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Home , Bronchiole, Olfactory mucosa, Serous membrane, Trachealis muscle, Vocal cords

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Anatomy 2 Midwest College of Oriental Medicine Dr. John Burns DPT, MS, LAc Class 4: •

Breathe

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Organization of the Respiratory System § Structural classifications: – upper – lower respiratory tract § Functional classifications: – Conducting portion: transports air • • • • • • progressively smaller airways, from the primary bronchi to the

Organization and Functional classification of the Respiratory System • Functional classifications: continued – Conducting portion: transports air – Respiratory portion: carries out • respiratory bronchioles • alveolar ducts • air sacs called alveoli • Upper respiratory tract is all conducting • Lower respiratory tract has both conducting and respiratory portions

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Respiratory System

• Respiration – Definition • exchange of gases between the atmosphere and body cells – Types of respiration • External: air & blood • Internal: blood & body cells

• Cellular: O2 à CO2 – Carried out through ventilation • Ventilation = – Definition • Movement of air in & out of

Respiratory System – Subdivisions

• Upper Respiratory Tract – Nose – Pharynx – Larynx • Lower Respiratory Tract – Trachea – Bronchi – Lungs

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Organs of Respiratory System

nose, pharynx, larynx, trachea, bronchi, lungs

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Respiratory System Functions • Breathing (pulmonary ventilation) – consists of two cyclic phases • inhalation, also called inspiration • exhalation, also called expiration – Inhalation draws gases into the lungs. – Exhalation forces gases out of the lungs

• Gas exchange: O2 and CO2 – External respiration • External environment and blood – Internal respiration • Blood and cells

Respiratory System Functions • Gas conditioning: – Warmed – Humidified – Cleaned of • Sound production: – Movement of air over true vocal cords – Also nose, , teeth, lips & tongue • Olfaction: – Olfactory over superior nasal conchae • Defense: – Course hairs, , lymphoid tissue

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Superficial of Nasal Region

Upper Respiratory Tract

• Composed of – Nose – nasal cavity – paranasal sinuses – pharynx () – associated structures • All part of the conducting portion of the respiratory system.

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Upper Respiratory Tract

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Nasal Cavity – Linings Mucosa • Reminder: (from Integumentary system) Mucosal membranes line cavities open to the outside. • Olfactory mucosa: lines roof of nasal fossa • Respiratory mucosa • Lines remainder of nasal cavity • Ciliated pseudostratified epithelium

Nasal Cavity – Linings

Nasal conchae • 3 folds of mucus membrane on lateral wall of nasal fossa • Superior, middle, & inferior • Supported by thin scroll- like turbinate bones • Erectile tissue of inferior concha Meatuses • Narrow air passage beneath each conchae

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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 – sphenoidal – maxillary • Communicate with the nasal cavity by ducts • Covered with the same pseudostratified ciliated columnar epithelium as the nasal cavity

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Pharynx • Common to both the respiratory & digestive systems. • Commonly called the throat. • Funnel-shaped – slightly wider superiorly and narrower inferiorly • Originates posterior to the nasal and oral cavities • Extends inferiorly near the level of the bifurcation of the larynx and • 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

Pharynx • Nasopharynx (pseudostratified epithelium) – Posterior to choanae, dorsal to soft palate – Receives auditory tubes & contains pharyngeal tonsil • Oropharynx (stratified squamous epithelium) – Space between soft palate and root of tongue – Extends inferiorly as far as hyoid bone – Contains palatine and lingual tonsils • Laryngopharynx (stratified squamous epithelium) – Extends from hyoid bone to cricoid (inferior end of larynx)

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Nasopharynx • Superior-most region of the pharynx • Location: – posterior to the nasal cavity – superior to the soft palate • separates it from posterior part of oral cavity • Normally, only air passes through • Soft palate – Blocks material from oral cavity and oropharynx – elevates when we swallow

Nasopharynx

• 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 .

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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 & swallowed food and drink pass through

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” against ingested or inhaled foreign materials. – Palatine tonsils • on the lateral wall between the arches – Lingual tonsils • At the base of the tongue

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Laryngopharynx • Inferior, narrowed region of the pharynx • Location: – Extends inferiorly from the hyoid bone – is continuous with the larynx and esophagus. – Terminates at superior border of the esophagus • is equivalent to inferior border of in larynx

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Laryngopharynx • The larynx ( box) forms the anterior wall • Lined with a nonkeratinized stratified squamous epithelium (mucus membrane) • Permits passage of both food and air.

Lower Respiratory Tract

• Conducting portion – Larynx – Trachea – Bronchi – bronchioles and their associated structures • Respiratory portion of the respiratory system – respiratory bronchioles – alveolar ducts – alveoli

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• Short, somewhat cylindrical Larynx 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 • cartilage • cricoid cartilage • – three cartilage pairs • arytenoids: on cricoid • corniculates: attach to arytenoids • cuniforms: in aryepiglottic fold – held in place by and muscles • Intrinsic muscles: regulate tension on true vocal cords • Extrinsic muscles: stabilize the larynx

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Sound Production

• Two pairs of ligaments • Inferior ligaments, called vocal ligaments – covered by a – vocal folds: and mucosa. – are “true vocal cords” • they produce sound when air passes between them

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Sound Production

• Superior ligaments, called vestibular ligaments – Covered by mucosa – vestibular folds: ligament and mucosa – Are “false vocal cords” • no function in sound production • protect the vocal folds. – The vestibular folds attach to corniculate

Sound Production • The tension, length, and position of the vocal folds determine the quality of the sound – Longer vocal folds produce lower sounds – Thicker cords produce lower pitch – More taunt, higher pitch – Loudness based on force of air • Rima glottidis: opening between the vocal folds • : rima glottidis and the vocal folds

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Vocal Cords & Musculature

§ Interior wall of larynx has 2 folds on each side • the folds extend from thyroid to arytenoid cartilages. • vestibular folds: close glottis during swallowing • vocal cords: produce sound § Intrinsic muscles • rotate corniculate and arytenoid cartilages • manipulate vocal cords § Extrinsic muscles • connect larynx to hyoid bone • elevate larynx during swallowing

Action of Vocal Cords

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Trachea • A flexible, slightly rigid tubular – often referred to as the “windpipe.” • Extends through the – immediately anterior to the esophagus – inferior to the larynx – superior to the primary bronchi of the lungs

Trachea • Anterior and lateral walls of the trachea are supported by 15 to 20 C- shaped tracheal cartilages. – cartilage rings reinforce and provide some rigidity to the tracheal wall to ensure that the trachea remains open (patent) at all times – cartilage rings are connected by elastic sheets called anular ligaments

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Trachea

• At the level of the sternal angle, the trachea bifurcates into two smaller tubes, called the right and left primary bronchi. • Each primary projects laterally toward each . • The most inferior tracheal cartilage separates the primary bronchi at their origin and forms an internal ridge called the carina.

Trachea

§ Rigid tube 4.5 in. long and 2.5 in. in diameter § Descends anteriorly to esophagus into § Supported by 16 to 20 C-shaped cartilaginous rings • opening in rings faces posteriorly towards esophagus • spans opening in ring § Lined with ciliated pseudostratified epithelium • Cilia • Goblet Cells

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Lower Respiratory Tract

Bronchial Tree

• A highly branched system – air-conducting passages – originate from the left and right primary bronchi • Progressively branch into narrower tubes as they diverge throughout the lungs before terminating in terminal bronchioles

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Bronchial Tree

• Primary bronchi – Incomplete rings of ensure that they remain open – Right primary bronchus • shorter, wider, and more vertically oriented than the left primary bronchus – Foreign particles are more likely to lodge in the right primary bronchus

Bronchial Tree

• Primary bronchi – enter the hilum of each lung – Also entering hilum: • pulmonary vessels • lymphatic vessels •

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Bronchial Tree

• Secondary bronchi (or lobar bronchi) – Branch of primary bronchus – left lung • two lobes • two secondary bronchi – right lung • three lobes • three secondary bronchi

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 lung called a

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Bronchial Tree § Bronchioles (lack cartilage) • layer • pulmonary lobule: portion ventilated by one • divides into 50 - 80 terminal bronchioles • terminal bronchioles • have cilia , give off 2 or more respiratory bronchioles • respiratory bronchioles • divide into 2-10 alveolar ducts

Bronchial Tree § Alveolar ducts - end in alveolar sacs § Alveoli - bud from respiratory bronchioles, alveolar ducts and alveolar sacs § In six adult human lungs, the mean alveolar number was 480 million (range: 274-790 million)

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Respiratory Bronchioles, Alveolar Ducts, and Alveoli

• Contain small saccular outpocketings called alveoli. • An alveolus is about 0.25 to 0.5 millimeter in diameter.

Respiratory Bronchioles, Alveolar Ducts, and Alveoli

• Its thin wall is specialized to promote diffusion of gases between alveolus and blood in the pulmonary capillaries. • Gas exchange can take place in the respiratory bronchioles and alveolar ducts as well as in the lungs, within the alveoli. • The spongy nature of the lung is due to the packing of millions of alveoli together.

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Alveolar Blood Supply

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Structure of an Alveolus

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Lungs - Surface Anatomy

Gross Anatomy of the Lungs • Each lung has a conical shape. • Its wide, concave base rests upon muscular diaphragm. • Its relatively blunt superior region, called the apex or (cupola), projects superiorly to a point that is slightly superior and posterior to the clavicle.

•

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Gross Anatomy of the Lungs • Both lungs are bordered by the thoracic wall anteriorly, laterally, and posteriorly, and supported by the rib cage. • Toward the midline, the lungs are separated from each other by the mediastinum. • The relatively broad, rounded surface in contact with the thoracic wall is called the costal surface of the lung.

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Pleura and Pleural Cavities • The outer surface of each lung and the adjacent internal thoracic wall are lined by a called pleura, which is formed from simple squamous epithelium.

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Pleura and Pleural Cavities

• The outer surface of each lung is tightly covered by the visceral pleura • The internal thoracic walls, the lateral 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 visceral pleura, while the internal thoracic walls, the lateral surfaces of the mediastinum, and the superior surface of the diaphragm are lined by the parietal pleura.

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Pleura and Pleural Cavities

• The potential space between these serous membrane layers is a . • The pleural membranes produce a thin, serous fluid that circulates in the pleural cavity and acts as a lubricant, ensuring minimal friction during breathing.

• The Respiratory System: • hps://youtu.be/MrDbiKQOtlU

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TCM & The Lungs

TCM & the Lungs • From Shen Jin'ao, Doctor Shen's Compendium of Honoring Life (Shen Shi Zunsheng Shu), 1773: • The lung is the master of qi. – Above, it connects to the throat; below, it connects to the orifices of the . • It is in charge of inhalation and exhalation, and, in more general terms, the flux of coming in and going out. • The lung is associated with the phase element metal - like metal that forms a bell

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TCM: Lung the “Metal” organ

• Just like a metal object absorbs the temperature of its environment in an instant, • The metal organ (lung) is most easily influenced by external influences of pernicious heat or cold.

TCM: Venlaon • The nose is in charge of breathing and smelling; – Functions that depend entirely on a healthy lung. – Also, the nose is one possible gateway through which external pernicious qi can invade the lung.

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TCM: Venlaon • If the lung is invaded by pernicious qi, there may be nasal symptoms such as stuffy nose, nasal discharge, or loss of smell. – If there is an acute obstruction of qi due to lung heat, there will be asthmatic breathing.

TCM: Lung & Water • Lung qi constantly descends, moving water downwards: it thus provides the rest of the organ networks with fluids • The defining Neijing line reads: – "The lung is the upper source of water." • If it loses its crucial descending function, there may be symptoms of: – Stuffy chest, cough, , or signs of water stagnation such as , edema, etc.

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TCM: Voice

• The throat is in charge of the voice: – Which can be compared to the sound emanating from a metal bell. • When the metal organ (lung) is afflicted by disease: – The voice may appear changed, muffled, or even lost as in the case of sore or hoarse throat.

TCM: Pathogen Invasion • The lung is the lid of the five organ networks. – It produces the voice, and it provides proper moisturization to the skin. • As soon as there is either internal damage due to the seven harmful emotions, or external injury due to the six climatic influences, – The rhythmical process of inhaling and exhaling and the general qi flow between the body's inside and outside are disturbed; – The lung metal then loses its clear quality.

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TCM: Body Breathing

• If we want to restore purity in the metal, we must first strive to regulate the breath. – Once the breath is regulated, erratic movement will not occur and the heart fire will calm down • The process is as follows: – First, we must concentrate on the dantian, • this will quiet the heart; – Then, we must relax – Finally, we must visualize that the qi comes and goes freely through every single pore of our body. • Goal: to have no obstruction – This, then, can be called the true breath [as achieved during meditation].

Lung & Wei Qi • The lung qi is in charge of propelling the protective qi (wei qi), the fluids, and the food essence over the entire body. • It thus warms the muscles and the surface, harmonizes the opening and closing action of the surface pores, and moistens the body hair and the skin. • If lung qi is weak, the protective qi (wei qi) cannot nourish the body properly, causing it to become dry and brittle

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• Similar to the pores on the surface of the lung, moreover, the pores on the surface of the skin are qi gates in charge of "body breathing." – If the protective qi is too weak to properly close the pores, sweat pours out. • If there is an excess of pernicious qi in the lung, on the other hand, the opening mechanism of the pores easily gets jammed; – Then the ventilating function of the pores gets disturbed, and there may be symptoms of inhibited sweating, such as no sweating during a fever.

Breathing & Meditang (Appreciang) • Sing Qi Gong or Buddhist Meditaon • Are ancient ways of ulizing the breath to bring awareness to the moment and calmness of the mind-body • Many research studies have validated this ancient exercise as a natural way to reduce stress and improve health • e.g. Dr. Benson a Harvard trained medical doctor researched these pracces extensively and wrote the book: • “The Relaxaon Response”

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What is required

• Sing quietly • Breathing deeply • Relaxing Fully • Quieng the mind by focusing on the breath • Be the Buddha!

Breathing & Bleeding

• While blood may be the most important bodily fluid we possess, the main reason this is true revolves around the transport of oxygen. • Humans are aerobic creatures, meaning we require oxygen to release energy and exist. • Without oxygen, our cells wouldn’t be able to release the energy in the food we eat, and we would die.

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• We take in oxygen through respiraon — we move air in and out of the lungs, and blood takes oxygen to the cells of the body. • Carbon dioxide, a waste product in our bodies, is moved out of the body by the same system. • Without breathing and circulang blood we would survive.

Minutes from death

• Gunther Van Hagens • Minutes from death • hps://youtu.be/mx8cDDB6OQM?list=PLV6F- vYLHBFar7mIb5hLtm3-7g-N5XLhD • NOTICE: Some of the scenes in this video are not suitable for all ages

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