ANATOMY & PHYSIOLOGY

Respiratory System
The respiratory system consists of the external nose, the nasal cavity, the pharynx, the
larynx, the trachea, the bronchi and the lungs. Although air frequently passes through the oral
cavity, it is considered to be a part of the digestive system instead of the respiratory system. The
upper respiratory tract refers to the external nose, nasal cavity, pharynx and other associated
structures; the lower respiratory tract includes the larynx, trachea, bronchi and lungs. The
terms are not official anatomical terms, however, and there are several alternative definitions.
For example, one alternative places the larynx in the upper respiratory tract.

NOSE

The nose consists of the external nose and the nasal cavity. The external nose is the
visible structure that forms a prominent feature of the face. Most of the external nose is
composed of hyaline cartilage, although the bridge of the external nose consists of bone. The
bone and cartilage are covered by connective tissue and skin.


The nasal cavity extends form the nares to the choane. The nares or nostrils are the
external openings of the nose and the choane are the openings into the pharynx. The nasal
septum is a partition dividing the right and left parts. The deviated nasal septum occurs when
the septum bulges to one side or the other. The hard palate forms the floor of the nasal cavity,
separating the nasal cavity from the oral cavity. Air can flow through the nasal cavity when the
mouth is closed or when the oral cavity is full with food.

Three prominent bony ridges called conchae are present on the lateral walls on each side
of the nasal cavity. The conchae increase the surface area of the nasal cavity.

Paranasal sinuses are air-filled spaces within bone. The maxillary, frontal, ethmoidal,
and sphenoidal sinuses are named after the bones in which they are located. The paranasal
sinuses open into the nasal cavity and are lined with a mucous membrane. They reduce the
weight of the skull, produce mucus and influence the quality of voice by acting as resonating
chambers.



The nasolacrimal ducts, which carry tears from the eyes, also open into the nasal cavity.
Sensory receptors for the sense of smell are found in the superior part of the nasal cavity.

Air enters the nasal cavity through the nares. Just inside the nares, the epithelial lining is
composed of stratified sqaumous epithelium containing coarse hairs. The hairs traps some of the
large particles of dust suspended in the air. The rest of the nasal cavity is lined with
pseudostratified columnar epithelial cells containing cilia and many mucus producing goblet
cells. Mucus produced by the goblet cells also traps debris in the air. The cilia sweep the mucus
posteriorly to the pharynx, where it is swallowed. As air flows through the nasal cavities, it is
humidified by moisture from the mucous epithelium and is warmed by blood flowing through the
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, food and water from the mouth. Inferiorly, the pharynx leads
to the rest of the respiratory system through the opening into the larynx and to the digestive
system through the esophagus. The pharynx can be divided into three regions: the nasopharynx,
the oropharynx, and the laryngopahrynx.

The nasopharynx is the superior part of the pharynx. It is located posterior to the
choanae and superior to the soft palate, which is an incomplete muscle and connective tissue
partition separating the nasopharnx from the oropharynx. The uvula is the posterior extension of
the soft palate. The soft palate forms the floor of the nasopaharynx. The nasoharynx is lined with
pseudostratiifed ciliated columnar epithelium that is continuous with the nasal cavity. The
auditory tubes extend from the middle ears and open into the nasopharynx. The posterior part of
the nasopharynx contains pharyngeal tonsils which aids in defending the body against infection.
The soft palate is elevated during swallowing; this movement results to the closure of the
nasopharynx which prevents food from passing from the oral cavity into the nasopharynx.

The oropharynx extends fro the uvula to the epiglottis, and the oral cavity opens into the
oropharynx. Thus food, drink and air all pass through the orpharynx. The oropharynx is lined
with stratified squamous epithelium which protects against vibration. Two sets of tonsils, the
palatine tonsils, are located near the opening between the mouth and the oropharynx. The
lingual tonsil is located on the surface of the posterior part of the tongue.
The laryngopharynx passes posterior to the larynx and extends from the tip of the
epiglottis to the esophagus. Food and drinks pass through the laryngopharynx to the esophagus.
A small amount of air is usually swallowed with the food and drink. Swallowing too much air
can cause excess gas in the stomach and may result in belching. The laryngopharynx is lined
with stratified squamous epithelium and ciliated columnar epithelium.

LARYNX

The larynx is located in the anterior throat, and it is continuous superiorly with the
pharynx and inferiorly with the trachea. The larynx consists of an outer casing of nine cartilages
that are connected 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 on which the other cartilages rest. The thyroid and cricoid cartilages maintain an open
passageway fro air movement.

The third unpaired cartilage is the epiglottis. It differs from other cartilages in that it
consists of elastic cartilage rather than hyaline cartilage. Its inferior margin is attached to the
thyroid cartilage anteriorly, and the superior part of the epiglottis projects as a free flap toward
the tongue. The epiglottis helps prevent swallowed materials from entering the larynx. As the
larynx elevates during swallowing, the epiglottis tips posteriorly to cover the opening of the
larynx.

The six paired cartilages consist of three cartilages on either side of the posterior part of
the larynx. The top cartilage on each side is the cuneiform cartilage, the middle cartilage is the
corniculate cartilage, and the bottom cartilage is the arythenoid cartilage. The arythenoid
cartilage articulates with the cricoid cartilage inferiorly. The paired cartilages form an attachment
site for vocal folds.

Two pairs of ligaments extend from the posterior surface of the thyroid cartilage to the
paired cartilages. The superior pairs forms the vestibular folds, or false vocal cords, and the
inferior forms the vocal folds, or true vocal folds. When the vestibular folds come together, 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 the larynx.

The vocal cords are the primary source of voice production. Air moving past the vocal
folds causes them to vibrate, producing sound. Muscles control the length and tension of the
vocal folds. The force of the air moving past the vocal folds controls the loudness, and the
tension of 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 voice production.

TRACHEA

The trachea or windpipe is a membranous tube that consists of connective tissues and
smooth muscle, reinforced with 16-20 C-shaped pieces of cartilage. The adult trachea is about
1.4-1.6 centimeters in diameter and about 10-11 cm long. It begins immediately inferior to the
cricoid cartilage, which is the most inferior cartilage of the larynx. The trachea projects through
the mediastinum, and divides into the right and left primary bronchi at the level of the fifth
thoracic vertebra. The esophagus lies immediately posterior to the trachea.

C-shaped cartilages from the anterior and lateral sides of the trachea. The cartilages
protect the trachea and maintain an open passageway for air. The posterior wall of the trachea
has no cartilage and consists of a ligamentous membrane and smooth muscle. The smooth
muscle can alter the diameter of the trachea.
The trachea is lined with pseudostratified columnar epithelium, which contains numerous
cilia and goblet cells. The cilia propel mucus produced by the goblets cells, as well foreign
particles 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 constant smoke can cause
the tracheal epithelium to change to stratified squamous epithelium. The stratified squamous
epithelium has no cilia and therefore has no ability to clear the airway of mucus and debris. The
accumulation provides a place for microorganisms to grow, resulting in respiratory infections.
Constant irritation 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 is more horizontal than the right main bronchus
because it is displaced by the heart. Foreign objects that enter the trachea usually lodge in the
right main bronchus, because it is more vertical than the left main bronchus and therefore more
in line with the trachea. The main bronchi extend from the trachea to the lungs. Like the trachea,
the main bronchi are lined with peudostratified ciliated columnar epithelium and are supported
by C-shaped pieces of cartilage.



LUNGS

The lungs are the principal organ of respiration, each lung is cone-shaped, with its base
resting on the diaphragm and its apex extending superiorly to a point about 2.5 cm above the
clavicle. The right lung has three lobes called the superior, middle, and inferior lobes. The left
lung has two lobes called the superior and inferior lobes. The lobes of the lungs are separated by
deep, prominent fissures on the surface of the lung. Each lobe is divided into
bronchopulmunary segments separated from one another by connective tissue septa, but these
separations are not visible as surface fissures. Individual diseased bronchopulmonary segments
can be surgically removed leaving the rest of the lung relatively intact, because major blood
vessels and bronchi do not cross the septa. There are 9 bronchopulmunary segments in the left
lung and 10 in the right lung.

The main bronchi branch many times to form the tracheobronchial tree. Each main
bronchus 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 into each lobe. The lobar
bronchi in turn give rise to segmental (tertiary) bronchi, which extend to the
bronchopulmonary segments of the lungs. The bronchi continue to branch many times, finally
giving rise to bronchioles. The bronchioles also subdivide numerous times to give rise to
terminal bronchioles, which then subdivide into respiratory bronchioles. Each respiratory
bronchiole subdivides to form alveolar ducts, which are like long, branching hallways with
many open doorways. The doorways open into alveoli, which are small air sacs. The alveoli
become so numerous 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 of the lungs become smaller, the structure of their wall changes.
The amount of cartilage decreases and the amount of smooth muscle increases, until at the
terminal bronchioles, the walls have a prominent smooth muscle layer, but no cartilage.
Relaxation and contraction of the smooth muscle with the bronchi and bronchioles can change
the 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 the
smooth muscle in the terminal bronchioles can result in greatly reduced airflow. In severe cases,
air movement can be so restricted that death results.

As air passageways of the lungs become smaller, the lining of their walls also changes.
The trachea and bronchi have pseudostratified ciliated columnar epithelium, the bronchioles have
ciliated simple columnar epithelium and the terminal bronchioles have ciliated simple cuboidal
epithelium. The ciliated epithelium of the air passageways functions as a mucus cilia escalator,
which traps debris in the air and removes it from the respiratory system.

As the passageways beyond the terminal bronchiole become smaller, their walls become
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 by the walls of the alveoli and surrounding capillaries but
theres some contribution by the alveolar ducts and respiratory bronchioles. The respiratory
membrane is very thin to facilitate the diffusion of gases. It consists of:

1. A thin fluid lining the alveolus
2. The alveolar epithelium composed of a simple squamous epithelium
3. The basement membrane of the alveolar epithelium
4. A thin interstitial space
5. The basement membrane of the capillary epithelium
6. The capillary endothelium composed of a simple squamous epithelium

The elastic fibers surrounding the alveoli allow them to expand during inspiration and
recoil during 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 cells
within the walls of the alveoli secrete a chemical called surfactant that reduces the tendency of
alveoli to recoil.

PLEURAL CAVITIES

The lungs are contained within the thoracic cavity. In addition, each lung is surrounded
by a separate pleural cavity. Each pleural cavity is lined with a serous membrane called the
pleura. The pleuron consists of a parietal and visceral part. The parietal pleura, which lines the
walls of the thorax, diaphragm, and mediastinum, is continuous with the visceral pleura, which
covers the surface of the lung.

The pleural cavity, between the parietal and visceral pleurae, is filled with a small volume
of pleural fluid produced by the pleural membranes. The pleural fluid performs two functions: 1.)
it acts as a lubricant, allowing the visceral pleurae to slide past each other as the lungs and thorax
change shape during respiration, and 2.) it helps hold the pleural membranes together. The
pleural fluid acts like a thin film of water between two sheets of glass (the visceral and parietal
pleurae); the glass sheets can slide over each other easily, but it is difficult to separate them.