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Respiratory System

Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

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Page 1: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Respiratory System

Page 2: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Respiratory System• Consists of the respiratory and conducting parts• Respiratory part

– Site of gas exchange – Consists of bronchioles, alveolar ducts, and alveoli

• Conducting part – Provides rigid conduits for air to reach the sites of gas

exchange– Includes all other respiratory structures (e.g., nose,

nasal cavity, pharynx, trachea)

• Respiratory muscles: diaphragm and other muscles that promote ventilation

Page 3: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Major Functions of the Respiratory System

• To supply tissues with oxygen and dispose of carbon dioxide

• Respiration: four distinct processes must happen

– Pulmonary ventilation: moving air into and out of the lungs

– External respiration: gas exchange between the lungs and the blood

– Internal respiration: gas exchange between blood and tissues

– Transport: transport of oxygen and carbon dioxide between the lungs and tissues

Page 4: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

General Anatomy

• Upper respiratory tract:

• The nose, Mouth, pharynx, and Larynx.

• Lower respiratory tract:

• The trachea, Bronchi, Alveoli, and Lungs.

– The thoracic cavity consists of:

• Right and left pleural cavities (the parietal pleura lines the

thoracic cavity, and the visceral pleura adheres directly to the

lung tissue.

• Mediastinum.

Page 5: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Respiratory Zone

• Begins as terminal bronchioles, feed into respiratory

bronchioles.

• Respiratory bronchioles lead to alveolar ducts, then to

terminal clusters of alveolar sacs composed of alveoli

• Approximately 300 million alveoli:

– Account for most of the lungs’ volume

– Provide great surface area for gas exchange

Page 6: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Respiratory Zone

Page 7: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,
Page 8: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Gross Anatomy of the Lungs

• Lungs occupy all of the thoracic cavity except the

mediastinum

– Root or Hilum: site of vascular and bronchial

attachments

– Costal surface: anterior, lateral, and posterior

surfaces in contact with the ribs

– Apex: narrow superior tip

– Base: inferior surface that rests on the diaphragm

Page 9: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,
Page 10: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Hilum of the lungs

Page 11: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Blood Supply to Lungs• Lungs are perfused by pulmonary and bronchial arteries.

1- Pulmonary arteries: – Supply systemic venous blood to be oxygenated– Ultimately feed into the pulmonary capillary network

surrounding the alveoli– Pulmonary veins: carry oxygenated blood back to the

heart

2- Bronchial arteries:

– Provide systemic blood to the lung tissue

– Arise from aorta and enter the lungs at the hilus

– Supply all lung tissue except the alveoli

Page 12: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,
Page 13: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Pleurae

• Thin, double-layered serosa

• Parietal pleura

– Covers the thoracic wall and superior face of the diaphragm

– Continues around heart and between lungs

• Visceral pleura

– Covers the external lung surface

– Divides the thoracic cavity into three chambers

• The central mediastinum

• Two lateral compartments, each containing a lung

Page 14: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Mediastinum• Divided into: anterior, middle, and posterior

portions.

– Anterior mediastinum contains: the thyroid and thymus glands.

– Middle mediastinum contains: heart and great vessels, esophagus, and trachea.

– Posterior mediastinum contains: descending aorta and spine.

Page 15: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Chest X-Ray ReviewImaging techniques used to investigate chest

pathology include:

Plain X-Ray film

Computed Tomography (CT Scan)

Magnetic Resonance Imaging (MRI)

Ultrasound (US)

Angiography

Page 16: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Radiographic signs

• Silhouette sign: opacity near the heart so you can not detect the heart boarder easily.

• Notes from the radiographs: opacity frontal and heart frontal so lesion is frontal.

Page 17: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Negative Silhouette

• Lesion Posterior.

Page 18: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

• Q. Lesion anterior or posterior?

Page 19: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Air Bronchogram• Opacity in the lung contains a tree filled with air (bronchi

contains air but alveoli opaque).

• Lesion arises from the lung not chest wall or pleura or mediastinum.

• Air bronchogram=alveolar pathology=consolidation (lung filled with liquid).

Page 20: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

• Pulmonary nodule: well defined lesion less than 3cm.

• Mass: well defined lesion more than 3cm.

Page 21: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

To interpret chest x-raydifferentiate between

• Focal lesion

• Diffuse lesion

Page 22: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Focal lesions

• Nodules

• Masses

• Cavities: sphere filled with air.

• Patches: opacity contains air bronchogram.

Page 23: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,
Page 24: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Nodules maybe due tomost common

• Tuberculoma

• Hamartoma

• Bronchogenic carcinoma

• Metastases

(multiple nodules or solitary)

• AVM

• Hydatid cyst

Page 25: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

• Benign nodule (Hamartoma and Tuberculoma): If we have pulmonary nodule and the edge is smooth and contains calcification.

Page 26: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Bronchogenic carcinoma

• Speculated margin nodule= malignancy.

• Upper lobe distribution 70%.

Page 27: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Bronchogenic carcinoma

• Lateral view showing the speculated margin.

Page 28: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Hydatid cyst• Single or multiple lesions

filled with water.

• Thin non enhancing margin.

• Abscess: thick enhancing margin, usually contains air.

Page 29: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

X- ray lung abscess

Page 30: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

CT is needed to show if the lesions are cystic or solid

Page 31: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Patch • An ill defined lesion with air

bronchogram.

• Air bronchogram: air filled bronchi passing through opaque lung.

• Pulmonary lesion.

• Alveolar pathology.

• Consolodation.

• Patch may be due to:

• Pneumonia or infarction.

Page 32: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Pneumonia

• is an inflammatory condition of the lung affecting primarily alveoli.

• It is usually caused by infection with viruses or bacteria.

• Typical symptoms include a cough, chest pain, fever, and difficulty breathing  

Page 33: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Pneumonia is accompanied by Consolidation

Page 34: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

Diffuse lung disease

• We have 4 radiographic pattern:

1. Reticular pattern

e.g. Pneumonia, Bronchitis: Confluent small ill-defined densities produce a reticular pattern.

Page 35: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

2. Ground glass pattern: increase in density in areas of ground glass and air trapping in lower lobes in patients with hypersensitivity pneumonitis (inflammation of lung tissue).

Pneumonia is pneumonitis combined with consolidation (is a region of (normally compressible) lung tissue that has filled with liquid) due to infection.

Page 36: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

3. Cystic lesions: air filled cysts.

Page 37: Respiratory System. Consists of the respiratory and conducting parts Respiratory part – Site of gas exchange – Consists of bronchioles, alveolar ducts,

4. Nodular pattern