Anatomy RCR1 Respiratory

General Structure of the Respiratory system

 Main functions of the respiratory system –

o Transport of gases between the atmosphere and sites in the lungs
where gaseous exchange between air and blood occurs
o Surface for gas exchange between air and circulating blood and for
the regulation of pH in the body
o Phonation, laryngeal sound production used for communication
o Smell or Olfaction is the detection of olfactory stimuli
 Upper respiratory system includes the nasal cavity and sinuses and the
pharynx, with the lower being the larynx, trachea, bronchi and lungs
 The respiratory system is also split into the conducting zone (that
prepares air for the fine membrane), being all those parts except the lungs
and the respiratory zone which is the lungs
 Disorders of the respiratory system include – inflammation, infection,
tumours, immune disorders, trauma, degenerative diseases and
congenital disorders
 Function of natal cavity
o Cleaning using hairs and cilia
o Moistening via the mucus produced by glands and goblet cells
o Warming using the vascular network which is close to the air
o NB the conchae form turbulences of inhaled air, which circulates
around, trapping particles in the mucus and exchanging heat to
warm the air
 Nasal cavity is made up of external nares (or nostrils) with hairs, three
nasal conchae (split into superior middle and inferior), three meatuses
(the spaces between the conchae) and the chonae which is the internal
nares seen in the sagittal section
 The superior conchae is the one with olfactory receptors for sense of
smell
 Via a coronal section you can see the nasal cavity, the nasal septum which
splits the left and right side, the three nasal conchae and the three
meatuses
 Due to many blood vessels in the nasal cavity it is common to have a nose
bleed
 Rhinitis is the inflammation of the mucosa of the nasal cavity, and
symptoms include a runny or blocked nose, sneezing, mild irritation or
discomfort in and around the nose and a reduced sense of smell
 Paranasal air sinuses, have these both on right and left
o Frontal sinus
o Maxillary sinus
o Sphenoidal sinus
o Ethmoidal cells
 Sinusitis is the swelling and inflammation of the mucosa causing local
pain, the swelling of the mucosa may block one or more openings
 Pharynx is made up of the nasopharynx, oropharynx and the
laryngopharynx (latter two are common parts of the respiratory and GI
tract
 Tonsillitis is inflammation of the tonsils, usually caused by a viral
infection or less commonly a bacterial one, tonsils are lymphoid tissue
present to clean the air
 Larynx is formed from cartilage, membranes and muscles

 Trachea is made up of 16-20 C shaped cartilage rings, with trachealis

muscle on the posterior aspect (a smooth muscle), where the trachea
splits into the two is called the carina
 Lungs, the right lung is split into superior, inferior and middle while the
left lung is only split into the superior and inferior, there are two fissures
called the oblique (on both) and the horizontal (only on R)
 The smallest functional unit that can be removed without affecting
adjacent regions is a bronchopulmonary segment, there are 10 of these in
each lung, and you can remove one of these, leaving the others with septa
in between
 Primary bronchi, is R and L and is called the pulmonary bronchi
 Secondary bronchi is the superior, middle and inferior on the right and
the superior and inferior on the left, also called lobar bronchi
 Tertiary bronchi are segmental bronchi, of which there are 10 on each
side
 Bronchoscopy – aspiration of a foreign body, the right bronchus is wide
and shorter and so 80% will get lodged here
 As the bronchi get smaller and smaller into bronchioles there is less
cartilage, and it moves further away from the conducting zone and into
the respiratory zone, there are 16-20 generations of bronchi, the
epithelium moves from respiratory epithelium, to ciliated simple
columnar and goblet cells, to ciliated low columnar or cuboidal with no
goblet cells, to the very smallest with simple flattened squamous cells
 Beyond this, the lobules behind with terminal bronchioles, respiratory
bronchioles, the alveolar sac and finally the alveolus
Development of the respiratory tract

 Cavities of the adults body include the pleural, pericardial, another pleura
in the thoracic body cavity, and then below the diaphragm, within the
abdominal body cavity is mostly organs and then the pelvis cavity is the
peritoneal serous cavity
 Gastrulation occurs in week 3 where three germ layers form, the
ectoderm (for skin and nervous system), the mesoderm (the skeleton,
muscle, kidney, heart and blood) and finally the endoderm (for the gut,
liver and lungs), this is the start of organogenesis
 At 20 days, the coelom forms, this is lateral folding of the embryo to form
a 3D embryo

 Ectopia cordis (heart outside body), gastroschisis (abdominal wall 

herniation), bladder extrophy, all caused by the failure of the anterior
wall during foetal development, results in a protrusion of the thoracic,
abdominal or l=pelvic organ through the anterior wall
 NB for the gut tube
o Foregut – oesophagus and lower respiratory tract
o Mid gut – stomach and top of large intestine
o Hind gut – upper anus
 Tracheo-oesophageal fistula – as a small foetus, usually premature labour,
leads to respiratory distress and choking, feeding difficulties in first few
hours, some present later with cough and recurrent chest infection, food
into respiratory tract and stomach acid into lungs
 Formation of trachea and larynx – there is slow out-pouching’s, origin of
the trachea is linked to the oesophagus which then split to form two
tubes, the septum is where the fistula can occur
 Tracheo-oesophageal fistula or oesophageal atresia is the incomplete
separation of trachea and oesophagus and results below, occurs 1/3000
  Pulmonary hypoplasia 9-11/10,000, incomplete development of the
lungs, malformed trachea or absent or poorly differentiated lung tissue,
this is a failure of lung development and results in an abnormally low
number or size of bronchopulmonary segments or alveoli
 Cartilage in bronchi and SM are both from the mesoderm, it is lined by the
pleural cavity, with serous fluid inside

  Respiratory distress
syndrome occurs in 1/1000 babies, 50% of these being premature babies
in weeks 26-28, leads to cyanosis and their lungs collapse due to
problems with surfactant, inability of alveoli to expand and stay
expanded, surfactant is a mixture of proteins in a fluid and it is produced
by alveolar type II cells, developmental insufficiency of surfactant due to
structural immaturity

 Lungs continue to develop until 8 years of age

 Mesoderm – cartilage, smooth muscle, blood vessels and pleura
 Endoderm – the epithelium

Regional Anatomy of the Thorax

 The thorax includes the rib cage (sternum, all 12 pairs of ribs and the 12
thoracic vertebrae), the thoracic wall (the skin, fascia and muscles) and
the thoracic cavity (space, contains organs including the heart, great
vessels, lungs, trachea and oesophagus)
 RIB CAGE
o Sternum include the manubrium, body and xiphoid process, with
the jugular notch at the top, the manubriosternal joint or sternal
angle at T4/T5 vertebral disc (level or carina, aortic arch starts
and ends and the pulmonary artery splits into L and R) and the
xiphosternal joint
o Ribs include the 12 pairs of ribs, where ribs 1-7 are true ribs, 8-10
are false (as join to 7), and 11 and 12 are floating ribs, a typical rib
 has a head, neck, tubercle and on the body or shaft, the costal
groove (the head is at the posterior)
o Rib cage – 1st rib is flat and only articulates with T1, 2nd to 10th ribs
articulate with 2 vertebrae, 11th and 12th are floating and articular
with T11 and T12 respectively
 Key land marks include T2/3 at the jugular notch, T4/5 for the sternal
angle, T9 for the xiphisternal joint and L3 for the lower costal margin
 Rib fracture – usually 7-10, usually at the angle or the rib (a rib articulates
with 2 vertebrae)
 The ribs have 5 joints, the costovertebral, the costotransverse, the
costchondral (primary cartilaginous joint, no movement), the
sternalcostal (1st is primary cartilaginous, 2-7 are synovial) and the
interchondral (7, 8, 9, 10 articulate with each other by synovial joints
 THORACIC WALL
o Made of the skin, muscle (3 layers of muscle) and fascia
(superficial and endothoracic)
o Intercostal space is the space between two adjacent ribs,
containing muscles, vessels (arteries, veins and lymphatic) and
nerves
o Muscles are the external (hand into pocket) intercostal muscles
and the internal intercostal (opposite way) and then the innermost
intercostal, which are all innervated by the intercostal nerves
 Respiratory movements are either quiet or forced and inspiration or
expiration
 Quiet inspiration - inspiratory muscles contract, diaphragm ascends and
the rib cage rises, lungs are stretched and air flows in because thoracic
volume increases
 Quiet expiration – inspiratory muscles relax, diaphragm rises and rib cage
descends, lungs recoil passively and air flows out due to decreased
thoracic volume
 Sternum moves like a pump handle moving up and out, while ribs move
like a bucket handle upwards to change the volume of the thorax
 Neurovascular bundle moves down (superior to
inferior) as VAN, vein, artery nerve, the vein and
artery are protected by the rib, there are collateral
branches which are NAV above the rib below
 Thoracocentesis – in between rib, used in chest
drain in the 5th intercostal space in the axillary
line
 THORACIC CAVITY
o Main contents include the lungs, trachea,
heart, great vessels and the oesophagus
 Pleural cavity – in reality are stuck together,
visceral and parietal pleura which is continuous,
it reduces friction on inspiration, movement of
the thorax moves the pleura, moving the lung via
–ve pressure in lung, it is a potential space as
cant see the space between the lung and pleura
 Innervation of the pleura, autonomic is simply sensitive for stretch but no
pain, uses the phrenic nerve and intercostal nerves, C3-5 (over shoulder)
 Parietal pleura, is larger than the lungs as at the midclavicular line it
reaches 8th rib but the lungs only the 6th, and at the midaxillary line it
reaches the 10th rib but the lung only reaches the 8th
 Lung carcinoma – lung cancer is the second most
common type of cancer in men in the UK, and the
leading cause of death from cancer in the UK,
smoking is the most common cause of lung
cancer, spreads via the lymphatic system
 Panacoast syndrome is when the tumour
compresses the vagus nerve and the sympathetic
chain and brachial plexus giving pain and paresis
of the arm and hand and eye problems due to the
sympathetic chain, severe pain in shoulder,
radiates to axilla and scapula, atrophy of hand
and arm muscles, oedema
 MEDIASTINUM – L and R mediastinal pleura, diaphragm, sternum,
thoracic inlet and thoracic vertebrae
o Superior mediastinum is above the T4/T5 sternal angle, it contains
the great vessels, trachea, oesophagus, phrenic nerves, vagus
nerve, left recurrent laryngeal nerve, thoracic duct and part of the
thymus gland
o Inferior is below the sternal angle and is further split into the
anterior, middle and posterior
o Anterior mediastinum, loose CT, few lymph nodes and sometimes
inferior part of the thymus gland
o Middle mediastinum is loose CT, the heart in its pericardial sac and
the great vessels
o Posterior mediastinum contains the thoracic part of the
descending aorta, oesophagus, the thoracic duct, azygos,
hemiazygos and accessory hemiazygos veins, R and L sympathetic
chains with splanchnic nerves, R and L vagi nerves