Anatomy And Pattern Recogniton Of The Upper Respiratory System And Neck Flashcards
Summary of respiratory system
• Our cells need O2 to produce ATP. It is vital to life
• We also need to eliminate the toxic bi-product of
the cellular processes – CO2
• Our respiratory and cardiovascular system work
in collaboration to exchange and transport gases
• Failure of this process due to pathology will lead
to rapid cell death and a build-up of toxins
• Secondary functions of the respiratory system
include:
• Helps to regulate PH alongside the kidneys
• Smell receptors
• Filters and moistens inspired air
• Sound production
• Release of heat and some water
What is respiratory system divided into
Divided into:
• Upper:
• Nose (nasal cavity and paranasal sinuses)
• Pharynx
• Lower:
• Larynx
• Trachea
• Bronchi
• Lungs
• Conducting system:
• Transport of air: filter, warm, moisten
• Respiratory portion:
• Gas exchange between air and blood
Nose
• Has 3 main functions
• Warming, moistening and filtering inhaled air
• Detecting smell
• Modifying speech and sounds through resonance
• It is the only part of the respiratory system that is externally visible
• Is often divided into
• External – nose
• Internal – nasal cavity
External nose
• Muscle and skin supported by bone/ hyaline cartilage framework
• Lined internally with mucous membrane
• External opening – nares
• Bones:
- Paired nasal bones (bridge)
- Frontal bone (root)
- Maxilla
• Hyaline cartilage:
- Septal cartilage (midline)
- Lateral processes of septal cartilage
- Alar cartilages (form flared rim of nares)
• Shape of nose dependent on cartilage structure
What is Nasal cavity
- Paired spaces either side of midline
- Upper part of respiratory tract between external nares and nasopharynx thought the choanae
- Wedge-shaped (apex anteriorly)
- Formed by complex bone and cartilage framework
- Have floor, roof, and medial/lateral walls
- Separated;
• From each other by nasal septum
• From oral cavity by hard palate
• From the cranial cavity by the frontal, ethmoid, and sphenoid bone
3 regions of nasal cavity
3 regions:
Vestibule:
• Within nares/external nose
• Lined with skin
• Coarse hairs filter large particles
Respiratory:
• Largest
• Very neurovascular (capillaries warm air)
• Respiratory epithelium
Olfactory:
• Contains olfactory (smell receptors)
• Lined with olfactory epithelium
Nasal cavity
Respiratory epithelium
Secretes (1litre per day):
• Mucous
• Watery-fluid containing lysozyme (antibacterial enzyme)
• Defensins (natural antibiotics)
Cilia propel mucous and ‘foreign particles’ towards throat; swallowed and digested
. Medial wall/division between cavities called nasal septum
• Anteriorly formed by septal cartilage
• Posteriorly formed by vomer bone and perpendicular plate of ethmoid bone
Nasal cavity – lateral walls
. Three ‘shelves / scroll-like’ bony protuberances from each wall; nasal conchae (sometimes called turbinates)
• Groove inferior to each called nasal meatus
• Mucous covered
• Increase surface area and cause air turbulence meaning particles more likely to become trapped in mucous
• Also extract moisture and heat on exhaling so not lost
Paranasal sinuses
Extensions of nasal cavity; drain into lateral walls
Develop in adolescence
Four pairs named after bone in which they are found:
• Ethmoid air cells
• Sphenoid sinuses
• Maxillary sinuses (largest)
• Frontal sinuses (variable in size)
• Lined with respiratory mucosa
Help lighten skull and resonate voice
Nasal-lacimal duct also drains into lateral wall of nasal cavity
Pharynx
- Funnel shaped tube between the nasal cavity
(base of skull) and the oesophagus / larynx (C6) - Approximately 13cm long
- Composed of skeletal muscle
- Functions as
• Common pathway for food / air before splitting into the respiratory / digestive systems
• Helps form sounds as a resonating chamber
• Contains the tonsils as part of the immune system - Is subdivided into 3 regions
• Nasopharynx – at the level of the choanae in the
nasal cavity
• Oropharynx – at the level of the oral cavity and
mouth
• Laryngopharynx (or hypopharynx) – at the opening for the larynx: laryngeal inlet
Nasopharynx
. Superior to soft palate; passage of air only
• Swallowing elevates the soft palate to close the nasopharynx
• Continuous with epithelial layer of respiratory region of nasal cavity; similar role
• Pharyngeal tonsil on posterior wall; pathogens in air
• Pharyngotympanic (Eustachian) tubes open into lateral wall
• Adjacent ridge of tubular tonsils; prevent spread of infection into middle ear
Oropharynx
. Continuous with nasopharynx above at the level
of the soft palate; passage of air and food
• Continues inferiorly to level of epiglottis / hyoid bone
• Stratified squamous epithelium; protection
• Opening with oral cavity called oropharyngeal isthmus
• Closed when chewing; can still breath through nose
• Surrounded by arches called palatoglossal folds
• Inferior to this, anterior wall is formed by posterior part of tongue
• More tonsils on posterior tongue and lateral walls of oropharynx
Laryngophalynx
• Continuous with oropharynx above at the level of the hyoid bone passage of air and food
• Continues inferiorly to level of cricoid cartilage (C6) and start of oesophagus and larynx
• Continuous with oesophagus
• Stratified squamous epithelium; protection
The tonsils
. They are collections of lymphoid tissue within the nasal and oral cavities and pharynx as part of the body’s defence against disease
• The largest of these form distinct areas called tonsils
• They form a ring around the pharynx and there are 4 main areas
• Pharyngeal tonsil
• Palatine tonsil
• Lingual tonsil
• Tubal tonsil
Pharyngeal Musculature
. Arranged in two groups separated by fascia (allows passage of other structures)
• Constrictors:
- circular around cavity
- Superior, middle, and inferior
. Longitudinal:
- Vertically orientated
Larynx
• Main function of the larynx are
Breathing
Speaking making noise
Forced closure (val salva)
swallowing
• 5cm long between the laryngopharynx and trachea
• Anterior to 4-6th cervical vertebrae
• Suspended from hyoid bone superiorly
• Inferiorly linked to trachea via ligaments
• Is a framework of 9 cartilages supported and connected by fibrous membrane and intrinsic muscles
• Innervated by branches of the vagus nerve
• Mucosal lined
• Start of the lower respiratory tract, functions as:
- A sphincter to close off the lower respiratory tract; guide passage of food
- Maintain a patent airway
- To produce sound ‘Voice box’
Epiglottis
• Spoon/leaf-shaped elastic cartilage
• Anchored anteriorly on thyroid cartilage
• Projects postero-superiorly into the pharynx posterior to the tongue
• Covered in mucosal epithelium containing tastebuds
• Normally open at laryngeal inlet
• On swallowing, larynx is elevated and epiglottis occludes trachea
So how do we swallow
• Aim to close off lower respiratory tract completely
• Adduction of both vocal and vestibular folds
• Rima glottides, vestibule, and vestibule closed
• Extrinsic muscles elevate the larynx which
causes the epiglottis to close the laryngeal inlet
• Simultaneously causes the oesophagus, posteriorly, to open (attached to cricoid cartilage)
The neck
• Extends from
Anteriorly
• Inferior border of the mandible to the manubrium
Posteriorly
• Posterior occipital protuberance to C7/T1 disc space
• It is often divided into 4 compartments
Visceral;
• Anterior
• Contains parts of digestive and respiratory systems
• Also contains several endocrine glands
Vertebral;
• Posterior
• Contains vertebrae and related muscles
• Also contains spinal cord and nerves
Left / right Vascular;
• Lateral
• Contains major vessels and vagus nerve (CN X)
Separated by surrounding layers of cervical fascia
Surface anatomy
• C3 / C4:
Superior border of thyroid cartilage (palpable)
Bifurcation of common carotid artery
• C5 / C6
Indentation of cricoid cartilage / first tracheal ring (palpable)
Inferior border of pharynx / larynx
Superior limit of trachea / oesophagus
• Lies anteriorly in the midline of the neck
• There are 2 lobes and in total is approximately 5cm long.
• It is part of the endocrine system and is key to several metabolic functions including:
- Production of thyroxine, calcitonin and tri-idothyronine
- Assists in protein, fat and carbohydrate production, heat
production and calcium regulation
Parathyroid glands
• These are bilateral glands (4) in the posterior aspect of the thyroid gland
• Secrete parathyroid hormones. This increases blood calcium levels.
Calcium is needed for
• Muscle contraction
• Transmission of nerve impulses
• Blood clotting
• Normal enzyme actions
Acute sinusitis description
• Acute inflammation of any of the paranasal sinus mucosa that lasts less than 4 weeks. If the nasal cavity is also involved its called rhinosinusitis
Acute sinusitis causes and symptoms
Causes
• Normally follows an upper respiratory tract infection.
Symptoms
• Fever, headache, postnasal discharge, abnormal sense of smell
Treatment acute sinusitis
• Antibiotics. If it becomes chronic, FESS (functional endoscopic sinus surgery) may be carried out
Cystic fibrosis description
Genetic disease affecting the lungs, liver, pancreas, small bowel and urogenital system
Cystic fibrosis causes and symptoms
Causes
• Most common genetic disease affecting 1:2000/3500 live births
Symptoms
• Lung and upper respiratory system manifestations
• Repeated bacterial infections, chronic sinusitis, nasal polyps
Treatment for cystic fibrosis
For respiratory complications
• Physiotherapy for airway clearance
• Anti-inflammatory therapy
• Antibiotics
• Lung transplant
Nasal polyps Description
• Multiple benign polyps in the nasal cavity and paranasal sinuses
Causes and symptoms Nasal polyps
Causes
- Most commonly seen in adults. Rare in children.
• May be associated with cystic fibrosis, asthma,
rhinosinusitis
Symptoms
• Patient has a feeling of nasal obstruction, facial pain,headache, loss of smell. May also have symptoms of sinusitis
Treatment nasal polyps
- steroid
- surgery if advanced
Retropharyngeal abscess description
Life threatening infection involving the retropharyngeal space. Needs immediate diagnosis
Retropharyngeal abscess description
Life threatening infection involving the retropharyngeal space. Needs immediate diagnosis
Retropharyngeal abscess causes and symptoms
Causes
• Most commonly seen in young children (<5yrs)
• Commonly a complication of a primary infection
elsewhere in the sinuses, ear or nasopharynx.
• These areas drain lymph to the retropharyngeal
lymph nodes which become infected and
develop into an abscess
Symptoms
• Nonspecific symptoms of infection
• May have stridor and neck swelling
Retropharyngeal abscess for treatment
Surgical drainage
IV antibiotics
If treatment is timely 100% of patient recover fully
Pharyngeal diverticulum
. Also known as a pharyngeal pouch
• Posterior outpouching of the hypopharynx through a weakness in the muscle
Pharyngeal diverticulum causes and symptoms
Causes
- Advancing age
Symptoms
- Food and liquid become trapped leading to a sensation of trapped food, dysphagia, regurgitation, chronic cough, aspiration pneumonia
Treatment of Pharyngeal diverticulum
Endoscopic surgery to resect it
Foreign bodies
In America foreign body aspiration is the 4th leading
cause of death in younger children
Tonsillitis and complications description
Inflammation of any of the tonsils
Tonsillitis and complications causes and symptoms
Causes
- Bacterial infection, commonly Strep A
Symptoms
- Pain, dysphagia, fever
Treatment of tonsillitis and complications
Antibiotics. Oral if uncomplicated, IV if there is concern for quinsy
Underactive thyroid (hypothyroidism)
Description
- The thyroid does not produce enough thyroid hormone resulting in decreased cellular metabolism.
Causes
- Autoimmune diseases such as Hashimoto’s is the most common cause.
Symptoms
- Affects nearly every system in the body
- SOB
- Muscle / joint pain
- Weight gain, cold intolerance
Treatment
Drugs to replace the thyroid hormone - levothyroxine
overactive thyroid (hyperthyroidism)
Description
• The thyroid produces too much thyroid hormone
Causes
• Graves disease, radiation or drug induced, tumours
Symptoms
• Heart arrythmias most commonly
• Goitre
• Weight loss
Treatment
. Drugs, radioactive iodine treatment, surgery
Thyroid cancer causes symptoms and treatment
Causes
. Head and neck radiotherapy
• Family history
• There are many different types
Symptoms
• Usually a palpable mass
Treatment
. Surgery and radioactive iodine treatment
Enlarged lymph nodes
. Description
Enlarged lymph nodes
• Causes
Infection
Neoplastic (due to cancer)
Due to certain drugs
• Symptoms
Depends in cause but can cause pain and
difficulty in movement
• Diagnosis
Can be seen and measured on CT and MRI.
PET will show intense F-FDG uptake
