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1、Respiratory System,Functions of the Respiratory System,Breathing processExchange of Oxygen and Carbon DioxideEnable speech production,Respiratory System Function,Exchange of oxygen and carbon dioxide between the atmosphere and body cells.The process is called respiration.External respiration(breathi
2、ng)Internal respiration,Internal Respiration,All cells require oxygen for metabolismAll cells require means to remove carbon dioxideGas exchange at cellular level,External Respiration,Ventilationexchange of air between lungs and atmosphereGas Exchange in pulmonary capillariesBreathing largely involu
3、ntary activity,Organs of the Respiratory System,Structures of Respiratory System,upper respiratory tractnose,mouth,pharynx,epiglottis,larynx and trachealower respiratory tractbronchial tree and lungs,Nose,nasal cavitynasal septummucous membranemucusciliaolfactory receptors,Structures of the Nasal Pa
4、ssages and Throat,Pharynx,Nasopharynxadenoids or pharyngeal tonsilsoropharynxpalatine tonsilslaryngopharynxlarynx,Epiglottis,oropharynx and laryngopharynx serve as a common passageway for both food and airepiglottis acts as a lid or flap that covers the larynx and trachea(airway)so food does not ent
5、er the lungs.,Larynx,voice boxlarynx/oglottis(vocal apparatus)vocal bands or vocal cords,Trachea,Windpipe or airwaymucous membrane lining with ciliasmooth muscle with c-shaped cartilage ringsdivides into two branches:bronchino gaseous exchange,Bronchi,Bronchus,singularc-shaped cartilage rings with s
6、mooth muscleeach bronchi divides into bronchioles terminate in air sacs called alveoli,bronchus:one of two branches from the trachea,which conducts air into the lungs,where it divides and subdivides(referred to as a bronchial tree).bronchioles:smallest subdivision of the bronchial treealveolus:air s
7、acs at the end of the bronchioles;oxygen and carbon dioxide are exchanged through alveolar walls and capillaries,Bronchioles and Alveoli,Bronchoscope:An Overview,Bronchoscopy is a procedure to examine the bronchial tree Bronchoscope leading invasive tool for evaluation,diagnosis and treatment of dis
8、orders of the lung Catheter a thin,tube like instrument inserted into the lungs with a small light and camera on the tip which transmits imagesDirect Examination,Diagnosis&TreatmentAllows for removal of obstructions and foreign bodiesTissue may be biopsied(removed for microscopic observation),Normal
9、 view through the vocal cords into the subglottis,Thoracic Cavity,thoracicthoraxmediastinumheartaortaesophagusbronchithymus,Alveoli,air sacsalveolar wall membranes one cell thick and surrounded by capillariesgaseous exchange takes place here,Right-3 lobes,Left-2 lobes,Lungs,trachea,Pleura,each lung
10、enclosed in pleuraparietal pleura(inner)visceral pleura(outer)pleural space or pleural cavitylubricating fluid,Diaphragm,muscle separating chest and abdomeninspiration,diaphragm contracts and increases thoracic spaceair flows inexpiration,diaphragm relaxes and decreases thoracic spaceair flows outph
11、renic nerve,Respiration,external respiration-exchange of gases in lungsinternal respiration-exchange of gases within cells of the body organs and tissuesventilation-movement of air,Combining Forms for the Respiratory System,adenoid/o alveol/o bronch/i,bronch/o diaphragmat/o epiglott/o laryng/o,lob/o
12、 nas/o,rhin/o pharyng/o pleur/o pneum/o,pneumat/o,pneumon/o,pulmon/o,Combining Forms for the Respiratory System(contd),sept/o sinus/o thorac/o tonsill/o trache/oPhren/o,pector/osteth/othorac/oconi/oanthrac/o,Combining Forms Commonly Used with Respiratory System Terms,atel/o capn/ohem/o,hemat/omuc/oo
13、rth/oox/o,ox/i,py/ospir/o,Prefixes,a-,an-brady-endo-tachy-eu-pan-poly-,Suffixes,-algia-ar,-ary-cele-centesis-eal-ectasis-emia-gram,-graphy-graph-meter-metry-oxia-pexy-phonia-pnea,Suffixes(contd),-rrhagia-scope-scopic-scopy-spasm-stenosis-stomy,-thorax-tomy-osmia-ptysis-thorax,Word Parts Meaning Brea
14、thing,Oxygen,and Chest Appear as Combining Forms and Suffixes,Meaning Combining Form Suffixbreathing spir/o-pneachest thorac/o-thoraxoxygen ox/o,ox/i-oxia,Disease and Disorder Terms Built from Word Parts,adenoiditis atelectasis bronchogenic carcinoma hemothorax pansinusitis pneumonitis pneumothorax
15、rhinorrhagia,Disease and Disorder Terms Not Built from Word Parts,adult respiratory distress syndrome(ARDS)asthmachronic obstructive pulmonary disease(COPD)Coccidioidomycosis(valley fever or cocci)emphysemaobstructive sleep apnea(OSA)pulmonary embolismtuberculosis(TB),Surgical Terms Built from Word
16、Parts,bronchoplasty laryngocentesis lobectomy pleuropexy pneumobronchotomy thoracocentesis or thoracentesis thoracotomy tracheostomy,(chest)/cv/(surgical puncture to remove fluid),Types of Diagnostic Procedures,radiography:x-ray images of internal organs using ionizing radiationnuclear medicine:scan
17、s using radioactive material to determine the functional capacity of an organultrasound:sonograms,or echograms,using high-frequency sound waves to create an image of body organs,Types of Diagnostic Procedures(contd),computed tomography(CT scans):computerized images of body organs in slices,horizonta
18、llymagnetic resonance imaging(MRI scans):gives information about the bodys biochemistry by placing the patient in a magnetic field,Types of Diagnostic Procedures(contd),endoscopy:endoscopes,which are lighted,flexible instruments,are used for visual examination of a hollow organ or body cavitylaborat
19、ory:diagnostic procedures performed on specimens such as blood,tissue,sputum,and urinepulmonary function tests:diagnostic tests performed to determine lung function,Diagnostic Terms Built from Word Parts,capnometer endoscope endoscopic endoscopy laryngoscopy thoracoscope thoracoscopy,oximeterpolysom
20、nographyspirometerspirometry,Pulse Oximetry,Spirometer,Diagnostic Terms Not Built from Word Parts,Diagnostic imagingchest CT(computed tomography)scanchest x-rayventilation-perfusion scanningLaboratory procedureacid-bacilli(AFB)smear,Diagnostic Terms Not Built from Word Parts(contd),Pulmonary functio
21、narterial blood gases(ABGs)pulmonary function tests(PFTs)pulse oximetryOther PPD skin test,Complementary Terms Built from Word Parts,acapnia anoxia aphonia apnea bronchospasm diaphragmatic dysphonia dyspnea,Complementary Terms Built from Word Parts(contd),eupnea hypercapnia hypocapnia hypoxemia hypo
22、xia laryngeal nasopharyngeal rhinorrhea,Complementary Terms Not Built from Word Parts,airway asphyxia aspirate bronchoconstrictor bronchodilator hyperventilation hypoventilation mucopurulent,Complementary Terms Not Built from Word Parts(contd),nebulizer nosocomial infection patent sputum ventilator,
23、Abbreviations,ABGsAFBARDSCFCOPDCTCXRCO2,LLLLTBLULO2OSAPCP,Abbreviations(contd),PEPFTsPSGRLL,RULTBURI,PathologyBreathing Disorders,Chronic Obstructive Pulmonary DiseaseCOPD(COLD)DyspneaBradypneaTachypnea,Respiratory tracts infections,Diphtheria DiphtheriaMeningococcal meningitisMeaslesPertussis Pertu
24、ssisScarlet feverRubella RubellaMumpsChicken poxTuberculosis influenza,COPD,Asthmabronchospasms,parosysmal,productive cough,mucolytics,bronchodilatorsChronic Bronchitismucosal swelling,productive cough,chest painexpectorants,bronchodilators,steroidsEmphysemabarrel-chest,dyspnea,orthopnea,Influenza,A
25、cute infectious respiratory diseaseViralFever,chills,headache,myalgia,anorexiaAvoid aspirin in children,Pleural Effusions,Excess fluid in pleural cavityassociated with congestive heart failure,ascites,infectious lung diseases,traumadiagnosisauscultation,percussionEmpyema,hydrothorax,hemothorax,pnrum
26、othorax,pyopneumothoraxthoracentesis,Tuberculosis,Infectious,highly communicable diseaseaerosol transmissionprimary tuberculosis,tuberclesimmunocompromisedeffects other organ systemsdrug resistant strains,Bronchopneumonia,Inflammatory disease of lungslobar,bilateralhemoptyisisconsolidationPneumocyst
27、is carinii lavage,Cystic Fibrosis,Hereditary disorder,affects exocrine glandssystemic involvementlungs,pancreas,digestive tractViscous mucus blocks bronchiolesGas exchange impaired,Respiratory Distress Syndrome,Surfactantdecreases the surface tension of the alveolineeded for alveoli to fill with air
28、 and expand(compliance)Infant respiratory distress syndrome(hyaline membrane disease)Adult respiratory distress syndrome,Oncology,Primary Pulmonary CancerSmoking is leading cause of ALL TYPES OF LUNG CANCERScommon site:epithelium of bronchibronchogenic carcinomamasses form and block air passagesmeta
29、stasizes frequently to lymph noes,liver,bones,brain,or kidney,Endotracheal Intubation,passage of a tube through the mouth,pharynx,and larynx into the trachea to establish an airway.,Are you tired?,Medical terminologypractice,Wu Xiaohong,Internal medicine departmentSir Run Run Shaw Hospital,history,A
30、 68-years-old woman is brought to the emergency room after coughing up a cupful of red blood.For the previous 3-4 months,she has had a chronic nonproductive cough,but no fevers.More recently,she has noticed some blood-streaked sputum.,On review of her symptoms,she reports increased fatigue,decreased
31、 appetite,and a 25-lb weight loss in the past 3 months.She denies chest pain,fever,chills,or night sweats.,The patient has smoked one pack of cigarettes per day for the past 35 years.She drinks two martinis every day and has not had any significant mental illness.She worked in a library in the New E
32、ngland area for 35 years.She does not take any medication except for one aspirin per day.,This is thin woman who is mildly anxious,alert,and oriented.Her blood pressure is 150/90mmHg,her heart rate is 88rpm,her respiratory rate is 16 breaths per minute,and her temperature is 99.2F.Her neck examinati
33、on reveals no lymphadenopathy,thyromegaly,or carotid bruit.,The chest has scattered rhonchi bilaterally,but there are no wheezes or crackles.The cardiovascular examination reveals a regular rate and rhythm,without rubs,gallops,or murmurs.,The abdomen is benign with no hepatosplenomegaly.Examination
34、of her extremities reveals 1+ankle edema and no cyanosis;there is finger clubbing.The neurological examination is normal.,?,What is the chief complaint of the patient?Chief complaint=main symptoms+time(duration).,Main symptoms:Coughing out red blood and blood-streaked sputum Time:1 dayMore concise o
35、ne?,terms,HemoptysisHepatosplenomegaly,thyromegalyCardiovascularLymphadenopathyCyanosisneurological,Summary,A 68-years-old female smoker has coughed up a cupful of red blood.For the previous 3-4 months,she has had a chronic nonproductive cough,and more recently,some blood-streaked sputum.,Summary 2,
36、She reported increase fatigability,reduced appetite,and a 25-lb weight loss in the past 3 months.She denies chest pain,fever,chills,or night sweats.On examination her chest reveals scattered rhonchi bilaterally without wheezes or crackles.She has clubbing of the fingers.,Chief complaint,Hemoptysis f
37、or 1 day.,Answers to case,Hemoptysislung cancer,Finger clubbing 1,Finger clubbing is defined as an enlargement of the terminal digital phalanges with the loss of the nail bed angle.Clubbing of the fingers is seen in a variety of conditions,including congenital heart disease and a number of pulmonary
38、 diseases.Clubbing can also be congenital and unassociated with any diseases.,Finger clubbing 2,In pulmonary disease,clubbing of fingers is most commonly seem in patients with lung cancer or with chronic septic conditions,such as bronchiectasis or lung abscess.,Horner syndrome,Horner syndrome:sympto
39、ms are ptosis,loss of pupillary dilation(miosis),and loss of sweating on the same side of the face(anhydrosis)caused by compression of the superior cervical ganglion.,Superior vena cava syndrome(SVCS),Superior vena cava syndrome(SVCS):obstruction of venous drainage leads to dilation of collateral ve
40、ins of the upper part of the chest and neck,edema of the face,neck and upper part of the torso,shortness of breath,and CNS symptoms,such as confusion,headache,and visual problems.,Hemoptysis 1,Hemoptysis is defined as a coughing up blood as a result of bleeding from the respiratory tract.It is an al
41、arming symptom,both because it may be a manifestation of a serious underlying diagnosis such as malignancy,and because massive amounts of hemoptysis can fill up alveolar air spaces and cause asphyxiation.,massive hemoptysis,Hemoptysis,particularly if in large quantity or recurrent,is a potentially f
42、atal event requiring an immediate search for the cause and precise location of the bleeding.A reasonable definition of massive hemoptysis is 600ml of blood in 24 hours.Hemoptysis must be differentiated from hematemesis and from blood dripping into the bronchial passages from the nose,mouth,and nasop
43、harynx.,Causes of hemoptysis,Currently,the most common causes of hemoptysis in the United States are bronchitis and lung cancer.Historically,the most common causes have been tuberculosis,lung abscess,and bronchiectasis.,Diagnostic steps 1,History is an important diagnostic step:blood-streaked purule
44、nt sputum suggests bronchitis;chronic copious sputum production suggests bronchiectasis.Hemoptysis with an acute onset of pleuritic chest pain and dyspnea suggests a pulmonary embolism.,Diagnostic steps 2,Every patient with hemoptysis should undergo a chest X-ray to look for a mass lesion,evidence o
45、f bronchiectasis,or parenchymal diseases.If the chest radiograph reveals a pulmonary mass,the patient should undergo fiberoptic bronchoscopy to localize the site of bleeding,and to visualize and attempt to biopsy and endobronchial lesion.,Diagnostic steps,Patients with massive hemoptysis require mea
46、sures to maintain their airway and to prevent spilling blood into inaffected areas of the lungs.They should be kept at rest with suppression of cough.If the bleeding is localized to one lung,the affected side should be placed in a dependent position so bleeding does not flow into the contralateral side.They may also require endotracheal intubation,and rigid bronchoscopy for better airway control and suction capacity.,
