Anatomy- Respiratory System: Trachea & Lungs

Front 1

Trachea
a) Lengt
b) Parts
c) Diameter:

Back 1

a) 10-12cm long
b) Cervical part: C6-C7 (C4 in newborn and C5 in child), Thoracic part: T1-T4
c) 12mm

Front 2

Bifurcatio trachea
a) What?
b) Where?
c) Carnia trachea:

Back 2

a) 1st division of the bronchial tree---> primary bronchi
b) T4
c) A saggital oriented ridge inside the bifurcation that divides the airstream into the right and left main bronchi

Front 3

Neurovascular supply of trachea
a) Arteries
b) Veins
c) Lymph
d) Innervation

Back 3

a) 1. a.thyroidea inf.---> rr.tracheales
2. Aorta---> rr.bronchiales
3. (2% also: a.thyroidea ima)
4. Newborn and child- branches of thymic arteries

b) Drains to oesophagal veins---> plexus thyroideus impar and to v.brachiceohalica sin.

c) Ln. tracheobronchiales, nodi tracheales---> truncus bronchomediastinalis dx/sin.

d) 1. n. vagus---> n. laryngeus recurrens
2. Truncus sympaticus

Front 4

Coniotomy
a) What do you cut through?
b) What should you be careful about?

Back 4

a) 1. Skin
2. Subcutaneous connective tissue
3. Lamina superficialis fasciae cervicalis
4. Lamina pretrachealis fasciae cervicalis
5. Lig.cricothyroideum + mucosa

b) Joining rr.cricothyroidei a.laryngea sup. close below cartilagio thyroidea and lobus pyramidalis glandula thyroidae

Front 5

Tracheotomy
a) What?
b) Where?
c) What do you cut through?

Back 5

a) Sagital cut through tracheal cartilage for cannulation (inhospital)
b) 1. Superior: Above isthmus glandulae thyroidea (2-4 tracheal cartilage)
2. Inferior: below isthmus, above incisura jugularis

c) 1. Skin
2. Subcutaneous tissue
3. Lamina superficialis fasciae cervicalis
4. Arcus vebosus jugularis (inf trach)
5. Lamina pretrachealis fasciae cervicalis + fibrous connection betweem mm. sternohyoidei of both sides (inf. trach)
6. Venous plexus thyroideus impar (inf. trach)
7. Annular lig + mucosa

Front 6

Trachea wall structure:

Back 6

1. Resp epithelium
2. Glandulae tracheales: seromucinous glands
3. 15-20 C shaped hyaline cartilages known as cartilagines tracheales
4. Ligg. anularia
5. M. trachealis: smooth, transverse + longitudinal fibers
6. Paries mebranaceus
7. Adventia on outer surface

Front 7

Bronchial tree (arbor bronchialis)- Dichotomic divisions= bifurcations
a) Nr of successive divisions
b) Primary bronchi
c) Secondary bronchi
d) Tertiary bronchi
e) Further divisions

Back 7

a) 23 successive divisions

b) Bronchus principialis dx. + sin. Right: shorter/ wider/ starighter- 75% of foreign bodies

c) Bronchi lobares: 2 sin., 3 dx.

d) Bronchi segmentales: 8 sin., 10 dx. (exception: 6th segment bronchus of both sides has a trifurcation)

e) 4th level: bronchi subsegmentalis (b=ventral, a=dorsal)
5th level: (ii=ventral, i=dorsal) (medium)
6th level (β= ventral, α= dorsal) (small)

Bronchiolus terminalis: 14th-16th level (1 terminal bronchiole supplies 1 secondary lung lobule)

Front 8

Pulmonary lobule

Back 8

Subunits of bronhcopulmonary segments. Found mainly on the surface. Are polygonal regions with a size of 0,5-3cm

Front 9

Bronchi consist of: (6)

Back 9

1. Tunica fibromusculocartilaginea
2. Cartilages of irregular shape
3. Spiral smooth mm. fibers
4. Seromucinous glands
5. Nodules of lymphoid tissue at bifurcations
6. Resp epithelium--> ciliated one layer

Front 10

Bronchioli consist of: (6)

Back 10

1. Flattened epithelium---> cubic form
2. Clara`s cells (dome shaped cells with microvilli, secrete GAGs to protect bronchiole lining
3. 0,3- 0,5mm in diameter
4. No cartilage, glands or lymph nodes
5. Successive growing of elastic fibers
6. Terminal bronchioli= secondary lung lobule

Front 11

Lungs consist of: (5)

Back 11

1. Respiratory bronchioli
2. Alveolar ducts
3. Alveolar sacs
4. Alveoli
5. Pleura

Front 12

Lungs surface description, basis, apex: (7)

Back 12

1. Facies costalis (+pars vertebralis)
2. Facsies mediastinalis (+impressio cardiaca)
3. (Facies interlobaris)
4. Margo anterior (incusura cardiaca p.sin), inferior
5. Hilum pulmonis, radix (root) pulmonis
6. Fissura obliqua, fissura horizontalis p. dx.
7. Impressions (aorta on left side, oesophagus and subclavian impression on right lung)

Front 13

Hilum structures
a) Sinister
b) Dexter

Back 13

a) ABV (Veins lie anteriorly, one of the veins lie besides the main bronchus only anteriorly)

b) BAV (Bronchus lie posterior, then artery which lies behind and superior and then vein which lie anterior and inferior to main bronchi)

Front 14

Pulmo dexter, lobes?

Back 14

3 lobes: sup, medius, inf

Front 15

Pulmo sinister:

Back 15

2 lobes (sup, inf)
Pars lingula on sinister

Front 16

Segments (segmenta bronchopulmonale)
a) Right
b) Left

Back 16

a) 10
b) 10 (sometimes 8, segment I+ II share segmental bronchus, 90% miss VII)

Front 17

Lung impressions
a) Common
b) Left lung
c) Right lung

Back 17

a) 1. Sulcus arteriae subclaviae (facies mediastinalis)
2. Impressio costae primae (margo anterior)
3. Impressio costarum (facies costalis)
4. Impressio cardiaca (facies mediastinalis

b) On facies medistinalis:
1. Sulcus aorticus
2. Impressio oesophagea
3. Sulcus venae brachiocephalicae sinistrae

c) On the facies mediastinalis:
1. Sulcus venae vavae superioris
2. Sulcus venae azygos
3. Sulcus esophagus

Front 18

Functional circulation of lungs:

Back 18

Right ventricle---> truncus pulmonaris---> a. pulmonaris dx. + sin.---> division similar to bronchi (hyparterial bronchus sin. eparterial bronchus dx.) - elastic arteries (low pressure), smooth muscle in fetus only, in adults arterias <1mm.

Cappilaris---> veins independent on arteries run in the septi between lobules---> 4 venae pulmonales---> left atrium

- Arterio- venous anastomoses (a-a, v-v)
- Hypoxia--> rapid smooth mm. proliferation==> right ventricle hypertophy

Front 19

Nutritive circulation of lungs:
a) Arteries
b) Veins

Back 19

a) Aortoa thoracia---> Rami bronchiales:
- 1dx.- often branch of a.intercostalis tertia
- 2. sin.- direct branches of thoracic aorta
---> along bronchi up to bronchioli respiratori
(rami bronchiales accessorii in lig.pulmonale

b) Veanae bronchialis--->
- Deep system ends in vv.pulmonales
- Superficial system drains extrapulmonary bronchi, visceral pleura and hilum lymph nodes----> vv. pulmonales or v.azygos/hemiazygos

Front 20

Right lung segments:
a) Superior lobe
b) Medium lobe
c) Inferior lobe

Back 20

a) Superior lobe:
I: Apicale
II: Posterius
III: Anterius

b) Medium:
IV: Laterale
V: Mediale

c) Inferior:
VI: Superius
VII: Basale mediale
VIII: Basale anterius
IX: Basale laterale
X: Basale posterius

Front 21

Left lung segments:
a) Superior
b) Inferior

Back 21

a) Superior:
I+II: Apicoposterius
III: Anterius
IV: Lingulare superius
V: Lingulare inferius

b) Inferior:
VI: Superius
VII: Basale mediale
VIII: Basale anterius
IX: Basale laterale
X: Basale posterius

Front 22

Lymph drainage of lungs:

Back 22

1. Superficial subpleural plexus
2. Deep plexus along bronchi and vessels (NO LYMPH VESSELS IN ALVEOLAR WALLS)

N.l. intrapulmonales---> n.l. tracheobronchiales inferiores (both lungs except 3 left upper segments) ---> n.l.tracheobronchiales sup.dx.---> truncus bronchomediastinalis dx.--->angulus venosus dx.---> veins of neck

Front 23

Lymph drainage of 3 upper segments (I+II, III) of left lung:

Back 23

Directly to n.l.tracheobronchiales sin.---> truncus bronchomediastinalis sin.---> ductus thoracicus---> angulus venosus sin.---> veins of neck

Front 24

Lungs- innervation:

Back 24

1. Nervus vagi of both sides
- Viscerosensory
- Autonomic parasympathetic fibers

2. Truncus symphaticus
- Autonomic sympathetic fibers

Front 25

Alveolar tree (Arbor alveolaris)- dichotomic division:
a) Respiratory bronchioli
b) Alveolar ducts
c) Alveolar sacculi
d) Pulmonar alveoli

Back 25

a) 17th- 19th level (arises by 17th division)
- Alveoli open from the wall
- At level 19th, 8 primary lobuli forms 1 secondary lobuli

b) Ductus alveolares:
- 20th- 22th level
- Alveoli open from the wall
- Atrium is at the end of alveolar duct of 3rd level
- In the last 23th bifurcation divided into 2 alveolar sacs.

c) Sacculi alveolares
- 23th level
- Forming pouches===>

d) Alveoli pulmonis

Front 26

Bronchioli respiratorii:
a) Diameter
b) Kind of epithelium
c) Contains?

Back 26

a) <0,3mm
b) Cubic ciliated epithelium
c) Alveoli with flat epithelium, and is successively changing in alveolar ducts

Front 27

Alveoli
a) Diameter
b) Alveolar lining
c) Contain

Back 27

a) 200 micrometer, polyhedric with thin wall

b) Respiratory epithelium:
- Membranous pneumocyte (1st type)
- Granular pneumocyte (2nd type)

c) Alveolar septum and Kohns pore (10 micrometer) between adjacent alveoli to ensure ventilation and for pressure equalization

Front 28

Blood air barrier:
a) Consists of
b) Total respiratory lung surface

Back 28

a) Alveolar pneumocytes of 1st type
Basal membrane
Endothelial cells of cappilaries

b) 140 m2

Front 29

Clinical examination of lungs:

Back 29

1. Inspection, percussion, auscultation, palpation
2. Rtg, CT
3. Bronchoscopy
- Rigid- to 3rd level
- Flexible to 6th level
4. Bronchografie
5. Spirometry- VLC

Front 30

Pleura- Serous membrane (mesothel)
a) Pleura visceralis
b) Pleura parietalis

Back 30

a) 1. Tunica serosa
2. Tela subserosa

b) 1. Pars: costalis, diaphragmatica, mediastinalis
2. Tunica serosa, tela subserosa

Front 31

Cupula pleurae (protrudes anteriorly above the superior thoracic aperture and extends posteriorly to the head of 1st rib)
a) Strengthen by what membrane?
b) Other ligaments and mm.:

Back 31

a) Membrana suprapleurais (Sibsoni)

b) 1. lig.scalenopleurale, lig.vertebropleurale, transversopleurale + m.scalenus minimus (Sibosni), lig. costapleurale

Front 32

Recessus pleurales:

Back 32

1. Costodiaphragmaticus
2. Costomediostinal recess (costo/phrenico/vertebromediastinalis recess)
3. Lig.pulmonale
4. Pleural cavity: liquosus pleurae

Front 33

Pleura parietalis neurovascular supply:
a) Arteries
b) Veins
c) Lymph drainage
d) Innervation

Back 33

a) 1. A.thoracica interna--->a.musculophrenica---> aa.intercostales anteriores
2. Aorta thoracica---> aa.intercostales posteriores

b) Veins of thorax wall

c) N.l. intercostales, parasternales, diaphragmatici, mediastinales posteriores

d) 1. Nn. intercostales (pleura costalis+ periphreric pleura diaphragmatica)
2. N. phrenicus (pleura medistina+ central pleura diaphragmatica)

Front 34

Pleura visceralis neurovascular supply:

Back 34

Arteries: rr.bronchiales
Veins: vv.bronchiales
Lymph: Superficial subpleural plexus
Nerves: Only autonomic along the vessels.

NB: No pain receptors in visceral pleura except for at the hilum!

Front 35

Projections of lungs:

Back 35

1-2 ribs higher the of the pleura
Area interpleuralis sup.: Thymus
Area interpleuralis inf.: Heart

Front 36

Respiratory mm.
a) Main inspiratory
b) Auxilliary inspiratory

Back 36

a) Main insp:
1. Diaphragma
2. mm.intercostales externi (mm.scaleni)

b) Auxiliary insp:
1. m. pectoralis major+ minor
2. Latissimus dorsi
3. m.serratus anterior+ post+ sup
4. m.sternocleidomastoideus
5. m.subclavicus
6. (m.sternothyroideus, m.sternohyoideus)

Front 37

Respiratory mm.
a) Main expiratory
b) Auxiliary expiratory

Back 37

a) Main exp:
mm. intercostales interni (+intimi)

b) Auxiliary exp:
1. m.rectus abdominis
2. m.obliquus abdominis ext.+ int.
3. m.transversus abdominis
4. m.quadratus lumborum
5. m.serratus post.inf
6. m.transversus thoracis