1. The Respiratory System
Chapter 7

2. Overview Major Structures Wd Part Nose nas/o Sinuses sinus/o
Pharynx pharyng/o
Larynx laryng/o
Epiglottis epiglott/o
Trachea trache/o
Bronchi bronch/o, bronchi/o
Alveoli alveol/o
Lungs pneum/o, pneumon/o, pulmon/o

4. Word Parts Bronchi/o Pneum/o, pneumon/o, pneu- Cyan/o Pulm/o, pulmon/o
Laryng/o
Somn/o
Ox/i, ox/o, ox/y
Tachy-
Pharyng/o
Thorac/o, -thorax
Phon/o
Trache/o
Pleur/o
-pnea

5. Objectives
ID and describe the major structures and functions of the respiratory system
Recognize, define, spell and pronounce terms related to the pathology and the diagnostic and treatment procedures of the respiratory system

6. Functions of the Respiratory System
Bring oxygen (O2) from the inhaled air into the blood for delivery to the body cells
Expel waste products (carbon dioxide [CO2] and some water [H2O] waste) returned to the lungs by the blood
Produce airflow through the larynx that makes speech possible

7. Structures of the Respiratory System
For descriptive purposes, the respiratory system is divided into upper and lower tracts:

8. The Upper Respiratory Tract consists of the nose, mouth, pharynx, epiglottis, larynx, and trachea

9. The Lower Respiratory Tract consists of the bronchial tree and lungs.
These structures are located within, and protected by, the thoracic cavity [aka the rib cage]

12. The Nose
Air enters through the nose and passes through the nasal cavity [the int portion of the nose]
The nasal septum is a wall of cartilage that divides the nose into 2 equal sections
Cilia – thin hairs located just inside the nostrils that filter incoming air
Mucous Membranes – specialized tissues that line the respiratory, digestive, reproductive and urinary systems

13. Mucus – secreted by the mucous membranes, protects and lubricates these tissues
In the nose, they help moisten, warm and filter the air as it enters
Olfactory Receptors – nerve endings that act as the receptors for the sense of smell
Also important to the sense of taste

15. The Tonsils Form a protective circle of lymphatic tissue
[you were just tested on these ;)]

16. The Paranasal Sinuses
Air filled cavities lined with mucous membrane, located in the bones of the skull and are connected to the nasal cavity via short ducts
Function:
To make the bones of the skull lighter
To help produce sound by giving resonance to the voice
To produce mucus to provide lubrication for the tissues of the nasal cavity
4 pairs located on either side of the nose and are named for the bones in which they’re located

17. Function, etc
Frontal Sinuses – located in the frontal bone jut above the eyebrows
Sphenoid Sinuses – located in the sphenoid bones close to the optic nerves (an infection here can damage vision)
Maxillary Sinuses – the largest of the paranasal sinuses located in the maxilla
Ethmoid Sinuses – located in the ethmoid bones; their irregularly shaped air cells that are separated from the orbital cavity (eye socket) by a thin layer of bone

19. The Pharynx
Commonly known as the throat; receives air after is passes through the nose
Made up of 3 divisions:
Nasopharynx – posterior to the nasal cavity and continues downward to behind the mouth
Oropharynx – the portion that is visible when looking into the mouth
Laryngopharynx – shared by both respiratory and digestive systems; Air, food and fluids continue down to the openings of the esophagus and trachea where air enters the trachea, while food and fluids flow into the esophagus

21. The Larynx
Also known as the voice box; it’s a triangular chamber located between the pharynx and the trachea
Protected and supported by a series of nine separate cartilages
The thyroid cartilage is the largest; commonly known as the Adam’s Apple
It contains the vocal cords
During breathing the cords are separated to let air pass
During speech they are close together, and sound is produced as air is expeller from the lungs causing the cords to vibrate against each other

23. Protective Swallowing Mechanism
Because the respiratory and digestive systems share part of the pharynx, during swallowing there is a risk of blocking the airway or pneumonia caused by food or H2O going into the trachea and entering the lungs (to aspirate)
During swallowing, the soft palate (the muscular post portion of the roof of the mouth) moves up and backward to close off the nasopharynx (which is why food and such doesn’t come out our noses!)
At the same time the eppiglottis (the lid-like structure at the base of the tongue) sings downward to close off the laryngopharynx to stop food from entering the trachea and lungs

25. The Trachea
Commonly known as the wind pipe; the tube located in front of the esophagus that extends from the neck to the chest
Transports air to, and from, the lungs
It is held open by a series of C-shaped cartilage rings
The wall between the rings is flexible which makes it possible for the trachea to adjust to different body positions

27. The Bronchi
Formed where the trachea divides into two branches known as the primary bronchi
Because they look like an inverted tree, it’s referred to as the bronchial tree
Within the lung, each primary bronchus divides and subdivides into increasingly smaller bronchioles (the smallest branches of the bronchi)

29. The Alveoli
Also known as air sacs; the very small grape-like clusters found at the end of each bronchiole
Each lung contains millions of alveoli that are filled with air from the bronchioles
A network of microscopic pulmonary capillaries surround the thin, elastic walls of the alveoli
During respiration, the exchange of O2 and CO2 between the alveolar air and the pulmonary capillary blood occurs through the walls of the alveoli

32. The Lungs
The organs of respiration; are divided into lobes (subdivisions of the whole)
Right Lung – 3 lobes; superior, middle and inferior
Left Lung – 2 lobes; the superior and inferior; slightly smaller because of the space taken up by the heart
They produce a detergent-like substance called surfactant that reduces the surface tension of the lungs allowing air to flow over the lungs and be absorbed more easily

34. The Mediastinum The cavity located between the lungs
Contains connective tissue and organs, including the heart and its veins and arteries, the esophagus, trachea, bronchi, thymus gland, and lymph nodes

36. The Pleura
A thin, moist, and slippery membrane that cover the outer surface of the lungs and lines the inner surface of the rib cage
Parietal Pleura – the outer layer or the pleura that lines the walls of the thoracic cavity
Visceral Pleura – the inner layer of the pleura that surrounds each lung
The Pleural Cavity – the airtight area between the layers of the pleural membranes
Contains a thin layer of fluid that allows the membranes to slide easily during respiration

38. The Diaphragm
The muscle that separates the thoracic cavity from the abdomen.
The contraction and relaxation of the diaphragm is what makes breathing possible
Stimulated by the phrenic nerves causing it to contract

41. Respiration The exchange of O2 and CO2 that is essential to life
One respiration consists of one inhalation and one exhalation

42. Inhalation and Exhalation
Inhalation – the act of taking in air as the diaphragm contracts and pulls downward
Causes the thoracic cavity to expand
Produces a vacuum within the thoracic cavity that draws air into the lungs
Exhalation – the act of breathing out
The diaphragm relaxes and moves upward causing the thoracic cavity to become narrower and force air out of the lungs

44. External Respiration – the act of bringing air into and out of the lungs and exchanging gases from this air
Air is inhaled into the alveoli, O2 immediately passes into the surrounding capillaries and is carried by RBCs to all the body cells
At the same time, CO2 (waste) is transported to the air spaces in the lungs to be exhaled
Internal Respiration
O2 passes from the bloodstream into the cells
Cells give off CO2 (waste)
Bloodstream transports CO2 to the lungs to be expelled

46. Internal Respiration
External Respiration

47. Medical Specialties Related to the Respiratory Systems

48. Otolaryngologist – ENT; a physician who specializes in the dx and tx of diseases and disorders of the ear, nose, throat and related structures of the head and neck
Pulmonologist – a physician who specializes in the dx and tx of the lungs and associated tissues

49. Pathology of the Respiratory System

50. Chronic Obstructive Pulmonary Diseases
COPD; a lung disease in which it is hard to breath
Damage to the bronchi obstructs them, making it difficult to get air in and out
Often occurs in smokers or former smokers
Chronic Bronchitis – the airways have become inflamed and thickened, and there is an increase in the number and size of mucus-producing cells

52. Emphysema – the progressive loss of lung function that is characterized by:
A decrease in the total number of alveoli
The enlargement of the remaining alveoli
The progressive destruction of the walls of the remaining alveoli
As the alveoli are destroyed, breathing becomes increasingly rapid, hallow and difficult
In an effort to compensate, the lungs expand and the chest some times assumes a barrel shape

54. Asthma
A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing
These episodes are known as asthmatic attacks
Wheezing is the sound caused by partially obstructed airways
Airway Inflammation – the swelling and clogging of the airways with mucus
Bronchospasm – a contraction of the smooth m in the walls of the bronchi and bronchioles that tighten and squeeze the airway shut

57. Asthma Treatment – most people take 2 kinds of medications:
Controller Medications – medicines like inhaled corticosteroids that are taken daily to prevent attacks
Help to control inflammation and to stop the airways to reacting to the factors that trigger an attack
Quick Relief – rescue medications; taken at the first sign of an attack to dilate the airways and make breathing easier
Ex: bronchiodilators (we’ll discuss these later)

58. Upper Respiratory Diseases
Upper Respiratory Infections and acute nasopharyngitis are the common terms to describe the common cold.
Allergic Rhinitis – an allergy; an allergic reaction to airborne allergens that causes an increased flow of mucus
Croop – an acute respiratory syndrome in children and infants characterized by obstruction of the larynx, hoarseness and a barking cough

59. Diphtheria – an acute bacterial infection of the throat and upper respiratory tract
Largely prevented through immunizations
The bacteria can produce toxins that damage the heart muscle and peripheral nerves
Epistaxis – nose bleed; bleeding from the nose commonly caused by an injury
Influenza – the flu; an acute, highly contagious viral respiratory infection that is spread via respiratory droplets and occurs most commonly in epidemics during the colder months

60. Pertussis – whooping cough; a contagious bacterial infection of the upper resp tract that is characterized by recurrent bouts of a paroxysmal (sudden or spasm-like) cough, followed by breathlessness and noisy inspiration
Rhinorrhea – runny nose; the watery flow of mucus from the nose
Sinusitis – an inflammation of the sinuses

61. Pharynx and Larynx
Pharyngitis – sore throat; inflammation of the pharynx
Laryngoplegia – paralysis of the larynx
Laryngospasm – the sudden spasmodic closure of the larynx

62. Voice Disorders
Aphonia – the loss of the ability of the larynx to produce normal speech sounds
Dysphonia – any change in vocal quality, including hoarseness, weakness, of the cracking of a boy’s voice during puberty
Laryngitis – inflammation of the larynx; commonly used to describe voice loss that is caused by this inflammation

63. Trachea and Bronchi
Tracheorrhagia – bleeding from the mucous membranes of the trachea
Bronchorrhea – excessive discharge of mucus from the bronchi

64. Pleural Cavity
Pleurisy – pluritis; an inflammation of the pleura that produces sharp chest p! with each breath
Pleurodynia – p! in the pleura that occur in relation to breathing movements
Pneumothorax – the accumulation of air in the pleural space causing a pressure imbalance that prevents the lung from fully expanding or can cause it to collapse
Can have external cause like a stab wound, or internal by rupturing the pleura

66. Pleural Effusion – the abnormal accumulation of fluid in the pleural space; produces feeling of breathlessness because it prevents the lung from fully expanding
Hemothorax – a collection of blood in the pleural cavity
Hemoptysis – coughing up blood or bloodstained sputum derived from the lungs or bronchial tubes as a result of a pulmonary or bronchial hemorrhage
Pyothorax – the presence of pus in the pleural cavity between the layers of the pleural membrane

69. Lungs
Acute Respiratory Distress Syndrome (ARDS) – not a specific disease; severe lung dysfunction affecting both lungs that happens suddenly and makes breathing extremely difficult
Atelectasis – the collapse of part of all of a lung by blockage of the air passages or by very shallow breathing
Pulmonary Edema – an accumulation of fluid in lung tissue
Pneumorrhagia – bleeding from the lungs

71. Tuberculosis – (TB) an infectious disease caused by Mycobacterium tuberculosis
TB occurs most commonly in individuals whose immune systems are weakened by another condition
Multidrug-resistant Tuberculosis – a dangerous form of tuberculosis because the germs have become resistant to the effect of primary TB drugs

73. Pneumonia Named for the Affected Lung Tissue
Pneumonia – a serious infection or inflammation of the lungs in which the smallest bronchioles and alveoli fill with pus and other liquid
Bronchopneumonia – a localized form of pneumonia that often affects the bronchioles and surrounding alveoli
Lobar Pneumonia – affects larger areas of the lungs, often including one of more sections, or lobes, of a lung
Double Pneumonia is lobar pneumonia involving both lungs and is usually a form of bacterial pneumonia

77. Pneumonia Named for the Causative Agent – 30 causes of pneumonia have been identified; the most causative agents are inhaled substances, bacteria, fungi and viruses
Aspiration Pneumonia – when a foreign substance, such as vomit, is inhaled into the lungs
Bacterial Pneumonia – often caused by Streptococcus Pneumoniae, is the only form that can be prevented through vaccination

79. Mycoplasm Pneumonia – a milder but longer lasting form of the disease cause by the bacteria Mycoplasm pneumoniae
Sometimes called walking pneumonia because the patient is not bedridden
Pneumocystic Carinii Pneumonia – an opportunistic infection caused by the fungus Pneumocystic Carinii
Viral Pneumonia – caused by several different types of viruses

80. Interstitial Lung Disease – a group of almost 200 diseases that cause inflammation and scarring of the alveoli and their supporting structures; lead to a reduction of O2 being transferred to blood
Interstitial Fibrosis – the inflammation and thickening of the walls of the alveoli
Fibrosis is the condition in which normal tissue is replaced by fibrotic (hardened) tissue

81. Environmental and Occupational Lung Diseases
Pneumoconiosis - fibrosis of the lung tissue caused by dust in the lungs that usually develops after prolonged environmental occupational contact
Anthracosis – coal miner’s pneumoconiosis or black lung disease; caused by coal dust in the lungs
Asbestosis – caused by asbestos particles in the lungs
Byssinosis – brown lung disease; caused by inhaling cotton dust; usually after working in a textile factory
Silicosis – caused by inhaling silica dust; foundry work, quarrying, ceramics, glass work and sand blasting.

84. Pulmonary Fibrosis – the formation of scar tissue in the lung, resulting in decreased lung capacity and increased difficulty in breathing
Can be caused by autoimmune disorders, infections, dust, gases, toxins, and some drugs

86. Cystic Fibrosis – a genetic disorder in which the lungs and pancreas are clogged with large quantities of abnormally thick mucus
Treatment options:
Digestive enzymes
Antibiotics
Postural Draining – positioning the patient in various positions to allow gravity to help drain secretions from the lungs
Chest Percussion – performed to remove excess mucus from the lungs

88. Lung Cancer – the leading cause of death in the US.
A condition in which cancer cells form in the tissues of the lung
Risk factors include tobacco smoking and inhaling second-hand smoke
Diagnostic Tests:
Chest x-ray
Sputum Cytology – a sample of mucus is coughed up and examined under microscope to detect cancer cells

90. Breathing Disorders
Describes abnormal changes in the rate or depth of breathing
Eupnea – easy or normal breathing (-pnea means breathing)
Apnea – the absence of spontaneous respiration
Sleep Apnea Syndromes – a group of potentially fatal disorders in which breathing repeatedly stops during sleep for long-enough periods to cause a decrease in blood O2 levels
Snoring can be a symptom

91. Bradypnea – an abnormally slow rate of respiration; usually < 10 breaths per minute
Tachypnea – abnormally rapid rate of respiration; usually > 20 breaths per minute
Cheyne-Stokes Respiration – a pattern of alternating periods of hypopnea or apnea followed by hyperpnia
Dyspnea – shortness of breath; difficult or labored breathing

93. Hypernia – commonly associated with exertion, is breathing that is deeper and more rapid than is at rest
Hypopnea – shallow or slow respirations
Hyperventillation – an abnormally rapid rate of deep respiration that is usually associated with anxtiety

94. Lack of O2
Airway Obstruction – choking; occurs when food of a foreign object blocks the airway and prevents air from entering or leaving the lungs
Life threatening, performing abdominal thrust maneuver or the Heimlich maneuver can remove the object
Anoxia – the absence of O2 from the body’s gases, blood, or tissues
If it continues for 4-6 min, irreversible brain damage occurs
Asphyxia – occurs when the body cannot get the air is needs to function

96. Asphyxiation – suffocation; an interruption of normal breathing resulting in asphyxia
Cyanosis – a bluish discoloration of the skin caused by a lack of adequate O2
Hypercapnia – the abnormal build up of CO2 in the blood (capn means CO2)
Hypoxemia – having below-normal O2 level in the blood

98. Hypoxia – the condition of having below-normal O2 levels in the body tissues and cells; less sever than anoxia
Altitude Hypoxia; altitude sickness a condition brought on by the decreased O2 in the air at higher altitudes (usually above 8,000 ft)
Respiratory Failure – respiratory acidosis; a condition in which the level of O2 is the blood becomes dangerously low or the lever of CO2 becomes dangerously high
Smoke Inhalation – damage to the lungs in which particles from a fire coat the alveoli and prevent normal gas exchange

99. Sudden Infant Death Syndrome
SIDS or crib death; the sudden unexplainable death of an apparently healthy sleeping infant between the ages of 2 weeks to 1 year
Happens more often among babies who sleep on their stomach; put infants to sleep on their backs

100. Diagnostic Procedures of the Respiratory System

101. Broncoscopy – the visual examination of the bronchi using a bronchoscope
Bronchoscope – a flexible, fiber optic device that is passed through the nose down the airways
Chest Imaging – chest x-ray; valuable tool for diagnosing pneumonia, lung tumors, pneumothorax, etc
Laryngoscopy – the visual examination of the larynx using a laryngoscope through the mouth and placed into the pharynx

105. Peak Flow Meter – handheld device often used to test asthmatics to measure how quickly they can expel air
Polysomnography – sleep apnea test; measure physiological activity during sleep and is most often performed to detect nocturnal defects in breathing
Pulmonary Function Tests – a group of tests that measure volume and flow of air by utilizing a spirometer
Spirometer – a recording device that measures the amount of air inhaled or exhaled and the length of time required for each breath

109. Pulse Oximeter – an external monitor places on the patient’s finger of earlobe to measure the O2 saturation level in the blood
Levels of % saturation are normal
Sputum – phlegm ejected through the mouth that can be examined for diagnostic purposes
Phlegm – thick mucus secreted by the tissues lining the respiratory passages

111. Tuberculosis Testing
Tuberculin Skin Test – the skin of the arm is injected with a harmless antigen extracted from the TB bacteria
The Mantoux PPD Skin Test – a more accurate skin test from dx TB
A small amount of PPD Tuberculin (a purified protein derivative) is injected just under the top layer of skin on the forearm. It is checked hours later