ANATOMYS MODUL

7TH BLOK

ANATOMY LABORATORY
MEDICAL FACULTY
MUHAMMADIYAH UNIVERSITY OF PURWOKERTO
2016

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Anatomys modul 6th blok (Respiratory system)

Editors Team:
Rosmayda Ria Julianti (1413010002)
Mahidin (1413010006)
Tyas Ratna Pangestika (1413010030)
Nadya Ratu Aziza Fuady (1413010031)
Dewandaru Istighfaris Argadinanta Brahmanti (1413010044)

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RESPIRATORY SYSTEM
Based on the location, the respiratory tractus divided into two parts
1. Upper Respiratory Tract
a. Nasal
b. Pharynx
2. Lower Respiratory Tract
a. Larynx
b. Trachea
c. Bronchus
d. Bronchiolus
e. Alveolus
f. Pulmo
Respiratory Tract
Nares anterior vestibulumnasi (cilia) cavum nasi nares posterior (choana) pharynx
larynx trachea primary bronchus secondary bronchus tertiary bronchus
bronchioles bronchiolus terminal bronchiolus respiratory alveolus duct alveolus
sac alveolus
A. Upper Respiratory Tract
1. Nasal
Upper Respiratory Tract divided into two organs, nasal and pharynx. When we
inhaled, air that comes to nasal will be filtered, humidified and adjusted the
temperature tobodys temperature. Anterior nasal called nares anterior and
posterior nasal called nares posterior (choana).
a. Anatomy of the nasal cavity
Boundary of the nasal and oral cavity are:
- Pallatum durum
- Pallatum molle
Structure of the nasal cavity are:
- Nares anterior
- Dorsum nasi
- Vestibulum nasi
- Cavum nasi
Cavum nasi formed by two structures, there are concha and meatus.
Concha :
1) Concha nasalis superior
2) Concha nasalis media
3) Concha nasalis inferior
Meatus :
1) Meatus nasalis superior
2) Meatus nasalis media
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3) Meatus nasalis inferior

Nares posterior (choana)
Sinus paranasal
Sinus is room that formed by ossa facialis. There are six sinuses in our
body
1)
2)
3)
4)

Sinus maxillaris (2)

Sinus frontalis (1)
Sinus ethmoidalis (2)
Sinus sphenoidalis (2)
Pict 1. Lateral of the nasal cavity

b. Vascularization of the nasal cavity

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Anatomys modul 6th blok (Respiratory system)

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Internal of the nasal cavity get vascularization from two great plexus, there
are:
1) Kiesselbach plexus (anterior)
2) Woodruff plexus (posterior)
Pict 2. Kiesselbach plexus

c. Inervation
Nasal cavity inervated by nervus trigeminus (N. V) and nervus olfactorius
(N. I)
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d. Clinical Aplication
1) Epistaxis
2) Anosmia
3) Polip nasi
4) Alergic rhinitis
5) Sinusitis
2. Pharynx
Pharynx divided into three parts, there are nasopharynx, ororpharynx and
lryngopharynx.
a. Anatomy of pharynx
Nasopharynx
- Ostium pharyngeum
- Tuba auditiva
- Tonsilla pharyngea
Oropharynx
- Fauces
- Tonsilla palatina
Laryngopharynx
- Aadytus laryngeus
There are structure named Compiler of Waldayers Ring. Waldayers ring
formed by three tonsilla, there are:
- Tonsilla palatina
- Tonsilla pharyngea
- Tonsilla lingualis
3. Structure of pharynx
- Glotis
- Epiglottis cartilage
- Cricoidea cartilage
- Ligamentum vestibularis
- Ligamentum vocalis
- Plica vestibularis
- Plica vocalis

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Pict 3. Saggital section of pharynx

b. Inervation
Pharynx inervated by three nervus, there are
1) Nasopharynx Nervus trigeminus branch maxillary (N. V branch II)
2) Oropharynx Nervus glossopharyngeus (N. IX)
3) Laryngopharynx Nervus vagus (N. X)
c. Clinical application
1) Pharyngitis
2) Ca pharynx
2. Lower Respiratory Tract
1.

Larynx
Structure of the larynx
a.Three single cartilage:
cartilagethyroidea (terdapat prominentia laryngeal/ jakun)
cartilagecricoidea
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 epiglottis
b. Three pairs cartilage

cartilagearytenoidea

cartilagecuneiforme

cartilagecorniculata

c.Plicavestibularis
d. Plicavocalis
Innervation larynx
a. Sensory nerves
The above plica vocalists : laryngeus ramus internus , laryngeus superior
branch of the vagus nerve .
Under the plica vocalists : laryngeus nerve recurrens
a. nerves Motoris

All intrinsic muscles of the larynx , except musculus cricothyroideus

innervated by nerves laryngeus recurrens .

Musculus cricothyroideus innervated by rami laryngeus superior

laryngeus externus of the vagus nerve .

Vascularization larynx

The top half of the larynx : laryngeus superior ramus superior thyroldea
artery .

The bottom half of the larynx : laryngeus inferior rami thyroidea artery
inferior

Lymph flow Larynx

Lymphatics empties into the deep cervicales lymphoidei nodi .
Laryngeal function

As the airway / lower respiratory tract

Protect the airway and foreign objects or food

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Producing sound

Clinical applications
Asthma
Asthma is an obstructive airway disease intermittent , reversible where the
trachea and brokhi respond in a hyperactive manner against certain stimuli

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2.

Trachea

struktur of the trachea

a.Cartilage trachealis
b.

Ligamentumannularia

c.Bifurcatiotrachealis (branch oftrachea as high as angulussterni) there is carina.

Innervation trachea
sensory innervation comes from the vagus nerve and nerve laryngeus

Vascularization trachea

1/3 of the trachea gets blood from the artery thyroidea inferior , and

the bottom third of arteriae bronchiales got dalah

Flow limfetrachea
Lymph flows into nodi lymphatici pretracheales and paratracheales and into nodi
lymphoidei cervicales profundi

Laryngeal function

The trachea serves as an air pipe .

As eskalatormuko - tracheal ciliary because the cilia in the trachea can encourage

foreign objects bound substance mucus toward the pharynx to be issued

Clinical applications
Laryngitis
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laryngitis is an inflammation of the larynx that occurs for many reasons and caused
primarily by a virus and can be caused by bacteria

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3. Bronchus
Bronchus is a channel which branching from trachea

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Primary bronchus / principalis

Secondary bronchus / lobaris
Tertiary bronchus / segmentalis
Table1. Difference between bronchus primer dextra and sinistra:
______________________________________________________________
Difference
Bronchus primer dextra
Bronchus primer sinistra
________________________________________________________________
Long
shorter
longer
Wide
wider
Tighter
Tilt
more upright
more horizontal
4. Bronchiolus
Bronchiolus is a channels which branching from bronchus.

Figure 1.Bronchus

A : Bronchus principalis dextra

B : Bronchus lobaris superior dextra
B1 : Bronchus segmentalis apicalis
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B2 : Bronchus segmentalis posterior

B3 : Bronchus segmentalis anterior
D : Bronchus lobaris media dextra
D1 : Bronchus segmentalis lateralis
D2 : Bronchus segmentalis medialis
E : Bronchus lobaris inferior dextra
E6 : Bronchus segmentalis superior
E7 : Bronchus segmentalis basalis medialis
E8 : Bronchus segmentalis basalis anterior
E9 : Bronchus segmentalis basalis lateralis
E10 : Bronchus segmentalis basalis posterior
F : Bronchus principalis sinister
G : Bronchus lobaris superior sinistra
G1 : Bronchus segmentalis apicoposterior
G2 : Bronchus segmentalis apicoposterior
G3 : Bronchus segmentalis anterior
H : Bronchus lingualis
H4 : Bronchus lingualis superior
H5 : Bronchus lingualis inferior
I : Bronchus lobaris lobus inferior pulmo sinistra
I6 : Bronchus segmentalis superior
I7 : Bronchus segmentalis basalis medialis
I8 : Bronchus segmentalis basalis anterior
I9 : Bronchus segmentalis basalis lateralis
I10 : Bronchus segmentalis basalis posterior

5. PULMO AND ALVEOLUS

A. ANATOMY
Part of pulmo
1) Pulmo Dextra:
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Lobus superior pulmo dextra

Border: Fissura horizontalis pulmo dextra
Lobus medius pulmo dextra
Border: Fissura oblique pulmo dextra
Lobus Inferior pulmo dextra

Image 1. Pulmo dextra

2) Pulmo Sinistra
- Lobus superior pulmo sinistra
Border: Fissura oblique pulmo sinistra
- Lobus inferior pulmo sinistra

Image 2. Pulmo sinistra

Segment of Pulmo
- Apex pulmo
- Basis pulmo
- Incisura cardiac
- Hillum pulmonalis
Entry of radix pulmo
- Radix pulmonalis
Consist of bronchus primer, artery and vein pulmonal, nodi lymphatic plexus
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pulmonalis (N.Vagus), limfe.

Structure of Pulmo
- Lingula pulmonalis
- Incisura cardiaca
- Impressio cardiaca
Wrapper of Pulmo
- Pleura visceralis 4 layers which stick in pulmo
- Pleura parietalis 4 layers which stick in thorax
- Cupula pleura : pleura parietalis which cover apex pulmo

Image 3. Pulmo and pleura

B. PHYSIOLOGY
Alveoli are tiny sacs within our lungs that allow oxygen and carbon dioxide to move between
the lungs and bloodstream.

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Image 4. Alveolus
CLINICAL APPLICATION
1. Bronchitis
Bronchitis is an inflammation of the mucose layer of bronchus. Picture of thorax
radiography in patients with bronchitis show that lungs mark is rude to 1/3 lateral.

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Figure

3. Condition of mucose

layer of bronchus in patients with bronchitis.

Figure 4. Normal thorax radiography (left), and in patients with bronchitis(right).

2. Asthma
Asthma is a chronic inflammatory disorder of the airways in which many cells and
cellular elements play a role. The chronic inflammation is associated with airway
hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness,
chest tightness, and coughing, particularly at night or in the early morning. These
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episodes are usually associated with widespread, but variable, airflow obstruction
within the lung that is often reversible either spontaneously or with treatment.

Figure 5 . Comparison between normal airway with asthmatic airway

Figure 6. Pathophysiology of asthm

3. Pneumothorax
Pneumothorax is the event of air or gas in the pleural cavity. In normal condition the
pleural cavity is filled with air, so that the lungs can freely expand in the chest cavity.
Etiology :
a. Traumatic pneumothorax.
Traumatic pneumothorax is a pneumothorax caused by a penetration into the pleural
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cavity due to stab wounds or gunshot wounds or puncture. Traumatic pneumothorax

also have 2 types. Non iatrogenic traumatic pneumothorax is pneumothorax which
occurs due to an accident for example rows of sharp chest wall open / closed. And the
second is Iatrogenic traumatic pneumothorax.
b. Pneumothorax caused by medical treatment.
Pneumothorax this type are grouped into traumatic pneumothorax iatragenik accidental
and iatrogenic traumatic pneumothorax meaning fisial (deliberate).
Clinical symptoms:
-

Chest pain on the side

Shortness of weight can sometimes be lost up to 24 hours when partially

collapsed lung is re-inflated.

Respiratory failure and may also be accompanied by cyanosis.
The combination of complaints and clinical symptoms pneumothorax is
influenced by the lesion penumothoraks.

Treatment :
Action decompression. Pleural cavity contact with the outside world by means of a
needle through the chest wall and then entering the pleural cavity thereby positive air
pressure in the pleural space would turn into a negative because the positive air in the
pleural space would turn into a negative because the air out through the needle. Making
contact with the outside air through a counter ventiles:
-

Can use the infusion set

Needle abbocath
Sealed water drainage pipe (WSD)

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Figure 5. Pneumothorax
4. Hematothorax

Figure 6. Hematothorax
Hematothorax is the presence of blood in the pleural space. The source of blood may
be the chest wall, lung parenchyma, heart, or great vessels. Although some authors state
that a hematocrit value of at least 50% is necessary to differentiate a hemothorax from a
bloody pleural effusion, most do not agree on any specific distinction. Hemothorax is
usually a consequence of blunt or penetrating trauma. Much less commonly, it may be a
complication of disease, may be iatrogenically induced, or may develop spontaneously.
Treatment Installation WSD (Water Sail Draignase) as high as SIC V - VI parallel to
the anterior axillary line on the affected side.

Figure 7. Water Seal Drainase

5. Pleural Effusion
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Figure 8. Pleural Effusion

Pleural effusion is an abnormal collection of fluid in the pleural cavity resulting from
excess fluid production or decreased absorption or both.

Figure 9. Radiologys picture of Pleural Effusion

On the radiologys picture posterior anterior (PA) of thorax the surface of the liquid
contained in the pleural cavity will form a shadow like the curve, with the surface of the
lateral region higher than at its medial region, looked blunt of costophrenicus angle. WSD
(Water Seal Drainage) is an attempt to insert a catheter into the pleural cavity to removing
the fluid contained inside.
6. Cronic Obstructive Pulmonary Disease (COPD)
COPD or chronic obstructive pulmonary disease, is a progressive disease that makes
it hard to breathe. "Progressive" means the disease gets worse over time. COPD can cause
coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness
of breath, chest tightness, and other symptoms.

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Figure 10. Radiologys picture of COPD

7. Pneumonia

Figure 11. Alveolus condition in Pneumonia

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Figure 12. Radiologys picture of Pneumonia

8. Tuberculosis
Tuberculosis, commonly known as TB, is a bacterial infection that can spread through
the lymph nodes and bloodstream to any organ in your body. It is most often found in the
lungs. Most people who are exposed to TB never develop symptoms because the bacteria
can live in an inactive form in the body. But if the immune system weakens, such as in
people with HIV or elderly adults, TB bacteria can become active. In their active state, TB
bacteria cause death of tissue in the organs they infect. Active TB disease can be fatal if
left untreated. TB bacteria most commonly grow in the lungs, and can cause symptoms
such as:
- A bad cough that lasts 3 weeks or longer
- Pain in the chest
- Coughing up blood or sputum (mucus from deep inside the lungs)
Other symptoms of TB disease may include:
-

Weakness or fatigue
Weight loss
No appetite
Chills
Fever
Sweating at night

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Figure 13. Radiologys picture of TBC

9. Rib Fracture

Figure 17. Rib Fracture

Rib fracture is interruption of continuity of bone tissue or cartilage that caused by
trauma. The trauma that can occur are blunt trauma or sharp trauma. The symptoms of rib
fracture are chest pain and disruption of respiration. Rib fracture can cause complications
such as hematothorax or pneumothorax.

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Figure 18. Radiologys picture of Rib Fracture

10. Carsinoma Pulmo (Lung Cancer)
Lung cancer is all malignancies in the lung, including lung malignancy derived from
itself or from extrapulmonary malignancy (tumor metastases in the lungs).

Figure 19. Lung Cancer

Lung carcinoma growing point is located at the branching segments or subsegmen
bronchus. In the place of tumor growth appeared in the form of small nodules then grew
into a wad and extends toward the central or centripetal and toward the pleura. Lung is the
most common place for metastatic cancer of various places. Many studies suggest that
smoking is a major cause of lung cancer. Another cause of lung cancer is air pollution,
exposure to arsenic, asbestos, radon, chloromethyl ethers, chromium, mustard gas, nickel
refining, polycyclic hydrocarbons, beryllium, cadmium, and vinyl chloride. The incidence
of lung cancer is higher also found on gas industries-coal, metal refining process. Genetic
predisposition also plays a role in the etiology of lung cancer. History will be obtained
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from the main complaints and course of the disease, as well as other factors that are often
very helpful upholding diagnose. The main complaints can be:
- Cough-cough with / without sputum (phlegm white, can also purulent)
- Coughing up blood
- Hard to breathe
- Hoarseness
- Chest pain
- Difficulty / pain swallowing
- A lump in the base of the neck
- Swollen face and neck, sometimes accompanied by a swollen arm with great pain
Not infrequently the first visible symptoms or complaints are due to metastases outside
the lung, such as abnormalities that arise because of severe compression of the brain, liver
enlargement or leg fractures. Symptoms and complaints that are not typical like:
-

Weight loss decreases

Appetite lost
Intermittent fever
Paraneoplastic syndromes, such as "Hypertrophic pulmonary osteoartheopathy"
peripheral venous thrombosis and neuropatia.

Radiological examination results is one that is absolutely necessary investigation to

determine the location of the primary tumor and metastasis, as well as disease staging by
TNM system. Radiological examination of the lungs that is CXR (Chest X-Ray) PA
/lateral, if possible thoracic CT scan, bone scan, bone survey, abdominal ultrasound
(USG) and Brain-CT needed to determine the location of abnormalities, tumor size and
metastasis.

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Figure 20. Overview CXR with lung cancer

Lung cancer treatment is combined modality therapy (multi-modaliti therapy). In fact at
the time of the selection of therapy, not only expected on histologic type, degree and
appearance of the patient but also non-medical conditions such as facilities owned by the
hospital and the patient economy is also a factor that was crucial. Therapy in lung cancer
include surgery, radiotherapy and chemotherapy.
Thoraxs Physical Examination

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