Week 8 Flashcards
1
Q
Respiratory Functions (4)
A
- breathing and gas exchange
- humidify and warm air
- speech
- sense of smell
2
Q
Division to the Respiratory System
A
- Upper Respiratory System
- nasal cavity, larynx, pharynx
- Lower Respiratory System
- Trachea, Bronchioles, Alveoli
3
Q
Functional Respiratory Division
A
- Conducting Portion
- Nasal Cavity –> Terminal Bronchiole
- Conduct, filtrate, warm, speech, smell
Respiratory portion - respiratory bronchioles –> alveoli
- exchange gas
4
Q
Embryological Origin
A
- Respiratory Diverticulum –> lung buds
- ventral budding off the gut tube
- respiratory system found anterior to digestive system
- just after birth, the respiratory system is always found anterior to the digestive system
5
Q
Order of the upper respiratory system
A
nose and nasal cavities –> Pharynx ( connects your nose and mouth to your esophagus): nasopharynx, oropharynx, laryngopharynx
6
Q
Visceral Cranium
A
The bones of the skull that make up the facial portion of the skull.
7
Q
Narrow Cranium
A
Less bones than the visceral cranium
8
Q
Ethmoid bone
A
- makes up medial wall of the eye/ orbit socket
9
Q
Inferior Nasal Chonca
A
- in the nasal cavity, right and left
- lateral wall of nasal cavity
10
Q
Lacrimal bone
A
make up medial wall of the orbit or eye socket
11
Q
Zygomatic bone
A
- most lateral bone of the visceral cranium
- connects with the large maxilla bone
12
Q
Maxilla bone
A
- ## feel on yourself below your eye socket
13
Q
Nasal Bone
A
Most superior part of the nasal cavity
- nasal bone (red pointer is nasal bone) is anterior to the nasal septum
14
Q
Mandible
A
- very large bone
- spans from right to left
- jaw bone
15
Q
Vomer bone
A
Midline at the bottom of the nasal cavity
16
Q
Palatine Bone
A
- Posterior aspect of the roof of the mouth (hard palate)
(in the blue)
17
Q
Nasal septum
A
- cartilage (soft and flexible tissue)
- nasal septum sits in the middle that divides the right and the left nostril
- nasal bone makes up anterior part of the nasal septum and vomer bone makes up inferior part
18
Q
Superior, Middle, Inferior Concha
A
Superior and Middle nasal concha are part of the ethmoid bone
- inferior nasal chonca is its own bone
19
Q
Nasal Cavity Function
A
Smell: Olfactory Mucosa (specialized epithelium that is for the sense of smell), Olfactory Nerve (CNI)
Warm and moisten air
Filtrate air: Respiratory Mucosa (remove as many particles, different epithelium cells than olfactory)
Speech: Resonance Chamber
- conduct air into the pharynx
- enter through nares
- exit through choanae (hole heading to the pharynx)
20
Q
Nasal cavity and Nose Structures
A
- Nasal cartilages: Anterior protrusion on the nose
- Hard palate: maxilla and palatine
- Medial Wall: Ethmoid Bone, Vomer Bone
- Lateral Walls: Superior, Middle Nasal Conchae (ethmoid), Inferior Nasal conchae
21
Q
Meatuses
A
- Below each nasal conchae
- Superior, Middle, Inferior
- Increase the surface area for the mucosa so it does a good job of filtrating or olfactory mucosa for smell
22
Q
Mucosa Location
A
- olfactory mucosa is only on the superior aspect
- rest is covered in respiratory mucosa
- covers the meatuses
23
Q
Paranasal Sinuses
A
- “para” = beside
- air filled cavities in bones
- all connections to nasal cavities
- help lessen the density of the skull and serve physiological purposes and balancing pressure
- if there is an issue, they might be filled with fluid
24
Q
Frontal Sinus Location
A
yellow on forehead
25
Ethmoid Sinus Location
Green one
26
Sphenoid Sinus Location
Blue colour
27
Maxillary Sinus
orange on cheeks
- part of the narrow cranium
28
Blood Vascular
- have to pull away the mucosa to find the neurovascular underneath
- Medial Wall (septum) and Lateral wall both received blood supply from Internal Carotid Artery: Ophthalmic Artery
External Carotid Artery: Maxillary Artery, Facial Artery
- Kiesselbach's area: all the arteries are making connections
29
Nerve supply
- Medial wall (septum) and lateral wall both innervation from:
Olfactory Nerve (CNI): smell, poking out from the cribriform plate of the ethmoid bone
Trigeminal Nerve (CNV): sensory
- Ophthalamic (V1): Anterior/Superior
- Maxillary Nerve (V2): Inferior/Posterior
30
Structures of the Pharynx
Muscular tube
- 3 longitudinal muscles
- 3 constrictor muscles
Mainly vagus nerve
- one muscle CNIX (glossopharyngeal nerve)
- connection to nasal cavity, oral cavity, trachea, esophagus
- Nasopharynx (choanae--> soft palate), oropharynx (soft palate --> epiglottis), laryngopharynx (epiglottis --> cricoid cartilage)
- continuous with:
Trachea (anterior)
Esophagus (posterior)
31
Epiglottis
- involuntary cartilaginous structure
Swallowing: snaps down to cover larynx
- food forced posteriorly (through esophagus)
- normally without food, the epiglottis is elevated and air can travel to and from the respiratory system
32
Larynx Functions
- anterior portion of the laryngopharynx
- connects oropharynx with trachea
- protects respiratory system while swallowing
-vocalization
33
Larynx components:
- Hyoid bone
-cartilage
- ligaments
- vocal folds
- muscles
34
Hyoid bone
- important for muscle attachment in the neck
35
Thyroid cartilage
- thyroid cartilage is incomplete on the posterior aspect
- anterior projection (adam's apple)
36
Cricoid Cartilage
complete, full circle
37
Arytenoid
- have two of them
- The vocal cords attach to the front of these pyramid-shaped cartilages (at the top part of the pyramid).
The muscles attach to the back/bottom part of these cartilages to help them move.
38
Epiglottis Cartilage Material
- made up of elastic cartilage, whereas the rest of the cartilages are made of hyaline cartilage so a bit more sturdy
39
Thyrohyoid Ligament
thyroid cartilage with the hyoid ligament above
40
Cricothyroid Ligament
cricoid ligament connects the cricoid cartilage with the thyroid cartilage
- these ligaments are important for maintaining the orientation of the cartilages
41
Quadrate Ligament
- yellow one
- connects the arytenoid cartilages to the epiglottis
42
Vocal Ligaments
- can see from the superior view
- true vocal cords
- arytenoid cartilage to the thyroid cartilage
43
Vestibular Ligaments
- false ligaments
- these do not move
44
Cricothyroid muscle
- stretch laryngeal muscles = higher pitch
- muscles are superficial to the ligaments
- move the thyroid cartilage anterior
- stretch cords = increase pitch
- external laryngeal nerve (CNX) which is a branch of cranial nerve CNX which is a branch of the vagus nerve
- when the muscle contracts, it pulls the thyroid anterior, tightens the cords which increases the pitch
45
Thyroarytenoid Muscle
- when it contracts it will pull the arytenoid anterior
- slacken cords = decreases pitch
- recurrent laryngeal nerve which is a branch of the vagus nerve CN
46
Posterior Cricoarytenoid Muscle
- coming posteriorly on the cricoid cartilage and attaches on the muscular process on the arytenoid
- aBduct the cords, widen the space between them and increase the volume
- recurrent laryngeal nerve
47
Lateral Cricoarytenoid muscle (orange)
- coming posteriorly on the cricoid cartilage and attaches on the muscular process on the arytenoid
-aDduct cords = decrease volume
- recurrent laryngeal nerve
48
Oblique (blue/purple) and Transverse Interarytanoid (green) muscle
- ADduct cords = decrease volume
- recurrent laryngeal nerve
- pull the arytenoid cartilage closer together and this will decrease volume
49
Aryepiglottic muscle
- depress epiglottis = close airway
- has nothing to do with vocalization
- recurrent laryngeal nerve
50
Vocal Nodules
- Nodules develop on the true cords (vocal cords)
- overuse or misuse
- swelling from vibrations harden
- makes it harder for vocal fold to vibrate
- Laryngoscopy exam
51
Thoracic Cavity
- enclosed by the rib cage and associated structures on this schematic
52
Pleura Cavity
- occupy space in thoracic cavity
- structures related to the heart
- R and L pleural cavities on either side of the mediastnum
53
Pleura
- fluid filled membrane
- lungs develop into the pleural sac
- Fluid filled membrane
- Lung develop into the pleural sac
- 2 layers
- Parietal (superficial on body wall)
- Visceral (deep directly on lungs)
- Continuous at the hilum
- impossible to rip off the visceral pleura without ruining lung tissue with it
54
Pleura Cavity
- fluid filled space
- maintains surface tension so lungs are increasing with each inhalation
55
Pleural cavity vs Pleura space
- pleural cavities are the physical spaces to the right and left of the mediastinum that houses the lungs and the pleura around it
- pleura space is the fluid filled space between the two layers of pleura
56
Lungs
- asymmetrical, right and left
- pyramidal shape
- diaphragmatic surface: which is along the inferior border of both lungs in contact with the respiratory diaphragm
- costal surface: anterior, lateral and posterior surface that's all in contact with the ribs
- mediastinal surface: these lungs are divided functionally into different lobes
- Lobes: superior, middle, inferior
- Fissure (1/2): Oblique Fissure, Horizontal Fissure (left lung does not have this)
57
Right lung Specific Feature
- costal grooves
- esophagus
- Superior vena cava
- we only see these features after fixation otherwise, it would take the shape of whatever is pushing on them
58
Left Lung Specific Features
- Costal Impression
- Lingula (along the medial and inferior border)
- Cardiac Notch (see from medial view)
- Aorta
- we can only see a small part of the esophagus here
59
Hilum (Root of the lung)
- Parietal pleura is reflecting in on itself to become continuous with the visceral pleura
- medial surface
- strutures are entering and exiting the lungs
- Pulmonary Arteries (Superior): bringing deoxygenated blood from the right ventricles towards the lungs
- Pulmonary Veins (Inferior and anteriorly): carries oxygenated blood back towards the left atrium
- Bronchi (Posterior):
60
Pathway of Air
1) Nasal cavity
2) Pharynx
3) Larynx (upper respiratory system ends here)
4) Trachea
5) Primary Bronchi
6) Secondary Bronchi (Lobular)
7) Tertiary Bronchi (segmental)
8) Terminal Bronchioles
9) *Respiratory Bronchioles
10) *Aleveoli
(9 and 10 function do gas exhange exchange and the rest do conducting portion)
61
Trachea
- has cartilaginous rings
- smooth muscle posterior = esophagus is posterior, needs flexibility to expand
- Bifurcates into R/L Primary Bronchi (Carina) = around T4-T5 Level. That is where there is the manubrium of the sternal joint and the arch of the aorta.
- right bronchi is actually wider and more vertical slope compared to the left one
62
Primary Bronchi
- Trachea bifurcates into two primary bronchioles
63
Secondary BronchI
- (Lobular)
5 secondary bronchi, 3 for right lobes and 2 on left lobes
64
Tertiary Bronchi (segmental)
-upward of 20
65
Alveoli
- air filled sacs
- look like grapes and goes back to the trachea
66
Gax exchange
- Alveoli
- Pulmonary Arteries
- Pulmonary Veins
- the distal portion of the respiratory system = alveoli
67
Pulmonary Circulation
Pulmonary Arteries: carry deoxygenated blood from heart
Pulmonary Veins: carry oxygneated blood towards the heart
- alveoli is the cite where gas exchange occurs and red blood cell becomes deoxygenated
68
Gas exchange Structural Relationship
- Pulmonary veins and pulmonary arteries anastomose
- Capillary network around alveoli
- Aleolar cells in close contract with endothelial cells and RBC within vessels
69
Gas Exchange Mechanism of the cells
- Type I and Type II Alveolar cells that make up the border of each alveoli
- air filled space connected to broncioles
- surrounded by capillary vessels (pulmonary arteries and veins)
70
Gas Exchange Mechanism
- Gases follow concentration gradient
- oxygen diffuses from alveolus space into capillary --> bonds to RBC
- O2 on RBC travels through pulmonary vein to heart to systemic circulation
- CO2 diffuses from capillary into the alveolus space --> travels into bronchiole, exhaled through respiratory tract
71
Innveration of the Respiratory System: Sympathetic Innervation
- Spinal nerves T2-T5
- involuntary, sympathetic nerves coming from the spinal cord, post synaptic fibers from sympathetic chain
- relax smooth muscle in bronchi = bronchiodilation
72
Parasympathetic Innervation of Respiratory System
- rest and digest
- Cranial Nerve X (Vagus)
- contract smooth muscle in bronchi = bronchoconstriction, mucus production
73
Pulmonary Plexus
The pulmonary plexus is a network of nerves around the lungs.
74
Clinical Case: Asthma
- narrowing of airways and excessive mucus production
- this makes it harder to breath, wheezing, coughing
- can be brought up due to excerise, irritants in the air, allergic reactions to what's in the air, puffers in the air
- epinephrine helps treat excercise induced asthma by activating the sympathetic response: dilate bronchi/briochioles
75
Diaphragm
- main muscle of respiration
- separates thorax from abdomen
- skeletal muscle
- inferior thoracic aperature --> central tendon
76
3 openings:
Caval Opening (Inferior Vena Cava): T8
Esophagus Hiatus: T10
Aortic Hiatus: T12
77
Phrenic Nerve
Fibres from the spinal nerves C3, C4, C5
- descend through the thorax to reach the diaphragm
- between the pericardium (around heart) and pleura (around the lung)
- sensory and motor fibers
- involuntary control but you do have volutnary control over it like you can hold your breath
78
Respiration Mechanism of the Diagram
- cycles in contraction and relaxation change in the volume of the thoracic cavity
- creates a pressure gradient for air flow
- during inspiration, the diaphragm flattens out and makes the thoracic cavity larger: creates a low pressure environment and air rushes into lungs
- during expiration, it is going to relax and ball up (dome): thoracic cavity volume decreases, creates a high pressure environment and air rushes out of lungs
79
Phrenic Nerve
controls the diaphragm which is under involuntary control from the phrenic nerve and high order brain centers
80
External Intercostal muscles (Thoracic Wall Muscles)
- assist in forced respiration
- elevate ribs
- origin on superior rib and insert on inferior rib
- muscle pulls towards its organ and elevate and elevate the ribs
81
Internal Intercostal Muscles (Thoracic Wall Muscles)
- found more medially and slightly deeper than the external intercostal muscles
- these are originating on the inferior rib and inserting on a superior rib
- muscle pulls towards its origin and going to depress the ribs and helps with forced expiration
82
Innermost Intercostal muscle (Thoracic Wall Muscle)
- found most posteriorly and laterally along the inside of the thoracic wall
- Depress ribs
- helped with forced expiration
83
Thoracic Wall Vessels
- Intercostal Vein (superior)
- Intercostal Artery (middle)
- Intercostal Nerve (inferior)
- VAN found between internal intercostal and innermost intercostal muscles
84
Pleural Effusion
- Excess fluid in the pleural space
- caused by congestive heart failure, infection, cancers
- symptoms include shortness of breath, chest pain, cough
- diagnoses with medical imaging
- treated with thoracentesis (inserting a needle to drain excess fluid)
- have to go through superficial adipose tissue, external intercostal, internal intercostal, innermost intercostal, parietal pleura
85
What bone?
- Perpendicular plate of the ethmoid bone, partially makes up the septum of the nasal cavity
- Ethmoid bone contributes to the orbit, eye socket
- crista galli separates the two sides of the ethmoid bone
86
Which bone?
Vomer bone makes up the septum
87
Cribiform plate
either side of the crista galli.
- here the olfactory nerves, cranial nerve I sits in
88
What bone is this?
- Inferior Conchae, it's own bone
- Superior Conchae and middle conchae is its own bone
- these bones are covered with nasal mucosa that is highly vascularized that will act to slow down air as it is coming in and it will warm it up
89
Nasal Septum
- anterior part of the nasal septum consists of cartilage, posterior aspect is the vomer bone or perpendicular plate of the ethmoid bone
90
What is this?
Olfactory mucosa
- detect odours
91
What does this part of the nose do?
does not have chemoreceptors for smell, but acts to trap particles, to warm up the air and to slow the air down
92
What is this opening?
- The frontal sinus near the superior, middle and inferior conchae.
93
What is this?
Ethmoid sinus
94
What is this?
Sphenoid sinus
95
What is this?
Under the middle conchae is the maxillary sinus
96
What is this?
The lacrimal duct which connects to the medial corner of the eye to the nasal cavity. Excess tears are produced.
97
What artery is here?
Ethmoidalartery which is a branch coming off of the internal carotid artery.
98
What artery covers most of this area?
Maxillary artery
99
What artery comes here?
Facial artery
100
What is this area where all of the arteries?
Kiesselbach's area, highly vascularized point and the source of many nosebleeds
101
What is the innveration of the mucosa?
- the autonomic nervous system, nerves coming along with the cranial nerve 5 the manibular division of the trigeminal nerve that supplies mainly the upper molars, but it will send branches into the nasal cavity for sensory as well.
- the mucosa with parasympathetic and sympathetic innervation
102
What sinus is this?
Frontal Sinus, frontal bone is here too
103
What sinus is here?
The maxillary sinus which takes up a large space of the cheeks.
104
What is this?
The hard palate and it goes into the oral cavity
105
What is the maxillary sinus just above?
The molars
106
What is in the middle?
The nasal septum
107
What is the bone she is pointing to?
Nasal conchae on each side
108
What are these?
Ethmoidal air cells and the maxillary sinus will drain into the nasal cavity. Opening of the maxillary sinus is at the top.
109
What is this?
Nasal pharynx, is the space posterior to the nasal cavity
- Everything above the hard palatte is the nasopharynx
110
What area is below the hard palatte?
oropharnynx
111
What is the area between here?
Laryngopharynx
112
Where is the trachea and what does the epiglottis do
The epiglottis flops over the opening to close off the larngeal pharynx and to force food down into the esophagus.
113
What is this?
Esophagus
114
What parts of the pharynx is this showing?
posterior aspect of the pharynx from the oropharynx to the larynopharnyx
115
What is this pointing to?
Epiglottis and Larynx
116
What is this pointing to?
The Esophagus
117
Anterior view: what is this pointing to?
Hyoid bone, not a cartilage
118
What is the cartilage here?
Thyroid cartilage. Thyroid means shield
- incomplete at the back
119
What is this pointing to?
Laryngeal prominence, adam's apple
Female on top and male on bottom
120
What are the pointy things?
Greater horn on top and lesser horn on the bottom
121
What cartilage is this?
Cricoid cartilage
- is a complete cartilage ring
122
What is this?
The cricoid cartilage
123
What is this?
- sitting on top of the cricoid cartilage are two triangular cartilages which are arytenoid cartilages.
124
What is this?
Epiglottis, it is flexible, elastic cartilage while the others are hyaline cartilage which is much firmer
125
What is this?
Vocal cords
- vocal ligaments run from the vocal process of the arytenoid to the anterior aspect of the thyroid cartilage
126
What muscle is this?
Cricothyroid
- moves the thryoid cartilage anteriorly
- make the vocal cords much tighter = increase the pitch
- outiside of the thyroid cartilage.
127
What muscle is this?
Vocalis muscle or thyroarytenoid muscle
- decrease the pitch
128
What muscles are these?
Oblqiue: crisscrossing and transverse arytenoids
- these will draw the arytenoid cartilage closer together
- adduction
128
What is this muscle?
Posterior Cricoarytenoid
- abduct the vocal ligaments, widen
- increase volume
128
Innervation
Easy for the vagus nerve which runs behind it to split into the internal laryngeal and external laryngeal branch.
- External laryngeal nerve is for the muscle cricothyroid
- Internal laryngeal nerve is for the sensory to this area, branch of the vagus nerve
128
What muscle is this?
Lateral cricoarytenoid muscle. Attaches to th earytenoid and the cricoid cartilage down below. This is where it contracts
- adduction
128
What is this?
Trachea
- cartilage rings which are horse shoe shaped which is closed by the trachealis muscle which is a smooth muscle
- contract or expand that airway
128
What nerve is this?
Left Phrenic nerve going to the diaphragm
128
What nerve is this?
Right Phrenic nerve
128
What nerve is this?
- vagus nerve
- will go under the arch of the aorta and go back up as the recurrent laryngeal nerve
128
What artery is this?
Right subclavian artery
128
What nerve is this?
Recurrent laryngeal nerve
- that will supply the vocal cords excepts for the cricothyroid
128
What can extend here?
The pleural cavity can extend all the way here
128
What is this?
The hilum of the lungs. Pulmonary arteries, pulmonary veins, reflects on the anterior thoracic walls.
128
What is this?
The cardiac notch where the heart sits on the left lung
128
What is this?
The lingula on the left side
129
What are these impressions from?
The diaphragm
129
What is this?
Carina branch into primary bronchioles
129
What is the inner surface of the lung covered with?
The visceral pleura
129
What is this ligament called?
Pulmonary ligament. Point where the visceral pleura comes together and reflect onto the thoracic wall. Reflection point
129
What is the hole she is pointing to?
Pulmonary arteries
129
What vessels are these?
Pulmonary veins. Inferior and come back to the left atrium
130
What is this?
Pulmonary ligament. Reflection of the visceral pleura reflects on the thoracic wall. fold of tissue helps anchor the lungs to the chest of wall
131
Point to the pulmonary arteries, bronchi and pulmonary veins?
Red- pulmonary artery
Green - bronchi
Blue - pulmonary vein
132
What comes off of the arch of the aorta to supply the lungs with oxygenated blood?
Bronchial arteries
132
Label the fissures (right lung and left lung)
132
Name the lobes
133
What is this impression left by on the left lung?
The aorta
133
What is this impression at the top left by? which artery from the aorta?
The left common carotid artery
133
Where do the parasympathetic innervation come from for the lungs?
The vagus nerve
133
On the sagittal view, label the hard palate, soft palate, tongue and epiglottis.
On the sagittal view, label the extent of the nasopharynx, oropharynx and
laryngopharynx and sphenoid sinus
134
Label the ethmoid bone with conchae, Inferior nasal conchae cribriform plate
and vomer on the normal coronal ct of the head.
Label the maxillary, ethmoid, frontal and sphenoid sinuses on the coronal
(normal) and sagittal views of the head.
134
What is abnormal about the “Abnormal” coronal CT?
Give the anatomical rationale for this condition.
Sinusitis: When they're blocked (from a cold, allergies, or infection), mucus builds up inside.
This trapped fluid creates a perfect spot for germs like bacteria or viruses to grow, causing infection.
134
Question 1
External nares (nostrils)
Nasal cavity
Nasopharynx
Oropharynx
Laryngopharynx
Larynx
Trachea
Carina
Right main bronchus
134
Question 2
Why the bead is more likely to travel to the right bronchus:
Anatomical differences:
Right bronchus:
Wider in diameter.
Shorter length.
Nearly vertical angle (more in line with the trachea).
Left bronchus:
Narrower.
Longer.
Sharper angle (more horizontal, curving away from the trachea).
134
What is abnormal about the “Abnormal” image?
There appears to be a large pleural effusion (fluid in the pleural space) on the right side of the chest, compressing the lung. The lung tissue is pushed medially (toward the center), reducing lung volume.
The CT scan is at the mid-thoracic level, likely near the carina, as visible in the central airway and lung structures.
