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ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM The respiratory system consists of the nose, the nasal cavity,

the pharynx, the larynx,the trachea, the bronchi, and the lungs. The upper respiratory tract refers to the nose, nasalcavity, pharynx, and associated structures; and the lower respiratory tract includes the larynx,trachea, bronchi, and lungs. These terms are not official anatomical terms, however, and thereare several alternative definitions. For example, one alternative places the larynx in the upper respiratory tract. Although air frequently passes through the oral cavity, it is considered to bepart of the digestive system instead of the respiratory system. NOSE AND NASAL CAVITY The term nose refers to the visible structure that forms a prominent feature of the face.Most of the nose is composed of cartilage, although the bridge of the nose consists of bone.The bone and cartilage are covered by connective tissue and skin. The nasal cavity extends from the nares to the choane. The nares, or nostrils, are theexternal openings of the nose and the choane are the openings to the pharynx. The nasalseptum is a partition dividing the nasal cavity into the right and left sides. The hard palate formsthe floor of the nasal cavity, separating the nasal cavity from the oral cavity. Air can flowthrough the nasal cavity when the mouth is closed or when the oral cavity is full of food. Three prominent bony ridges called conchae resembling a conch shell, are present onthe lateral walls on each side of the nasal cavity. The conchae increase the surface area of thenasal cavity. Paranasal sinuses are air-filled spaces within the bone. The maxillary, frontal,ethmoidal, and sphenoidal sinuses are named after the bones in which they are located. Theparanasal sinuses open into the nasal cavity and are lined with a mucous membrane. Theyreduce the weight of the skull, produce mucus, and influence the quality of the voice by actingas resonating chambers. Mucus produced by the epithelium of the paranasal sinuses, drains through smallpassageways into the nasal cavity. When the mucous membranes become swollen because of nasal infections, sinus infections, or allergies, these passages can become blocked. The mucusthen accumulates within the sinuses, and the increasing pressure can produce a painful sinusheadache. The nasolacrimal ducts, which carry the tears from the eyes, also open into the nasalcavity. Sensory receptors for the sense of smell are found in the superior part of the nasalcavity. Air enters the nasal cavity through the nares. Just inside the nares the epithelial lining iscomposed of stratified squamous epithelium containing coarse hairs. The hairs trap some of the large particles of dust suspended in the air. The rest of the nasal cavity is lined withpseudostratified columnar epithelial cells containing cilia and many mucus-producing gobletcells. Mucus produced by the goblet cells also traps debris in the air. The cilia sweep themucus posteriorly to the pharynx, where it is swallowed. As air flows through the nasal cavities,it is humidified by moisture from the mucus epithelium and is warmed by blood flowing throughthe superficial capillary networks underlying the mucous epithelium. PHARYNX The pharynx is the common passageway of both the respiratory and digestive systems.It receives air from the nasal cavity and air, food, and water from the mouth. Inferiorly, thepharynx leads to the rest of the respiratory system through the esophagus. The pharynx can bedivided into three regions; the nasopharynx, the oropharynx, and the laryngopharynx.

The nasopharynx is the superior part of the pharynx and extends from the choane of thenasal cavity to the level of the uvula, a soft process that extends from the posterior edge of thesoft palate. The soft palate forms the floor of the nasopharynx. The nasopharynx is lined withpseudostratified ciliated columnar epithelium that is continous with the nasal cavity. Theauditory tubes extend from the middle ears and open into the nasopharynx. The posterior partof the nasopharynx contains the pharyngeal tonsil, which aids in defending the body againstinfections. The soft palate and the uvula are elevated during swallowing; this movement resultsin the closure of the nasopharynx, which prevents food from passing from the oral cavity into thenasopharynx. The oropharynx extends from the uvula to the epiglottis, and the oral cavity opens intothe oropharynx. Thus food, drink, and air all pass through the oropharynx. The oropharynx islined with stratified squamous epithelium, which protects against abrasion. Two sets of tonsils,the palatine tonsil and lingual tonsil, are located near the opening between the mouth and theoropharynx. The palatine tonsils are located in the lateral walls near the border of the oralcavity and the oropharynx. The lingual tonsil is located on the surface of the posterior of thetonque. The laryngopharynx passes posterior to the larynx and extends from the tip of theepiglottis to the esophagus. The laryngopharynx is lined with stratified squamous epitheliumand ciliated columnar epithelium. LARYNX The larynx is located in the anterior throat, and it connects superiorly to the pharynx andinferiorly to the trachea. The larynx consists of an outer casing of nine cartilages that areconnected to one another by muscles and ligaments. Three of the nine cartilages are unpaired,and six of them form three pairs. The largest cartilage is the unpaired thyroid cartilage, or Adams apple. The thyroid cartilage is attached superiorly to the hyoid bone. The most inferior cartilage of the larynx is the unpaired cricoid cartilage, which forms the base of the larynx onwhich the other cartilages rest. The thyroid and cricoid cartilages maintain an openpassageway for air movement. The third unpaired cartilage is the epiglottis. It differs from the other cartilages in that itconsists of elastic cartilage rather than hyaline cartilage. Its inferior margin is attached to thethyroid cartilage anteriorly, and the superior part of the eipiglottis projects as a free flap towardthe tonque. The epiglottis helps prevent swallowed materials from entering the larynx. As thelarynx elevates during swallowing, the epiglottis tips posteriorly to cover the opening of thelarynx. The six paired cartilages consists of three cartilages on either side of the posterior partof the larynx. The top cartilage on each side is the cuneiform cartilage, the middle cartilage isthe corniculate cartilage, and the bottom cartilage is the arytenoid cartilage. The arytenoidscartilages articulate with the cricoid cartilage inferiorly. The paired cartilages form andattachment site for the vocal folds. Two pairs of ligaments extend from the posterior surface of the thyroid cartilage to thepaired cartilages. The superior pair forms the vestibular folds or false vocal cords, and theinferior pair composes the vocal cords, or true vocal cords. When the vestibular folds cometogether, they prevent air from leaving the lungs, such as when a person holds his breath.Along with the epiglottis, the vestibular folds also prevent food and liquids from entering thelarynx. The vocal folds are the primary source of voice production. Air moving past the vocalcords causes them to vibrate, producing sound. Muscles control the length and tension of thevocal folds. The force of air moving past the vocal folds controls the loudness, and the tensionof the vocal folds controls the pitch of the voice. An inflammation of the mucous epithelium of the vocal folds is called laryngitis. Swelling of the vocal folds during laryngitis inhibits voiceproduction. TRACHEA

The trachea or windpipe is a membraneous tube that consists of connective tissue andsmooth muscle, reinforced with 16 - 20 C-shaped pieces of cartilage. The adult trachea isabout 1.4 - 1.6 centimeters in diameter and about 10 11 cm. long. It begins immediatelyinferior to the cricoid cartilage, which is the most inferior cartilage of the larynx. The tracheaprojects through the mediastinum, and divides into the right and left primary bronchi at the levelof the fifth thoracic vertebra. The esophagus lies immediately posterior to the trachea. C-shaped cartilages form the anterior and lateral sides of the trachea. The cartilagesprotect the trachea and maintain an open passageway for air. The posterior wall of the tracheahas not cartilage and consists of a ligamentous membrane and smooth muscle. The smoothmuscle can alter the diameter of the trachea. The trachea is lined with pseudostratified columnar epithelium, which contains numerouscilia and goblet cells. The cilia propel mucous produced by the goblet cells, as well as foreignparticles embedded in the mucus, out of the trachea, through the larynx, and into the pharynx,from which they are swallowed. Constant irritation of the trachea by cigarette smoke can cause the tracheal epithelium tochange to stratified squamous epithelium. The stratified squamous epithelium has no cilia andtherefore lacks the ability to clear the airway of mucus and debris. The accumulations of mucusprovide a place for microorganisms to grow, resulting in respiratory infections. Constantirritation and inflammation of the respiratory passages stimulate the cough reflex, resulting in smokers cough. BRONCHI The trachea divides into the left and right main (primary)bronchi, each of which connects to a lung. The left main bronchus ismore horizontal than the right main bronchus because it is displacedby the heart. Foreign objects that enter the trachea usually lodge inthe right main bronchus, because it is more vertical than the left mainbronchus and therefore more in direct line with the trachea. The main bronchi extend from thetrachea to the lungs. Like the trachea, the main bronchi are lined with pseudostratified ciliatedcolumnar epithelium and are supported by C-shaped pieces of cartilage. LUNGS The lungs are the principal organs of respiration. Each lung is cone-shaped, with itsbase resting on the diaphragm and its apex extending superiorly to a point about 2.5 cm abovethe clavicle. The right lung has three lobes called the superior, middle, and inferior lobes. Theleft lung has two lobes called the superior and inferior lobes. The lobes of the lungs areseparated by deep, prominent fissures on the surface of the lung. Each lobe is divided intobronchopulmonary segments separated from one another by connective tissue septa, but theseseparations are not visible as surface fissures. Individual diseased bronchopulmonary segmentcan be surgically removed leaving the rest of the lung relatively intact, because major bloodvessels and bronchi do not cross the septa. There are nine bronchopulmonary segments in theleft lung and 10 in the right lung. The main bronchi branch many times to form the tracheobronchial tree. Each mainbronchus divides into lobar bronchi as they enter their respective lungs. The lobar (secondary)bronchi, two in the left lung and three in the right lung, conduct air to each lobe. The lobar bronchi in turn give rise to segmental (tertiary) bronchi, which extend to the bronchopulmonarysegments of the lungs. The bronchi continue to branch many times finally giving rise tobronchioles. The bronchioles also subdivide numerous times to give rise to terminalbronchioles, which then subdivide into respiratory bronchioles. Each respiratory bronchiolesubdivides to form alveolar ducts, which are like long, branching hallways with many opendoorways. The doorways open into alveoli, which are small air sacs. The alveoli becomes sonumerous that the alveolar duct

wall is little more than a succession of alveoli. The alveolar ducts end as two or three alveolar sacs, which are chambers connected to two or more alveoli.There are about 300 million alveoli in the lungs. As the air passageways in the lungs become smaller, the structure of their wallschanges. The amount of cartilage decreases and the amount of smooth muscle increases, untilat the terminal bronchioles the walls have a prominent smooth muscle layer, but no cartilage.Relaxation and contraction of the smooth muscle within the bronchi and bronchioles can changethe diameter of the air passageways. For example, during exercise, the diameter can increase,thus increasing the volume of air moved. During an asthma attack, however, contraction of thesmooth muscle in the terminal bronchioles can result in greatly reduced airflow. In severecases, air movement can be so restricted that death results. As the air passageways of the lungs becomes smaller, the lining of their walls alsochanges. The trachea and bronchi have pseudostratified ciliated columnar epithelium, thebronchioles have ciliated simple columnar epithelium, and the terminal bronchioles have ciliatedsimple cuboidal epithelium. The ciliated epithelium of the air passageways functions as amucus cilia escalator, which traps debris in the air and removes it from the respiratory system. As the air passageways beyond the terminal bronchioles become smaller, their wallsbecome thinner. The walls of the respiratory bronchioles are cuboidal epithelium and those of the alveolar ducts and alveoli are simple squamous epithelium. The respiratory membrane of the lungs is where gas exchange between the air and blood takes place. It is mainly formed bythe walls of the alveoli and the surrounding capillaries, but theres some contribution by thealveolar ducts and respiratory bronchioles. The respiratory membrane is very thin to facilitatethe diffusion of gases. It consists of: 1. A thin layer of fluid lining the alveolus. 2. The alveolar epithelium composed of simple squamous epithelium. 3. The basement membrane of the alveolar epithelium. 4. A thin interstitial space. 5. The basement membrane of the capillary endothelium. 6. The capillary endothelium composed of simple squamous epithelium.The elastic fibers surrounding the alveoli allow them to expand during inspiration and recoilduring expiration. The lungs are very elastic, and when inflated, they are capable of expelling the air and returning to their original, uninflated state. Specialized secretory cellswithin the walls of the alveoli secrete a chemical called surfactant that reduces the tendencyof the alveoli to recoil. PLEURAL CAVITIES The lungs are contained within the thoraciccavity. In addition, each lung is surrounded bya separate pleural cavity. Each pleural cavity islined with a serous membrane called the pleura.The pleura consists of a parietal and visceralpart. The parietal pleura, which lines the wallsof the thorax, diaphragm, and mediastinum, iscontinuous with the visceral pleura, whichcovers the surface of the lung. The pleural cavity, between the parietaland visceral pleurae, is filled with a small volume of pleural fluid produced by the pleuralmembranes. The pleural fluid performs two functions: (1) it acts as a lubricant, allowing thevisceral and parietal pleurae to slide past each other as the lungs and thorax change shapeduring respiration, and (2) it helps hold the pleural membranes together. The pleural fluid actslike a thin film of water between two sheets of glass (the visceral and parietal pleurae); the glasssheets can slide over each other easily, but it is difficult to separate them. LYMPHATIC SUPPLY

The lungs have two lymphatic supplies. Thesuperficial lymphatic vessels are deep to thevisceral pleura and function to drain lymph from thesuperficial lung tissue and the visceral pleura. Thedeep lymphatic vessels follow the bronchi andfunction to drain lymph from the bronchi andassociated connective tissues. No lymphaticvessels are located in the walls of the alveoli. Boththe superficial and deep lymphatic vessels exit thelungs at the main bronchi.Phagocytic cells within the lungs phagocytize carbon particles and other debris frominspired air and move to the lymphatic vessels. In older people, the surface of the lungs canappear gray to black because of the accumulation of these particles, especially if the person smoked or lived most of his life in a city with air pollution. Cancer cells from the lungs can alsospread to other parts of the body through the lymphatic vessels.