ANATOMY AND PHYSIOLOGY

UPPER RESPIRATORY TRACT

Respiration is defined in two ways. In common usage, respiration refers to the act of breathing, or inhaling and
exhaling. Biologically speaking, respiration strictly means the uptake of oxygen by anorganism, its use in the tissues,
and the release of carbon dioxide. By either definition, respiration has two main functions: to supply the cells of the
body with the oxygen needed for metabolism and to remove carbon dioxide formed as a waste product from
metabolism. This lesson describes the components of the upper respiratory tract.
The upper respiratory tract conducts air from outside the body to the lower respiratory tract and helps protect the
body from irritating substances. The upper respiratory tract consists of the following structures:
The nasal cavity, the mouth, the pharynx, the epiglottis, the larynx, and the upper trachea. The oesophagus leads to
the digestive tract.
One of the features of both the upper and lower respiratory tracts is the mucociliary apparatus that protects the
airways from irritating substances, and is composed of the ciliated cells and mucus-producing glands in the nasal
epithelium. The glands produce a layer of mucus that traps unwanted particles as they are inhaled. These are swept
toward the posterior pharynx, from where they are either swallowed, spat out, sneezed, or blown out.
Air passes through each of the structures of the upper respiratory tract on its way to the lower respiratory tract. When
a person at rest inhales, air enters via the nose and mouth. The nasal cavity filters, warms, and humidifies air. The
pharynx or throat is a tube like structure that connects the back of the nasal cavity and mouth to the larynx, a
passageway for air, and the esophagus, a passageway for food. The pharynx serves as a common hallway for the
respiratory and digestive tracts, allowing both air and food to pass through before entering the appropriate
passageways.
The pharynx contains a specialised flap-like structure called the epiglottis that lowers over the larynx to prevent the
inhalation of food and liquid into the lower respiratory tract.
The larynx, or voice box, is a unique structure that contains the vocal cords, which are essential for human speech.
Small and triangular in shape, the larynx extends from the epiglottis to the trachea. The larynx helps control
movement of the epiglottis. In addition, the larynx has specialised muscular folds that close it off and also
prevent food, foreign objects, and secretions such as saliva from entering the lower respiratory tract.
 LOWER  RESPIRATORY TRACT
The lower respiratory tract begins with the trachea, which is just below the larynx. The trachea, or windpipe, is a
hollow, flexible, but sturdy air tube that contains C-shaped cartilage in its walls. The inner portion of the trachea is
called the lumen.
The first branching point of the respiratory tree occurs at the lower end of the trachea, which divides into two larger
airways of the lower respiratory tract called the right bronchus and left bronchus. The wall of each bronchus contains
substantial amounts of cartilage that help keep the airway open. Each bronchus enters a lung at a site called the
hilum. The bronchi branch sequentially into secondary bronchi and tertiary bronchi.
The tertiary bronchi branch into the bronchioles. The bronchioles branch several times until they arrive at the terminal
bronchioles, each of which subsequently branches into two or more respiratory bronchioles.
The respiratory bronchiole leads into alveolar ducts and alveoli. The alveoli are bubble-like, elastic, thin-walled
structures that are responsible for the lungs’ most vital function: the exchange of oxygen and carbon dioxide.
Each structure of the lower respiratory tract, beginning with the trachea, divides into smaller branches. This branching
pattern occurs multiple times, creating multiple branches. In this way, the lower respiratory tract resembles an
“upside-down” tree that begins with one trachea “trunk” and ends with more than 250 million alveoli “leaves”. Because
of this resemblance, the lowerrespiratory tract is often referred to as the respiratory tree.
In descending order, these generations of branches include:
 trachea
 right bronchus and left bronchus
 secondary bronchi
 tertiary bronchi
 bronchioles
 terminal bronchioles
 respiratory bronchioles
 alveoli
THE LUNGS

The thoracic cage, or ribs, and the diaphragm bound the thoracic cavity. There are two lungs that occupy a significant
portion of this cavity.
The diaphragm is a broad, dome-shaped muscle that separates the thoracic and abdominal cavities and generates
most of the work of breathing. The inter-costal muscles, located between the ribs, also aid in respiration. The
internal intercostal muscles lie close to the lungs and are covered by the external intercostal muscles.
The lungs are cone-shaped organs that are soft, spongy and normally pink. The lungs cannot expand or contract on
their own, but their softness allows them to change shape in response to breathing. The lungs rely on expansion and
contraction of the thoracic cavity to actually generate inhalation and exhalation. This process requires contraction of
the diaphragm.
To facilitate the movements associated with respiration, each lung is enclosed by the pleura, a membrane consisting
of two layers, the parietal pleura and the visceral pleura.
The parietal pleura comprise the outer layer and are attached to the chest wall. The visceral pleura are directly
attached to the outer surface of each lung. The two pleural layers are separated by a normally tiny space called the
pleural cavity. A thin film of serous or watery fluid called pleural fluid lines and lubricates the pleural cavity. This fluid
prevents friction and holds the pleural surfaces together during inhalation and exhalation.

ETIOLOGY

Pulmonary Tuberculosis is caused by bacterium called Mycobacterium tuberculosis. The possible factor that
contributes to the patient is here nature of work, lifestyle and get closed to TB patient. The patient was exposed to
different person since she works as a street cleaner and sweeper, also, her husband is a jeepney driver which
increases the risk of her getting the disease. She is also a smoker. But major factor that contributes was her
exposure to TB patient which is her mother.

DISEASE PROCESS
 TB results from infection by any of the TB complex mycobacteria, including Mycobacteriumtuberculosis, M
bovis, M africanum, M microti, and M canetti.5
TB can be divided into primary, progressive-primary, and postprimary forms on the basis of the natural
history of the disease. Postprimary TB results from either reactivation of a latent primary infection or, less commonly,
from the repeat infection of a previously sensitized host. The term“postprimary” is preferred to “reactivation” when
referring to the clinical diagnosis because firmly distinguishing recurrence from an antecedent infection is impossible
in most cases. Approximately 10% of all infected patients are likely to develop reactivation, and the risk is highest
within the first 2 years or during periods of immunosuppression.
The major determinants of the type and extent of TB disease are the patient’s age and immune status, the
virulence of the organism, and the mycobacterial load. Postprimary TB is typically a disease of adolescence and
adulthood that results from reactivation of an initially contained infection by a TB complex mycobacterium. Pulmonary
reactivation usually occurs in the apical and posterior segments of the upper lobes or in the superior segments of the
lower lobes.This distribution may be related to the higher oxygen tension or the reduced perfusion and lymphatic
clearance in these lung segments.

SYMPTOMATOLOGY

The common symptoms of PTB are:

 A bad cough that lasts 3 weeks or longer

 Pain in your chest
 Coughing up blood or mucus
 Feeling weak or very tired
 Unexplained weight loss
 Chills
 Fever
 Sweating at night
 Having no appetite

The diagnostic test to detect PTB is:

 Imaging tests

If you've had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This might show white spots
in your lungs where your immune system has walled off TB bacteria, or it might reveal changes in your lungs caused
by active tuberculosis.