1. Medical Training - Anatomy - For internal use only

2. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20082 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.

3. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20083 Contents Conducting airways Gas exchange system Lungs, thorax, diaphragm Central controller Upper and lower airways Oxygen transport

4. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20084 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/gas- exchanging system).

5. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20085 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.

6. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20086 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.

7. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20087 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)

8. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 20088 Thorax and Diaphragm Osseous Thorax –Thoracic spine –Ribs (costae) –Breastbone (sternum) –Parietal pleura Diaphragm Intercostal muscles

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

10. 10 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.

11. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200811 Nasal Cavity Organ for inspiration and expiration Warms respiratory air Moistens respiratory air Filters out foreign bodies (by means of nasal hair and cilia)

12. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200812 Pharynx Throat Part of the respiratory and digestive systems Mucosal covering Component of upper airways

13. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200813 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

14. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200814 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.

15. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200815 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

16. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200816 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)

17. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200817 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

18. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200818 Alveoli Cells of alveoli wall Pneumocyte Type I Pneumocyte Type II Capillary endothelium Interstitial cells (fibrocytes, lymphocytes, mastocytes) Alveolar macrophage

19. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200819 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

20. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200820 Alveolar epithelium Interstitium Capillary endothelium Plasma Erythrocyte Alveolar-Capillary Membrane

21. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200821 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

22. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training Anatomy, June 200822 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.