Respiratory Anatomy - Quiz 1 Flashcards
Anatomical Structures of Respiratory System
Nose and Mouth Pharynx Larynx Trachea Bronchi Terminal Bronchi Lungs and Alveoli Pulmonary Vessels
Structures of Nose
Nare Meati Conchae Sinuses Septum Palate
Functions of Nose
- Conchae and Septum warms inhaled air
- Filtration and obstruction of foreign particles
- Assists in sound making and sensation of smell (CNI)
How does conchae and septum warm air
- Increased inspired air to body temp
- Humidify air to 95% water vapor saturation
- 160 sq. cm. area
What does pharynx connect?
nose, mouth larynx and middle ear
What are tonsils
muscular mucosal lymph tissues
Function of Pharynx and Tonsils
AIDE
A ssists phonation (Make sounds) I nitiates deglutition - swallow D efends against pathogens E nlarges w/ inflammation and tumor
Pharynx: Waldeyer’s Ring
Ring of Tonsils:
- Adenoid
- Eustachian
- Palatine
- Lingual
- Sublingual
Mallampati Classes
MP 1: Full view of uvula and tonsillar pillars, soft palate
MP 2: Partial view of uvula/base, partial view of tonsils, soft palate
MP 3: Only soft palate
MP 4: Only hard palate
Glossoptosis
collapse of oropharynx, tongue drops posteriorly
Macroglossia
Big tongue
Micrognathia
Small jaw, mandible
Prognathism
Protruding jaw, mandible
Microgenia
Small chin
Microstomia
Small mouth
Malocclusion
Upper protrusion, buck teeth, overbite
Larynx Location
- Between Pharynx and Trachea
- Adult: anterior to 3rd-6th vertebre
- At Birth: level at C3-4
What is Larynx made of
Multiple cartilages and muscles bound by elastic tissue. AO extension 35 degrees.
Functions of Larynx
- Airway protective sphincter
- Closes airway during swallow
- Supports vocal cords
- Modulates speech
- autoPEEP
Compartments of Larynx
- Supraglottis
- Glottis
- Infraglottis
Supraglottis Compartment
Epiglottis, False vocal cords
Glottis (Ventricle)
- True vocal cords
- Rima glottidis (narrowest part of adult upper airway)
- Arytenoids (cartilage)
Infraglottis
- Below vocal cords
- Cricoid Cartilage
- Trachea
9 Structures of Larynx
- Epiglottis
- Thyroid
- Cricoid
4-5: Arytenoid
6-7: Corniculate
8-9: Cuneiform
Hyoid bone suspends Larynx
What do Extrinsic muscles of Larynx do?
Attach larynx to bone or pharynx and move larynx UPWARD during swallow
What do Intrinsic muscles of Larynx do?
Two Sets: Innervated by RLN
First Set: Alters size and shape of larynx
Second Set: Move true vocal cords
Aryepiglottic
Part of the First set of Larynx intrinsic muscles that pulls epiglottis down over larynx.
Thyroepiglottic
Part of the First set Larynx intrinsic muscles the HELP pulling epiglottis down
Oblique Arytenoid
Part of the First set of Larynx intrinsic muscles that pulls arytenoids together, ADDuctor
What are the muscles in the FIRST set of intrinsic larynx muscles?
Aryepiglottic, thyroepiglottic, oblique arytenoid
What are the muscles in the SECOND set of intrinsic larynx muscles?
Chubby Tired Leprechauns Piss Terrible Venom
- Cricothyroid
- Thyroarytenoid
- Lateral Cricoarytenoid
- Posterior Cricoarytenoid
- Traverse Arytenoid
- Vocalis
Cricothyroid - Action and Nerve
Part of SECOND set of larynx intrinsic muscles - Tensor of Vocal Cords - External (SLN)
Thyroarytenoid - Action and Nerve
Part of SECOND set of larynx intrinsic muscles - Relaxor of Vocal Cords - RLN
Lateral Cricoarytenoid - Action and Nerve
Part of SECOND set of larynx intrinsic muscles - ADDuctor - RLN
Posterior Cricoarytenoid - Action and Nerve
Part of SECOND set of larynx intrinsic muscles - ABductor - RLN
Traverse Arytenoid - Action and Nerve
Part of SECOND set of larynx intrinsic muscles - ADDuctor - RLN
Vocalis - Action and Nerve
Part of SECOND set of larynx intrinsic muscles - ABductor (Weak) - RLN
What EXTRINSIC muscles moves the larynx indirectly?
Hyoid bone elevators - Suprahyoid
Which EXTRINSIC muscles attach directly to larynx
- Thyrohyoid
- Stylopharyngeus
- Palatopharyngeus
- Salpingopharyngeus
- Inferior constrictor
Membranes of Larynx
Thyrohoid Membran, Quadrangular Membrane, Cricothyroid Membrane
Quadrangular Membrane
Epiglottis to arytenoid, lateral wall of larynx
Cricothyroid Membrane
Inferior to true vocal cords, Emergency airway (Circothyroidotomy/Jet Ventilation)
What does Recurrent Laryngeal Nerve (RLN) do?
- Sensory innervation to infra glottis
- Motor innervation to all larynx EXCEPT cricothyroid muscle
- Left RLN passes @ aortic arch
Stimulation of RLN causes…
ABduction of Vocal Cords
Damage of RLN causes…
ADDuction of Vocal Cords
What does Superior Laryngeal Nerve (SLN) do - INTERNAL
Provides SENSATION to supraglottic and ventricle compartment
What does Superior Laryngeal Nerve (SLN) do - EXTERNAL
Provides MOTOR innervation of cricothyroid muscle
What happens when you stimulate the INTERNAL SLN?
Laryngospasm
Sphenopalatine Ganglion
Middle CN V - nasal mucosa, superior pharynx, uvula, tonsils
Glossopharyngeal Nerve
CN IX, Lingual Back 1/3, Pharyngeal, Tonsillar Nerves - oral pharynx, supraglottic region
Internal Superior Laryngeal Nerve
CN X - mucus membrane above vocal cords, glottis
Recurrent Laryngeal Nerve
CN X - trachea below vocal cords
Epiglottis
Flap-like structure that is positioned UPRIGHT during inspiration
Epiglottic Vallecula
Space/depression anterior to epiglottis at tongue root
How do you lift epiglottis during laryngoscopy?
Pressure on hyoepiglottic ligament
What happens during swallowing
- Epiglottis covers glottis to protect airway
- Larynx raised upward via muscle contraction
- Epiglottis pressed downward by base of tongue
False Vocal Cords
Upper folds that close during swallow
True Vocal Cords
Mobile elastic fibers that make sound and has vocal ligament within.
Direct Laryngoscopy (DL) Grades of VIew
Grade 1: Full view of vocal cords, glottis
Grade 2: Partial view of vocal cords, arytenoid and corniculate cartilages
Grade 3: Only epiglottis
Grade 4: Only soft palate
How is sound produced?
Air forced b/t closed cords and causes vibration. Vibration formed into words by pharynx/oral cavity, tongue, lips
How is vocal pitch modified?
Vocal cord tension. More tension = higher pitch. Less tension = lower pitch.
How is vocal volumed controlled?
Force of air passing b/t vocal cords. Stronger blast cause VC to vibrate more –> louder sounds
What is Cricoid Ring
Complete signet-shaped cartilage ring below larynx and thyroid cartilage (Adam’s apple) and b/t Cricothyroid Membrane and Trachea. Narrowest part of airway in children < 8yrs., cone-shaped narrowing inferiorly
Sellick Maneuver
Pressure on cricoid applied posteriorly closes to Esophagus
Why is Sellick’s Maneuver used?
Prevent gastric regurg, aligns glottic opening during intubation and prevents pushing air into stomach
Trachea
Flexible cylinder supported by 20-25 C-shaped cartilages that extends from C6-T5.
Where does trachea divide into 2 bronchi
At carina (T5-7). Carina at 25cm from teeth.
Diameter of trachea
18-20 mm
Length of trachea
12.5-18cm
What prevents tracheal collapse
C-shaped cartilage
What allows esophageal expansion (tracheal)
Posterior smooth muscle
What filters air and moves particles upward to pharynx on mucous carpet?
Ciliated Epithelium
Functions of Bronchial Tree
distributes air to alveoli, warm/humidify air, filter and move particles from lungs
Bronchial Divisions
Primary, secondary, lobar, segmental bronchi branching to bronchopulmonary segments
What do small bronchopulmonary segments divide into?
Bronchial lobules and separate into terminal bronchioles
Dead Space
Ventilation, no perfusion. 30% each breath wasted. ETT reduces dead space by about 100mL. ~2cc/kg or pt’s weight lbs.
What is an acinus
Site of gas exchange that its structures include respiratory bronchiole, alveolar ducts/sacs, and alveoli
How does gas exchange b/t airspace and pulmonary capillaries happen?
Simple diffusion
Pseudostratified Ciliated Columnar Epithelium (PS-CC) - Location and Function
Found from Larynx to Bronchi. Moves mucous blanket upward, removing trapped particles with cilia beating 1000-1500 cycles/min
What disables the PS-CC
Smoke
Function of Goblet Cells
Makes mucous blanket to trap particles, prevent airway drying and moistens air. Increases with injury/infection
Clara Cells
located in smaller bronchiole where there are no goblet cells. Makes watery, protein material that combines with surfactant and mucus to help clean small airways and reduces bronchiole surface tension
Types of Cells of Alveolar Wall
- Type I Pneumocyte
- Type II Pneumocyte
- Endothelial Capillaries
- Macophages - help clean
- Septal Cells (fibroblasts) - maintains connective lung tissue
- Mast Cells - histamines
Type I Pneumocyte
Squamous epithelial cell, covering 95% of alveolar wall and increases surface area. Very thin (<0.2 µm) for gas exchange. Can be injured; can’t heal.
What cell controls fluid movement b/t interstitium and air space
PC I - Type I Pneumocyte
Type II Pneumocyte
Cuboidal, mitotic, repairs and regenerates PC I, and secretes Surfactant.
How long does it take for PC II to mature
24 Weeks gestation
What is surfactant?
Mix of proteins, phospholipids and ions. Mixes with water to decrease surface tension to reduce force needed to inflate alveoli. Prevents alveolar collapse during expiration.
Where does gas exchange first occur?
Respiratory bronchiole