PowerPoint Presentation

Upper and Lower Respiratory SystemSindhu WisesaDepartment of AnatomyUniversitas Jenderal SoedirmanRespiration System

VentilationVentilationGas ExchangeAerobicCell MetabolismCase 1A little girl, 3 years old, was brought by her mother with fever and cough. She complained about her sore throat and changed voice. The doctor said that was just a common pharyngitis and gave her an antibiotics and acetaminophen. On the night, the little girl was crying without voice production and look very hard to breath. Her mother picked her up to ER in the nearest hospital immediately.

Laryngitis3Respiratory Organ

Gambar batas upper dan lower45The Respiratory OrgansConducting zoneRespiratory passages that carry air to the site of gas exchangeFilters, humidifies and warms airRespiratory zoneSite of gas exchangeComposed ofRespiratory bronchiolesAlveolar ductsAlveolar sacs

Conducting zone labeledRespiratory System Surface Anatomy

Ga penting6Respiratory System Classification

Pars konduktorianares (nostril), cavitas nasi, choanae, pharynx, larynx, trachea, bronchus primarius, sekundus (lobaris), tertius (segmentalis), bronchiolus, bronchiolus terminalis

Pars respiratoriabronchiolus respiratorius,ductus alveolus, atria, saccus alveolaris, alveolus 7Upper Respiratory System

9Respiratory MucosaPseudostratified ciliated columnar epitheliumScattered goblet cellsUnderlying connective tissue lamina propriaMucous cells secrete mucousSerous cells secrete watery fluid with digestive enzymes, e.g. lysozymeTogether all these produce a quart/dayDead junk is swallowed

Nose

Septum Nasi

Gambar batas upper dan lower11Nasal Septum Deviation

Etiology:TraumaCongenital Childbirth Connective tissue disorderTreatment: SeptoplastyUpper Respiratory SystemSagittal View

Cavum Nasi

Cavum NasiVestibulum Nasi vibrisaeRegio respiratoryRegio olfactory

Cavum Nasi: Meatus

Nasal Polyp

Alergic relatedCavum Nasi - Vascularization

Epistaxis

Cavum Nasi - Innervation

Sympathetic: ganglion sphenopalatinumParasympathetic: Plexus Caroticus InternusAsal gangglion dari n V2 maxilaris dengan n VII facialis. Sedangkan ethmoidalis anterior berasal dari n nasociliaris cabang dari n V1 opthalmicus19Olfaction

Cilliated pseudostratified20Sinus paranasal

Sinusitis

Head CT Scan coronal viewTrans illuminationPaling sering sinus maxilaris, caldwel luc dan fess (functional endoscopic sinus surgery), besar, lebar22Nasopharynx

Atresia ChoanaTo warm, moisten, and filter the incoming air. >10um particle cannot pass because stick to the mucosa membrane, m salfingopharingea buka tutup os tuba auditivaTo receive olfactory stimuliTo provide resonating chambers for speech sounds

23Nasopharyngeal Cancer(NPC)

NPC predilection: fossa rossenmullerCT Scan Sagittal viewCorpus Alienum

Oropharynx

Ventral viewSagittal viewWaldeyer Ring

Reseptor muntah n vagus27Tonsilitis & Tonsillectomy

TonsilitisTonsillectomyIntermezzo

Larynx - Position

Surface anatomy of larynxLarynx and esophagusTHE LARYNX THE LARYNXI. THE SKELETON & WALL 1. SKELETAL CARTILAGESmajor THYROID STRUCTURESCRICOID ARYTENOIDminorTRITICEACORNICULATECUNEIFORMLIGAMENTS2. MUSCLES

EXTRINSIC INTRINSIC(move the larynx as a whole (-alter the positions of laryngeal cartilagesrelative to other structyres)relative to each other or control directly thearyapiglottic and vocal folds)II. CAVITIESVESTIBULEVENTRICLEINFRAGLOTTIC(of the larynx)(of the larynx)LARYNXLarynxCartilago

9 cartilage, 3 pairs 3 solo32Constrictor Pharynx

Suprahyoid and Infrahyoid muscle

InfrahyoidSuprahyoidElevasi larynx kecuali geniohyoid (elevasi dan protrusi os hyoid); deprasi larynx34Larynx Intrinsic Muscle

Membuka aditus laryngis: plica aryepiglotica (m thyroepiglotica (TE))Menutup aditus laryngis:m aryepigloticus (AE), m arytenoid tranversus (AT), m arytenoid oblique (AO), Membuka plika vocalis: cricoarytenoid posterio (CAP)Menutup plica vocalis:cricoarytenoid lateral (cal)Menegangkan plica vocalis: m cricityroid (CT) Mengendorkan plica vocalis: m thyroarytenoid (TA), Intrinsic muscle: m aryepigloticus (AE), m arytenoid tranversus (AT), m arytenoid oblique (AO), m thyroarytenoid (obliq, TA), m cricoarytenoid posterior et lateral (cap cal), m cricityroid (CT) // plica aryepiglotica (m thyroepiglotica (TE))35Open and Close Airways

Open and Close Airways

Laryng tinggi, up to 2 years37Vocalization anatomy aspect

Kartilago arytenoid mengabduksi dan aduksi plica vocalis. Cowok lebih tebal dan lambar virasinya. Resonansi dipengaruhi lainnya.Register: low/fry, chest, head/falseto, whistle38Thyroglossus cyst

Larynx Stricture and Stenosis

Laryngomalacia

Tracheostomy

Larynx Vascularization

A carotis externa a thyroidea superior a laryngea superior. A thyrocevicalis a throidea inferior a laringea inferior43Larynx Innervation

Kiri aorta kanan a subcalvia dextra. Thyroidectomy, n larungeus recuren semua otot intrinsik kecuali CT44Lymph node Spread Infection

Laryngitis, epiglottitis, and Croup in Children

Hudkins, 1997. AJNR Am J Neuradiol 18:239-245The tongue is larger,easily displaced, and the most common cause of airway obstruction in child. The narrowest portion of the child airway is at the cricoid ring, making obstruction with subglottic pathology more likely than adults.Remember 1mm of swelling in an infant airway causes BIG problems!!!

46Question?

Case 245 years old man was brought to ER because he cannot breathing. The result of chest x ray examination can be seen beside. The doctor took an action immediately by performing needle thoracotomy in triangle safety. Suddenly severe bleeding occurred at the puncture site. The doctor directly pressed the bleeding point to stop it.

Lower Respiratory SystemSurface Anatomy

Thorax Cage

Trachea & Bronchus

12,5x2,5 cm16-25 cartilage. Menjaga agar tidak kolapse teapi tetap lentur. Adanya celah C membuat bisa mengambang ketika ada makanan.Pernafasan mulai di respiratory bronchial51TRACHEA & BRONCHI TRACHEAC-shaped partial cartilaginous ringPrevent tracheal collapse

Cartilaginous platesBronchi:- semirigidPrevent bronchial collapse- pliableBend and stretch to accommodate the enlargement of the lung during inspirationRespiratory bronchiolesTRACHEALEFT BRONCHUSPrimary bronchusRIGHT BRONCHUSBRONCHICARTILAGESAlveolar ductsAtriumAlveolar saccsAlveoliRESPIRATORY LOBULETERMINAL BRONCHIOLESECONDARY /LOBAR BRONCHUSTERTIARY / SEG -MENTAL BRONCHUSTERMINAL BRONCHUSLOBULAR BRONCHIOLE

Cough Sneeze and Hiccups

N vagus. Hiccup gerakan myyoclonic unilateral diafragma, bunyi dari pergerakan epiglotsi, karena distensi gaster, perubahan suhu, alkohol, psikogenik. Singultus. Ada teori untuk mengeluarkan air bubble dalam perut, alasan kenapa sering pada bayi56Asthma Bronchiale

T H E L U N G STHE LUNG LOBESThe Lungs Covered by:

VISCERAL PLEURAPLEURAL CAVITY(content: mucoidpleural fluidLubrication)PARIETAL PLEURA

THE LUNGSRIGHT LUNG(3 lobes)LEFT LUNG(2 lobes)SUPERIORSUPERIORMIDDLEINFERIORINFERIORRight and Left Lung

Right lung and left lung59Pleura

N phrenicus60Ventilation anatomical aspect

Diafragma, tekanan negatif, surfactan61Ventilation

Besides the diaphragm (only creates about 60-75% of the volume change) what are the muscles of inspiration & expiration?Ventilation anatomical aspect

Intercostalis muscle

Ventilation

VentilationSurfactant is produced by the septal cellsDisrupts the surface tension & cohesion of water moleculesImpact?prevents alveoli from sticking together during expiration

Gas TransportCO2 transport7% in plasma23% in carbamino compounds (bound to globin part of Hb)70% as BicarbonateCarbon DioxideCO2 + H2O H2CO3H+ + HCO3-Enzyme is Carbonic AnhydraseChloride shift to compensate for bicarbonate moving in and out of RBC

Lung Innervation

RESPIRATORY CENTERMedulla OblongataDorsal Respiratory Group (DRG) inspiration muscleVentral Respiratory Group (VRG) expiration muscle (forced)PonsApneutic center stimulate inspiration, inhibit expirationPneumotactic center inhibit inspiration duration, increase ventilation frequency Cerebri CortexVoluntary ventilationPontine respiratory group: 72Respiratory RhytmCentral Nervous SystemCortex CerebriMedulla OblongataPonsPeripheral Nervous SystemAortic BodiesCarotid Bodies Hydrogen Ions40 3 mmHgCO2O2 < 60 mmHg

Lung Auscultation

Pathologic Lung Sound

Pneumothorax

PA PhotoCNeedle thoracotomy

Safety triangle midaxillar line2nd intercostal midclavicullar line5th intercostal midaxillarTube thoracotomy vs needle thoracotomy

Pleural Effusion

Left pleural EffusionRight pleural EffusionEffusion can be hematothorax (blood), pyothorax (pus), hydrothorax (water/transudate), chylothorax (lymph fluid)Thoracocentesis

Thoracocentesis

Linea mid axillaris7th 9th intercostal space1-2 space below effusion lineFlail Chest

Mass/Abscess

Lung MassLung AbscessSegmentectomy Lobectomy and Pneumectomy

Akhirnya Selesai ..SPIROMETER