RSPT 1207
Cardio Pulmonary Anatomy &
Physiology

• Respiratory tract : combination of organs and tissues that have one function – the transfer of gas to be used by the body.
• This process exposes the respiratory tract to many environmental extremes

• Consists of:
– The nose
– Oral cavities
– The pharynx
– The larynx

• Function: There are 4 Functions
– Direct respiratory gases to and from the lung
– Defense mechanism
– Humidify inspired air
– Heat inspired air
• Also involved with:
– Speech
– Eating, drinking
– Smell

• Midline, external and internal structure
• Upper third is bone and covered by skin
• Lower 2/3 is cartilage

• Filters particles prior to entering lower airways
• Humidify and heat inspired air
• Provides a location for sensory receptors used in the sense of smell
• Provides resonance for speech

Major Structures of the Nose

Major Structures of the Nose

Major Structures of the Nose

• Separated by the septum making it into a symmetric bilateral structure
• Anterior portion formed by the septal cartilage
• Posterior septum formed ethmoid and vomer bones

• External nares – (nostrils) the openings of the nasal passageway
• Internally protected from particles by
Vibrissae (nose hairs)
• Immediately behind vibrissae is an open chamber called the vestibule

• As incoming gas flow enter posterior to the vestibule it is separated by the turbinates or conchae
• By having the turbinates, surface area is increased for heat/moisture exchange

• Lines the nasal cavity like three walls
• Twisted to allow particles to be filtered and air to be heated and humidified
• Mucous membranes line turbinates, Mucous glands line

• Lumen – the space (hole) in a vessel, tube, or intestine
• In the nasal passage this is call the
Choandae
• Choanal atresia is a common birth defect found in infants

• Consists of the: frontal, maxillary, ethmoid and posterior sphenoid
Sinuses
• Openings are along the nasal passage
• Paired sinuses contain mucous glands and membranes
• Helps strengthen the skull

• Simply known as the mouth
• Functions:
– Alternate passageway for breathing
– Start of the alimentary canal
– Contains major speech structures
– Facial expressions

• Anteriorly begins with lips and mouth
• Follows with oral vestibule and teeth and gums
• Oral cavity begins after the teeth

• The palate is the roof of the oral cavity
• Consists of:
• Hard palate – anterior 2/3 of the palate and is bony
• Soft palate – posterior 1/3 and is made of soft tissue.

• Protects the nasal passage from food
• Aids in swallowing
• Hard palate and tongue are used in speech
• Uvula helps protect the airway from occlusion

• Made of soft tissue
• This allows for food to be passed out of the oral cavity to the pharynx
• Two structures form the soft palate:
– Palatoglossal arch (anterior)
– Palato-pharyngeal arch (posterior)

• As the arches of the soft palate come together they form the uvula
• Protects the lower airways by being extremely sensitive to tactile stimulation
• Can cause violent gagging and possibly vomiting

• Lies in palato-glossal arch
• Lympathic tissue that is part of the immune system

• Generally known as the throat
• Divided into three areas:
– Nasopharynyx
– Oropharynx
– Laryngopharynx

• Located behind the nasal cavities
• Contains:
– Adenoids or Pharyngeal tonsils
– Eustachian tube:
• Runs between the back of the throat and middle ear
• Equilibrates pressure in the middle ear
• Acts like a pop-ff valve to release excess gas behind eardrum

• Located below soft palate down to base of tongue
• Only portion that can be seen without exam tools
• Contains:
– Lingual tonsils: at base of the tongue, tactile stimulation will cause gagging

• Also called the hypopharynx
• Located from base of the tongue to entrance of the esophagus
• Contains: Epiglottis
– structure that protects the opening to the lower airways which is the glottis
– Strong but flexible fibro-cartilage flap that comes out of the larynx into the laryngopharynx

• The most critical moment is when the food enters the laryngopharynx.
• Any mishap in coordination can lead to the food being aspirated into the lower airway
• There are more than 20 muscles that are involved in the act of swallowing
• The interaction of the tongue, palate and epiglottis in moving the food from the oral cavity to the oropharynx to the laryngopharynx and the esophagus

• Food is broken down and lubricated in the oral cavity
• As one swallows the muscles of the tongue and mouth move food up and back
• Soft palate protects the nasopharynx
• Gravity moves food into oropharynx

• When the tongue moves up & forward the epiglottis moves down and backward
• Results in the glottis is covered as the food moves into esophagus
• Once food is in esophagus, the epiglottis moves back in place to allow gas to enter trachea
• http://www.hopkinsgi.org/multimedia/database/intro_250_Swallow.swf

• Located immediately below the pharynx
• Formed by:
– Three large external cartilages
• Epiglottis
• Thyroid cartilage
• Cricoid cartilage
– Three pairs of internal cartilages
• Arytenoid cartilage
• Corniculate cartilage
• Cuneiform cartilage

• All protect the airway
• Thyroid cartilage is open in the posterior but it is solid in the anterior to protect the vocal cords inside them
• Cricoid cartilage is rigid ring and is the only structure that encircles the airway

• Form a three sided pyramid of ligaments and muscles to control the movement of the vocal cords
• Pitch of the voice is controlled by tightening and loosening the cords
• Volume or loudness is controlled by the amount of air forced through the cords

• Viewing the glottis from above a clinician will see the base of the tongue on top
• Below the tongue will be the epiglottis
& between these two will stretch the 3 ligaments of the vallecula
• Egan’s page 173, figure 7-35

• The base of the glottal triangle is opposite from the base of the tongue
• Surrounding the true vocal cords are tissue folds that are called the vestibular fold or the false cords
•
Vallecula
– space betweent the tongue & epiglottis
 Important landmark in intubation

• The vocal cords come together and separate during quiet breathing so that the glottis is always slightly open.
• A Valsalva maneuver or laryngospasm are the only time the glottis closed completely
• To close the glottis completely, not only requires bringing the vocal cords together but the person tightens all laryngeal muscles at the same time

• Purpose: When the body requires positive pressure for expulsion
• Examples: urination, defecation, birth, vomiting, coughing, sneezing
• Person must exhale forcefully against a closed glottis, building pressure in the abdomen and thorax
• Side effects:
– Increase thoracic pressure decreases output of heart
– Increased pressure in head

• Cough reflex is triggered when there is an irritant in the tracheal bronchial tree
• Deep breath : 12-15 mL/kg IBW,
• Inspiratory hold : 3 seconds for air to get behind irritant
• Compression : Valsalva maneuver. True cords close for 0.2 seconds, resulting intrathoracic pressure is 1001-200 cm H2O pressure
• Expulsion : Glottis opens and velocity can reach 300-500 LPM