RESPIRATORY SYSTEM ANATOMY AND PHYSIOLOGY REVIEW

Respiration is essential for life. The body can survive a fair length of time without food, a few days without water, but only minutes without air. Refer to Figure for a review of the structure of the respiratory system.

The respiratory system

FIGURE. The respiratory system.

There are two levels involved in the respiratory process: external and internal respiration. External respiration is the exchange of two gases within the lungs. Oxygen that is present in inhaled air is exchanged for carbon dioxide that diffuses from the blood, across cell walls, into the air spaces of the lungs. The carbon dioxide is then exhaled from the lungs. Internal respiration is the exchange of oxygen and carbon dioxide at the cellular level within the organs of the body. Carbon dioxide is a waste product that results when oxygen and nutrients are metabolized within body cells.

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The respiratory system is divided between the upper respiratory tract and the lower respiratory tract. The upper tract is composed of the organs located outside the chest cavity: the nose and nasal cavities, pharynx, larynx, and upper trachea. The lower tract is composed of the organs located inside the chest cavity: the lower trachea, bronchi, bronchioles, alveoli (microscopic air sacs in the lung), and lungs. Additional parts of the lower tract are the pleural membranes and the respiratory muscles that form the chest cavity.

Midsagittal section of the head and neck

FIGURE. Midsagittal section of the head and neck showing the structures of the upper respiratory tract. (From Scanlon, VC, and Sanders, T: Understanding Human Structure and Function, ed 5. FA Davis, Philadelphia, 2007, p 345, with permission.)

Air enters the nose, which is composed of bone and cartilage and contains ciliated epithelium and cells where the air is humidified and warmed. Tiny hairs just inside the nostrils help prevent particles of dust from entering the nasal cavities. The nasal septum separates the two sides of the nose. The nasal cavities are lined with a membrane that creates mucus designed to further trap bacteria and air pollutants. The upper nasal cavities contain the olfactory receptors that detect odors. Olfactory nerves pass through the ethmoid bone into the brain. The paranasal sinuses, the air cavities in the maxillae, frontal, sphenoid, and ethmoid bones, function to lighten the skull and provide resonance for the voice. These sinuses contain several drainage openings where mucus drains into the nasal cavity.

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The pharynx, or throat, is divided into three parts: the nasopharynx, the oropharynx, and the laryngopharynx. The nasopharynx is the passageway for air only. The adenoids are located in the nasopharynx. The soft palate within the nasopharynx prevents food from going up into the nasopharynx. The oropharynx contains the palatine tonsils at the base of the tongue; and the laryngopharynx opens into the larynx and into the esophagus.

The larynx, or voice box, serves as an air passageway and allows for speaking. Cartilage in the larynx prevents the collapse of the larynx, which must stay open for air passage. The epiglottis, located at the top of the larynx, closes over to prevent the entry of food into the larynx. The vocal cords are located on either side of the glottis.

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The trachea contains C-shaped cartilage that keeps the wind pipe open for air passage yet allows food to pass through to the esophagus, which is located behind the trachea. The trachea extends downward into the chest cavity where it splits into the right and left bronchus. These bronchi branch into secondary bronchi leading into the right and left lungs to form the bronchial tree. The branches become smaller, forming bronchioles that terminate in clusters of alveoli, the air sacs of the lungs. The millions of tiny alveoli (only one cell thick) in each lung are important for respiration. They house macrophages to phagocytize any foreign pathogens that might have made it all the way to the lungs. They also permit the diffusion of gases between air in the alveoli and blood in the pulmonary capillaries (also only one cell thick).

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The lungs, located on either side of the heart, are protected by the rib cage and rest on the diaphragm. They are lined with pleural membranes. The parietal pleura lines the chest wall, while the visceral pleura is on the surface of the lung. Pleura serve to prevent friction and keep the two membranes together during breathing. The lungs are soft and cone-shaped and take up most of the thoracic cavity. The lobes of the lung (three on the right and two on the left) contain the bronchial tree.

Pulmonary embolism ICD-9: 416.2 Description A pulmonary embolism is a mass of undissolved matter in the pulmonary artery or one of its branches. It is the most common pulmonary complication among hospitalized individuals with about 250,000 incident cases occurring annually. It is not considered a disease itself but is a complication of venous thrombosis. It is potentially lethal. Etiology FIGURE. Embolism. (From Thomas, CL : Taber’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2005, p 744, with permission.) A pulmonary embolism generally originates in the pelvic veins or deep lower extremity veins and travels through the circulatory system until it blocks a pulmonary artery. At high risk for pulmonary emboli are individuals immobilized with chronic diseases, those in body casts, persons with congestive heart failure or neoplasms, and postoperative clients. Also at risk are pregnant women; women taking oral contraceptives; and individuals with venous diseases, such as var...
BRONCHIECTASIS (ACQUIRED) ICD-9: 490.0 Description Bronchiectasis is the widening and destruction of the large airways or bronchi, usually in the lower lung portions. Etiology The common cause is recurrent inflammation or infection of the airways. Cystic fibrosis is a cause in nearly half of all cases. Risk factors include recurrent lung infections, tuberculosis, and obstruction of the airways by a foreign body or tumor. Signs and Symptoms Symptoms may develop gradually and can include chronic cough with large amounts of foul-smelling sputum, bluish skin color, hemoptysis, fatigue, paleness, shortness of breath, weight loss, and wheezing. Diagnostic Procedures Auscultation reveals small clicking, wheezing, bubbling, rattling sounds, usually in the lower lung lobes. Chest x-ray, CT scan, complete blood count (CBC), and tuberculin skin test are often ordered. Treatment Treatment aims at controlling infections and bronchial secretions and relieving airway obstruction. Antibiotics, bronc...
Understanding ARDS Acute respiratory distress syndrome (ARDS) is sudden, life-threatening lung failure. ARDS occurs when the alveoli become inflamed and filled with liquid, causing their collapse. Gas exchange ceases, and the body is starved for oxygen. ARDS is a syndrome rather than a disease. It most often occurs within 24 to 48 hours of injury or illness, and the intensity and duration varies from one person to another. The mortality rate ranges from 35% to 50%, in most cases as a result of underlying disease or mechanical ventilation complications.
Pneumoconiosis ICD-9: 505 Pneumoconiosis is a disease of the respiratory tract caused by inhaling inorganic or organic dust particles or chemical irritants over a prolonged period. It is an occupational disorder associated with mining and stonecutting. Four of the most frequently seen varieties of pneumoconiosis are silicosis (most common), asbestosis, berylliosis, and anthracosis.
ASTHMA ICD-9: 493.9x* Description Asthma is a respiratory condition marked by recurrent attacks of labored breathing accompanied by wheezing. Asthma is an inflammatory disorder of the airways that causes spasms of the bronchial tubes or swelling of their mucous membranes. Extrinsic asthma occurs when the bronchospasm is the result of an allergic response to environmental irritants. Intrinsic asthma is present when the client suffers attacks without evidence of allergic response. Extrinsic asthma is most common in childhood; intrinsic asthma more often begins in adulthood. Asthma affects 22 million Americans, of whom 6 million are children under age 12. Etiology The etiology of asthma is uncertain. There is often a family history of allergy and an individual history of hypersensitivity. Persons with asthma have very sensitive airways that react to “triggers” that cause asthma symptoms to start or worsen. Common triggers include upper respiratory infections; allergens, such as pollens...