Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University. Systematic Anatomy. Splanchnology - Part 2 Respiratory system

Transcription

1 Systematic Anatomy Splanchnology - Part 2 Respiratory system Dr.Hongqi Zhang ( 张红旗 ) zhanghq58@126.com 1

2 Respiratory system

3 Composition Respiratory tract Nose Pharynx Upper respiratory tract Larynx Trachea Lower respiratory tract Bronchi Lungs Paired organs of respiration Function: Inspiring oxygen Expiring carbon dioxide Vocalization olfaction Assisting venous return to heart

4 The Nose Composition External nose Nasal cavity Paranasal sinuses Function Regulate temperature & moxture. Phonation Smell

5 The external nose External nose: 1. Root of nose 2. Back of nose 3. Apex of nose 4. Alae of nasi 5. Nostril Nasal cavity communicate with the pharynx behind through the choanae.

6 The nasal cavity Two halves by nasal septum Two parts: Boundary:Divided by limen nasi 1 - Nasal vestibule 2 - Proper nasal cavity Boundaries Roof-cribriform plate of ethmoid Floor-hard & soft palate Medial wall-nasal septum Lateral wall Three nasal conchae Sup.mid.& inf.nasal conchae Three nasal meatuses Sup.mid.& inf.nasal meatuses Medial wall of nasal cavity Copy Right- Hongqi ZHANG-Department Med.wall of Anatomy-Fudan of nasal cavity(nasal Universityseptum) 1 2

7 The structures of lateral wall of nasal cavity Three nasal conchae 1-Sup.nasal concha 2-MId.nasal concha 3-Inf.nasal concha Three nasal meatuses 4-Sup.nasal meatus 5-Mid.nasal meatus 6-Inf.nasal meatus

8 Medial wall of nasal cavity (nasal septum) Bone and cartilages Frontal sinus Sphenoidal sinus Septal cartilage Perpendicular plate of ethmoid Vomer Palatine process of maxilla Horizontal plate of palatine bone

9 The Mucous membrane of nose Olfactory region (blue) Located upper nasal cavity,above superior,nasal conchae, contains olfactory cells Respiratory region: situated out of olfactory region. its function is to warm, moisten, and clean the inspired air Olfactory region Olfactory region Lat.wall of nasal cavity Nasal septum

10 Paranasal sinuses Are the gas cavity in cranium around the nasal cavity Mucosa of sinuses is migrating with the mucosa of nasal cavity Have openings pass the nasal cavity There are four paired sinuses 1 - Frontal sinus - one pair 2 - Sphenoidal sinus -one pair 3 - Maxillary sinus -one pair Ethmoidal sinus - three groups (ant.mid. & post. groups)

11 The paranasal sinuses and their site of drainage into the nose Name of sinus Frontal sinus Maxillary sinus Sphenoid sinus Ethmoidal sinuses anterior group middle group posterior group Site of drainage Mid. meatus via infundibulum Mid. meatus through semilunar hiatus Sphenoethmoidal recess Mid. meatus Mid. meatus Sup. nasal meatus

12 Frontal sinus Ethmoidal sinuses Sphenoidal sinus Maxillary sinus Removed anterolateral wall of sinus Frontal s. Ethmoidal s. Sphenoidal s. Maxillary s.

13 openings of paranasal sinus Lateral wall of nasal cavity (remove nasal concha partially 1. Frontal sinus open at ant. part of mid. nasal meatus 2. Sphenoidal sinus - open at sphenoethmoid recess. 3. Maxillary sinus open at mid. part of mid. nasal meatus

14 Location and opening of maxillary sinus Maxillary sinus The opening of Maxillary sinus Maxillary sinus-opening in middle meatus

15 Openings of paranasal sinus Ethmoidal sinus have three groups. Ant.& mid. group of ethmoidal sinus open at mid nasal meatus. Posterior group open at sup.nasal meatus. The opening of nasolacraminal duct

16 Sinusitis

17 Position: Situated in the anterior part of the neck (below the hyoid bone), Composition: Cartilage,muscle & mucosa Boundary: Upper boardline: upper border of epiglottic cartilage: lower boardline : lower border of cricoid cartilage Communication:to pharynx upwardly,to trachea downwardly Neighbouring:.skin, fascia, muscle, anteriorly; pharynx posteriorly; blood vessel. nerve and lateral lobe of thyroid are in both side:. larynx larynx Function: voice box involved in breathing, sound production (phonation), and protecting the trachea against food aspiration

18 Cartilages of the larynx Epiglottic cartilage (1) Thyroid cartilage (1) Cricoid cartilage (1) Arytenoid cartilage(2) Ant.view Post.view

19 Cartilage of the larynx Thyroid cartilage Shield - shaped cartilage Laryngeal prominence at base of thyroid notch (Adam s apple) Sup.thyroid notch, sup.& inf. cornua Cricoid cartilage Complete ring of cartilage (shaped like a single ring) Arch of cricoid cartilage-at level of C 6 Lamina of cricoid cartilage Ant. Thyroid cartilage Cricoid Post. cartilage Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan Ant. University Post.

20 Cartilage of the larynx Arytenoid cartilage(2) Paired,pyramid shaped, articulate with lamina of cricoid cartilage Vocal process anteriorly, site of post.attachment of vocal fold Muscular process Epiglottic cartilage Spoon-shaped elastic cartilage situated behind the root of the tongue Epiglottic cartilage Arytenoid cartilage

21 Epiglottic cartilage Cartilage of the larynx Thyroid cartilage Ant.view Cricoid cartilage Arytenoid cartilage Thyroid cartilage Arytenoid cartilage Post.view Post.view Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan Post.view University

22 Cartilage of the larynx (specimen) Post. Ant. Thyroid cartilage Cricoid cartilage Arytenoid cartilage

23 Learn by yourself Thyrocricoid puncture Ant.view of the larynx

24 Learn by yourself Copy Right- Hongqi ZHANG-Department Post.view of the of larynx Anatomy-Fudan University

25 Laryngeal joints Cricothyroid joint Cricoarytenoid joint Laryngeal lig. and membrane The important,lig.& membrane joints of larynx Thyrohyroid membrane - extending from hyoid bone to thyroid cartilage Thyrohyroid membrane Cricothyroid joint Cricoarytenoid joint

26 Quadrangular membrane Between epiglottic,thyroid & arytenoid cartilages Lower free border forms vestibular lig.which constructs the frame of vestibular fold. Conus elasticus Situated between arytenoids,thyroid, & cricoid cartilages Upper free border forms vocal lig.median cricothyroid lig. May be site of circothyrotomy during acute respiratory obstruction Cricotracheal lig. Between cricoid cartilage & first ring of trachea Thyroid cartilage Fissure of glottis Median cricothyroid lig. cricotracheal lig. Sup.view Conus elasticus Vocal process Arytenoid cartilage Muscular process

27 Posterior view of laryngeal cavity (coronal section)

28 Muscles of larynx Epiglottis Cuneiform tubercle Aryepiglottic fold Aryepiglottic m. Oblique arytenoid m. Transverse arytenoid m. Cricoid cartilage Post.cricoarytenoid m. Post.view of muscles of layrnx

29 Muscles of larynx Epiglottis Aryepiglottic m. Oblique & transverse Arytenoid m. Post.cricoarytenoid m. Thyroepiglottic m. Thyroarytenoid m. Lat.cricoarytenoid m. Thyroid articular surface Conus elasticus. Cricothyroid m. (cut away) Intrinsic muscles of larynx (lateral dissection)

30 Muscles of larynx & their function Close the glottis Transverse and oblique arytenoid m. Open the glottis Post. cricoarythenoid m. Tense and lengthen the vocal fold Cricothyroid & post. cricoarytenoid m. Relax & shorten the vocal fold Thyroarytenoid m.

31 Laryngeal cavity Aperture of larynx -bounded by upper border of epiglottic cartilage,aryepiglottic folds and interarytenoid notch Epiglottis Aryepiglottic folds Interarytenoid notch Post.view of larynx (post.wall of pharynx is cut)

32 Three parts Laryngeal vestibule Extends from the aperture of larynx to vestibular fold Intermedial cavity of larynx Extends from the level of the rima Vestibuli to the level of the fissure of glottis - the narrowest portion Ventricle of larynx a small recess between vestibular & vocal folds on each side Infraglottic cavity Laryngeal cavity Extends from vocal folds to the lower border of the cricoid cartilage Laryngeal vestibule Intermedial cavity of larynx Infraglottic cavity Coronal section(post.view)

33 Structure features Two pairs of shelf like folds 1 - Vestibular folds & 2 - Vocal folds Two fissures Rima vestibuli & fissure of glottis Inter membranous part Ant.3/5, between vocal-folds Inter cartilagrnous part Post. 2/5, between arytenoids cartilages Thyroid cartilage Fissure of glottis Vocal lig. Conus elasticus Laryngeal cavity Vocal ligment Vocal process Arytenoid cartilage Muscular process Vestibular folds Vocal folds

34 Epiglottis Thyroid cartilage Laryngeal vestibule Laryngeal vestibule Fissure of glottis Vestibular folds Laryngeal ventricle Vocal folds Cricoid cartilage Infraglottic cavity Laryngeal cavity (coronal section, posterior view)

35 Aperture of larynx (sup. aspect) & the change of vocal cord in sounding or smooth respiration Epiglottis Epiglottis Vestibular fold Med.border Vocal fold Med.border Glottis is open (breathing) Aryepiglottic folds Interarytenoid notch Glottis is open (sounding) Trachea Learn by yourself Glottis is close (sounding)

36 Larynx specimen Ant.view of larynx Post.view of larynx Post.view of larynx (trachea is cut) Lat.view of larynx

37 Description: Is the passage for air. divides into left & right principal branchi at the level of sternal angle. Boundary: C 6 ~T 4 lower border Length: about 10cm Portions: Cervical part & thoracic part Constitution: C-shaped cartilages Consitution: C-shape cartilage, smooth muscle. mucosa Carina of trachea: Ridge of cartilage at bifurcation Trachea Connective tissue into principal bronchi. Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan Carina of University trachea

38 Tracheostomy (usuaslly 3-5 tracheal cartilage are cut)

39 Right principal bronchus The principal Bronchi Trachae usually divides into right and left principal bronchi at the level of sternal angle (between T 4 -T 5 vertebrae) Shorter,wider,& more vertical in position than left one,is about 2-3cm in length. Left principal bronchus Finer,longer & less vertical than right one is about 4-5cm in length. Usually, foreign bodies are therefore more likely to lodge in right bronchus or one of its branches. Foreign particles are easily to enter right bronchus.

40 Bronchial tree Each principal bronchus divides into lobar bronchi (two on the left, three on the right), each of which supplies a lobe of lung. Each lobar bronchus then divided into segmental bronchi, which supply specific segments of the lung. Bronchi looks like up down tree

41 General description of the Lung Position:Located in the thoracic cavity by both sides of mediastinum Color: Related with age,occupation, health station Weight:800~1300g more in male than female Air content:5000~6500ml, more in male than female Function: air interchange (both O 2 and CO ) 2 Lung in newborn don t float in water(not breath) Respired lung can float in water. (contain air)

42 General features Cone-shaped, the right lung is shorter and broader, the left one is longer and narrower Left lung have two lobes (oblique fissure); it is longer, lighter and thinner than right lung. Right lung Lobes : it have three lobes(oblique fissure & horizental fissure), right lung is shorter,heavier and broader, Forensic medicine:density of fetus lung is more than 1,not floating after the birth, it is less than 1 in density. Lung-general description floating on the water

43 General features Cone-shaped, the right lung is shorter and broader, the left one is longer and narrower Apex of lung-rises 2~3 cm above the medial third of clavicle into neck Base-concave, related to diaphragm, also called diaphragmatic surface Costal surface-large, convex, related to thoracic wall The Lungs - shape features

44 The position of Lungs Position: Located in the thoracic cavity by both sides of mediastinum Lungs in sity(ant. view) Topography of lungs(post.view)

45 External feature of the lungs Apex: Rises 2~3 cm above the medial 1/3 of clavicle into neck. Base: Concave,close to diaphragm (diaphragmatic surface). Two surfaces: Mediastinal surface and sternocostal surface. Three borders: Ant. post. & inf. border. Apex Ant.border Post.border Sternocostal surface Sternocostal surface Ant.border Mediastinal surface Base Medial surface Inf.border of right lung

46 Medial surface of the the lungs Medial surface-concave,related to mediastinum and vertebrae Hilum of lung:area on medial surface where structures in root enter or leave lung Root of lung Contents Principal bronchus Pulmonary artery and vein Nerves and lymphatics Surrounded by connective tissue Order of structures in the root of lung From before backward: V.A. B. From above downward: A-artery» R.-B. A. V. V-vein» L.-A. B. V. B-bronchus Left lung Med.surface Right lung (med.surface)

47 Lung specimen Oblique fissure Ant.surface of left lung Oblique fissure horizental fissure Lat.surface of right lung Med.surface of right lung Med.surface of left lung

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49 General features The Pleura Serous membranes forming closed sacs Two layers Visceral pleura adheres to lung, continuous with parietal pleura at root of lung Parietal pleura lines the thoracic cavity Two pleural layers continue with each other at root of lung forming closed potential space pleural cavity Contains a small amount fluid Subatmospheric pressure

50 Cupula of pleura Costal pleura Division of pleura Mediastnal pleura Visceral pleura lung Pleural cavity Costaldiaphregmatic recess Diaphragmatic pleura

51 Named parts of parietal pleura Cupula of pleura Extends up into the neck, over the apex of lung, 2-3cm above the medial third of clavicle Costal pleura Lines the inner surface of the wall of the chest Mediastinal pleura Lines mediastinum Pulmonary lig. -redundant pleura at root of lung, which extends downward, allows movement of structures forming root of lung Diaphragmatic pleura Lines diaphragm

52 Pleural reesses potential spaces of pleural cavity which lungs are not occupied in quiet respiration Costodiaphragmatic recesse are the slit-like intervals between costal and diaphragmatic pleurae on each side, the lowest point of pleural cavity Costomediastinal recess on the left side between the mediastinal pleural and costal pleura Costaldiaphregmatic recess lung Costomediastinal recess

53 1. It is a closed cavity 2. Each one on both sides 3. Left & right side don t communicate each other 4. Pressure of cavity is subatomospheric pressure 5. Contain a little lubricating liquid Pleural cavity 6. Costaldiaphrematic recess (lowest) 7. Clinic puncture. Pneumothorax (Thoracic wall is open.lung injury) Collapsed lung Inflated lung

54 The lower boundary of lungs and pleura T 6 T 8 T 10

55 The surface projection of lower border of lung and pleurae Lower border Midclavicular lines Midaxillary lines Sides of the vertebral column Lungs 6th rib 8th rib 10th rib Pleura 8th rib 10th rib 12th rib

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57 Asthma

58 Cilial dysfunction

59 Bronchitis

60 Lung cancer

61 肺的 X-ray 支气管造影

62 Emphysema

63 Mediastinum Concept The mediastinum is the full term of all structures between the two mediastinal pleurae. It contains all the thoracic viscera except the lungs Boundary line:at the plane from the sternal angle to the disc of T4-T5 Sup.mediastinum-above the upper level of the pericardium, Inf.mediastinum:below the upper level of the pericardium. three parts, Ant. mediastinum - in front of the pericardium, the; Mid. mediastinum -containing the pericardium and its contents, Post.mediastinum- that behind the pericardium Sup.mediastinum Ant.mediastinum Mid.mediastinum Post mediastinum Inf.mediastinum Disease:Tumor,inflammation,pneumomediastinum, a widened mediastinum (aortic Copy unfolding,traumatic Right- Hongqi ZHANG-Department aortic rupture, thoracic of Anatomy-Fudan aortic aneurysm) University

64 Mediastinum-lateral view (from left & right side) Lateral view (left) Lateral view (right)

65 Healthy lung lung tumor

66 The contents you have to master today 1. The constitution and function of respiratory system. 2. The concept of upper and lower respiratory tract. 3. The position and openings of paranasal sinuses. 4. The cartilage of larynx, laryngeal cavity and change of apeature of larynx while both deep breathing and quiet respiration. 5. The constitution, length and function of trachea. 6. The feature of left and right principal bronchi. 7. The morphological feature of lungs (apex,base, surface. border, lobes, fissure etc) 8. Concept and division of pleura and pleural cavity. 9. Concept and division of mediastinum.

67 Good luck to you!

68 Bronchopulmonary segments It is the whole name for every segmental bronchi & all the lung tissues in its branching area. There are usually ten pulmonary segments eachlung. Wedge shaped, with the base lying peripherally & the apex lying towards the root of lungs. Every segment has its name. The bronchopulmonary 肺段, 每侧肺 10 个肺段 - 切除 segments could regards as the reference of partially pulmonary resection. Copy Right- Hongqi Learn ZHANG-Department by yourself of Anatomy-Fudan University

69 Bronchopulmonary segments Learn by yourself

70 Bronchopulmonary segments Learn by yourself