Introduction

• The branch of medicine that deals with the diagnosis and treatment of diseases
of the ears, nose, and throat (ENT) is called otorhinolaryngology
(oto- ear; rhino- nose; laryngo- voice box; -logy study of ).

• A pulmonologist ( pulmon- lung) is a specialist in the diagnosis and treatment of

diseases of the lungs.
 Introduction
The entire process of gas exchange in the body, called respiration, occurs in three basic
steps:
• 1. Pulmonary ventilation, or breathing, is the flow of air into and out of the lungs.
• 2. External respiration is the exchange of gases between the air spaces (alveoli) of the
lungs and the blood in pulmonary capillaries. In this process, pulmonary capillary
blood gains O2 and loses CO2.
• 3. Internal respiration is the exchange of gases between blood in systemic capillaries
and tissue cells.
Two systems are cooperating to supply O2 and eliminate CO2: the respiratory system and
the cardiovascular system.
 The first two steps (1. and 2.) are the responsibility of the respiratory system,
 while the third step (3.) is a function of the cardiovascular system.
 Organization of the Respiratory System

• The respiratory system consists of two

parts:

• The upper respiratory system

includes the nose, pharynx, and
associated structures;

• The lower respiratory system

consists of the larynx, trachea,
bronchi, and lungs.
 Organization of the Respiratory System
• The respiratory system can also be
divided into two parts based on function
• Conducting portion transports air. It
includes the nose, nasal cavity,
pharynx, larynx, trachea, and Conducting portion
progressively smaller airways, from
the primary bronchi to the terminal
bronchioles

• Respiratory portion carries out gas

exchange. It is composed of small
airways called respiratory bronchioles
and alveolar ducts as well as air sacs
called alveoli

Respiratory portion
Functions Of The Respiratory System
1. Supplies the body with oxygen and disposes of carbon dioxide
2. Helps regulate blood pH
3. Moistens and warms incoming air
4. Filters inspired air
5. Produces vocal sound (phonation),
6. Contains receptors for smell
7. Rids the body of some excess water and heat
 Organs Of The Respiratory System
1- The Nose: it has 2 portions
• The external nose, the visible portion, which
consists of bone and cartilage covered with
skin and lined with mucous membrane. It
has two openings called the external nares
(singular is naris) or nostrils entering inside
via the nasal vestibule.
• The internal nose or internal portion inside
the skull (Figure 6.2). It connects to the
throat (or pharynx) through two openings
called the internal nares.
The space inside the internal nose, called the nasal
cavity, lies below the cranium and above the palatine
bone which separates the oral cavity from the nasal
cavity.
 Organs Of The Respiratory System
1- The Nose (continue) :
• Four paranasal sinuses (frontal, sphenoidal, maxillary, and ethmoidal) and the
nasolacrimal ducts also connect to the internal nose (nasal cavity) .

nasal cavity

nasolacrimal duct
 Organs Of The Respiratory System
1- The Nose (continue) :
• A vertical partition, the nasal septum, divides the nasal cavity into right and left sides.
The septum consists of the perpendicular plate of the ethmoid bone, vomer, and
cartilage.

Perpendicular
plate of ethmoid
 Organs Of The Respiratory System
1- The Nose (continue) :
The interior nose are specialized for three basic functions:
• (1) filtering, warming, and moistening incoming air;
• (2) detecting olfactory (smell) stimuli; and
• (3) modifying the vibrations of speech sounds.

When air enters the nostrils, it passes coarse hairs that trap large dust particles. The air
then flows over three shelves called the superior, middle, and inferior nasal conchae
(KONGke¯ ) that extend out of the wall of the cavity.
Mucous membrane lines the nasal cavity and the three conchae. As inspired air whirls
around the conchae, it is warmed by blood circulating in abundant capillaries.
 Organs Of The Respiratory System
1- The Nose (continue) :
• The olfactory receptors lie in the membrane lining the superior
nasal conchae and adjacent septum (Superior portion of nasal
cavity). This region is called the olfactory epithelium.

Olfactory Epithelium:
Contains receptors for smell
 Organs Of The Respiratory System
1- The Nose (continue) :
• Pseudostratified ciliated columnar epithelial cells
and goblet cells (secrete mucus) line the nasal
cavity. Mucus secreted by goblet cells moistens
the air and traps dust particles. Cilia move the
dust-laden mucus toward the pharynx, at which
point it can be swallowed or spit out, thus
removing particles from the respiratory tract.
 Organs Of The Respiratory System
2- The pharynx : Pharyngeal tonsil Palatine tonsil

• The pharynx (FAR-inks), or throat, is a funnel-

shaped tube that starts at the internal nares
and extends partway down the neck (Figure Pharynx
6.2). It lies just posterior to the nasal and oral
cavities and just anterior to the cervical (neck)
vertebrae. Its wall is composed of skeletal cervical (neck)
muscle and lined with mucous membrane. The vertebrae
pharynx functions as a passageway for air and
food, provides a resonating chamber for
speech sounds, and houses the tonsils Lingual tonsil

(pharyngeal, palatine and lingual tonsils),

which participate in immunological responses
to foreign invaders.
 The Pharynx and Divisions
Organs Of The Respiratory System
2- The pharynx and its divisions

I. The Nasopharynx
• Superior portion of the pharynx
II. The Oropharynx
• Middle portion of the pharynx
III. The Laryngopharynx
• Inferior portion of the pharynx
 Organs Of The Respiratory System
2- The pharynx and its divisions
I. The Nasopharynx
• connects with the two internal nares Pharyngeal tonsil Opening of auditory
tube
• has two openings that lead into the auditory
(eustachian) tubes.
Nasopharynx
• The posterior wall contains the pharyngeal tonsil.
• The nasopharynx exchanges air with the nasal
cavities and receives mucus–dust packages. The
cilia of its pseudostratified ciliated columnar
epithelium move the mucus–dust packages
toward the mouth. The nasopharynx also
exchanges small amounts of air with the auditory
tubes to equalize air pressure between the
pharynx and middle ear.
 Organs Of The Respiratory System
2- The pharynx and its divisions
II. The Oropharynx
Palatine tonsil
• It opens into the mouth and nasopharynx. Oral cavity

• Two pairs of tonsils, the palatine tonsils and Oropharynx

lingual tonsils, are found in the oropharynx.

III. The Laryngopharynx

Laryngopharynx
• connects with both the esophagus (food tube) Tongue

and the larynx (voice box). Thus, the oropharynx

and laryngopharynx both serve as passageways Esophagus
for air as well as for food and drink
Lingual tonsil

Larynx
 Organs Of The Respiratory System
3- The Larynx :
• The larynx, or voice box, is a short tube of many
cartilages lined by mucous membrane that
connects the pharynx with the trachea (Figure
6.3). It lies in the midline of the neck anterior to
the fourth, fifth, and sixth cervical vertebrae (C4
to C6), and also to the esophagus. Epiglottis

• The thyroid cartilage (Adam’s apple), which

consists of hyaline cartilage, forms the anterior
and lateral wall of the larynx. Its common name Esophagus C4
(Adam’s apple) reflects the fact that it is often C5 Thyroid cartilage
Adam’s apple
larger in males than in females due to the C6
influence of male sex hormones during puberty.
Thyroid gland
• The epiglottis: elastic cartilage Larynx (voice box)
 Epiglottis

Organs Of The Respiratory System

Posterior view
3- The Larynx (continue) :
• The epiglottis (epi- over; glottis tongue) is a large, leaf- Cricoid
shaped piece of elastic cartilage that is covered with
epithelium (see also Figure 6.2 on the booklet). The “stem” of
the epiglottis is attached to the anterior rim of the thyroid
cartilage and hyoid bone. The broad superior “leaf” portion
of the epiglottis is unattached and is free to move up and
down like a trap door. During swallowing, the pharynx and
larynx rise. Elevation of the pharynx widens it to receive food
or drink; elevation of the larynx causes the epiglottis to move
down and form a lid over the larynx, closing it off. The closing
of the larynx in this way during swallowing routes liquids and
foods into the esophagus and keeps them out of the airways
below. When anything but air passes into the larynx, a cough Anterior view
reflex attempts to expel the material.
 Epiglottis

Organs Of The Respiratory System

Posterior view
3- The Larynx (continue) :
• The cricoid cartilage (KRI¯-koyd) is a ring of Cricoid
hyaline cartilage that forms the inferior wall
of the larynx and is attached to the first
tracheal cartilage. The cricoid cartilage is the
landmark for making an emergency airway
(a tracheotomy).

tracheotomy is a surgical
procedure while
tracheostomy is the opening
itself Anterior view
 Organs Of The Respiratory System
3- The Larynx (continue) :
• The paired arytenoid cartilages, consisting mostly of hyaline cartilage, are located
above the cricoid cartilage. They attach to the true vocal cords and pharyngeal
muscles and function in voice production.

Anterior view
 Organs Of The Respiratory System

Elastic cartilage close off during swallowing

Adam’s apple hyaline cartilage

hyaline cartilage Attach to true vocal cords
to produce sound

hyaline cartilage ring (complete ring in comparison to trachea)

inferior wall of the larynx
landmark for making an emergency airway (a tracheotomy).

Anterior view
The Structures of Voice Production
• The mucous membrane of the larynx forms two pairs of folds: an upper pair called
the false vocal cords and a lower pair called the true vocal cords (see Figure 6.2).
The false vocal cords hold the breath against pressure in the thoracic cavity when
you strain to lift a heavy object, such as a backpack filled with textbooks. They do
not produce sound.
The Structures of Voice Production
• The true vocal cords produce sounds during speaking and singing. They contain
elastic ligaments stretched between pieces of rigid cartilage like the strings on a
guitar. Muscles attach both to the cartilage and to the true vocal cords. When the
muscles contract, they pull the elastic ligaments tight, which moves the true vocal
cords out into the air passageway. The air pushed against the true vocal cords
causes them to vibrate and sets up sound waves in the air in the pharynx, nose,
and mouth. The greater the air pressure, the louder the sound.
• Pitch is controlled by the tension of the true vocal cords. If they are pulled taut,
they vibrate more rapidly and a higher pitch results. Lower sounds are produced by
decreasing the muscular tension. Due to the influence of male sex hormones, vocal
cords are usually thicker and longer in males than in females. They therefore
vibrate more slowly, giving men a lower range of pitch than women.
 Organs Of The Respiratory System TV5

4- The trachea :
• The trachea (TRA-ke-a) or windpipe
• is a tubular passageway for air
• is anterior to the esophagus.
• It extends from the larynx (cricoid) to the upper part of the fifth
thoracic vertebra (T5), where it divides into right and left
primary bronchi (Figure 6.4).
• Carina cartilage - marks where trachea divides into two
primary bronchi trachea
• C-shaped cartilage rings keep airway open (contrary to the
cricoid)
right primary left primary
bronchus bronchi
 Organs Of The Respiratory System
4- The trachea (continue) :
• It consists of 16 to 20 C-shaped
rings of hyaline cartilage.
• The open part of each C-shaped
cartilage ring faces the esophagus
posteriorly and permits it to
expand slightly into the trachea
during swallowing.
• The solid parts of the C-shaped
cartilage rings provide a rigid
support so the tracheal wall does
not collapse inward and obstruct
the air passageway.
• The rings of cartilage may be felt
under the skin below the larynx.
 Organs Of The Respiratory System
4- The trachea (continue) :
• The wall of the trachea is lined with mucous
membrane and is supported by cartilage. The
mucous membrane is composed of pseudostratified
ciliated columnar epithelium, consisting of ciliated
columnar cells, goblet cells, and basal cells, and
provides the same protection against dust as the
membrane lining the nasal cavity and larynx.
• The cilia in the upper respiratory tract move mucus
and trapped particles down toward the pharynx, but
the cilia in the lower respiratory tract move mucus
and trapped particles up toward the pharynx.
Pseudostratified Ciliated Columnar Epithelium
 Organs Of The Respiratory System
5- Bronchi and Bronchioles :
• The trachea divides into a right primary
trachea
bronchus, which goes to the right lung, and a
left primary bronchus, which goes to the left
lung (Figure 6.4).
• Like the trachea, the primary bronchi right primary bronchus left primary
bronchi
(BRONG-ke¯) contains incomplete rings of
cartilage and are lined by pseudostratified
ciliated columnar epithelium.
• Pulmonary blood vessels, lymphatic vessels,
and nerves enter and exit the lungs with the
two bronchi.
 Organs Of The Respiratory System
5- Bronchi and Bronchioles (continue) :
1
• On entering the lungs, the primary bronchi 1
divide to form the secondary bronchi, one 2

for each lobe of the lung (the right lung has

three lobes; the left lung has two.) 3 2

• The secondary bronchi continue to branch,

forming smaller bronchi, called tertiary
bronchi, that divide several times, ultimately
giving rise to smaller bronchioles.
• Bronchioles, in turn, branch into even
smaller tubes called terminal bronchioles.
• Because all of the airways resemble an
upside-down tree with many branches, their
arrangement is known as the bronchial tree.
 Organs Of The Respiratory System
5- Bronchi and Bronchioles (continue) :
 Tissue Composition of Conducting and respiratory Zone
The tissue composition of conduction and respiratory zone changes along
pathway
1- Supportive connective tissues change (cartilage)
the amount of cartilage decreases (see next slide)
2- Epithelium changes
the type of epithelium changes from pseudostratified to squamous cells
(see after next slide)
3- Smooth muscle
becomes important at the bronchioles: as the amount of cartilage
decreases, the amount of smooth muscle increases.
It is controlled by the ANS (autonomous nervous system) for bronchoconstriction
and bronchodilation. Smooth muscle encircles the lumen in spiral bands. During
exercise, activity in the sympathetic division of the autonomic nervous system
(ANS) increases and causes the adrenal medullae to release the hormones
epinephrine and norepinephrine. Both chemicals cause relaxation of smooth
muscle in the bronchioles, which dilates (widens) the airways. The result is
improved airflow, and air reaches the alveoli more quickly.
Tissue Composition Of Conducting And Respiratory Zone
• 1- Supportive connective tissues change (cartilage)
The amount of cartilage decreases
• C-shaped rings cartilage
(trachea, primary bronchi)

• plates cartilage
(secondary & tertiary bronchi …)

• No cartilage
(bronchioles)
 Tissue Composition Of Conducting And Respiratory Zone

• 2- Epithelium changes
• First, pseudostratified ciliated columnar cells
– trachea and bronchi ciliated
• Replaced by simple ciliated columnar cells
– bronchioles and terminal bronchioles
• Then simple cuboidal ciliated cells and squamous cells
– respiratory bronchioles
• Squamous cells ciliated
– alveoli

ciliated
 Organs Of The Respiratory System
6- Lungs :
• The lungs ( lightweights, because they float)
are paired cone-shaped organs in the
thoracic cavity .
• They are separated from each other by the
heart and other structures of the
mediastinum, which divides the thoracic
cavity into two anatomically distinct
chambers. As a result, if trauma causes one
lung to collapse, the other may remain
expanded.
 Organs Of The Respiratory System
6- Lungs (continue) :
• Each lung is enclosed and protected by a
double-layered serous membrane called the
pleural membrane (PLOOR-al; pleur- side).
• The superficial layer, called the parietal
pleura, lines the wall of the thoracic
cavity;
• the deep layer, the visceral pleura, covers
the lungs themselves.
• Between the visceral and parietal pleurae is a
small space, the pleural cavity, which
contains a small amount of lubricating fluid
secreted by the membranes.
 Organs Of The Respiratory System
6- Lungs (continue) :
• This pleural fluid reduces friction between the membranes, allowing them to slide
easily over one another during breathing.
• Pleural fluid also causes the two membranes to adhere to one another just as a film
of water causes two glass microscope slides to stick together, a phenome-non called
surface tension.
• Separate pleural cavities surround the left and right lungs. Pleurae help divide the
thoracic cavity into
• Central mediastinum
• Two lateral pleural compartments
• Inflammation of the pleural membrane, called pleurisy or pleuritis, may in its early
stages cause pain due to friction between the parietal and visceral layers of the
pleura. If the inflammation persists, excess fluid accumulates in the pleural space, a
condition known as pleural effusion.
 Organs Of The Respiratory System
6- Lungs (continue) :
Apex
• The lungs extend from the diaphragm to just slightly
superior to the clavicles and lie against the ribs Costal surface
anteriorly and posteriorly (Figure 6.5a).
• The broad inferior portion of the lung, the base, is
concave and fits over the convex area of the Base
diaphragm.
• The narrow superior portion of the lung is the apex.
Diaphragm
• The surface of the lung lying against the ribs, the
costal surface, matches the rounded curvature of
the ribs.
 Organs Of The Respiratory System
6- Lungs (continue) :
• The mediastinal (medial) surface of each lung contains a region, the hilum, through which
bronchi, pulmonary blood vessels, lymphatic vessels, and nerves enter and exit (Figure
6.5e). These structures are held together by the pleura and connective tissue and
constitute the root of the lung.
 Organs Of The Respiratory System
6- Lungs (continue) :
• Medially, the left lung also contains a concavity, the cardiac notch, in which the apex of
the heart lies. Due to the space occupied by the heart, the left lung is about 10% smaller
than the right lung.
 Organs Of The Respiratory System
6- Lungs (continue) :
• Although the right lung is thicker and broader, it is also somewhat shorter than the left
lung because the diaphragm is higher on the right side, accommodating the liver that lies
inferior to it.
 Organs Of The Respiratory System
6- Lungs (continue) :
• The lungs almost fill the thorax. The apex of the lungs lies
superior to the medial third of the clavicles, and this is the
only area that can be palpated. The anterior, lateral, and
posterior surfaces of the lungs lie against the ribs. The base
of the lungs extends from the sixth costal cartilage anteriorly
to the spinous process of the tenth thoracic vertebra
posteriorly. The pleura extends about 5 cm (2 in.) below the
base from the sixth costal cartilage anteriorly to the twelfth
rib posteriorly. Thus, the lungs do not completely fill the
pleural cavity in this area. Removal of excessive fluid in the
pleural cavity can be accomplished without injuring lung
tissue by inserting a needle anteriorly through the seventh
intercostal space, a procedure called thoracentesis (-
centesis =puncture). Inferior to the seventh intercostal
space there is danger of penetrating the diaphragm.
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules :
• One or two fissures divide each lung into lobes (one in the left and 2 in the right)
• Both lungs have an oblique fissure
• The right lung also has a horizontal fissure.
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) :
• The oblique fissure in the left lung separates the superior lobe from the inferior lobe.
• In the right lung, the superior part of the oblique fissure separates the superior lobe from
the inferior lobe;
• The inferior part of the oblique fissure separates the inferior lobe from the middle lobe,
which is bordered superiorly by the horizontal fissure.
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) : primary bronchi

• Each lobe receives its own lobar bronchus. Thus, the right main secondary bronchi
bronchus gives rise to three lobar bronchi called the superior,
middle, and inferior lobar bronchi, and the left main bronchus
gives rise to superior and inferior lobar bronchi.

Lobar bronchi or

Superior, Superior,
middle and middle and
inferior inferior
trachea lobs Lobar bronchi

right primary left primary

bronchus bronchi
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) : primary bronchi

• Within the lung, the lobar bronchi give rise to the segmental secondary bronchi
bronchi, which are constant in both origin and distribution— tertiary bronchi
there are 10 segmental bronchi in each lung. The segment of lung
tissue that each segmental bronchus supplies is called a
bronchopulmonary segment.

Lobar bronchi or
Segmental or tertiary
bronchi

trachea

right primary left primary

bronchus bronchi bronchopulmonary segment
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) :
• Bronchial and pulmonary disorders (such as tumors or abscesses) that are localized in
a bronchopulmonary segment may be surgically removed without seriously disrupting
the surrounding lung tissue.

bronchopulmonary segment
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) :
• Each bronchopulmonary segment of the
lungs has many small compartments
called lobules; each lobule is wrapped in
elastic connective tissue and contains a
lymphatic vessel, an arteriole, a venule,
and a branch from a terminal bronchiole.

• Terminal bronchioles subdivide into

microscopic branches called respiratory
bronchioles. They also have alveoli
budding from their walls. Since they
contain Alveoli that participate in gas
exchange, thus respiratory bronchioles
begin the respiratory zone of the
respiratory system.
 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) :
• Respiratory bronchioles in turn subdivide into several (2–11) alveolar ducts, which
consist of simple squamous epithelium. The alveolar ducts Lead to alveolar sacs
containing alveoli.

Respiratory Zone Of The Respiratory System.

 Organs Of The Respiratory System
7- Lobes, Fissures, and Lobules (continue) :

• The respiratory passages from primary bronchi

the trachea to the alveolar ducts Conducting portion

secondary bronchi
contain about 25 orders of tertiary bronchi
branching; branching from the
trachea into primary bronchi is
called first-order branching, than
from main bronchi into lobar
bronchi is called second-order
branching, and so on down to
the alveolar ducts.
Respiratory portion
Structures of the Respiratory Zone

• Consists of air-exchanging structures

• It starts with the Respiratory bronchioles – branch from terminal
bronchioles
• Lead to alveolar ducts
• Lead to alveolar sacs containing alveoli
 Organs Of The Respiratory System
8- Alveoli :
• Around the circumference of the alveolar
ducts are numerous alveoli and alveolar sacs. terminal bronchioles

• An alveolus is a cup-shaped lined by simple

squamous epithelium and supported by a
Respiratory bronchioles
thin elastic basement membrane;
• an alveolar sac consists of two or more Respiratory alveolar ducts
alveoli that share a common opening.

Alveolar sac

Alveoli
 Organs Of The Respiratory System
8- Alveoli (continue) :
• The walls of alveoli consist of two types of
alveolar epithelial cells:
• The type I alveolar cells (more numerous)
are simple squamous epithelial cells that
form a nearly continuous lining of the
alveolar wall. The thin type I alveolar cells
are the main sites of gas exchange
• Type II alveolar cells, also called septal cells,
are fewer in number and are found between
type I alveolar cells. Type II alveolar cells,
rounded or cuboidal epithelial cells with free
surfaces containing microvilli, secrete
alveolar fluid, which keeps the surface
between the cells and the air moist.
 Organs Of The Respiratory System
8- Alveoli (continue) :
• Associated with the alveolar wall are
alveolar macrophages (dust cells),
phagocytes that remove fine dust particles
and other debris from the alveolar spaces.
• Also present are fibroblasts that produce
reticular and elastic fibers.
• On the outer surface of the alveoli, is
dispersed a network of blood capillaries that
consist of a single layer of endothelial cells
and basement membrane
Gas Exchange Between the Blood
and Alveoli

The exchange of O2 and CO2 between the

air spaces in the alveoli and the blood
takes place by diffusion across the alveolar
and capillary walls which are only one cell
thick to facilitate the diffusion, and which
together form the respiratory membrane. Figure 10.8A
 Gas Exchange Between the Blood
and Alveoli
Extending from the alveolar air space to blood
plasma, the respiratory membrane consists of four
layers:

1. A layer of type I and type II alveolar cells and

associated alveolar macrophages that constitutes the
alveolar wall
2. An epithelial basement membrane underlying the
alveolar wall
3. A capillary basement membrane that is often fused
to the epithelial basement membrane
4. The capillary endothelium
Figure 10.8A
 Gas Exchange Between the Blood
and Alveoli

• Despite having several layers, the respiratory

membrane is very thin (only 0.5 micrometer
thick), about one-sixteenth the diameter of a
red blood cell to allow rapid diffusion of
gases.

• It has been estimated that the lungs contain

300 million alveoli, providing an immense
surface area of 70 m2 (750 ft2) about the size
of a racquetball court for gas exchange.
Figure 10.8A