SYSTEMA RESPIRATORIUM

BERNARD SM HUTABARAT, dr, PAK

FACULTY OF MEDICINE UPH
LIPPO VILLAGE - KARAWACI
DEFINITION

SYSTEMA RESPIRATORIUM IS A SYSTEM WHICH FUNCTION

IS RESPIRATION

RESPIRATION ( RESPIRATIO ) IS THE PROCESS OF GAS

EXCHANGE BETWEEN CO2 AND O2 IN ALVEOLI.

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 LEARNING OBJECTIVE
AFTER LECTURE STUDENS ARE ABLE TO EXPLAIN :
1. EMBRYOLOGY AND DEVELOPMENT OF SYSTEMA
RESPIRATORIUM.
2. CONGENITAL MALFORMATION OF SYSTEMA RESPIRATORIUM
3. DIVISION OF SYSTEMA RESPIRATORIUM
3. LOCATION OF SYSTEMA RESPIRATORIUM
5. THORACIC CAVITY AND ITS CONTENTS
6. RESPIRATORY TRACTS AND ORGANS
7. PROJECTION OF PLEURAL REFLEXION
8. PLEURAL RECESSUSES
9. LUNGS AND PARTS

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DIVISION
1. TRACTUS RESPIRATORIUS
1.1. PARS SUPERIOR TRACT. RESP.*
1.1.1. CAVITAS NASI
1.1.2. NASO & LARYNGOPHARYNX
1.2. PARS INFERIOR TRACT. RESP.
1.2.1. LARYNX**
1.2.2. TRACHEA ***
1.2.3. BRONCHUS AND ITS
BRANCHES****

* : CRANIUM ( HEAD )
** : COLLUM ( NECK )
*** : COLLUM & THORAX
**** : THORAX
DIAPHRAGMA
2. ORGANAE RESPIRATORIAE****
2.1. PULMONES DEXTER ET SINISTER

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 EMBRYOLOGIA SYSTEMA RESPIRATORIUM
EMBRYOLOGICLY SYSTEMA RESPIRATORIUM ORIGINATED FROM
INTERACTION BETWEEN 2 GERM LAYERS :
1. ENTODERM : RESPIRATORY TRACTS AND ORGANS
2. MESODERM : LINING MEMBRANES, CARTILAGE, MUSCLES AND
CONNECTING TISSUES OF RESPIRATORY SYSTEM.
WEEK 4 : VENTRAL WALL OF 2ND PART OF FOREGUT :

DIVERTICULUM RESPIRATORIA

OESOPHAGUS
GASTER

DIVERTICULUM HEPATICA

MEMBRANA
08/22/17 BUCCOPHARYNGEALIS 4
DEVELOPMENT OF DIVERTICULUM RESPIRATORIA
DIVERTICULUM RESPIRATORIA & OESOPHAGUS

EXPAND CAUDALLY

CRISTA TRACHEO-OESOPHAGEALIS ( TRACHEOESOPHAGEAL RIDGE )

SEPTUM TRACHEO-OESOPHAGEALIS

DIVERTICULUM RESPIRATORIA
EXPAND DICHOTOMOUSLY
TOWARD CAUDAL

DAY 26-28 : BIFURCATE

DIVERTICULAE BRONCHIALES ( LUNG BUDS )

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DEVELOPMENT OF DIVERTICULAE BRONCHIALES

OESOPHAGUS
TRACHEA
BIFURCATE
DIVERTICULAE BRONCHIALES DEXTER ET SINISTER

WEEK 5 : ENLARGED

PRIMARY BRONCHI DEXTER ET SINISTER.

EXPAND TO CAUDAL
BRONCHI LOBARES DEXT ( 3 ). DICHOTOMOUSLI

BRONCHI LOBARES SIN.( 2 )

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DEVELOPMENT OF DIVERTICULAE BRONCHIALES
BRONCHI LOBARES DEXT. ET SIN.
EXPAND DICHOTOMOUSLY TO CAUDAL

CANALIS PERICARDIACO-PERITONEALIS
COVERED

NEARBY VISCERAL & SOMATIC MESODERMS

OESOPHAGUS
VISCERAL & PARIETALIS PLEURAS

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DEVELOPMENT OF BRONCHUS LOBARIS
WEEK 6 : BRONCHI LOBARIS ( SECONDARY BRONCHUS ) EXPAND
DICHOTOMOUSLY TO FORM TERTIARY BRONCHUS ( BRONCHUS
SEGMENTORIUM ; 10 ON THE RIGHT AND 8 ON THE LEFT )
COVERED BY VISCERAL AND SOMATIC MESODERMS.

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DEVELOPMENT OF THE SYSTEMA RESPIRATORIUM
CONSISTS OF 4 STAGES :
1. GLANDULAR STAGE : WEEK 7 16 ; REPEATED BRANCHING
2. CANALICULAR STAGE : WEEK 16 28 : DEVELOPMENT BRONCHIOLI.
3. SACCULAR STAGE : WEEK 28 36 ; PRIMARY ALVEOLI
4. ALVEOLAR STAGE : WEEK 36 40 ; ALVEOLI MATURING
POST NATALLY NEW ALVEOLI CONTINUE TO BE FORMED TILL THE AGE
OF 8 YEARS OLD.

EXPAND CAUDOMEDIOLAT.

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 CONGENITAL ABNORMALITIES
1. BORN BEFORE 28 WEEKS OF GESTATION SURVIVAL CHANCE
IS VERY SMALL DUE TO LACK OF PULMONARY ALVEOLI.
2. BORN AT 32 36 WEEKS OF GESTATION USUALLY SUFFERS
RESPIRATORY DISTRESS SYNDROME DUE TO LACK OF
SURFACTANT SECRETED AT THE ALVEOLAR STAGE.
3. TRACHEOESOPHAGEAL FISTULAS ( TEFS ) DUE TO
DISTURBANCE AT THE DEVELOPMENT OF DIVERTICULUM
TRACHEO-ESOPHAGEALIS.
3.1. INCINDENCE : 1 OF 3000 BIRTHS.
3.2. KIND OF CASES :
3.2.1. ATRESIA OESOPHAGUS WITH TRACHEAL
FISTULA :
* BLIND POUCH OF ESOPHAGUS UPPER ENDING
* LOWER SEGMENT FISTULA WITH TRACHEA
* 90%

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TRACHEO-ESOPHAGEAL FISTULA
3.2.2. ISOLATED ESOPHAGEAL ATRESIA ( 4% )
3.2.3. H TYPE TRACHEO-ESOPHAGEAL FISTULA ( 4 % )
3.2.4. OTHER VARIATIONS ( 1% )

3.2.2. 3.2.3. 3.2.4.

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 APERTURA THORACIS
1. APERTURA THORACIS SUPERIOR ( THORACIC INLET )
SMALL , KIDNEY SHAPED, BORDERED BY
1.1. INCISURA JUGULARIS STERNI &
CRANIAL MARGIN OF MANUBRIUM
STERNI
1.2. CARTILAGO COSTALIS I AND
FACIES SUPERIOR COSTA PRIMA ( I )
1.3. CORPUS VERTEBRAE T1
2. APERTURA THORACIS INFERIOR
( THORACIC OUTLET )
LARGE, BORDERED BY :
2.1. PROCESSUS XIPHOIDEUS
2.2. ARCUS COSTALIS
2.3. COSTA XII
2.4. CORPUS VERTEBRAE T12

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CHEST WALL
1. STRATUM SUPERFICIALIS ( STRATUM EXTERNUS )
1.1. CUTIS ( SKIN )
1.2. SUBCUTIS ( SUBCUTANEUS TISSUE ) :
1.3. FASCIA MUSCULI

2. STRATUM INTERMEDIUS :
2.1. MM.DORSALES ( MUSCLES OF THE BACK )
2.2. MM. ABDOMINALES ( MUSCLES OF THE ABDOMINAL WALL )
2.3. MM.MEMBRI SUPERIORIS ( MUSCLES OF THE UPPER LIMB )

3. STRATUM PROFUNDUS ( STRATUM INTERNUS ):

3.1. OSSA THORACALES ( BONES OF THE CHEST )
3.2. MM. INTERCOSTALES EXTERNI ET INTERNI
3.3. A/V INTERCOSTALES
3.4. NN. INTERCOSTALES
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 ARTERIAE INTERCOSTALES
ORIGIN
1. RR.INTERCOSTALES ANTERIORES :

1.1. I VI : A.THORACICA INTERNA

1.2. VII IX : A.MUSCULO PHRENICA
( A. THORACICA INTERNA )

2. AA.INTERCOSTALES POSTERIORES
2.1. I II : A. INTERCOSTALIS SUPREMA
(TRUNCUS COSTOCERVICALIS)
2.2. III XI : AORTA THORACALIS

.
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PARACENTHESIS THORACIS
PARACENTHESIS THORACIS ( PUNCTIO CAVUM PLEURAE ) :
PROCEDURE TO TAP PLEURAL CAVITY

DIAGNOSTIC AND CURATIVE

PARACENTHESIS THORACIS
( PUNCTIO CAVUM PLEURAE ) :
1. LATERAL ( DORSAL LINEA
AXILLARIS ):
CRANIAL MARGIN OF RIB
2.VENTRAL LINEA AXILLARIS :
IN THE MIDLLE OF ICS.

AORTA
A. INTERCOSTALIS POSTERIOR
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PLEURA
IS MEMBRANOUS COVERING OF THE PULMONES

CONSISTS OF :
1. PLEURA PARIETALIS

--CAVUM PLEURAE---

2. PLEURA VISCERALIS

PARENCHYMA PULMONALIS

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PLEURA PARIETALIS
CONSISTS OF :
1. PARS CERVICALIS PLEURAE
( CUPULA PLEURAE )

HYPOVENTILATIO PULMONALIS

TUBERCULOSIS
2 PARS COSTOVERTEBRALIS PLEURAE
THE STRONGEST, THICKEST AND
EASILY DETACHED, EXCEPT BETWEEN
CAPITULUM COSTAE AND COLUMNA
VERTEBRALIS.
3. PARS DIAPHRAGMATICAE PLEURAE
THIN, COVERS FACIES DIAPHRAGMATICAE PULM.
4. PARS MEDIASTINALIS PLEURAE
COVERS .MEDIASTINAL SURFACE OF LUNG
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 PROJECTION OF PLEURAL REFLEXION
ARTIC. STERNOCLAVICULARE
1.TRIGONUM THYMICUM
( THYMUS*)
2 ANGULUS LUDOVIGI 2 ANGULUS LUDOVIGI

4 PRALLEL R & L SIDE 4 PRALLEL R & L SIDE

RIGHT LEFT
LATERAL TO STERNAL
MARGIN.
PROC. XIPHOIDEUS

PARALLEL ARC.COSTARUM 6
CAUDOLATERAL
(TILL CARTIL.COSTA 7)
8 LINEA MIDCLAVICULAR 8 LINEA MIDCLAVIC.
2. TRIG. CARDIACUM(COR)
10 LINEA AXILLARIS 10 LINEA AXILLARIS

12 COLLUM COSTAE 12 COLLUM COSTAE

ADULT : *CORPUS ADIPOSUS RETROSTERNALIS ( JUGULARE )

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RECESSUS ( SINUS ) PLEURAE
CAUDAL MARGINS OF THE LUNG ARE HIGHER THAN THE PLEURA BUT PLEURA NEVER REACH
DIAPHRAGMA

CAUDAL TO REFLEXIO COSTALIS, DIAPHRAGMA

DIRECTLY CONNECTED TO THE COSTAE AND
MM.INTERCOSTALES

DORSALLY & LATERALLY CAUDAL MARGIN OF

LUNGS DO NOT REACH REFLEXIO COSTALIS

PLEURAE DIAPHRAGMATICAE ET COSTALIS LIE

CLOSE TO EACH OTHER.

POTENTIAL SPACE WITHOUT LUNGS

SINUS PHRENICO-COSTALES DEXTER ET SINISTER

SINUS COSTO-MEDIASTINALIS.

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THORACIC WOUND STAB OR GUNSHOT
AREA WITHOUT LUNGS :
1. VENTRAL : ICS ( VII ), VIII XI :
SINUS PHRENICO-COSTALIS
(SINUS COSTO-PHRENICUS ):
2. DORSAL : COSTA VIII X :
SINUS COSTOMEDIASTINALIS
ICS X XI : NO PLEURA
STABS / GUNSHOT POSSIBILITIES:
3. HIGHEST : PULMO
2. HIGHER : MM.INTERCOSTALES , SINUS ,
DIAPHR. AND CAVUM ABD.
1
1. VENTRAL PART OF ICS X XI
INJURY TO MM.INTERCOSTT, DIAPHRAGMA AND CAVUM ABDOMINALIS.
BLUNT.
CAIRAN ( PLEURAL EFFUSIO )
SINUS PHRENICO-COSTALIS
.
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 PULMONES
WEIGHT, FORM & STRUCTURE

1. EMPTY : 240 Gr ( R ) & 212 Gr ( L )

2. CONTAIN BLOOD : 625 Gr & 567 Gr

CONE SHAPED FORM, ITS BASE AT THE CONVEXITY OF THE

DIAPHRAGMA; TOP AT COLLUM COSTA PRIMA

NEWBORN : PINK ; ADULT : DARK GREY COLOR

STILL BORN BABY : COMPACT, NO AIR , DROWN

DOCIMACIA PULMONUM HYDROSTATICA

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 PARTS OF THE LUNG
LOBUS SUPERIOR DEXT. LOBUS SUPERIOR SIN.
LOBUS MED.
APEX PULMONIS
MARGO POSTERIOR
FACIES COSTALIS
MARGO ANTERIOR
FACIES POSTERIOR
FISSURA HORIZONTALIS
FISSURA OBLIQUA
INCISURA CARDIACA
LINGULA
BASIS PULMONIS
( ( FACIES DIAPHRAGMATICA )
MARGO INFERIOR
LOBUS INFERIOR LOBUS INFERIOR
PULMO DEXTER PULMO SINISTER

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FACIES MEDIASTINALIS PULMONIS DEXTER
SULCUS A. BRACHIOCEPHALICA
SULCUS V.C.S.
HILUS PULM.
1. BRONCHUS :
EPARTERIALIS
HYPARTERIALIS
2.A. PULMONALIS
VV. PULMONALIS
IMPRESSIO CARDIACA

SULCUS OESOPHAGICUS

LIG. PULMONALE

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 FACIES MEDIASTINALIS PULMONIS SINISTER
SULCUS V. BRACHIOCEPHALICA SINISTER
SULCUS A. SUBCLAVIA SINISTER
HILUM PULMONIS :
1. A. PULMONALIS

V.PULMONALIS

2.BRONCHUS HYPARTERIALIS

SULCUS AORTICUS

IMPRESSIO CARDIACA
LINGULA
LIG. PULMONALE

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HILUS PULMONIS
IS THE AREA OF FACIES MEDIASTINALIS PULMONIS WHERE
STRUCTURES ENTER OR LEAVE THE LUNGS.
ORDERS OF STRUCTURES POSITION AT HLUS
1. BEFORE BACKWARDS:
V;A;B
2. ABOVE DOWNWARD :
2.1. RIGHT : B ; A ; V
2.2. LEFT : A ; B ; V
.
BRONCHUS

A. PULMONALIS
V. PULMONALIS
DEXTER SINISTER
BRONCHUS EPARTERIALIS
BRONCHUS HYPARTERIALIS
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DIFFERENCE BETWEEN RIGHT & LEFT HILUS
BASED ON POSITION OF BRONCHUS AND A. PULMONALIS

RIGHT
EPARTERIALIS

BRONCHUS

A. PULMONALIS

LEFT
HYPARTERIALIS
08/22/17 26
RADIX PULMONIS
IS THE STRUCTURES THAT ENTER / LEAVE THE LUNG AT
HILUS PULMONALIS ( T 5,6,7 ).

CONSISTS OF :

1. BRONCHUS
2. A/V BRONCHIALIS
3. PLEXUS NERVOSIS PULMONALIS .
4. DUCTUS LYMPHATICUS ( LYMPHATIC DUCTS ).
5. NN. LL. BRONCHOPULMONALES

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TRACHEA AND ITS BRANCHES
TRACHEA ( C6 T5 )
BRONCHUS LOBARIS LOBUS SUPERIOR DEXTRA

BRONCHUS PRINCIPALIS DEXTER

( BRONCHUS PRIMARIUS DEXTER )
BRONCHUS PRINCIPALIS SINISTER

BRONCHUS LOBARIS SUP.SIN

BRONCHUS SEGMENTALIS

BRONCHUS LOBARIS SUP. DEXTER : BRONCHUS EPARTERIALIS

ALL OTHER BRONCHI LOBARES : HYPARTERIALIS
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ARBOR BRONCHIALIS ( BRONCHIAL TREE )
TRACHEA
BRONCHUS PRINCIPALIS ( BRONCHUS PRIMARIUS )
DEXTER:WIDER ,SHORTER, MORE VERTICAL

LOCATION OF CORPUS ALIENUM ( FOREIGN BODY )

BRONCHUS LOBARIS
BRONCHUS SEGMENTALIS

BRONCHIOLI TERMINALIS
BRONCHIOLI RESPIRATORIUS

DUCTUS ALVEOLARIS*
ATRIA*
SACCUS ALVEOLARIS*
ALVEOLUS*
BIFURCATIO TRACHEAE (CARINA,T5)
*PULMONARY ( LUNG ) UNIT
08/22/17 29
BRONCHI SEGMENTALES

DEXTER SINISTER
1. APICALIS 1+3: APICOPOSTERIOR
2. ANTERIOR 2 : ANTERIOR
3. POSTERIOR
4. LINGULARIS SUP.
5.LINGULARIS INF.
4. LATERALIS
5. MEDIALE
6. APICALE(SUPERIOR)
7+8: ANTEROMEDIO
BASALE
9 : LATEROBASALE

6. SUPERIOR 10. POSTEROBASALE

7. BASALIS MEDIALIS
8. BASALIS LATERALIS
9. BASALIS ANTERIOR
10. 08/22/17
BASALIS POSTERIOR 30
VASCULARIZATION
A. PULMONALIS
1. A. BRONCHIALIS
1.1.SINISTER: AORTA THORACALIS
1.2. DEXTER : A. INTERCOSTALIS /
A. BRONCHIALIS SINISTRA.

Vv. BRONCHIALES
V. PULMONALIS

INNERVATIO.
SYMPATHIS :T 1- 5 ; BRONCHODILATOR
PARASYMPATHIS :N.X (VAGUS);BRONCHOCONSTRICTOR &
SECRETOMOTOR.

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 LYMPHATIC DRAINAGE
1. NN. LL. SUPERFICIALES.: BENEATH THE PLEURAE
2. NN.LL. PROFUNDAE: ALONGSIDE PULMONARY VESSELS AND ARBOR
BRONCHIALES
ANGULUS VENOSUS DEXTRA ANGULUS VENOSUS SINISTRA

TRUNCUS BRONCHOMEDIASTINALIS DUCTUS THORACICUS

NN.LL PARATRACHEALES

NN.LL. TRACHEOBRONCHIALES
SUPERIORES DEXTRA ET SINISTRA

NN.LL. TRACHEOBRONCHIALES INFF.

NN. LL BRONCHOPULMONALES

NN.LL.PULMONALES

08/22/17 32
08/22/17 33
 SOURCES
1. CUSHIERI ; ALFRED PROF : DEVELOPMENT OF RESPIRATORY
SYSTEM AND DIAPHRAGMA ; DEPARTEMENT OF ANATOMY
UNIVERSITY OF MALTA.
2. HAMILTON ; W.J & MOSSMAN;H.W: HUMAN EMBRYOLOGY
1st edit; THE WILLIAMS & WILKINS COMPANY, BALTIMORE
3. LANGMAN; JAN: MEDICAL EMBRYOLOGY;3rd edit; IGAKU SHOIN
LTD; TOKYO
4. SEARCH BOOKS PRESENTATION BUSINESS ACADEMIC :
DEVELOPMENT ; www.scribd.com/doc/382753171/Development of
respiratory system
5. FEDERATIVE INTERNATIONAL PROGRAMME ON ANATOMICAL
TERMINOLOGIES : TERMINOLOGIA ANATOMICA , 2ND EDITION ;
GEORG THIEME VERLAG STUTTGART NEW YORK

08/22/17 34
 SOURCES
1. Anatomy Review : emtb.com
2. Basmajian;J.V:Grants Method of Anatomy;8th Asian edit;The Williams &
Wilkins Company;Calcutta.
3. Bony Boundaries of the Toracic cavity : home.comcast.net
4. Cardiorespiratoriuq.blogspot.com
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medicinembbs.blogspot.com
6. Mader, Sylvia S : Understanding Human anatomy & physiology ; 4 th edit
McGraw Hill Companies , Inc ; New York.
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Wesley Longman Inc ; San Francisco
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