Prezentace aplikace PowerPoint - Univerzita Karlova

Univerzita Karlova v Praze - 1. Lékařská fakultaRespiratory SystemInstitute of AnatomyAuthor: David SedmeraSubject: Anatomy 1Date: 2013

Division of respiratory system• Upper respiratory tract:- external nose- nasal cavity & paranasal sinuses- pharynx• Lower respiratory tract:- larynx- trachea (windpipe)- bronchi (down to respiratorybronchioli)- lungs• Significance: ENT vs. pneumologyURTI vs. pneumonia

Nasal passages and paranasal sinuses

Nasal cavity and paranasalsinuses• Common colds are common• Spatial relationships (syntopies) areimportant for spread of infection• Complications: meningitis, teeth, orbit,mediootitis, mastoiditis, sinusitis…

Nasal cavity and paranasalsinuses• Why do we have them (other than tokeep ENT doctors in business)• Maxillary, frontal, sphenoidal,ethmoidal• Surface projections, visible and X-rayexamination - sinusitis

RESUMEN DE ORIENTACIÓNENFERMEDADES CON LA MAYOR CONTRIBUCIÓN CAUSAL DEL MEDIO AMBIENTELa barra verde oscura más la barra verde clara del diagrama representan la carga de morbilidad total.Retraso mental (causado por el plomo), tal como se define en la lista de enfermedades de la OMS correspondiente a 2002,accesible en Internet (www.who.int/evidence).AVAD: una medida ponderada de la mortalidad, la morbilidad y la discapacidad.función pulmonar, es atribuible a factores de riesgo ambientales. La exposición profesional al polvo y asustancias químicas, así como la contaminación del aire en locales cerrados por utilización de combustiblessólidos en los hogares, parecen ser dos de los principales factores que contribuyen a aumentar la fracciónde la carga de morbilidad relacionada con el medio ambiente. Sin embargo, otras formas de contaminacióndel aire en locales cerrados y del aire exterior, que van desde la producida por los medios de transportehasta el humo del tabaco de segunda mano, también ejercen una influencia importante.En el gráphico de arriba figura una lista de las 24 enfermedades con la mayor carga de morbilidad globalatribuible al medio ambiente. En el informe completo se proporciona una descripción detallada de losfactores ambientales y las repercusiones en todas las enfermedades que se examinan así como cuadros yanexos estadísticos que cubren la carga de morbilidad mundial y regional, así como la de subgruposespeciales, como los niños.7

Frontal CT

Horizontal CT

Postnatal growthof paranasalsinuses(pneumatization)

Histology of airwaysTaken from and see more in: Junquiera’s Histology!

Laryngeal cartilagesThyroid cartilage – left + right lamina, superior + inferior notch,superior + inferior horn, oblique line, cricoid articular surfaceCricoid cartilage - arch, lamina, arytenoid + cricoid articular surfaceArytenoid cartilage - base, apex, muscular + vocal process, cricoidarticular surface,Epiglottis, Cuneiform + Corniculate + Triticeal cartilages

The Larynx - development

The Larynx - sagittal view

The Larynx - vocal cordmovementsanteriorposterior

The Larynx - frontal view

The Larynx - examination(laryngoscopy)indirectdirect

The Trachea - cross section

Histology of Trachea Epithelium (cylindricalwith cilia and goblet cells) Connective tissue Glands in lamina propria Hyaline cartilage coveredby perichondrium Smooth (trachealis) muscle

The trachea and segmental bronchiStarts at C6Bifurcation at Th4-5Length: 13 cmDiameter: 2.5 cm

Coniotomy and tracheotomy

Coniotomy and tracheotomyconiotomySuperior tracheotomyInferior tracheotomy

Syntopy of cervical part of trachea

Blood supply• Nasal cavity - ethmoidal and sphenopalatineartery• Larynx -superior and inferior laryngealartery• Trachea - branches from thyroid arteries orthoracic aorta

Innervation• Nasal cavity - I, V1, V2; parasympatheticfibers from VII• Larynx -superior and recurrent laryngealnerve (from X)• Trachea - X, cervical sympathetics

Lymphatic drainage

The Lungs & Pleura - projections

Borders of Lungs & Pleura

Borders of Lungs & Pleura

The Lungs & Pleura - projections

Pleural recesses• Costodiphragmatic recess -accumulation of fluids• recessus phrenicomediastinalis• recessus costomediastinalis

The Pleural Cavity

• Penetration of thepleural cavity equalizespressure• This results in thecollapse of the affectedlung• Could be classified asopen, closed, or tension• Treatment is bydrainage that facilitatesair resorptionPneumothorax

Pneumothorax - X-ray

The lungs

The lungs

Syntopies of trachea and main bronchi

The bronchopulnonary segments

Histology of the Bronchi Epithelium (cylindricalwith cilia and goblet cells) Connective tissue Glands in lamina propria Hyaline cartilage(discontinuous) Smooth muscle

Histology of the Bronchi

Bronchography

Blood supply & innervation• Pulmonary artery and branches - functional• Rr. Bronchiales from thoracic aorta orintercostal arteries - nutritive• Pulmonary vein, anastomoses• Parasympathetic: left and right vagus• Sympathetic: inferior and middle cervicalganglia, rami from the first four thoracicganglia; almost no pain (only parietal pleura)

Lymphatic drainage

The Bronchioli No cartilage, just smooth muscle => bronchocostriction inasthma!

The Lung Lobes - projections

Terminal bronchioli and Clara cells

Histology of lungtissue - respiratorybronchioli, alveolarducts, alveoli

Branching ~23 bifurcations,300-400 mil alveolisurface area: 40-80 sq. m., air-blood barrier 0.2-0.5 µm

Alveolar wall: Capillaries, type I & II alveolar cells, macrophages

The muscles of respirationDiaphragma (C3-C5)Intercostal mm. - bucket handle actionAccessory respiratory muscles

• Piston&syringeMechanism of breathing

Respiratory movements of the diaphragm

Abdominal press• Simultaneous contraction ofdiaphragm and abdominalmuscles• Increased abdominal pressureuseful during miction,defecation, parturition• If the pelvic diaphragm iscontracted as well, supports thelumbar spine (muscular corset)

Pleural cavity dx., sin.Parietal pleuraCostal partMediastinal partDiaphragmatic partPleural cupula (dome))Pleural recesses:costodiaphragmaticcostomediastinalphrenicomediastinalPulmonary lig.bronchopericardialmembraneMediastinumSuperior, Inferior –anterior, middle,posterior

The PleuraLined by mesothelium (M) secreting pleural fluid(WHY this is NOT an epithelium?)The connective tissue is rich in both collagen and elastic fibers andcontains both blood vessels (V) and lymphatics (L).

Mediastinum (interpleural space)superius, inferius – anterius, medium,posterius

Space in thorax between the leftand right pleural cavities,filled by vessels, organs,fatty tissueBorders:• cranial – apertura thoracissuperior• caudal – diaphragm• ventral – sternum and ribs• dorsal – vertebral columnMediastinum

Posterior mediastinum• esophagus• n. vagus dexter et sinister(plexus oesophageus)• Aortic arch (end)• aorta thoracica• ductus thoracicus• v. azygos• v hemiazygos ethemiazygos accessoria• truncus sympaticus dexteret sinister• Lymph nodes

Anterior mediastinumAnterior superior mediastinum• thymus• Venous layer – vv.brachiocephalicae, v. cava sup.,plexus thyroideus impar• Arterial layer – aortic arch andits branches• Trachea, bronchi, recurrentlaryngeal nerveAnterior inferiror (middle)mediastinum• Heart in pericardium• n. phrenicus

What is that?

What is that?

• Lympho-epithelial organ• Primary lymphatic organ• Left and right lobe• Lobules, cortex & medulla• (accessory lobules)• Fibrous capsule• Proportionally large at birth(12-14g)• With ageing undergoesinvolution and replacement byfatty tissue• Residues still discernible atthe old age (watch out duringdissections when opening thechest cavity!)The thymus

Located in the superiormediastinum behind thesternum30-40 g• Involution after puberty• Replaced by fat after 50 years• Possible site of thymoma (cancer from whiteblood cells)

Development of thymus

Development of thymus◗ ventral process of 3rdbranchial pouch◗ mediocaudal descensus◗ endodermal proliferation◗ stem cell colonization in10th week /lymphocytes/derived from blood island,liver, bone marow◗ ingrowth of mesenchymalsepts (fibrous tissue)

P a ra thyro id tis s uein m e dia s tinumc a n bee ve ryw he rethym us c ould beinc ludingm e dia s tina l fa tResidual thymus tissueafter snadard thymectomy,based upon 50 clinicoanatomicalstudies

SUPERIOR VENA CAVA• Formed by the confluence of thebrachiocephalic veins• tributaries:– v. thyroidea inf.– v. vertebralis- v. intercostalis suprema, intercosalis sup. sin.• v. azygos• v. thoracica interna• Visceral branches of the mediastinal organs

Cranial tributaries ofthe superior vena cava

References• Cihak: Anatomie 2: Splanchnologia• Netter’s Atlas of Human Anatomy• Sobotta: Anatomy• Junquiera’s Histology• www.netanatomy.com