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THERESPIRATORYSYSTEM THERESPIRATORYSYSTEM VISCERAOFTHORACICCAVITY VISCERAOFTHORACICCAVITY THERESPIRATORYSYSTEM Thethoraciccavityisdividedintothreecompartments: • Rightandle9pulmonarycaviBes,bilateralcompartments thatcontainthelungsandpleuraeandoccupythemajorityofthe thoraciccavity. • AcentralmediasBnum,acompartmentinterveningbetweenand completelyseparaFngthetwopulmonarycaviFes,whichcontains essenFallyallotherthoracicstructures:theheart,thoracicpartsof thegreatvessels,thoracicpartofthetrachea,esophagus,thymus, andotherstructures(e.g.,lymphnodes). PLEURAE THERESPIRATORYSYSTEM Eachlungisinvestedbyandenclosedinaserouspleuralsacthat consistsoftwoconBnuousmembranes:thevisceralpleura,which investsallsurfacesofthelungsformingtheirshinyoutersurface,and theparietalpleura,whichlinesthepulmonarycaviFes Thepleuralcavity-thepotenBalspacebetweenthelayers ofpleura-containsacapillarylayerofserouspleuralfluid,which lubricatesthepleuralsurfacesandallowsthelayersofpleuratoslide smoothlyovereachotherduringrespiraFon. Thevisceralpleura(pulmonarypleura)closelycoversthelungand adherestoallitssurfaces,includingthosewithinthehorizontaland obliquefissures. ThevisceralpleuraisconFnuouswiththeparietalpleuraatthehilum ofthelung,wherestructuresmakinguptherootofthelung(e.g., bronchusandpulmonaryvessels)enterandleavethelung. PLEURAE THERESPIRATORYSYSTEM TheparietalpleuralinesthepulmonarycaviFes,therebyadheringto thethoracicwall,mediasFnum,anddiaphragm. Theparietalpleuraconsistsofthreeparts: • costal, • mediasFnal, • diaphragmaFc • andthecervicalpleura. Thecostalpartoftheparietalpleura(costovertebralorcostalpleura) coverstheinternalsurfacesofthethoracicwall. Itisseparatedfromtheinternalsurfaceofthethoracicwall(sternum, ribsandcostalcarFlages,intercostalmusclesandmembranes,and sidesofthoracicvertebrae)byendothoracicfascia. PLEURAE THERESPIRATORYSYSTEM ThemediasBnalpartoftheparietalpleura(mediasFnalpleura)covers thelateralaspectsofthemediasFnum ThediaphragmaBcpartoftheparietalpleura(diaphragmaFc pleura)coversthesuperior(thoracic)surfaceofthediaphragmon eachsideofthemediasFnum,exceptalongitscostala.achments(origins) andwherethediaphragmisfusedtothepericardium Athin,moreelasFclayerofendothoracicfascia,thephrenicopleural fascia,connectsthediaphragmaFcpleurawiththemuscularfibersof thediaphragm Thecervicalpleuracoverstheapexofthelung-thepartofthelung extendingsuperiorlythroughthesuperiorthoracicapertureintothe rootoftheneck. LUNGS THERESPIRATORYSYSTEM ThelungsarethevitalorgansofrespiraFon.TheirmainfuncFonisto oxygenatethebloodbybringinginspiredairintocloserelaFonwith thevenousbloodinthepulmonarycapillaries. ThelungsareseparatedfromeachotherbythemediasBnum. Eachlunghas: • apex • base • twoorthreelobes • threesurfaces • threeborders LUNGS THERESPIRATORYSYSTEM Eachlunghas: anAPEX,thebluntsuperiorendofthelungascendingabovethelevel ofthe1stribintotherootoftheneck;theapexiscoveredbycervical pleura. ABASE,theconcaveinferiorsurfaceofthelung,oppositetheapex, resFngonandaccommodaFngtheipsilateraldomeofthediaphragm TWOORTHREELOBES,createdbyoneortwofissures. THREESURFACES(costal,mediasFnal,anddiaphragmaFc). THREEBORDERS(anterior,inferior,andposterior). LUNGS THERESPIRATORYSYSTEM TherightlungislargerandheavierthantheleQ Therightlungfeaturesrightobliqueandhorizontalfissuresthat divideitintothreerightlobes: • superior • middle • inferior. Thele9lunghasasingleleQobliquefissuredividingitintotwoleQ lobes: • superior • inferior. LUNGS THERESPIRATORYSYSTEM TheanteriorborderoftheleQlunghasadeepcardiacnotch Themostinferiorandanteriorpartofthesuperiorlobeintoathin, tongue-likeprocess,thelingulawhichextendsbelowthe cardiacnotch ThemediasBnalsurfaceofthelungisconcavebecauseitisrelatedto themiddlemediasFnum ThemediasBnalsurfaceincludesthehilum,whichreceivestheroot ofthelung. LUNGS THERESPIRATORYSYSTEM ThemediasBnumoftherightlung: • groovefortheesophagus • cardiacimpressionfortheheart • grooveforinferiorandsuperiorvenacava • grooveforazygosvein ThemediasBnumofthele9lung: • cardiacimpressionfortheheart • grooveforthearchoftheaortaandthedescendingaorta • smallerareafortheesophagus LUNGS THERESPIRATORYSYSTEM ThediaphragmaBcsurfaceofthelung,whichisalsoconcave,forms thebaseofthelung,whichrestsonthedomeofthediaphragm. Thebordersofthelung: • anterior • inferior • posterior TheanteriorborderofthelungiswherethecostalandmediasFnal surfacesmeetanteriorlyandoverlaptheheart. TheinferiorborderofthelungcircumscribesthediaphragmaFc surfaceofthelungandseparatesthissurfacefromthecostaland mediasFnalsurfaces. TheposteriorborderofthelungiswherethecostalandmediasFnal surfacesmeetposteriorly LUNGS THERESPIRATORYSYSTEM Therootsofthelungs–wherethelungsareaSachedtothe mediasFnum.AshorttubularcollecFonofstructuresthattogether aSachthelungtostructuresinthemediasFnum. Therootsofthelungscontains: • bronchiandassociatedbronchialvessels, • pulmonaryarteries, • superiorandinferiorpulmonaryveins, • pulmonaryplexusesofnerves(sympatheFc,parasympatheFc), • lymphaFcvessels Generally,thepulmonaryarteryissuperioratthehilum, thepulmonaryveinsareinferior,andthebronchiaresomewhat posteriorinposiFon. THERIGHTLUNGS THERESPIRATORYSYSTEM Therightlunghasthreelobesandtwofissures. Theobliquefissureseparatestheinferiorlobe(lowerlobe)fromthe superiorlobeandthemiddlelobeoftherightlung. Thehorizontalfissureseparatesthesuperiorlobe(upperlobe)from themiddlelobe. THELEFTLUNGS THERESPIRATORYSYSTEM Thele9lungissmallerthantherightlungandhastwolobes separatedbyanobliquefissure. TheobliquefissureoftheleQlungisslightlymoreobliquethanthe correspondingfissureoftherightlung. Inferiortotherootofthelung,thisconFnuitybetweenparietaland visceralpleuraformsthepulmonaryligament,extendingbetweenthe lungandthemediasFnum,immediatelyanteriortotheesophagus. LUNGS THERESPIRATORYSYSTEM InthemediasFnum,thevagusnervespassimmediatelyposteriorto therootsofthelungs,whilethephrenicnervespassimmediately anteriortothem. TRACHEOBRONCHIALTREE THERESPIRATORYSYSTEM TRACHEA Isapproximately12cminlengthandhas16to20incompletehyaline carBlaginousringsthatopenposteriorlytowardtheesophagusand preventthetracheafromcollapsing. BeginsattheinferiorborderofthecricoidcarBlage(C6)asa conFnuaFonofthelarynx. EndsbybifurcaBngintotherightandleQmainstembronchiatthe levelofthesternalangle(discbetweenT4andT5). TRACHEOBRONCHIALTREE THERESPIRATORYSYSTEM TRACHEA Hasthecarina,adownwardandbackwardprojecFonofthelast trachealcarFlage,whichliesatthelevelofthesternalangleandforms akeel-likeridgeseparaFngtheopeningsoftherightandleQmain bronchi. Carinamaybedistorted,widenedposteriorly,andimmobileinthe presenceofabronchogeniccarcinoma. MaybecompressedbyanaorFcarchaneurysm,agoiter,orthyroid tumors,causingdyspnea. TRACHEOBRONCHIALTREE THERESPIRATORYSYSTEM RIGHTBRONCHUS Therightmainbronchusiswider,shorter,andrunsmoreverBcally thantheleQmainbronchusasitpassesdirectlytothehilumofthe lung. LEFTBRONCHUS TheleQmainbronchuspassesinferolaterally,inferiortothearchof theaortaandanteriortotheesophagusandthoracicaorta,toreach thehilumofthelung. TRACHEOBRONCHIALTREE THERESPIRATORYSYSTEM BRONCHI Eachmainbronchusdividesintosecondarylobarbronchi: • twoontheleQ • threeontheright EachlobarbronchusdividesintoseveralterFarysegmentalbronchi thatsupplythebronchopulmonarysegments TRACHEOBRONCHIALTREE THERESPIRATORYSYSTEM Thebronchopulmonarysegmentsare: • Thelargestsubdivisionsofalobe • Pyramidal-shapedsegmentsofthelung,withtheirapicesfacingthe lungrootandtheirbasesatthepleuralsurface. • SeparatedfromadjacentsegmentsbyconnecFveFssuesepta. • SuppliedindependentlybyasegmentalbronchusandterFary branchofthepulmonaryartery. • Namedaccordingtothesegmentalbronchisupplyingthem • Drainedbyintersegmentalpartsofthepulmonaryveins • Usually18–20innumber(10intherightlung;8–10intheleQlung, dependingonthecombiningofsegments). • Surgicallyresectable THERESPIRATORYSYSTEM TRACHEOBRONCHIALTREE LOBARBRONCHI ê • segmentalbronchi ê • terminalbronchioles • conducFngbronchioles • respiratorybronchioles ê • pulmonaryalveolus • alveolarducts • alveolarsacs Bronchioleslack carFlagein theirwalls ConducFngbronchioles transportairbutlack glandsoralveoli. Thepulmonaryalveolusisthebasicstructural unitofgasexchangeinthelung. VASCULATUREOFLUNGSANDPLEURAE THERESPIRATORYSYSTEM Eachlunghasapulmonaryarterysupplyingbloodtoitandtwo pulmonaryveinsdrainingbloodfromit. Therightandle9pulmonaryarteriesarisefromthepulmonary trunkatthelevelofthesternalangle;theycarrylow-oxygen (“venous”)bloodtothelungsforoxygenaFon. Eachpulmonaryarterybecomespartoftherootofthecorresponding lunganddividessecondarylobararteriesandsegmentalarteries. Twopulmonaryveins,asuperiorandaninferiorpulmonary veinoneachside,carryoxygen-rich(“arterial”)bloodfrom correspondinglobesofeachlungtotheleQatriumoftheheart. VASCULATUREOFLUNGSANDPLEURAE THERESPIRATORYSYSTEM BronchialarteriessupplybloodfornutriFonofthestructuresmaking uptherootofthelungs,thesupporFngFssuesofthelungs,andthe visceralpleura. Thetwole9bronchialarteriesusuallyarisedirectlyfromthe thoracicaorta. Thesinglerightbronchialarterymayalsoarisedirectlyfromthe aorta. ThepulmonarylymphaBcplexusescommunicatefreely. ThesuperficialsubpleurallymphaBcplexusliesdeeptothevisceral pleuraanddrainsthelungparenchyma(Fssue)andvisceralpleura. VASCULATUREOFLUNGSANDPLEURAE THERESPIRATORYSYSTEM LymphaFcvesselsfromthissuperficialplexusdrainintothe bronchopulmonarylymphnodes. ThedeepbronchopulmonarylymphaBcplexusislocatedinthe submucosaofthebronchiandintheperibronchialconnecFveFssue. LymphaFcvesselsfromthisdeepplexusdraininiFallyintotheintrinsic pulmonarylymphnodes,locatedalongthelobarbronchi. Lymphfromthetracheobronchiallymphnodespassestotheright andleQbronchomediasFnallymphtrunks,themajorlymphconduits drainingthethoracicviscera Thesetrunksusuallyterminateoneachsideatthevenousangles (juncFonsofthesubclavianandinternaljugularveins). NERVESOFLUNGSANDPLEURAE THERESPIRATORYSYSTEM Thenervesofthelungsandvisceralpleuraarederivedfromthe pulmonaryplexusesanteriorand(mainly)posteriortotheroots ofthelungs Thesenervenetworkscontain: • parasympatheFc • sympatheFc • visceralafferentfibers TheparasympatheBcfibersconveyedtothepulmonaryplexusare presynapFcfibersfromthevagusnerve(CNX). ThesympatheBcfibersofthepulmonaryplexusesarepostsynapFc fibers. TheircellbodiesareintheparavertebralsympatheBcgangliaofthe sympatheBctrunks THERESPIRATORYSYSTEM NERVESOFLUNGSANDPLEURAE ThesympatheBcnervefibers dilatetheluminaofthebronchi andconstrictthepulmonary vessels. TheparasympatheBcfibers constrictthelumina,dilatethe pulmonaryvessels,andincrease glandularsecreFon. THERESPIRATORYSYSTEM RESPIRATION Isthevitalexchangeofoxygenandcarbondioxidethatoccursinthe lungs. Theair–bloodbarrierconsistsofalveolartypeIcells,basallamina, andcapillaryendothelialcells.ThealveolartypeIIcellssecrete surfactant. INSPIRATION THERESPIRATORYSYSTEM Occurswhentheribsandsternum(orthoraciccage)areelevatedby thefollowingmuscles: • thediaphragm • external,internal(interchondralpart),andinnermostintercostal • sternocleidomastoid • levatorcostarum • serratusanterior • scalenus • pectoralismajorandminor • serratusposteriorsuperiormuscles. INSPIRATION THERESPIRATORYSYSTEM Involvesthefollowingprocesses: 1.ContracFonoftheDiaphragm 2.EnlargementofthePleuralCaviFesandLungs 3.ForcedInspiraBon InvolvescontracFonoftheintercostalmusclesandelevaFonofthe ribs(superolateralmovement),withthesternummovinganteriorly likeabuckethandle.(Whenthehandleisraised,theconvexitymoves laterally.) Resultsinincreasedtransverseandanteroposteriordiametersofthe thoraciccavity. Theabdominalvolumeisdecreasedwithanincreasedabdominal pressure. EXPIRATION THERESPIRATORYSYSTEM Involvesthefollowingmuscles:themusclesoftheanteriorabdominal wall,internalintercostal(costalpart)muscles,andserratusposterior inferiormuscles. Involvesthefollowingprocesses: 1.OverallProcess 2.ElasFcRecoiloftheLungs 3.ForcedExpiraFon EXPIRATION THERESPIRATORYSYSTEM Involvesthefollowingprocesses: 1.OverallProcess InvolvesrelaxaFonofthediaphragm,theinternalintercostalmuscles (costalpart),andothermuscles;decreaseinthoracicvolume;and increaseintheintrathoracicpressure.Theabdominalpressureis decreased,andtheribsaredepressed. EXPIRATION THERESPIRATORYSYSTEM Involvesthefollowingprocesses: 1.OverallProcess 2.ElasBcRecoiloftheLungs ProducesasubatmosphericpressureinthepleuralcaviFes.Thus, muchoftheairisexpelled.(QuietexpiraFonisapassiveprocess causedbytheelasFcrecoilofthelungs,whereasquietinspiraFon resultsfromcontracFonofthediaphragm.) EXPIRATION THERESPIRATORYSYSTEM Involvesthefollowingprocesses: 1.OverallProcess 2.ElasFcRecoiloftheLungs 3.ForcedExpiraBon RequirescontracFonoftheanteriorabdominalmusclesandthe internalintercostals(costalpart).