1 RESPIRATORY SYSTEM dr. SOENANTO ROEWIJOKO, MS, SpA.

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RESPIRATORY RESPIRATORY SYSTEMSYSTEM

dr. SOENANTO ROEWIJOKO, MS, SpA

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THE RESPIRATORY SYSTEM

LUNGS SYSTEM OF TUBE

A. VENTILATION MECHANISM

- Thoracic cage

- Intercostal muscle

- Diaphragm

- Elastic & collagen (of the lungs)

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NASOFARING

PLICA VOCALIS

CONUS ELASTICUS

Tonsil

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2 PRINCIPLES REGION

A CONDUCTING PORTION

A RESPIRATORY PORTION

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• Nasal cavityNasal cavity

• NasopharynxNasopharynx

• LarynxLarynx

• TracheaTrachea

• BronchiBronchi

• BronchiolesBronchioles

• Terminal Terminal bronchiolesbronchioles

• Gas exchange:Gas exchange:

- Resp. - Resp. bronchiolesbronchioles

- Alveoli ducts- Alveoli ducts

- Alveoli- Alveoli

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2 MAIN FUNCTIONS OF 2 MAIN FUNCTIONS OF THE CONDUCTING PORTIONTHE CONDUCTING PORTION

• To provide a conduit through which air can To provide a conduit through which air can travel to and from lungstravel to and from lungs

• To condition the inspired air To condition the inspired air – CleansedCleansed– Moistened and warmedMoistened and warmed

by:by:– Respiratory ephiteliumRespiratory ephitelium– Mucous and serous glandsMucous and serous glands– A rich vascular networkA rich vascular network

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RESPIRATORY EPHITELIUMRESPIRATORY EPHITELIUMCiliated pseudostratified Ciliated pseudostratified

Columnar ephiteliumColumnar ephiteliumwithwith

Goblet cellsGoblet cells

5 Cells (with EM):5 Cells (with EM):

• Ciliated columnar cellsCiliated columnar cells

• Mucous goblet cellsMucous goblet cells

• Columnar brush cellsColumnar brush cells

• Basal cellsBasal cells

• Small granule cellsSmall granule cells

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NASAL CAVITY

VESTIBULE NASAL FOSSAE

• Nares (nostril)• Vibrissae• Sebaceous &

sweat glands

• Nasal septum• Conchae:

- sup, mid, inf.• Venous

plexuses (of Kiesselbach)

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OLFACTORY EPHITELIUM OLFACTORY EPHITELIUM ORGANIZATIONORGANIZATION

Modified pseudostratified columnar epith.Modified pseudostratified columnar epith.

• Bipolar neurons cellsBipolar neurons cells

• Sustentacular cellsSustentacular cells

• Basal cellsBasal cells

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MUCOUSSECRETION

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Mechanism of smellMechanism of smell

Odor molecules stimulate receptorsOdor molecules stimulate receptors

Transduction processTransduction process

Toward the central nervous systemToward the central nervous system

OLFACTORY EPHITELIUM OLFACTORY EPHITELIUM ORGANIZATIONORGANIZATION

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PARANASAL SINUSESPARANASAL SINUSES• FrontalFrontal

• MaxillaryMaxillary

• EthmoidEthmoid

• SphenoidSphenoid

• Thinner resp. epitheliumThinner resp. epithelium

• Few goblet cellsFew goblet cells

• Few small glandsFew small glands

• Thinner lamina propia Thinner lamina propia periost periost– Sinusitis : Sinusitis :

Inflammatory process of the sinusInflammatory process of the sinus

Acute

Chronic

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PHARYNXPHARYNX

• NasopharynxNasopharynx– Respiratory type epitheliumRespiratory type epithelium

• OropharynxOropharynx– Squamous type epitheliumSquamous type epithelium

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LARYNXLARYNX

Laryngeal cartilagesLaryngeal cartilages

• Hyaline cartilagesHyaline cartilages::- ThyroidThyroid- CricoidCricoid- ArytenoidArytenoid

• Elastic cartilagesElastic cartilages::- EpiglottisEpiglottis- Cuneiform, corniculateCuneiform, corniculate

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EpiglottisEpiglottis

• Lingual surfaceLingual surface– Stratified squamous epith.Stratified squamous epith.

• Laryngeal surfaceLaryngeal surface– Respiratory epith.Respiratory epith.– Mixed mucous and serous glandsMixed mucous and serous glands

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EPIGLOTTIS

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2 Pairs of Mucous Folds2 Pairs of Mucous Folds

• The upper pair:The upper pair:– False vocal cords: (vestibular folds)False vocal cords: (vestibular folds)

• The lower pair:The lower pair:– True vocal cords:True vocal cords:

•Vocal ligament (elastic fiber)Vocal ligament (elastic fiber)

•Stratified squoamous epith.Stratified squoamous epith.

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TRACHEATRACHEA

• Respiratory epith.Respiratory epith.• C-shape rings of hyaline cartilageC-shape rings of hyaline cartilage

(pars. cartilaginea)(pars. cartilaginea)• Pars membranacea:Pars membranacea:

– Fibroelastic ligamentFibroelastic ligament– Smooth muscleSmooth muscle– Mixed mucous-serous glandsMixed mucous-serous glands

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Bronchial treeBronchial tree

• Bronchi extra pulmonalBronchi extra pulmonal

• Bronchi intra pulmonalBronchi intra pulmonal

• BronchioliBronchioli

(terminal bronchioles)(terminal bronchioles)

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BronchiBronchi

• Folded appearance of the bronchial Folded appearance of the bronchial mucous (observed in histologic section)mucous (observed in histologic section)

• Respiratory epith.Respiratory epith.

• Mucous and serous glandMucous and serous gland

• Spirally arranged smooth muscleSpirally arranged smooth muscle

• Rings / isolated plate of hyaline Rings / isolated plate of hyaline cartilagecartilage

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BronchioleBronchiole

• Diameter of 5 mm/lessDiameter of 5 mm/less

• Ciliated pseudostratified columnar Ciliated pseudostratified columnar ciliated simply columnar / cuboidal ciliated simply columnar / cuboidal epith.epith.

• Smooth muscle + elastic fiber in the Smooth muscle + elastic fiber in the lamina proprialamina propria

• Have neither cartilage nor glands in Have neither cartilage nor glands in their mucous layertheir mucous layer

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BronchialeBronchiale AsthmaAsthma

• The musculatur (both the bronchi and the The musculatur (both the bronchi and the bronchioles) bronchioles) is under the control of the is under the control of the vagus nerve and the sympathetic N.S.vagus nerve and the sympathetic N.S.

Stimulation ofStimulation of

• The vagus The vagus contraction contraction

• The parasympathetic The parasympathetic relaxationrelaxation

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Asthma AttacksAsthma Attacks

• Dispnoe (increased airway resistance)Dispnoe (increased airway resistance)

• Wheezing soundsWheezing sounds– Decreases the diameter of the lumenDecreases the diameter of the lumen– Hypersecretion of the mucous / serous Hypersecretion of the mucous / serous

glands + goblet cellsglands + goblet cells

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Respiratory BronchiolesRespiratory Bronchioles

• Respiratory portionRespiratory portion

• Their walls Their walls numerous saccular alveoli numerous saccular alveoli

• Ciliated cuboidal epith.Ciliated cuboidal epith.

• Smooth muscle + elastic C.T.Smooth muscle + elastic C.T.

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Alveolar DuctsAlveolar Ducts

• Squamous alveolar cellsSquamous alveolar cells• Smooth muscle cellsSmooth muscle cells• Matrix of elastic and collagenMatrix of elastic and collagen

AtriaAtria

Alveolar sac.Alveolar sac.

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ALVEOLIALVEOLI

• Terminal portions of the bronchial treeTerminal portions of the bronchial tree• Inter alveolar septum:Inter alveolar septum:

– CapillariesCapillaries– FibroblastFibroblast– Elastic and collagen fibersElastic and collagen fibers– MacrophagesMacrophages

• Blood:Blood:– Air barrierAir barrier– Cytoplasm of the alveolar cellsCytoplasm of the alveolar cells– Fused basal laminaeFused basal laminae– Cytoplasm of the endothelial (continuos Cytoplasm of the endothelial (continuos

type)type)

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2 TYPE OF ALVEOLAR CELLS

Type I cells

(squamous alveolar/

Pneumocyte type I)

Type II cells

(Septal cells/

Pneumocyte type II)

• Thin/squamous • Permeable to gases

• Cuboidal• Vesicular cytoplasm• Secretory cells

Pulmonary surfactant (to lower alveolar surface tension)

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ALVEOLAR PORESALVEOLAR PORES

• 10-15 10-15 m in diameterm in diameter

• Connecting neighboring alveoliConnecting neighboring alveoli

• Equalize pressure in the alveoliEqualize pressure in the alveoli

• Enable the collateral circulationEnable the collateral circulation

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PLEURAPLEURA

• Serous membrane covering the lungSerous membrane covering the lung• Parietal and visceral layerParietal and visceral layer• Mesothelial cellsMesothelial cells• Connective tissue (collagen + elastic)Connective tissue (collagen + elastic)• Pleural cavity + lubricantPleural cavity + lubricant• PleuricyPleuricy• PneumothoraxPneumothorax• Pleural effusion / haemothoraxPleural effusion / haemothorax

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DEFENSE MECHANISMDEFENSE MECHANISM

• Vibrissae (screen)Vibrissae (screen)

• Mucous-coated ciliated epith. (traped)Mucous-coated ciliated epith. (traped)

• Cough reflex (expectoration)Cough reflex (expectoration)

• Alveolar macrophagesAlveolar macrophages

• Lymphoid tissuesLymphoid tissues