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The EAR External Ear •Helix •Tragus •Lobule •Cartilaginous bony parts of •external acoustic meatus •Tympanic membrane Middle Ear •Ossicles (malleus, incus and staples •Middle ear/tympanic cavity •Pharyngotympanic/ eustachian tube •Aditus to mastoid antrum •Oval window (fenestra vestibule) •Round window (fenestra cochleae) Internal Ear Cochlea Vestibule Semicircular canals Internal acoustic meatus Nasal cavity and pharynx Nose •Superior, middle and inferior conchae •Superior, middle and inferior meatuses •Vestible Pharynx •Nasopharynx – opening of Eustachian tube •Oropharynx •Laryngopharyx •Epiglottis Note: Olfactory region of nasal cavity is the epithelium lining superior conchae Trachea and bronchi • The trachea bifurcates into R & L primary bronchi at the level of the sternal angle, the inside of the bifurcation is called the carina • R is shorter, wider, and takes a more direct path to hilum of R lung • Note its relationship to the oesophagus, aortic arch, thoracic aorta and Vena Cava Pleurae, cavities and mediastinum • Parietal pleura – Costal pleura – Diaphragmatic pleura – Cupula (cervical) pleura – Mediastinal pleura • Visceral Pleura • Costodiaphragmatic/ costophrenic recesses • Costomediastinal recesses • Mediastinum- potential space between 2 pleural cavities (that contain lungs), sternum and thoracic vertebra, that contains heart etc. NOTE: no sensory innervation of visceral pleura. Phrenic and intercostal nerve innervate perietal pleura. : pleura, pericardium, peritoneum and tunica vaginalis of the testis are all mesothelium • • • • • • Lungs The lungs are suspended freely, only attached at the hilum Apex and Base Margins- anterior and inferior Surfaces-costal, medial, diaphragmatic R lung- 3 lobes, 2 fissures L lung- 2 lobes, 1 fissure, lingula and cardiac impression Systemic Blood Supply • • • • • • two left bronchial arteries arise directly from the thoracic aorta a single right bronchial artery may also arise directly from the aorta but more commonly from the left superior bronchial artery or from one of the upper posterior intercostals arteries. bronchial arteries branches supply the upper oesophagus, the main bronchi respiratory bronchioles anastomose with branches of the pulmonary arteries The two bronchial veins drain only part of the blood supplied to the lungs by the bronchial arteries, primarily that near the more proximal part of the roots of the lungs The right bronchial vein drains into the azygos vein, and the left bronchial vein drains into the accessory hemiazygos vein or the left superior intercostal vein. Bronchial veins also receive some blood from esophageal veins. NOTE: parietal pleura supplied by arteries supply thoracic wall Pulmonary Blood Supply • Each lung has 1 pulmonary artery and 2 pulmonary veins • The pulmonary trunk right and left pulmonary arteries (2)secondary lobar arteries (5) tertiary segmental arteries • right and left superior lobar arteries arise, before entering the hilum • The arteries and bronchi run parallel course • Four pulmonary veins, a superior and an inferior pulmonary vein on each side, carries blood to the left atrium of the heart. – The middle lobe vein joins with the right superior pulmonary vein. • Segmental veins lobar veins (5) pulmonary veins (4) • The pulmonary veins run independently Roots of the Lung The lungs are attached to the mediastinum by the roots of the lungs the bronchi, pulmonary arteries, superior and inferior pulmonary veins, the pulmonary plexuses of nerves (sympathetic, parasympathetic, and visceral afferent fibers), and lymphatic Lymphatic drainageSuperficial plexus: lung tissue and visceral pleura bronchopulmonary (hilar) lymph nodes Deep Plexus: root of lung pulmonary lymph nodes bronchopulmonary (hilar) lymph nodes Then together bronchomediastinal lymph trunks junction of subclavian and internal jugular veins Nerves of lungs and visceral pleura • The right and left pulmonary plexuses, anterior and posterior to the roots of the lungs, receive sympathetic contributions from the right and left sympathetic trunks and parasympathetic contributions from the right and left vagus nerves (CN X). • After contributing to the posterior pulmonary plexus, the vagus nerves continue inferiorly and become part of the esophageal plexus, often losing their identity and then reforming as anterior and posterior vagal trunks. • Branches of the pulmonary plexuses accompany pulmonary arteries and especially bronchi to and within the lungs. Thoracic Wall • • • • • The intercostal muscles – External intercostal V – Internal intercostal /\ – Innermost intercostal serratus posterior levatores costarum subcostal (Crosses intercostal spaces) transversus thoracis (radiate from posterior aspect of inferior sternum) Respiratory Histological Features summary Bronchi Conducting Respiratory Alveoli zone zone Epithelium Ciliated pseudostratified Hyaline cartilage Smooth Muscle Goblet Cells Columnar Ciliated columbnar or cuboidal Simple squamous CPlates Shaped ++ ++++ Absent Absent + - ++++ ++ - +++ The Heart •Ventricle wall thickness>atria, L ventricle> R •Auricles- ear-like flaps of atrial walls R atrium- 4 openings IVC, SVC and coronary sinus, and atrioventricular orifice –Fossa ovalis, remanent of foramen ovale in fetus, oval depression in interarial septum R ventricle2 openings R atroventricular orifice and pulmonary trunk •R Atroventricular valve- guards AV orifice, is tricuspid, connects to chordae tendineae, with then attach to papillary muscles in ventricular wall • L atrium- 5 openings- 4 pulmonary veins and L AV orifice • L Atroventricular orifice is guarded by the mitral valve, which is bicuspid otherwise same R • L ventricle- 2 openings- AV orifice and aortic Valves • Aortic and pulmonary valves are semilunar • Pulmonary veins do not have valves Coronary Arteries • R and L coronary arteries arise from aorta, just after semilunar valve • R coronary artery supplies R atrium and ventricle, SA and AV nodes and small part of IV septum and L ventricle (none of the L atrium) • L coronary artery supplies L atrium and ventricle, most of IV septum including Bundle of His and Branches and small part of R ventricle (none of R atrium) A cross-section of the right and left ventricles demonstrates the most common pattern of distribution of blood from the RCA (red) and LCA (pink) to the ventricular walls and IVS. • R Coronary sinuatrial nodal branch R marginal Branch Continues posteriorly AV nodal branch posterior IV branch • L coronary artery circumflex branch L marginal artery Anterior IV branch lateral IV branch Note: Large vessels also need their own blood supply- vessels supplying large vessels are called vasa vasorum Venous drainage Venous drainage of the Heart is via the coronary sinus, which empties into the R atrium. The great, middle, and small cardiac veins; the oblique vein of the left atrium; and the left posterior ventricular vein are the main vessels draining into the coronary sinus Conducting system of heart • generates and transmits the impulses that produce the coordinated contractions of the cardiac cycle • SA node- anterolaterally just deep to epicardium at junction of SVC and R atrium - initiates and regulates the impulses for the contractions of the heart • The AV - posterior inferior region of interatrial septum near opening of coronary sinus -distributes the signal to the ventricles •Impulse travels down Bundle of His, which divides into Right, Left anterior and Left posterior (often not shown) bundles, before dividing into Purkinje Fibres which travel into the myocardium and coordinate contraction Cardiac Cycle Cardiovascular Histology •Common three layered structure for vessels of circulatory system •TUNICA INTIMA- endothelium , basement membrane and collagenous support •TUNICA MEDIA- muscle layer, with elastic tissue •TUNICA ADVENTITIA- outer supporting layer with collagen and sometimes vessels •In Heart- given special names ENDOCARDIUM, MYOCARDIUM & EPICARDIUM • Subendothelial layer thickest in atria • Myocardium thickest in ventricles • Epicardium is visceral layer of pericardium Ventricular Wall Ventricular Wall…. Section of IV septum • • • • 3 Main Types of arteries- Elastic, Muscular, Arterioles Elastic Arteries incl. Aorta, have a lot elastic fibres in media layer for normalisation of pressure More distally there is less elastin and more smooth muscle to enable control of BP with lumen size- Muscular Arteries Arterioles consist of only an intima, a fine internal elastic lamina and 1-2 layer media. Aorta- note thick Media VEINS • • • • Layers less obvious Lumen noticeably larger Amount smooth muscle increases with size of lumen Valves in large veins IVC