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Anatomy, Physiology and Pathology of The Respiratory
Anatomy, Physiology and Pathology of The Respiratory
External portion
– Bone and cartilage, covered by skin
– Mucous membrane lining
– Nostrils, midline septum
Internal portion
– Skull cavity inferior to cranium, superior to mouth
• Bounded by ethmoids, maxillae, palatine bone, inferior nasal conchae
– Communicates with pharynx through the choanae
– Communicates with paranasal sinuses
• frontal, sphenoid, maxillary, ethmoid
– Openings of naso-lacrimal ducts, Eustachian tubes
Pharynx (throat)
Important relations
– Anteriorly: thyroid isthmus, inferior thyroid
veins, sternohyoid and sternothyroid muscles,
manubrium, thymus remnants
– Laterally: lobe of thyroid, carotid sheath, SVC
(right), aortic arch and branches (left),
– Posteriorly: oesophagus, recurrent laryngeal
nerves
Trachea
Ciliated pseudo-stratified
columnar epithelium
Seromucous glands and
ducts
– humidify air
Cilia (‘brush border’)
– Transport excess mucus,
foreign bodies upwards
like an escalator
Primary (main) bronchi
Hilum
– Medial ‘root’ of the lung
– Point at which vessels, airways and lymphatics
enter and exit
Cardiac notch
– Lies in medial part of left lung to
accommodate the heart
Lobes and fissures
Cup-shaped outpouchings
Clustered in alveolar sacs
– Resemble microscopic bunches of grapes
Lined by epithelium
Thin elastic basement membrane
Lined by type I alveolar cells with occasional type II
alveolar cells
– Type II cells secrete alveolar fluid and surfactant
– Surfactant acts to reduce surface tension of alveolar fluid (like
detergent), helping to keep alveoli from snapping shut
Alveoli
Dual supply
– Bronchial supply
• Bronchial arteries supply bronchi, airway airway walls and
pleura
– Pulmonary supply
• Pulmonary arteries enter at hila and branch with airways
• Deoxygenated blood from right ventricle → pulmonary trunk
→ left and right pulmonary arteries → arterioles → capillaries
→ oxygenated blood to venules → pulmonary veins → left
atrium
– Venous return is common (ie. both return via
pulmonary veins)
Lymphatics
Expiration - passive
– Inspiratory muscles relax
• Ribs move downwards
• Diaphragm relaxes and its domes rise
– Surface tension of alveolar fluid causes an inward pull
– Elastic recoil of alveolar basement membranes
– Reverse pressure gradient
• 762mmHg in lungs, 760mmHg atmospheric
– Gas pushed out
Respiration
CO2 0.04% 5% 4%
0.3 mmHg 40 mmHg 27 mmHg
H2O 0.5% 6% 6%
4 mmHg 47 mmHg 47 mmHg
Internal respiration
Internal respiration
Gas transport in blood
Carbon dioxide
– 70% as bicarbonate ion (HCO3-) dissolved in
plasma
– 23% bound to hemoglobin
– 7% as CO2 dissolved in plasma
Oxygen
– 99% bound to hemoglobin
– 1% as O2 dissolved in plasma
Control of breathing
Chemical regulation
– Most important
– Central and peripheral chemoreceptors
– Most important factor is CO2 (and pH)
∀↑ in arterial CO2 causes ↑ in acidity of
cerebrospinal fluid (CSF)
∀↑ in CSF acidity is detected by pH sensors in
medulla
• medulla ↑ rate and depth of breathing
Regulation of respiratory centre
Cerebral cortex
– Voluntary regulation of breathing
Inflation reflex
– Stretch receptors in walls of
bronchi/bronchioles
Pathology
Benign pathology
Infective
– URTI, pneumonia, bronchitis, bronchiectasis
– Bacterial, viral, fungal
Vascular
– Pulmonary emboli, vasculitis, pulmonary oedema
Traumatic
– Pneumothorax, haemothorax
Inflammatory
– Idiopathic pulmonary fibrosis, sarcoidosis
Environmental
– Silicosis, asbestosis
Genetic/congenital
– Cystic fibrosis
Asthma
Common cancer
Peak incidence 40-70 years of age
Closely related to cigarette smoking and
industrial carcinogens
4 main histological types
– Squamous cell carcinoma (SCC) - 50%
– Small cell carcinoma (SCLCa) - 20%
– Adenocarcinoma - 20%
– Large cell anaplastic carcinoma (LCLCa) - 10%
Neoplastic diseases of the lung
Peripheral
adenocarcinoma
Lung cancer
Respiratory features
– Cough (80%), haemoptysis (70%), dyspnoea (60%), chest pain
(40%), wheeze (15%)
Systemic features
– Anorexia, weight loss, malaise
70% present with metastatic disease
– Local spread - bronchus, mediastinum
– Lymphatic spread - peribronchial, hilar nodes
– Trans-coelomic spread - malignant effusion, chest wall invasion
– Haematogenous spread - brain, bone, liver, adrenal glands
Lung cancer - prognosis
SCLCa
– ~30% are ‘limited stage’ (confined to within
an achievable RT field)
• Good local control with chemoRT but usually
progress to systemic disease
• Role of PCI
• Median survival 11 months
• 45% 1-year survival
– Extensive stage
• Palliation only
Malignant mesothelioma
Lungs
– Paired thoracic organs
– Facilitate gas exchange
– Differences between left and right
Pathology
– Huge range of benign conditions
– Neoplastic disease
• SCLCa
• NSCLCa - SCC, adenoca, LCLCa
• Mesothelioma
• Poor prognosis
“The real reason dinosaurs
became extinct…”