Respiratory anatomy and histology

• True ribs
• 1-7
Ribs that have costal cartilage directly attaching them to sternum
• Name?
• Which rib numbers?

Rib 2
Which rib attaches to the sternal angle?

• False ribs
• 8-10
Ribs that have an indirect connection to the sternum. Their cartilages are joined to the cartilage of the rib above
• Name?
• Which rib numbers?

costal margin
Joined costal cartilages of the false ribs together with the 7th rib

• Floating ribs
• 11 and 12
Ribs that have no attachment to the sternum
• Name?
• Which rib numbers?

Has grooves for the subclavian vessels and scalene tubercle
How does the first rib differ from the others?

• costovertebral joint
• 2
• costovertebral joint
• 2
Synovial joint “A”
• Name?
• Does this articulate with 1 or 2 vertebral bodies?

• costotransverse joint
• 1
• costotransverse joint
• 1
Synovial joint “B”
• Name?
• Does this articulate with 1 or 2 vertebral bodies?

T5-9
Body of sternum is at the level of which vertebral bodies?

T10
Xiphoid process is located at level of which vertebral body?

• Inspiration
• Expiration
Diaphragm is most important muscle of respiration
• contracts during _______
• relaxes during _______

Phrenic nerve
Diaphragm contraction is mediated by what nerve?

• External intercostal during inspiration
• Internal and innermost intercostal during expiration
Intercostal muscles are involved in respiration
• Which muscles are active during inspiration?
• Which muscles are active during expiration?

• Lift the upper thorax
• Raise intraabdominal pressure
Accessory muscles of respiration
• How do muscles that assist in inspiration increase the thoracic cavity?
• How do muscles that assist in expiration decrease thoracic cavity?

Pneumothorax
Condition when air enters pleural cavity, causing collapse of the lung

Cupula (Cervical pleura)
Division of parietal pleura that extends above the first rib into the neck

Costophrenic angle
Costophrenic angle
What is the black arrow pointing to?

Pulmonary ligament
Pulmonary ligament
What is the red arrow pointing to?

Costodiaphragmatic recess
• ribs 6-8
• ribs 8-10
• ribs 10-12
Costodiaphragmatic recess
• ribs 6-8
• ribs 8-10
• ribs 10-12
Blue area under lung
• Location anteriorly
• Location at midaxillary line
• Location posteriorly

• General sensory nerve fibers (from intercostal, phrenic, etc)
• Pain is sharp and localized
• What innervates the parietal pleura?
• How is pain in the parietal pleura perceived?

• Autonomic innervation of lungs
• unconscious sensation or reflexes
• What innervates the visceral pleura?
• What kind of sensory information is carried by these nerves?

• Shoulder
• Pain sensation of the diaphragmatic pleura is carried by the phrenic nerve, which carries branches of spinal nerves C3,4,5. Same segments of the cervical plexus form the supraclavicular nerves
• Where does pain from the diaphragmatic pleura refer to?
• Why is this?

Left
Left
Is this the hilum of the right lung or left lung?

Pulmonary veins
Which hilum structure is generally most anterior and inferior?

• Anterior
• Superior
Where is the pulmonary artery in relation to the bronchus in the:
• Right lung
• Left lung

Pulmonary artery
Pulmonary artery
6

6th
The oblique fissure roughly follows which rib?

Right 4th rib
The horizontal fissure roughly follows which rib?

• SVC and arch of azygos vein
• cardiac area (RA and RV)
• esophagus
What mediastinal structures are immediately medial to the right lung?

• Aorta
• LV
What mediastinal structures are immediately medial to the left lung?

Respiratory and olfactory
What are the two types of epithelia that can be found in the nasal cavity?

Olfactory epithelium (lots of vessels, nerves, and thick layer of bipolar cells)
Olfactory epithelium (lots of vessels, nerves, and thick layer of bipolar cells)
What epithelium is this? how can you tell?

Bowman (olfactory) glands
Serous glands in the olfactory epithelium that play a role in olfaction

Bowman gland
Bowman gland
A

• Capillaries near the epithelium of conducting zone. Travels opposite direction of air flow
• Water released by small seromucous glands
• What warms inhaled ambient air?
• What humidifies inhaled ambient air?

Larynx (true and false vocal cord)
Larynx (true and false vocal cord)
Where in the airway is this found in?

• Vestibular folds (false cords)
• respiratory epithelium
• Vestibular folds (false cords)
• respiratory epithelium
• What is A?
• What is the epithelium at the beginning of the vestibule (D)?

• True vocal cord
• Vocalis muscle (striated skeletal)
• Stratified squamous
• Protect mucosa from abrasion
• True vocal cord
• Vocalis muscle (striated skeletal)
• Stratified squamous
• Protect mucosa from abrasion
• What is B?
• H?
• Epithelium in E?
• What is the function of epithelium in E?

• stratified squamous
• respiratory
• stratified squamous
• respiratory
Epiglottis
• Epithelium on oral side?
• Epithelium on respiratory side?

• Dense regular elastic connective tissue
• Vocal folds (“true vocal cords”)
What is the vocal ligament made out of and where is it located?

• Wider
• Shorter
• More vertical
Contrast the right and left main bronchus. Compared to the left bronchus, the right bronchus is:
• Diameter?
• Length?
• Orientation?

Respiratory epithelium
Epithelium of trachea

Trachea
Which part of the airway has C-shaped rings of hyaline cartilage

Trachealis muscle (smooth muscle)
Bridges the two open ends of hyaline cartilage rings on the posterior side of trachea

Main bronchi–lobar bronchi–segmental bronchi–terminal bronchiole–respiratory bronchiole–alveolar duct–alveolar sac
List the different generations of bronchial passages of the bronchopulmonary tree. Beginning with the main bronchi and ending with the alveolar sac

Right (wider, shorter, more vertical orientation) mostly in bronchus intermedius
Which main bronchi are aspirated objects more likely to become lodged and why

1. subpleural or interlobular lymphatic plexus
2. Deep lymphatic plexus
3. Hilar nodes
4. tracheobronchial nodes
5. Bronchomediastinal trunk
6. Lymphatic duct/thoracic duct
Describe the drainage of lymph in the lungs

Bronchus intermedius
Branch of the right main bronchi that further branches into the middle and lower lobar bronchi. A lot of aspirated objects get lodged here

Bronchi (cartilage rings become isolated plates of overlapping hyaline cartilage. spirally arranged smooth muscle)
Bronchi (cartilage rings become isolated plates of overlapping hyaline cartilage. spirally arranged smooth muscle)
This is what part of the airway?

Cartilage and glands
What structures are not found in bronchioles that can be found in upper airway structures?

Bronchiole (no cartilage. instead, surrounded by dense CT and smooth muscle)
Bronchiole (no cartilage. instead, surrounded by dense CT and smooth muscle)
What is structure B?

Terminal and respiratory bronchioles
Terminal and respiratory bronchioles
This is a transition of what two airway structures?

Acinus
The unit served by 1 terminal bronchiole

Clara cells
Exocrine bronchiolar cells that secrete surfactant

Mucociliary escalator
Mucus secreted in bronchial tree and trachea traps particles while cilia clears the material away. What is this function of the airway?

Respiratory bronchiole (with smooth muscle tufts and surrounded by alveoli)
Respiratory bronchiole (with smooth muscle tufts and surrounded by alveoli)
What part of the airway is the pen pointing to? How can you tell?

bronchovascular bundle
What aspect of lung anatomy ensures adequate matching of ventilation and perfusion?

• Terminal bronchiole 
• Conducting (end of it)
• Terminal bronchiole
• Conducting (end of it)
The upper half of the picture is what airway structure? Is this structure part of the conducting or respiratory zone?

Bronchioles still have it but starting at the alveolar ducts, there is no longer a respiratory epithelium
Where along the airway does the respiratory epithelium terminate?

Capillary
Capillary
3

Type II alveolar epithelial cell (cuboidal)
Type II alveolar epithelial cell (cuboidal)
1

Dust cell (alveolar macrophage)
Dust cell (alveolar macrophage)
2

Type I alveolar epithelial cell (squamous-makes up bulk surface area of alveolar space)
Type I alveolar epithelial cell (squamous-makes up bulk surface area of alveolar space)
3

Repopulate alveolar surface following injury by giving rise to Type I epithelial cells
Purpose of Type II alveolar epithelial cells

Pores of Kohn
Channels between adjacent alveoli that provide routes for collateral airflow (along with fluid movement, phagocyte migration, and bacterial spread)

• Dense network of capillaries that forms a nearly continuous envelope around the alveoli.
• Increase diffusion rate
Why is the surface area of the alveolar-capillary barrier so large and what is the purpose of that?

• Pores of Kohn
• Interdependence (alveoli exerts traction on neighboring alveoli to keep them open)
What are two mechanisms that prevent alveoli from collapsing (atelectasis)?

Alveolar capillaries do not have muscle support (only have thin basement membrane)
What is a major structural difference between alveolar capillaries and systemic capillaries?

• Large tongue and epiglottis location predisposes infants to nasal breathing
• Laryngeal structures are floppy and muscle activity is immature, predisposing airway to narrowing
How do pediatric upper airways differ from adults?

• Same number of airways but smaller, increasing resistance to airflow
• Less smooth muscle, lack cartilaginous support
How do pediatric lower airways differ from adults?

• Alveoli do not form until 33 weeks gestation
• Lack pores of Kohn, predisposing to atelectasis
How do pediatric alveolar spaces differ from adults?

Which of the following organs is not part of the lower respiratory system? A) oropharynx B) trachea C) larynx D) bronchi E) alveoli A oropharynx The epiglottis is part of the _____ and covers the glottis. A) trachea B) oropharynx …

What is the function of the respiratory system? To supply the body with oxygen and remove carbon dioxide. What are the 4 main processes that make up respiration? Ventilation, external respiration, transport, and internal respiration. WE WILL WRITE A CUSTOM …

Abscess Risk factors Smoking (70-80%) Immunodeficiency Bronchiectasis Malignancy (lung cancer in 12%) COPD Steroids Aspiration Decreased level of consciousness Seizures Alcohol abuse Swallowing disorders Mechanical ventilationImaging Thick, irregular wall Thickness > 15 mm suggests neoplasm Spherical Small contact with chest …

Respiratory Diagnostic and Therapeutic Procedures: Overview Respiratory diagnostic procedures are used to evaluate a client’s respiratory status by checking indicators such as the oxygenation of the blood, lung functioning, and the integrity of the airway. Respiratory Diagnostic and Therapeutic Procedures: …

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