Лекция 20

Lower respiratory tract

Trachea, lungs and pleura
 The lower respiratory tract
• The lower respiratory tract refers to the parts
of the respiratory system that lie below the
cricoid cartilage and vocal cords, including
the inferior part of the
larynx, tracheobronchial tree and lungs.
 The tracheobronchial tree
• The tracheobronchial tree is a portion of the
respiratory tract that conducts the air from the
upper airways to the lung parenchyma.
• It consists of the trachea and the intrapulmonary
airways (bronchi and bronchioles).
• The trachea is located in the superior mediastinum
and represents the trunk of the tracheobronchial
tree.
• The trachea bifurcates at the level of the sternal
angle (T5) into the left and right main bronchi, one
for each lung.
 The left main bronchus
• The left main bronchus passes inferolaterally
to enter the hilum of the left lung. On its
course, it passes inferior to the arch of the
aorta and anterior to the esophagus and
thoracic aorta.
 The right main bronchus
• The right main bronchus passes inferolaterally
to enter the hilum of the right lung. The right
main bronchus has a more vertical course than
its left counterpart and is also wider and
shorter. This makes the right bronchus more
susceptible to foreign body impaction.
• As they reach the lungs, the main bronchi
branch out into increasingly smaller
intrapulmonary bronchi.
• The left main bronchus divides into
two secondary lobar bronchi, while the right
main bronchus divides into three secondary
lobar bronchi that supply the lobes of the left
and right lung, respectively.
• Each of the lobar bronchi further divides into tertiary
segmental bronchi that aerate the bronchopulmonary
segments.
• The segmental bronchi then give rise to several generations
of intrasegmental (conducting) bronchioles, which end
as terminal bronchioles.
• Each terminal bronchiole gives rise to several generations
of respiratory bronchioles.
• Respiratory bronchioles extend into several alveolar ducts,
which lead into alveolar sacs, each of which contains many
grape-like outpocketings called alveoli.
• Since they contain alveoli, these structures mark the site
where gas exchange begins to occur.
 The lungs
• The lungs are a pair of spongy organs located
within the thoracic cavity.
• The right lung is larger than the left lung and
consists of three lobes (superior, middle and
inferior), which are divided by two
fissures; oblique and horizontal fissure.
• The left lung has only two lobes (superior and
inferior), divided by one oblique fissure.
Lower lobe of right lung
• Each lung has three surfaces, an apex and a base.
• The surfaces of the lung are the costal, mediastinal and
diaphragmatic surface, which are named after the
adjacent anatomical structure which that surface faces.
• The mediastinal surface connects the lung to the
mediastinum via its hilum.
• The apex of the lung is where the mediastinal and costal
surfaces meet.
• It is the most superior portion of the lung, that extends
into the root of the neck.
• The base is the lowest concave part of the lung that
rests upon the diaphragm.
Each hilum of the lung contains the following:

• Principal bronchus
• Pulmonary artery
• Two pulmonary veins
• Bronchial vessels
• Pulmonary autonomic plexus
• Lymph nodes and vessels
 Function
• The main function of the respiratory system
is pulmonary ventilation, which is the movement of
air between the atmosphere and the lung by
inspiration and expiration driven by the respiratory
muscles.
• The respiratory system works as a whole to extract
the oxygen from the inhaled air and eliminate
the carbon dioxide from the body by exhalation.
• The upper respiratory mainly has an air-conducting
function, while the lower respiratory tract serves
both the conducting and respiratory functions.
• Besides its main function to conduct the air to
the lower respiratory tract, the upper respiratory
also performs several other functions.
• As mentioned earlier, the nasal cavity and
paranasal sinuses change the properties of the
air by humidifying and warming it in order to
prepare it for the process of respiration.
• The air is also filtered from dust, pathogens and
other particles by the nasal hair follicles and the
ciliary epithelium.
 Clinical aspects

• Upper respiratory tract infections

• Upper respiratory tract infections are contagious
infections that can be caused by a variety of
bacteria and viruses. The most common causing
agents are influenza virus (the flu), rhinoviruses and
streptococcus bacteria. Depending on which part of
the upper respiratory tract is affected, these
infections may have different types, such
as rhinitis, sinusitis, pharyngitis, epiglottitis, laryngit
is and others.
• The common cold is the most common type of
upper respiratory tract infection. It is a viral
infection that usually involves the nose and
throat, but other parts can be affected as well.
The symptoms usually include sore throat,
coughing, sneezing, runny nose, headache,
and fever.
• Lower respiratory tract infections
• Lower respiratory tract infections are
infections that affect the parts of the
respiratory tract below the vocal cords. These
infections can affect the airways and manifest
as bronchitis or bronchiolitis, or they can
affect the lung alveoli and present
as pneumonia. These can also occur in
conjunction as bronchopneumonia.
• The most common cause of lower respiratory tract
infections are bacteria, but they can also occur due
to viruses, mycoplasma, rickettsiae and fungi.
These agents invade the epithelial lining, causing
inflammation, increased mucus secretion, and
impaired mucociliary function. The inflammation
and build-up of fluid in the lungs and airways may
result in symptoms such as coughing, fever, sputum
production, difficulty breathing or in severe cases,
airway obstruction and impaired gas exchange.