A case study

Mrs. Karen Valmores Callangan

III. ANATOMY AND PHYSIOLOGY

Human Respiratory System

The respiratory
system consists of all the
organs involved in
breathing. These include
the nose, pharynx, larynx,
trachea, bronchi and
lungs. The respiratory
system does two very
important things: it brings
oxygen into our bodies,
which we need for our
cells to live and function
properly; and it helps us
get rid of carbon dioxide,
which is a waste product
of cellular function. The
nose, pharynx, larynx,
trachea and bronchi all
work like a system of
pipes through which the
air is funneled down into
our lungs. There, in very small air sacs called alveoli, oxygen is brought into the
bloodstream and carbon dioxide is pushed from the blood out into the air. When
something goes wrong with part of the respiratory system, such as an infection
like pneumonia, it makes it harder for us to get the oxygen we need and to get rid
of the waste product carbon dioxide. Common respiratory symptoms include
breathlessness, cough, and chest pain.

Nose

A nose is a protuberance in
vertebrates that houses the nostrils, or
nares, which admit and expel air for
respiration in conjunction with the
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mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the
nasal cavity, air next passes through the pharynx, shared with the digestive
system, and then into the rest of the respiratory system. In humans, the nose is
located centrally on the face; on most other mammals, it is on the upper tip of the
snout.

In cetaceans, the nose has been reduced to the nostrils, which have
migrated to the top of the head, producing a more streamlined body shape and
the ability to breathe while mostly submerged. Conversely, the elephant's nose
has elaborated into a long, muscular, manipulative organ called the trunk.

Mouth

The mouth, buccal cavity,

or oral cavity is the first portion of
the alimentary canal that receives
food and begins digestion by
mechanically breaking up the solid
food particles into smaller pieces
and mixing them with saliva.[1] The
oral mucosa is the mucous
membrane epithelium lining the
inside of the mouth.In addition to its primary role as the beginning of the digestive
system, in humans the mouth also plays a significant role in communication.
While primary aspects of the voice are produced in the throat, the tongue, lips,
and jaw are also needed to produce the range of sounds included in human
language. Another non-digestive function of the mouth is its role in secondary
social and/or sexual activity, such as kissing. The physical appearance of the
mouth and lips play a part in defining sexual attractiveness.

The mouth is normally moist, and is lined with a mucous membrane. The
lips mark the transition from mucous membrane to skin, which covers most of the
body.

Pharynx

The pharynx (plural: pharynges) is the part of the neck and throat
situated immediately posterior to (behind) the mouth and nasal cavity, and
cranial, or superior, to the esophagus, larynx, and trachea. The pharynx is part of
the digestive system and respiratory system of many organisms.Because both
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Mrs. Karen Valmores Callangan

food and air pass through the pharynx, a flap of connective tissue called the
epiglottis closes over the trachea when food is swallowed to prevent choking or
aspiration. In humans the pharynx is important in vocalization.

Epiglottis

The epiglottis is a flap of elastic cartilage tissue covered with a

mucus membrane, attached to the root of the tongue. It projects obliquely
upwards behind the tongue and the hyoid bone. The term is, like tonsils, often
incorrectly used to refer to the uvula. The epiglottis guards the entrance of the
glottis, the opening between the vocal folds. It is normally pointed upward during
breathing with its underside functioning as part of the pharynx, but during
swallowing, elevation of the hyoid bone draws the larynx upward; as a result, the
epiglottis folds down to a more horizontal position, with its upper side functioning
as part of the pharynx. In this manner it prevents food from going into the trachea
and instead directs it to the esophagus, which is more posterior.

The epiglottis is one of nine cartilaginous structures that make up the

larynx (voice box). While breathing, it lies completely within the pharynx. When
swallowing it serves as part of the anterior of the larynx.

Larynx

The larynx (plural larynges), colloquially known as the voicebox, is

an organ in the neck of mammals involved in protection of the trachea and sound
production. The larynx houses the vocal folds, and is situated just below where
the tract of the pharynx splits into the trachea and the esophagus. Sound is
generated in the larynx, and that is where pitch and volume are manipulated. The
strength of expiration from the lungs also contributes to loudness.

Fine manipulation of the larynx is used to generate a source sound with a

particular fundamental frequency, or pitch. This source sound is altered as it
travels through the vocal tract, configured differently based on the position of the
tongue, lips, mouth, and pharynx. The process of altering a source sound as it
passes through the filter of the vocal tract creates the many different vowel and
consonant sounds of the world's languages as well as tone, certain realizations
of stress and other types of linguistic prosody. The larynx also has a similar
function as the lungs in creating pressure differences required for sound
production; a constricted larynx can be raised or lowered affecting the volume of
the oral cavity as necessary in glottalic consonants.
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Trachea

The trachea, or windpipe, is a tube that connects to the pharynx or

larynx, allowing the passage of air to the lungs. It is lined with pseudostratified
ciliated columnar epithelium cells with mucosal goblet cells which produce
mucus. This mucus lines the cells of the trachea to trap inhaled foreign particles
which the cilia then waft upwards towards their larynx and then the pharynx
where it can either be swallowed into the stomach or expelled as phlegm.

Bronchi

The trachea
(windpipe) divides into
two main bronchi (also
mainstem bronchi), the
left and the right, at the
level of the sternal
angle at the anatomical
point known as the
carina. The right main
bronchus is wider,
shorter, and more
vertical than the left main bronchus. The right main bronchus subdivides into
three lobar bronchi while the left main bronchus divides into two. The lobar
bronchi divide into tertiary bronchi, also known as segmental bronchi, each of
which supplies a bronchopulmonary segment. A bronchopulmonary segment is a
division of a lung that is separated from the rest of the lung by a connective
tissue septum. This property allows a bronchopulmonary segment to be
surgically removed without affecting other segments. There are ten segments per
lung, but due to anatomic development, several segmental bronchi in the left lung
fuse, giving rise to eight. The segmental bronchi divide into many primary
bronchioles which divide into terminal bronchioles, each of which then gives rise
to several respiratory bronchioles, which go on to divide into 2 to 11 alveolar
ducts. There are 5 or 6 alveolar sacs associated with each alveolar duct. The
alveolus is the basic anatomical unit of gas exchange in the lung.

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Alveoli

An alveolus (plural: alveoli, from

Latin alveolus, "little cavity") is an
anatomical structure that has the form of
a hollow cavity. Found in the lung, the
pulmonary alveoli are spherical
outcroppings of the respiratory
bronchioles and are the primary sites of
gas exchange with the blood. Alveoli are
particular to mammalian lungs. Different
structures are involved in gas exchange in other vertebrates.

Each human lung contains about 150 million alveoli. Each alveolus is
wrapped in a fine mesh of capillaries covering about 70% of its area. An adult
alveolus has an average diameter of 0.2–0.3 mm, with an increase in diameter
during inhalation.

Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to form very
narrow terminal bronchioles, which terminate in the alveoli. There are many
millions of alveloi in each lung, and these are the areas responsible for
gaseous exchange, presenting a massive surface area for exchange to
occur over.

Each alveolus is very closely associated

with a network of capillaries containing
deoxygenated blood from the pulmonary
artery. The capillary and alveolar walls
are very thin, allowing rapid exchange of
gases by passive diffusion along
concentration gradients.
CO2 moves into the alveolus as the
concentration is much lower in the
alveolus than in the blood, and O2 moves
out of the alveolus as the continuous flow

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of blood through the capillaries prevents saturation of the blood with O2 and
allows maximal transfer across the membrane.

THE PERITONEUM
The peritoneum is a serosal membrane,
which is composed of a single layer of flat
mesothelial cells supported by
submesothelial connective tissue.
In this subserosal tissue there are fat cells,
lymphatics, blood vessels and
inflammatory cells like lymphocytes and
plasma cells.

Peritoneal circulation

These compartments enable the peritoneal cavity to have a normal circulation for
peritoneal fluid. In the normal abdomen without intraperitoneal disease, there is a small
amount of peritoneal fluid that continuously circulates. The movement of fluid in this
circulatory pathway is produced by the movement of the diaphram and peristalsis of
bowel. It predominantly flows up the right paracolic gutter which is deeper and wider than
the left and is partially cleared by the subphrenic lymphatics. There are watershed
regions in the peritoneal cavity that are areas of fluid stasis:

• Ileocolic region
• Root of the sigmoid mesentery
• Pouch of Douglas

When you are staging a patient for gastrointestinal malignancy you have
to look for disease in these areas of stasis. Clearly the surgeons do better in
finding subtle disease in these areas.90% of peritoneal fluid is cleared at the
subphrenic space by the submesothelial lymphatics.These lymphatics are
connected with lymphatics at the other side of the diafragm.The peritoneum is
continuous in the male pelvis.In women the peritoneum is discontinuous at the
ostia of the oviducts.Through this opening disease can spread from the
extraperitoneal pelvis into the peritoneal cavity. For example, pelvic
inflammatory disease (PID).

Ovaries

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The primary female reproductive organs, or gonads, are the two ovaries.
Each ovary is a solid, ovoid structure about the size and shape of an almond,
about 3.5 cm in length, 2 cm wide, and 1 cm thick. The ovaries are located in
shallow depressions, called ovarian fossae, one on each side of the uterus, in the
lateral walls of the pelvic cavity.
They are held loosely in place by
peritoneal ligaments.

Beginning at puberty, under

the influence of follicle-stimulating
hormone, several primary oocytes
start to grow again each month.
One of the primary oocytes seems
to outgrow the others and it resumes meiosis I. The other cells degenerate. The
large cell undergoes an unequal division so that nearly all the cytoplasm,
organelles, and half the chromosomes go to one cell, which becomes a
secondary oocyte. The remaining half of the chromosomes go to a smaller cell
called the first polar body. The secondary oocyte begins the second meiotic
division, but the process stops in metaphase. At this point ovulation occurs. If
fertilization occurs, meiosis II continues. Again this is an unequal division with all
of the cytoplasm going to the ovum, which has 23 single-stranded chromosome.
The smaller cell from this division is a second polar body. The first polar body
also usually divides in meiosis I to produce two even smaller polar bodies. If
fertilization does not occur, the second meiotic division is never completed and
the secondary oocyte degenerates. Here again there are obvious differences
between the male and female. In spermatogenesis, four functional sperm
develop from each primary spermatocyte. In oogenesis, only one functional
fertilizable cell develops from a primary oocyte. The other three cells are polar
bodies and they degenerate.

Ovarian Follicle Development

An ovarian follicle consists of a developing oocyte surrounded by one or

more layers of cells called follicular cells. At the same time that the oocyte is
progressing through meiosis, corresponding changes are taking place in the
follicular cells. Primordial follicles, which consist of a primary oocyte surrounded
by a single layer of flattened cells, develop in the fetus and are the stage that is
present in the ovaries at birth and throughout childhood.

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Beginning at puberty follicle-stimulating hormone stimulates changes in

the primordial follicles. The follicular cells become cuboidal, the primary oocyte
enlarges, and it is now a primary follicle. The fllicles continue to grow under the
influence of follicle-stimulating hormone, and the follicular cells proliferate to form
several layers of granulose cells around the primary oocyte. Most of these
primary follicles degenerate along with the primary oocytes within them, but
usually one continues to develop each month. The granulosa cells start secreting
estrogen and a cavity, or antrum, forms within the follicle. When the antrum starts
to develop, the follicle becomes a secondary follicle. The granulose cells also
secrete a glycoprotein substance that forms a clear membrane, the zona
pellucida, around the oocyte. After about 10 days of growth the follicle is a
mature vesicular (graafian) follicle, which forms a "blister" on the surface of the
ovary and contains a secondary oocyte ready for ovulation

Ovulation

Ovulation, prompted by luteinizing hormone from the anterior pituitary,

occurs when the mature follicle at the surface of the ovary ruptures and releases
the secondary oocyte into the peritoneal cavity. The ovulated secondary oocyte,
ready for fertilization is still surrounded by the zona pellucida and a few layers of
cells called the corona radiata. If it is not fertilized, the secondary oocyte
degenerates in a couple of days. If a sperm passes through the corona radiata
and zona pellucida and enters the cytoplasm of the secondary oocyte, the
second meiotic division resumes to form a polar body and a mature ovum After
ovulation and in response to luteinizing hormone, the portion of the follicle that
remains in the ovary enlarges and is transformed into a corpus luteum. The
corpus luteum is a glandular structure that secretes progesterone and some
estrogens. Its fate depends on whether fertilization occurs. If fertilization does not
take place, the corpus luteum remains functional for about 10 days then it begins
to degenerate into a corpus albicans, which is primarily scar tissue, and its
hormone output ceases. If fertilization occurs, the corpus luteum persists and
continues its hormone functions until the placenta develops sufficiently to secrete
the necessary hormones. Again, the corpus luteum ultimately degenerates into
corpus albicans, but it remains functional for a longer period of time.

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