THE RESPIRATORY SYSTEM
approximately 2cm to 4cm above the
ANATOMY AND PHYSIOLOGY OF
THORAX
- we have 12 pairs of ribs
- 1st to 7th ribs (true ribs)
- 8th to 10th ribs (false ribs)
- 11th and 12th ribs (floating ribs)
- we have a total of 11 intercostal spaces
- abnormalities of the chest are described in
two dimensions; along the vertical axis and
around the circumference of the chest.
- to make vertical locations, count the ribs
and intercostal spaces
- the spinous process of the vertebrae are
also useful in anatomic landma rks
- when the neck is flexed forward, the most
protruding process is usually the vertebra of
C7, known as the vertebral prominens.
- if the two processes are equally
prominent, they are C7 and T1.
C1 (Atlas)
C2 (Axis)
7 CERVICAL - Aids in breathing
12 THORACIC - when damaged , the
affected part is the abdomen region
5 LUMBAR - when damaged, bladder is
affected
1 SACRAL
1 COCCYX
- the midsternal and vertebral lines are
precise, the others are estimated
- the midclavicular line drops vertically from
the midpoint of the clavicle. To find it, you
must identify bothe ends of the clavicle
accurately.
- the anterior and posterior axillary lines
drops vertically from the anterior and
posterior axillary folds, the muscle masses
that border the axilla.
- the midaxillary line drops from the apex of
the axilla
- posteriorly, the vertebral line overlies the
spinous process of the vertebrae.
- the scapular line drops from the inferior
angle of the scapula.
LUNGS, FISSURES, AND LOBES
RIGHT LUNG: 3 LOBES, 2 FISSURES
LEFT LUNG: 2 LOBES, 1 FISSURE
(A total of 5 Lobes and 3 Fissures)
 Anteriorly, the apex of each lung rises
inner third of the clavicle
 Lower border of the lung crosses the
6th rib at the midclavicular line and the
8th rib at the midaxillary line.
 Posteriorly, the lower border of the
lung lies about the level of the T10
spinous process, On inspiration, it
descends farther.
 Each lung is divided roughly in half by
an oblique (major) fissure
 Right lung is further divided by the
horizontal (minor) fissure
 Anteriorly, the fissure runs close to the
4th rib and meets the oblique fissure in
the midaxillary line near the 5th rib. The
right lung is thus divided into upper,
middle, and lower lobes.
 Left lung has only 2 lobes; upper and
lower
LOCATIONS ON THE CHEST
 SUPRACLAVICULAR - above the clavicle
 INFRACLAVICULAR - below the clavicle
 INTERSCAPULAR - between the
scapullae
 INFRASCAPULAR - below the scapullae
 BASES OF THE LUNGS - the lower most
portions
 UPPER, MIDDLE, AND LOWER LUNG
FIELDS.
THE TRACHEA AND THE MAJOR
BRONCHI
 Breath sounds over the trachea and
bronchi have a different quality than
breath sounds over the lung
parenchyma.
 The trachea bifurcates into its
mainstem bronchi at the levels of the
sternal angle anteriorly and the T4
spinous process posteriorly.
THE PLEURA
- are the two serous membranes that covers
The outer surface of each lung.
 VISCERAL PLEURA
- lies next to the lung
 PARIETAL PLEURA
- lies the inner ribcage and upper surface of
the diaphragm. It lacks sensory nerves.
 PLEURAL SPACE
- is the potential space between visceral and
parietal pleurae. It is richly innervated by
the intercoastal and phrenic nerves.
PLEURISY - INFLAMMATION
 PLEURAL EFFUSION - accumulation CHEST PAIN
of fluid between the pleurae - may be caused by cardiac, respiratory,
gastrointestinal, or musculoskeletal
BREATHING etiologies.
- an automatic act, controlled in the - lung tissue itself has no pain fibers. Pain in
brainstem, and mediated by the muscles of lung conditions such as pneumonia and
respiration in response to cellular demands pulmonary infarction usually arises from
of oxygen. inflammation of the adjacent parietal pleura.
 DIAPHRAGM - primary muscle for
inspiration. SOURCES OF PAIN
- during inspiration, this muscle contract, - trachea and large bronchi
the thorax expands. Intrathoracic pressure - parietal pleura
decreases, drawing air through the - chest wall
tracheobronchial tree into the alveoli, or - myocardium
distal air sacs and expanding the lungs. - pericardium
- after the inspiratory effort stops, the - aorta
expiratory phase begins. The chest wall and - esophagus
the lungs recoil, the diaphragm relaxes and - anxiety
rises passively, air flows outward, and the
chest and abdomen return to their resting
positions.

COMMON OR CONCERNING
SYMPTOMS
- Dyspnea - shortness/difficulty in
breathing/ air hunger
- cough
- wheezing (manifestation of asthma)
(high pitched, musical sound upon
expiration)
- chest pain
- blood streaked sputum (hemoptysis)

COUGH
- is typically a reflex response to a stimuli
that irritate receptors in the larynx, trachea,
or large bronchi. These stimuli includes
mucus, pus, blood, dust, foreign bodies, and
even extremely hot or cold air.
- may also be caused by inflammation of the
respiratory mucosa or tension in the air
passages from a tumor or enlarged
peribronchial lymph nodes.
- Can also be a symptom of left sided heart
failure.

MUCOID SPUTUM
- is translucent, white or gray

PURULENT SPUTUM
- yellowish or greenish

ACUTE COUGH - lasts less than 3 weeks

SUBACUTE - lasts 3 to 8 weeks
CHRONIC - more than 8 weeks