small intestine

-Person fails to absorb fats/fat soluble vitamins, patient suffers from Vitamin A/D/K deficiency diseases Treatment-Children- given pancreatic extract/large doses of Vitamin A/D/K -Newest treatment- heart-lung transplants Asbestos-related Diseases- Lung disorders that develop from inhaling asbestos particles that penetrate lung tissue -White blood cells respond and attempt to destroy by phagocytosis -Result- Fibers destroy WBC, may scar lung tissue -Asbestosis (widespread scarring of lung tissue), diffuse pleural thickening (thickening of pleurae), mesothelioma (cancer of pleurae or peritoneum) Sudden Infant Death Syndrome (SIDS)-Sudden, unexpected death of an apparently healthy infant during sleep -Rarely occurs between 2 weeks or after 6 months of age -More common with premature infants, male babies, low birth weight babies, babies of drug users/smokers, babies who have stopped breathing and have had to be resuscitated, babies with upper respiratory tract infections, babies who have had a sibling die with SIDS -African/Native American babies are at high risk -Exact cause unknown, may be due to abnormality in mechanism that control respiration or low levels of oxygen in blood -May be linked to hypoxia while sleeping in a prone position (on stomach) -Recommended that for the first 6 months, babies placed on back for sleeping (“back to sleep”) Severe Acute Respiratory Syndrome (SARS)-Emerging infectious disease, first appeared in southern China in late 2002, spread worldwide -Respiratory illness caused by a new variety of coronavirus Symptoms- fever, malaise, muscle aches, nonproductive (dry) cough, difficulty in breathing, chills, headache, diarrhea -10-20% of patients require mechanical ventilation

-Spread by person to person contact -No effective treatment
Medical Terminology

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