Kuliah Sistem Pernafasan (Dr.yani)

7/21/2019 Kuliah Sistem Pernafasan (Dr.yani)

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Respiratory System

Dr.Yani Istadi

Bagian Anatomi

FK Unissula Semarang

R espirat or y I nt r o You may be asking, what is the

Respiratory system? Well, the

Respiratory system is the system

that helps you breath in and out,

so oxygen (02) can be pumpedthrough your body and carbon

dioxide (CO2) can be removed

from the blood stream. You must

remember that the Respiratorysystem is made up of many

different organs.

Learning objective

Organization and Functions of the

Respiratory System

Mechanics of Breathing

Respiratory Diseases



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Human Respiratory System

Nasal Passage

Pharynx

Trachea

Bronchus

Larynx

Bronchioles

Alveoli

Organization and Functions of

the Respiratory System Structural classifications:

upper respiratory tract

lower respiratory tract.

Organization and Functions of

the Respiratory System Functional classifications:

Conducting portion: transports air.

Nose

nasal cavity

Pharynx

Larynx

Trachea

progressively smaller airways, from the primary bronchito the bronchioles

Respiratory portion: carries out gas exchange.

respiratory bronchioles

alveolar ducts

air sacs called alveoli

Upper respiratory tract is all conducting

Lower respiratory tract has both conducting and respiratoryportions



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Upper Respiratory Tract

Composed of

the nose

the nasal cavity

the paranasal sinuses

the pharynx (throat)

and associated structures.

All part of the conducting portion of the

respiratory system.

Nose

Two nasal cavities separated by nasal septum

The Nasal Septum is made up of cartilage & bone

Function

Warming of Air

Filtration of Air To keep nasal passage moist

Sensation of smell



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Paranasal Sinuses Paranasal sinuses:

In four skull bones

paired air spaces decrease skull bone weight

Named for the bones in which they are housed. frontal ethmoidal

sphenoidalmaxillary

Communicate with the nasal cavity by ducts. Covered with the same pseudostratified ciliated

columnar epithelium as the nasal cavity.

Pharynx

Common to both the respiratory and digestivesystems.

Commonly called the throat.

Funnel-shaped slightly wider superiorly and narrower infer iorly.

Originates posterior to the nasal and oralcavities

Extends inferiorly near the level of thebifurcation of the larynx and esophagus.

Common pathway for both air and food.



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Pharynx Walls:

lined by a mucosa

contain skeletal muscles primarily used for

swallowing.

Flexible lateral walls

distensible

to force swallowed food into the esophagus.

Partitioned into three adjoining regions:

nasopharynx

oropharynx

laryngopharynx

Nasopharynx Superiormost region of the pharynx.

Location:

posterior to the nasal cavity superior to the soft palate

separates it from the posterior part of the oral cavity.

Normally, only air passes through.

Soft palate Blocks material from the oral cavity and oropharynx

elevates when we swallow.

Auditory tubes paired

In the lateral walls of the nasopharynx

connect the nasopharynx to the middle ear .

Pharyngeal tonsil

posterior nasopharynx wall

single

commonly called the adenoids.



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Oropharynx

The middle pharyngeal region.

Location:

Immediately posterior to the oral cavity.

Bounded by the soft palate superiorly,

the hyoid bone inferiorly.

Common respiratory and digestive pathway

both air and swallowed food and drink passthrough.

Oropharynx

2 pairs of muscular arches

anterior palatoglossal arches

posterior palatopharyngeal arches

form the entrance from the oral cavity.

Lymphatic organs

provide the “first line of defense” againstingested or inhaled foreign materials.

Palatine tonsils on the lateral wall between the arches

Lingual tonsils At the base of the tongue.

Laryngopharynx

Inferior, narrowed region of the pharynx.

Location: Extends inferiorly from the hyoid bone

is continuous with the larynx and esophagus.

Terminates at the superior border of the esophagus

is equivalent to the inferior border of the cricoid cartilage in thelarynx.

The larynx (voice box) forms the anterior wall

Lined with a nonkeratinized stratified squamousepithelium (mucus membrane)

Permits passage of both food and air.



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Lower Respiratory Tract

Conducting portion

Larynx

Trachea

Bronchi

bronchioles and their associated structures

Respiratory portion of the respiratory system

respiratory bronchioles

alveolar ducts

alveoli

Larynx

Short, somewhat cylindrical airway

Location:

bounded posteriorly by the laryngopharynx,

inferiorly by the trachea.

Prevents swallowed materials from

entering the lower respiratory tract. Conducts air into the lower respiratory

tract.

Produces sounds.

Larynx Nine pieces of cartilage

three individual pieces Thyroid cartilage

Cricoid cartilage

Epiglottis

three cartilage pairs Arytenoids: on cricoid

Corniculates: attach to arytenoids

Cuniforms:in aryepiglottic fold

held in place by ligaments and muscles.

Intrinsic muscles: regulate tension on true vocalcords

Extrinsic muscles: stabilize the larynx



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Trachea A flexible, slightly rigid tubular fibromusculer

organ

often referred to as the “windpipe.”

Extends through the mediastinum

immediately anterior to the esophagus

inferior to the larynx

superior to the primary bronchi of thelungs.

Trachea

Anterior and lateral walls of the trachea aresupported by 15 to 20 C-shaped trachealcartilages.

cartilage rings reinforce and provide somerigidity to the tracheal wall to ensure thatthe trachea remains open (patent) at alltimes

cartilage rings are connected by elasticsheets called annular ligaments

The first cartilage ring devote to cricoidcartilage through cricotracheal ligament



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Trachea

VC.6 - VTh.4

Length: 9-15 cm; width: 2 cm

Fascia pretrachealis

At the level of the sternal angle, the trachea bifurcates

into two smaller tubes, called the right and left primary

bronchi (VTh.5-6)

Each primary bronchus projects laterally toward eachlung.

The most inferior tracheal cartilage separates the

primary bronchi at their origin and forms an internal ridgecalled the carina.

Trachea was divided into:

pars cervicalis and pars

thoracalis



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Inervation of trachea :

- Parasymphatic :

nervus laryngeus recurrens (it comes from

nervus vagus ) Bronchokonstriction

Secretomotoric

Sensoric

- Symphatic : ganglion cervicalis medius

: bronchodilatation

Vascularisation of trachea:

Artery thyroidea inferior

Bronchial Tree

A highly branched system

air-conducting passages

originate from the left and rightprimary bronchi.

Progressively branch into narrowertubes as they diverge throughout the

lungs before terminating in terminalbronchioles.

Bronchial Tree

Primary bronchiIncomplete rings of hyaline cartilage

ensure that they remain open.Right primary bronchus

Shorter (2,5 cm), wider, and morevertically oriented than the leftprimary bronchus.

Foreign particles are more likely tolodge in the right primary bronchus.

Vascularisation: vasa bronchialesInnervation: plexus pulmonum



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Bronchial Tree Primary bronchi

enter the hilum of each lung Also entering hilum:

pulmonary vessels

lymphatic vessels nerves.

Secondary bronchi (or lobar bronchi)

Branch of primary bronchus left lung:

two lobes two secondary bronchi(

right lung

three lobes three secondary bronchi.(1 eparteriel (lobus

superior & 2 hyparteriel (medius and inferior)

Bronchial Tree

Tertiary bronchi (or segmental bronchi)

Branch of secondary bronchi

left lung is supplied by 8 to 10 tertiary

bronchi.

right lung is supplied by 10 tertiary bronchi

supply a part of the lung called a

bronchopulmonary segment.

Respiratory Bronchioles,

Alveolar Ducts, and Alveoli Contain small saccular outpocketings called alveoli.

An alveolus is about 0.25 to 0.5 millimeter in diameter.

Its thin wall is specialized to promote diffusion of gasesbetween the alveolus and the blood in the pulmonarycapillaries.

Gas exchange can take place in the respiratorybronchioles and alveolar ducts as well as in the lungs,which contain approximately 300–400 million alveoli.

The spongy nature of the lung is due to the packing ofmillions of alveoli together.



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Paru-paru (lungs) Merupakan organ penting

untuk pernafasan

Jaringan yang bukan

merupakan jaringan

respiratorik didarahi oleh

arteri bronchialis dan

dialirkan ke vena pulmonalis Paru – paru berbentuk kurang

lebih sebagai conus dengan

basis dan apex

Paru-paru pada dinding paru dapat dibedakan :

Facies costalis merupakan dinding

ventral, lateral dan dorsal Facies mediastinalis merupakan dinding

medial

Facies diafragmatica merupakan basis

Antara facies diafragmatica danfacies costalis, terdapat margoinferior

Antara facies costalis disebelahventral dan facies mediastinalis,terdapat margo anterior

Basisnya terletak di atas permukaankonveks diafragma, descendenselama inspirasi dan ascendenselama ekspirasi



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Paru-paru Kanan Apexnya menonjol ke dalam pangkal leher

dan yang kanan lebih kecil dari yang kiri

Biasanya menerima satu arteri bronchialis

Adalah lebih berat dan lebih pendek daripada

yang kiri, disebabkan kubah kanan diafragma

lebih tinggi dan lebih luas karena jantung

lebih menonjol ke kiri

Dibagi menjadi lobus superior, medius, dan

inferior oleh fissura obliqua dan horizontal

Mempunyai 3 bronchus lobaris (sekunder)

dan 10 bronchi segmentalis (tertiar)

- Impressiones pulmo kanan ini

adalah:

Impressio cardiaca

Sulcus vena cava superior

Sulcus arteri subclavia

Sulcus vena azygos

Sulcus oesophagus

- Pada hilus pulmonalis pulmo

kanan terdapat: Bronchus eparterial

Arteri pulmonalis

Bronchus hyparterial

Vena Pulmonalis

Paru Kiri Biasanya menerima 2 arteri

bronchialis Mempunyai 2 lobus : superior

dan inferior

Mempunyai 1 fissura obliqua

yang mengikuti garis iga

keenam

Mempunyai satu Lingula yang

merupakan suatu bagian seperti

bentuk lidah pada lobus

superiornya yang sesuai dengan

lobus medius pada paru kanan.



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- Pada facies mediastinalisterdapat impressiones

berikut:

- Impressio cardiaca

- Sulcus arcus aorta

- Sulcus aorta descendens

- Pada hilus pulmonalisterdapat :

Bronchus eparterial

Arteri pulmonalis

Vena pulmonalis

Pleura and Pleural Cavities

The outer surface of each lung and the adjacent internalthoracic wall are lined by a serous membrane calledpleura, which is formed from simple squamousepithelium.

The outer surface of each lung is tightly covered by thevisceral pleura, while the internal thoracic walls, thelateral surfaces of the mediastinum, and the superior

surface of the diaphragm are lined by the parietal pleura. The parietal and visceral pleural layers are continuous at

the hilum of each lung.

Pleura and Pleural Cavities

The outer surface of each lung is tightly covered by the visceralpleura, while the internal thoracic walls, the lateral surfaces of the

mediastinum, and the superior surface of the diaphragm are lined by

the parietal pleura.

The potential space between these serous membrane layers is a

pleural cavity.

The pleural membranes produce a thin, serous fluid that circulates in

the pleural cavity and acts as a lubricant, ensuring minimal frictionduring breathing.



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Pelipatan pleura parietalis yang satu

ke pleura parietalis lainnya akan

membentuk suatu recesus / sinus.

Macam –macam sinus:

1. Sinus phrenicocostalis: dibentuk

oleh pelipatan pleura diafragmatica

dan pleura costalis.

2. Sinus costomediastinalis: dibentuk

oleh pelipatan pleura costalis dan

pleura mediastinalis.

3. Sinus phrenicomediastinalis :

dibentuk oleh pelipatan pleura

diafragmatica dan pleura

mediastinalis.

Perdarahan/vascularisasi pleura :

1. Pleura costalis : vasa intercostalis

2. Pleura mediastinalis : vasa pericardiacophrenica

3. Pleura diafragmatica : vasa intercostalis dan vasa

mammaria interna.

4. Pleura visceralis : a. bronkialis

Persarafan pleura :

1. Nervus intercostalis ( pleura costalis dan bagian

perifer pleura diafragmatika )

2. Nervus phrenicus ( sisa pleura diafragmatika dan

pleura mediastinalis )



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Lymphatic Drainage

Lymph nodes and vessels are located within the

connective tissue of the lung as well as around

the bronchi and pleura.

The lymph nodes collect carbon, dust particles,

and pollutants that were not filtered out by the

pseudostratified ciliated columnar epithelium.

Thoracic Wall Dimensional

Changes During Respiration

Lateral dimensional changes occur with ribmovements.

Elevation of the ribs increases the lateral

dimensions of the thoracic cavity, while

depression of the ribs decreases the

lateral dimensions of the thoracic cavity.



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Muscles that Move the Ribs The scalenes help increase thoracic cavity dimensions

by elevating the first and second ribs during forcedinhalation.

The ribs elevate upon contraction of the external

intercostals, thereby increasing the transversedimensions of the thoracic cav ity during inhalation.

Contraction of the internal intercostals depresses the

ribs, but this only occurs during forced exhalation.

Normal exhalation requires no active muscular effort.

A small transversus thoracis extends across the innersurface of the thoracic cage and attaches to ribs 2–6. Ithelps depress the ribs.

Muscles that Move the Ribs Two posterior thorax muscles also assist with

respiration. These muscles are located deep to the

trapezius and latissimus dorsi, but superficial to theerector spinae muscles.

The serratus posterior superior elevates ribs 2–5 during

inhalation, and the serratus posterior inferior depressesribs 8–12 during exhalation.

In addition, some accessory muscles assist withrespiratory activities.

The pectoralis minor, serratus anterior, andsternocleidomastoid help with forced inhalation, while the

abdominal muscles (external and internal obliques,

transversus abdominis, and rectus abdominis) assist inactive exhalation.



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I

n

tr

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to

D

ia

p

hr a

g

m

Now we will look at the Diaphragm.

You might be wondering, what does

the Diaphragm do? The

Diaphragm is an important factor in

breathing.

Diagram of Diaphragm



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Here is an experiment thatyou can try.

D iaphragm Exper iment

Mechanics of Breathing

Gas Exchange Between the Bloodand Alveoli



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The blood-air barrier

The surfactant layer

Regulation of Breathing

Figure 10.13



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Carotid and aortic bodies: sensitive tocarbon dioxide, pH, and oxygen levels

Conscious control: resides in higher braincenters; ability to modify breath is limited

Regulation of Breathing:Nervous System Involvement

Summary

Organs in the Respiratory SystemSTRUCTURE FUNCTION

nose / nasal cavitywarms, moistens, & filters air as it is

inhaled

pharynx (throat) passageway for air, leads to trachea

larynxthe voice box, where vocal chords are

located

trachea (windpipe)

keeps the windpipe "open"

trachea is lined with fine hairs calledcilia which filter air before it reaches the

lungs

bronchitwo branches at the end of the trachea,

each lead to a lung

bronchioles

a network of smaller branches leading from

the bronchi into the lung tissue &

ultimately to air sacs

alveolithe functional respiratory units in the lung

where gases are exchanged



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Respiratory Diseases

Malfunctions & Diseases of the Respiratory System

asthma

severe allergic reactioncharacterized by the

constriction of bronchioles

bronchitisinflammation of the lining of

the bronchioles

emphysema

condition in which the alveoli

deteriorate, causing the lungs

to lose their elasticity

pneumonia

condition in which the alveolibecome filled with fluid,

preventing the exchange of

gases

lung cancer

irregular & uncontrolled

growth of tumors in the lung

tissue

Asthma – contraction of the muscles of the

___________________ obstructing the

passage of air

• cause - ____________________________________

____________________________________

____________________________________

• attacks occur without warning

• treatment –



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_____________________________ - disease in which the

alveoli burst and blend to form fewer sacs for gas exchange

• caused by

___________________________________________________

_____________________________ – inflammation of the bronchi

resulting in excessive mucus secretion

• inflammation due to irritants such as

_______________________________________________________

• ___________________________common

Pneumonia – inflammation of the lungs caused by viruses or

bacteria

• ________________________fill with fluid

• greatly inhibits O2 and CO2 exchange

• if many alveoli are infected,

___________________________________________ may result



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Disorders of the Respiratory System

Tuberculosis -

___________________________

___________________________

• alveoli are slowly destroyed

• bloody sputum common

• nearly eliminated by antibiotics

but cases are increasing in U.S.

recently - why?

___________________________

___________________________

___________________________

___________________________

Cystic fibrosis - inherited disease in which a lung membrane

transport protein is not produced

• result is that mucus is not transported properly and becomes very

thick and ______________________________________

• thick mucus is a breeding ground for many bacteria; thus,

_________________________________ are common

• mean age for death is _________

Cystic fibrosis

Treatment:

• Disease is managed by

______________________________

to dislodge mucus in lungs

• Several new drugs are helpful

• New finding - ________________

responsible for

cystic fibrosis has been found and may

lead to a cure by gene therapy



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Disorders of the Respiratory System

Lung cancer – cancerous cells replace normal lung cells

• how common - ____________________________________

__________________________________________________

tar in lungs cancerous nodules

Bronchitis, emphysema, and lung cancer are

entirely avoidable.

They are caused by ______________________

______________________________________

- the chief avoidable cause of death in our

society, resulting in _____________ deaths/year

in the U.S.

Some facts about smoking

• Smokers have a 10 times greater chance of

developing bronchitis, emphysema, and lung cancerthan non-smokers.

• Risk for smoking-related diseases increases the

earlier one begins to smoke.

• Smokers are more likely to contract heart disease.

• Other cancers - mouth, laryngeal, esophageal,

pancreatic, and kidney - strike smokers at increased

rates.



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Some facts about smoking• Smoking during pregnancy causes preterm births

and low birth rates. Smokers are more likely to have

miscarriages.

• Nicotine in smoke is highly additive and is a

________________________. It strengthens the

desire to smoke and makes it difficult to quit.

• Cigarettes do not calm your nerves. They actually

create stress in the smoker.

• Smokers are 100 times more likely to smoke pot and

use other illicit drugs.

Some examples of Smoking-induced Disorders

Lung Cancers - taken from autopsies

What about this don’t you

understand?



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These disorders are entirely preventable.

The single, best thing you can do to prolong

your life is to simply not smoke.

Smoking is not cool anymore.

So - don’t start.

And if you do smoke, QUIT NOW!

All it will do is save your life!

Deformities of the chest wall are rare in children. The diagnosis of

these deformities will often not be made until adolescence due to theirprolonged development and usually benign nature. The major chest wall

deformities that are seen in children are Pectus Excavatum ("funnelchest") and Pectus Carinatum ("Pigeon Breast").



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Literature

Human Anatomy, First Edition McKinley &O'Loughlin

Atlas sobota Atlas sobota

Ethel Sloane, Anatomi dan Fisiologi, PenerbitEthel Sloane, Anatomi dan Fisiologi, PenerbitEGCEGC

Kyung Won Chung, Gross Anatomi, PenerbitKyung Won Chung, Gross Anatomi, PenerbitBinarupa AksaraBinarupa Aksara

Keith L.Moore dan Arthur F.Dalley. ClinicallyKeith L.Moore dan Arthur F.Dalley. Clinicallyoriented Anatomyoriented Anatomy

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