Medical Training Anatomy For internal use only WEINMANN

Medical Training - Anatomy For internal use only

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Objective of the Presentation • This presentation on the subject of anatomy of the respiratory system gives participants an overview of the anatomical structures required for normal respiration in a human being. 2

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Contents • • • Conducting airways Gas exchange system Lungs, thorax, diaphragm Central controller Upper and lower airways Oxygen transport 3

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Overview • The respiratory system includes – in addition to the air-conducting and gas exchanging respiration tract – all other structures involved in breathing. • They are categorized in groups according to anatomical descriptions (upper/lower airways) or to basic functions (air-conducting/gasexchanging system). 4

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Conducting Airways The conducting airways are divided into: • Nose • Mouth • Pharynx • Larynx • Trachea • Bronchial tree Within the conducting airways the air is warmed, moistened and transported. 5

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Gas Exchange System • The gas exchange system is subdivided into – alveoli – capillary network Within the gas exchange system oxygen is taken up by the blood and carbon dioxide is removed from the lungs. 6

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Lungs Two lungs: right lung and left lung Hilum of lung: main bronchus and vessels Right: Superior lobe (3 segments) Median lobe (2 segments) Inferior lobe (5 segments) Left: Superior lobe (4 – 5 segments) Inferior lobe (5 segments) Base of lung (basis pulmonis) Apex of lung (apex pulmonis) Visceral pleura (= pleura pulmonalis) 7

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Thorax and Diaphragm • Osseous Thorax – Thoracic spine – Ribs (costae) – Breastbone (sternum) – Parietal pleura • Diaphragm • Intercostal muscles 8

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Respiratory Controller • Respiratory center in brainstem • Medulla oblongata 9

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Upper Airways • The upper airways begin with the mouth or nose and come together in the pharynx and end near the larynx. • The upper airways also contain the pathway for nutrition (oropharyngeal area). • Airway assistance such as nasopharyngeal (Wendl) tubes or oropharyngeal (Guedel) tubes can be used within the upper airways. 10

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Nasal Cavity • • Organ for inspiration and expiration Warms respiratory air Moistens respiratory air Filters out foreign bodies (by means of nasal hair and cilia) 11

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Pharynx • • Throat Part of the respiratory and digestive systems Mucosal covering Component of upper airways 12

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Larynx • = voice box • Transition from upper to lower airways • Made up of three large pieces of cartilage – Thyroid cartilage (cartilage thyroidea) – Cricoid cartilage (cartilago cricoidea) – Epiglottis • Function: closes off the airways – to swallow – to cough – to generate sound 13

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Lower Airways • The lower airways start at the subglottis • The lower airways contain the trachea, main bronchus, segmental bronchi • The lower airways run to the alveoli level and, together with the upper airways, form the air-conducting system. 14

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Trachea • • = windpipe Length: approximately 10 – 12 cm Width: approx. 16 – 18 mm 16 – 20 rings of cartilage with membrane of connective tissue and muscles • Mucus membrane: ciliated epithelium with goblet cells • Bifurcation: Division of trachea (at 70° angle) into right and left main bronchus 15

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Bronchial Tree • Two (left and right) main bronchi (bronchi principales) • Two to three lobar bronchi (bronchi lobares ) • Two to five segmental bronchi • Subsegmental bronchi • Bronchioles • Terminal bronchioles • Respiratory bronchioles • Alveoli system (alveolar ducts, alveolar atria, alveolar sacs) 16

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Surfactant • • • Surface active agent Surface active substance on the interior surface of alveoli Reduction of surface tension by a factor of 15 to 20 Reduction of “opening pressure” of small alveoli To increase pulmonary compliance To prevent collapse of alveoli at end of expiration 17

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Alveoli Cells of alveoli wall • Pneumocyte Type II • Capillary endothelium • Interstitial cells (fibrocytes, lymphocytes, mastocytes) • Alveolar macrophage 18

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Gas Exchange • Transfer of O 2 from the alveoli into blood or of CO 2 from blood into alveoli by means of alveolar-capillary membrane 19

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Alveolar-Capillary Membrane Alveolar epithelium Interstitium Capillary endothelium Plasma Erythrocyte 20

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Oxygen Transport • 98. 5 % binds to hemoglobin (Hb) – Hemoglobin = red blood pigment in erythrocytes – Cooperative binding of four oxygen molecules – 1 gram Hb can bind 1. 34 ml oxygen • 1. 5 % physiologically dissolved 21

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO. KG, Medical Training Anatomy, June 2008 Summary • Basic knowledge of anatomy of airways makes respiratory disorders more understandable. • Basic knowledge of anatomy is a prerequisite for understanding respiratory physiology. • Basic knowledge of anatomy and physiology are fundamental prerequisites for patient adaptive ventilation. 22