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Principles of Anatomy
and Physiology
Thirteenth Edition
Gerard J. Tortora • Bryan H. Derrickson
Chapter 23
The Respiratory System
Copyright © 2012 by John Wiley & Sons, Inc.
Nose
Nasal cavity
Pharynx
Larynx
Trachea
Right primary
bronchus
Lungs
(a) Anterior view showing organs of respiration
Right common carotid artery
Trachea
Right subclavian artery
Brachiocephalic artery
Superior vena cava
Trachea
Thyroid gland
Subclavian artery
Phrenic nerve
Left common
carotid artery
Arch of aorta
Rib (cut)
Left lung
Right lung
Heart in pericardial
sac
Liver
Diaphragm
(b) Anterior view of lungs and heart after removal
of anterolateral thoracic wall and pleura
Bony framework:
Frontal bone
Nasal bones
Maxilla
Cartilaginous framework:
Lateral nasal cartilages
Septal cartilage
Alar cartilage
Dense fibrous
connective and
adipose tissue
(a) Anterolateral view of external portion of nose
showing cartilaginous and bony framework
Parasagittal
Nasal meatuses
plane
Superior
Middle
Inferior
Frontal sinus
Frontal bone
Sphenoid bone
Sphenoidal sinus
Internal naris
Pharyngeal tonsil
Olfactory epithelium
NASOPHARYNX
Nasal vestibule
External naris
Maxilla
Oral cavity
Palatine bone
Soft palate
Lingual tonsil
Mandible
Hyoid bone
Superior
Middle
Inferior
Opening of
auditory tube
Uvula
Palatine tonsil
Fauces
OROPHARYNX
Epiglottis
LARYNGOPHARYNX
Esophagus
Trachea
(b) Parasagittal section of left side of head and neck
showing location of respiratory structures
Tongue
Ventricular fold
(false vocal cord)
Vocal fold (true vocal cord)
Larynx
Thyroid cartilage
Cricoid cartilage
Thyroid gland
Nasal
conchae
Regions of the pharynx
Nasopharynx
Oropharynx
Laryngopharynx
Frontal plane
Periorbital fat
View
Ethmoidal cell
Eyeball
Superior nasal
concha
Middle nasal
concha
Nasal septum:
Perpendicular
plate of ethmoid
Inferior nasal
concha
Vomer
Maxillary
sinus
Hard palate
(c) Frontal section showing conchae
1
3
4
2
Anterior view
1. Root: Superior attachment of the nose to the frontal bone
2. Apex: Tip of nose
3. Bridge: Bony framework of nose formed by nasal bones
4. External naris: Nostril; external opening into nasal cavity
Larynx
Thyroid gland
(a) Anterior view
Epiglottis
Hyoid bone
Thyrohyoid membrane
Epiglottis:
Leaf
Stem
Corniculate cartilage
Thyroid cartilage
(Adam’s apple)
Arytenoid cartilage
Cricothyroid ligament
Cricoid cartilage
Cricotracheal ligament
Thyroid gland
Parathyroid glands (4)
Tracheal cartilage
(b) Posterior view
Epiglottis
Hyoid bone
Thyrohyoid membrane
Thyrohyoid membrane
Cuneiform cartilage
Fat body
Corniculate cartilage
Ventricular fold
(false vocal cord)
Arytenoid cartilage
Thyroid cartilage
Vocal fold
(true vocal cord)
Laryngeal sinus
Cricoid cartilage
Cricothyroid ligament
Cricotracheal ligament
Tracheal cartilage
Sagittal
plane
(c) Sagittal section
Epiglottic cartilage
Hyoid bone
Thyrohyoid membrane
Cavity
of larynx
Rima vestibuli
Laryngeal sinus
Thyroid cartilage
Rima glottidis
Vestibule of larynx
Thyrohyoid muscle
Vestibular fold
Vocal fold
Vocalis muscle
Inferior pharyngeal
constrictor muscle
Sternothyroid muscle
Cricoid cartilage
Cricotracheal ligament
Cavity
of larynx
Lateral cricoarytenoid
muscle
Cricothyroid muscle
First tracheal cartilage
Cricothyroid ligaments
Trachea
Thyroid gland
(d) Frontal section
Parathyroid gland
Thyroid cartilage
Cricoid cartilage
Vocal fold
Arytenoid cartilage
Superior view of
cartilages and muscles
Posterior
cricoarytenoid muscle
View through a
laryngoscope
(a) Movement of vocal folds apart (abduction)
Lateral
cricoarytenoid
muscle
(b) Movement of vocal folds together (adduction)
Tongue
Epiglottis
Glottis:
Vocal folds
(true vocal cords)
Rima glottidis
Ventricular folds
(false vocal cords)
Cuneiform cartilage
Corniculate cartilage
View
Larynx
Epiglottis
Vocal folds
(true vocal cords)
Rima glottidis
Cuneiform cartilage
Ventricular folds
(false vocal cords)
Corniculate cartilage
(c) Superior view
Esophagus Trachea
Transverse
plane
ANTERIOR
Cartilage of trachea
Right lateral lobe
of thyroid gland
Left lateral
lobe of
thyroid gland
Fibromuscular
membrane of
trachea (contains
trachealis muscle)
Esophagus
POSTERIOR
Superior view of transverse section of thyroid gland, trachea, and esophagus
BRANCHING OF
BRONCHIAL TREE
Larynx
Trachea
Trachea
Primary bronchi
Secondary bronchi
Left lung
Right lung
Tertiary bronchi
Visceral pleura
Bronchioles
Parietal pleura
Terminal bronchioles
Pleural cavity
Location of carina
Right primary
bronchus
Left primary bronchus
Left secondary bronchus
Right secondary
bronchus
Left tertiary bronchus
Left bronchiole
Right tertiary
bronchus
Right bronchiole
Right terminal
bronchiole
Left terminal bronchiole
Cardiac notch
Anterior view
Diaphragm
Transverse
plane
Sternum
Left lung
View
Visceral pleura
Ascending aorta
Superior vena cava
Pulmonary arteries
Parietal pleura
Pulmonary vein
Right lung
Esophagus
Pleural cavity
Thoracic aorta
Body of T4
Spinal cord
LATERAL
MEDIAL
POSTERIOR
Inferior view of transverse section through thoracic cavity
showing pleural cavity and pleural membranes
First rib
Apex of lung
Left lung
Base of lung
Pleural cavity
Pleura
(a) Anterior view of lungs and pleurae in thorax
View (b)
View (c)
Apex
Superior lobe
ANTERIOR
Oblique fissure
Inferior lobe
Horizontal
fissure
Oblique fissure
Cardiac notch
Inferior lobe
Middle lobe
POSTERIOR
POSTERIOR
Base
(b) Lateral view of right lung
(c) Lateral view of left lung
View (d)
View (e)
Apex
Superior lobe
Oblique fissure
POSTERIOR
Hilum and its
contents (root)
Horizontal
fissure
Inferior lobe
Middle lobe
Oblique fissure
ANTERIOR
Base
(d) Medial view of right lung
Cardiac notch
ANTERIOR
(e) Medial view of left lung
MICROSCOPIC
AIRWAYS
Terminal bronchioles
Terminal
bronchiole
Respiratory bronchioles
Alveolar ducts
Pulmonary
Alveolar sacs
arteriole
Lymphatic
Alveoli
vessel
Respiratory bronchiole
Alveoli
Pulmonary
venule
Elastic
connective
tissue
Pulmonary
capillary
Visceral
pleura
Alveolar ducts
Alveolar sac
Alveoli
(a) Diagram of portion of lobule of lung
Terminal bronchiole
Blood vessel
Respiratory bronchiole
Alveolar ducts
Alveoli
Alveolar sacs
Visceral pleura
LM
about 30x
(b) Lung lobule
Monocyte
Reticular fiber
Elastic fiber
Type II alveolar
(septal) cell
Respiratory
membrane
Alveolus
Type I alveolar
cell
Diffusion
of O2
Diffusion
of CO2
Alveolar
macrophage (dust cell)
Alveolus
Red blood cell
in pulmonary capillary
Red blood cell
Capillary endothelium
Capillary basement
membrane
Epithelial basement
membrane
Type I alveolar cell
Interstitial space
Alveolar fluid with surfactant
(a) Section through alveolus showing cellular components
(b) Details of respiratory membrane
Alveolar macrophage
(dust cell)
Alveolus
Type II alveolar
(septal) cell
Type I alveolar (squamous
pulmonary epithelial) cell
Alveolus
LM 1000x
(c) Details of several alveoli
Piston
Volume = 1 liter
Pressure = 1 atm
Pressure
gauge
Volume = 1/2 liter
Pressure = 2 atm
MUSCLES OF INHALATION
MUSCLES OF EXHALATION
Sternocleidomastoid
Scalenes
Internal intercostals
External intercostals
Diaphragm
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
(a) Muscles of inhalation and their actions (left);
muscles of exhalation and their actions (right)
Sternum:
Exhalation
Inhalation
Diaphragm:
Exhalation
Inhalation
(b) Changes in size of thoracic cavity
during inhalation and exhalation
(c) During inhalation, the ribs move upward
and outward like the handle on a bucket
Atmospheric pressure = 760 mmHg
1. At rest (diaphragm relaxed)
Atmospheric pressure = 760 mmHg
Alveolar
pressure =
760 mmHg
Alveolar pressure =
758 mmHg
Intrapleural
pressure =
756 mmHg
Intrapleural pressure =
754 mmHg
2. During inhalation (diaphragm contracting)
Atmospheric pressure = 760 mmHg
Alveolar pressure =
762 mmHg
Intrapleural pressure =
756 mmHg
3. During exhalation (diaphragm relaxing)
Alveolar pressure
increases to 762 mmHg
During normal quiet inhalation,
the diaphragm and external
intercostals contract. During
labored inhalation,
sternocleidomastoid, scalenes, and
pectoralis minor also contract.
Atmospheric pressure
is about 760 mmHg
at sea level
Thoracic
cavity increases
in size and volume of
lungs expands
Alveolar pressure
decreases to 758 mmHg
(a) Inhalation
During normal quiet
exhalation, diaphragm and
external intercostals relax.
During forceful exhalation,
abdominal and internal
intercostal muscles contract.
Thoracic cavity
decreases in size
and lungs recoil
(b) Exhalation
6000 mL
Inhalation
5000 mL
4000 mL
3000 mL
2000 mL
1000 mL
INSPIRATORY
RESERVE
VOLUME
3100 mL
(1900 mL)
INSPIRATORY
CAPACITY
3600 mL
(2400 mL)
Exhalation
VITAL
CAPACITY
4800 mL
(3100 mL)
TOTAL
LUNG
CAPACITY
6000 mL
(4200 mL)
TIDAL
VOLUME 500 mL
EXPIRATORY
RESERVE
VOLUME
1200 mL
(700 mL)
End of
record
RESIDUAL
VOLUME
1200 mL
(1100 mL)
LUNG VOLUMES
Start of
record
FUNCTIONAL
RESIDUAL
CAPACITY
2400 mL
(1800 mL)
LUNG CAPACITIES
CO2 exhaled
O2 inhaled
Atmospheric air:
PO2 = 159 mmHg
PCO2 = 0.3 mmHg
Alveoli
Alveolar air:
PO2 = 105 mmHg
PCO2 = 40 mmHg
CO2 O
2
Pulmonary capillaries
To lungs
(a) External respiration:
pulmonary gas
exchange
To left atrium
Deoxygenated blood:
PO2 = 40 mmHg
PCO2 = 45 mmHg
Oxygenated blood:
PO2 = 100 mmHg
PCO2 = 40 mmHg
To right atrium
To tissue cells
(b) Internal respiration:
systemic gas
exchange
Systemic capillaries
CO2
O2
Systemic tissue cells:
PO2 = 40 mmHg
PCO2 = 45 mmHg
Transport of CO2
7% dissolved in plasma
23% as Hb-CO2
70% as HCO3–
7%
Alveoli
CO2 O2
23%
70%
1.5%
CO2 + Hb
98.5%
O2
(dissolved)
HCO3–
Hb–CO2
Hb
(a) External respiration:
pulmonary gas
exchange
CO2
(dissolved)
To lungs
To right atrium
Hb–CO2
Hb
7%
Hb + O2
Pulmonary
capillaries
Hb–O2
Red blood cell
Plasma
To left atrium
To tissue cells
(b) Internal respiration:
systemic gas
exchange
O2
HCO3
23%
Transport of CO2
1.5% dissolved in plasma
98.5% as Hb-O2
–
70%
CO2
Hb
(dissolved)
Hb–O2
O2
Systemic
capillaries
1.5%
O2
Systemic
tissue cells
Deoxygenated blood
(contracting skeletal muscle)
Percent saturation of hemoglobin
Deoxygenated blood
in systemic veins
(average at rest)
PO2 (mmHg)
Oxygenated blood
in systemic arteries
Percent saturation of hemoglobin
High blood pH
(7.6)
Normal blood pH
(7.4)
Low blood pH
(7.2)
PO2 (mmHg)
(a) Effect of pH on affinity of hemoglobin for oxygen
Percent saturation of hemoglobin
Low blood
PCO2
Normal blood
PCO2
High blood
PCO2
PO2 (mmHg)
(b) Effect of PCO2 on affinity of hemoglobin for oxygen
Percent saturation of hemoglobin
Low temperature
(20°C, 68°F)
Normal blood
temperature
(37°C,
98.6°F)
High temperature
(43°C, 110°F)
P O2 (mmHg)
Percent saturation of hemoglobin
Fetal
Maternal
P O2 (mmHg)
Reverse
chloride
shift
Exhaled
–
CO2
CO2
O2
Cl
CO2
HCO3–
O2
Plasma
Cl
–
CO2 + Hb
CO2 + H2O
O2
Interstitial
fluid
Inhaled
Pulmonary
Alveolus
capillary wall
Hb–CO2
Carbonic anhydrase
H2CO3
HCO3– + H+
Hb–O2+ H+
O2 + Hb–H
Red blood cell
(a) Exchange of O2 and CO2 in pulmonary capillaries (external respiration)
Chloride
shift
Cl –
CO2
O2
Tissue cell
CO2
O2
Interstitial
fluid
CO2
HCO3–
O2
Plasma
Systemic
capillary wall
Cl –
CO2 + Hb
CO2 + H2O
O2 + Hb–H
Hb–CO2 + O2
Carbonic anhydrase
H2CO3 HCO3– + H+
Hb–O2
Red blood cell
(b) Exchange of O2 and CO2 in systemic capillaries (internal respiration)
Sagittal
plane
RESPIRATORY
CENTER:
Pneumotaxic area
Midbrain
Apneustic area
Pons
Medullary rhythmicity area:
Inspiratory area
Medulla
oblongata
Expiratory area
Spinal
cord
Sagittal section of brain stem
Activates
INSPIRATORY AREA
ACTIVE
2 seconds
INACTIVE
INSPIRATORY AREA
ACTIVE
EXPIRATORY AREA
3 seconds
Diaphragm and external
intercostals contract
Diaphragm and external
intercostals relax, followed
by elastic recoil of lungs
Diaphragm,
sternocleidomastoid,
and scalene muscles
contract
Normal quiet inhalation
Normal quiet exhalation
Forceful inhalation
(a) During normal quiet breathing
Internal intercostal
and abdominal
muscles contract
Forceful exhalation
(b) During forceful breathing
Medulla oblongata
Sensory axons in
glossopharyngeal nerve
(cranial nerve IX)
Internal carotid
artery
External carotid
artery
Carotid body
Carotid sinus
Sensory axons in vagus nerve
(cranial nerve X)
Common carotid
artery
Arch of aorta
Aortic bodies
Heart
Some stimulus disrupts
homeostasis by
Increasing
Arterial blood PCO2 (or
decreasing pH or PO2)
Receptors
Central
Chemoreceptors
in medulla
Peripheral
chemoreceptors
in aortic
and
carotid
bodies
Nerve
impulses
Input
Control center
Inspiratory area in
medulla oblongata
Output
Nerve
impulses
Effectors
Muscles of
inhalation and
exhalation
contract more
forcefully and
more frequently
(hyperventilation)
Decrease in arterial blood
PCO2, increase in pH, and
increase in PO2
Return to homeostasis
when response brings
arterial blood PCO2 ,
pH, and PO2 back to
normal
Pharynx
Pharynx
Respiratory
diverticulum
Trachea
Tracheal bud
Esophagus
Bronchial
buds
Esophagus
Fourth week
Trachea
Left primary
bronchus
Left secondary
bronchi
Right primary
bronchus
Right
secondary
bronchi
Right
tertiary
bronchi
Fifth week
Left
tertiary
bronchi
Sixth week
Trachea
Right superior
lobe
Left superior
lobe
Right middle
lobe
Right inferior
lobe
Left
inferior
lobe
Eighth week
Developing
pleura