Introduction

By
Dr. ali baay
It is a major system in the body which concern by
many functions
Primary Function: to obtain O2 for use by body’s
cells & to eliminate CO2 that body cells produce ,it
consists of two separate but related processes :
External Respiration ( Exchange of O2 and CO2
between the atmosphere and body tissues)
Internal Respiration ( Oxidative Phosphorylation
or cell breathing )
Secondary Functions:
• Short-term pH regulation (acid-base balance)
• Enabling speech & other vocalizations
• Defence against pathogens in the airways
• Removes, modifies, activates, or inactivates
various materials passing through the pulmonary
circulation
• Eliminates heat & water
• Assists venous return
• Nose serves as the organ of smell
 Applied anatomy
I- the upper extra- thoracic passages : nose ,
oral cavity , naso-pharynx ,larynx
The major function are the conduction of the air
into & out of the lungs plus other secondary
functions.
It is the major concern of ENT medicine
II- the conducting zone:
passages within the chest but have no gas exchange activity so
called also non-respiratory zone or anatomical dead space area,
consist of
• Trachea & Bronchi
• Secondary Bronchi: Right Side – 3 (to 3 lobes of right lung)
Left Side – 2 (to 2 lobes of left lung)
• Tertiary Bronchi 20-23 branching Up to 8 million tubules
• Bronchioles: Less than 1mm diameter No cartilage - risk of
collapse but the elastic fibers prevent this
• Terminal Bronchioles
Functions of the Conducting Zone
• Air passage way : 150ml volume Dead space volume
• Increase air temperature to body temperature
• Humidify air
As it contain a cartilage so any injury here is irreversible i.e.,
end with fibrosis & narrowing which is called strictures
III- the respiratory zone :
consist of :
• Respiratory bronchioles
• Alveolar ducts
• Alveolar sacs
• Alveoli
Functions of the Respiratory Zone
Exchange of gases between air & blood by Diffusion

As it seen the cartilage disappear in the lower part so

the injury here can recovered completely as the are
no goblet cells so the is no secretion
Also in the lower small segments the smooth muscles
appear that make them reactive
Gas exchange membrane
Lung paranchyma
 Evaluation of the Pulmonary Patient
Key components in the evaluation of patients
with pulmonary symptoms are the history,
physical examination, and, in most cases, a chest
x-ray.
History
The history can FOCUS ON :
1- Respiratory symptoms as dyspnea, chest pain,
wheezing, stridor, hemoptysis, and cough
2- systemic symptoms such as fever, weight loss,
and night sweats.
important information includes
• Occupational and environmental exposures
• Family history, travel history, and contact history
• Previous illnesses
• Use of prescription, OTC, or illicit drugs
• Previous test results (eg, tuberculin skin test,
chest x-rays)
Physical Examination: 5 main steps:
1- Agreement patient explanation with hand
washing
2- Physical general examination as the effect of
talking or movement on symptoms (eg, inability to
speak full sentences without pausing to breathe) or
signs of hypoxia or hypercabnia
3- Vital signs as PR , PB , temperature , RR & SPO2
4- Chest examination : inspection, palpation
,percussion & auscultation are done.
5- Completing the examination with other sites &
systems , bedside test as peak flow meter cover the
patient thank him & explain the next step of
investigations or treatment
Investigations
Mainly divided into :
non-invasive as imaging & PFT
invasive as scope & biopsy taken
 Imaging
Plain CXR:
They are usually the initial test done to evaluate the
lungs.
 The standard chest x-ray :posteroanterior view
 AP view
 from the side of the thorax (lateral view).
 Lordotic or oblique views
 Lateral decubitus views
 End-expiratory views can be used to detect small
pneumothoraxes.
• Chest fluoroscopy : is the use of a continuous
x-ray beam to image movement. It is useful for
detecting diaphragmatic motion or used in
interventional pulmonology procedures
Computed tomography
CT defines intrathoracic structures and
abnormalities more clearly than does a chest x-
ray.
Conventional (planar) CT with or without
contrast provides multiple 10-mm–thick cross-
sectional images through the thorax. Its main
advantage is wide availability & low radiational
dose. Disadvantages are motion artifact and
limited detail from volume averaging of tissue
within each 10-mm slice.
High-resolution CT (HRCT) provides 1-mm–thick
cross-sectional images. HRCT is particularly
helpful in evaluating interstitial lung diseases
,emphysema & bronchiectasis but high
radiational dose
CT angiography uses a bolus of IV radiopaque
dye to highlight the pulmonary arteries, which is
useful in diagnosis of pulmonary embolism. But
the risk of contrast complication
Magnetic Resonance Imaging
MRI has a relatively limited role in pulmonary
imaging but is preferred over CT in specific
circumstances as nerve & chest wall invasion by
tumors
Advantages include absence of radiation
exposure, excellent visualization of vascular
structures, lack of artifact due to bone, and
excellent soft-tissue contrast. But the
disadvantages include respiratory and cardiac
motion & the time it takes to do the procedure,
ultrasonography
trans-thoracic ultrasonography is often used to
facilitate procedures such as thoracentesis and
central venous catheter insertion , Ultrasonography
is also very useful for evaluating presence and size
of pleural effusions and is now commonly used at
the bedside to guide thoracentesis..
Endobronchial ultrasonography (EBUS) is
increasingly being used in conjunction with
fiberoptic bronchoscopy to help localize masses and
enlarged lymph nodes. Diagnostic yield of
transbronchial lymph node aspiration is higher
using EBUS than conventional unguided techniques.
Nuclear Scanning: including
V/Q scanning
V/Q scanning uses inhaled radionuclides to detect
ventilation and IV radionuclides to detect
perfusion. Areas of ventilation without perfusion,
perfusion without ventilation.
V/Q scanning is most commonly used for
diagnosing pulmonary embolism but has largely
been replaced by CT angiography.
PET
PET uses radioactively labeled glucose
(fluorodeoxyglucose) to measure metabolic
activity in tissues. It is used in pulmonary
disorders to determine whether lung nodules or
mediastinal lymph nodes harbor tumor
(metabolic staging) to decide the need for
invasive procedures such as mediastinoscopy
and needle biopsy, False-positive results can
occur with inflammatory lesions, such as
granulomas; while slowly growing tumors (eg,
bronchoalveolar carcinoma, carcinoid tumor,
some metastatic cancers) may cause false-
negative results.
Thanks