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ANATOMY OF THE RESPIRATORY SYSTE M . Vincent Van Gogh – Skull with Cigarette (1886). 25.10.2013 Friday. Kaan Yücel M.D., Ph.D . Nose is divisible into : E xternal nose N asal cavity. External Nose. E xtends the nasal cavities onto the front of the face P yramidal in shape .

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Vincent Van Gogh – Skull with Cigarette (1886)

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Vincent van gogh skull with cigarette 1886

ANATOMY OF THE

RESPIRATORY SYSTEM

Vincent Van Gogh – Skull with Cigarette (1886)

  • 25.10.2013 Friday

Kaan Yücel M.D., Ph.D.


Vincent van gogh skull with cigarette 1886

Nose is divisible into :

Externalnose

Nasal cavity


Vincent van gogh skull with cigarette 1886

External Nose

Extendsthe nasal cavities onto the front of the face

Pyramidalin shape


Vincent van gogh skull with cigarette 1886

  • External nose has bony &cartilaginous parts.

  • BonesCartilages

  • Nasal bonesLateral cartilages (paired)

    • Frontal process of maxillaAlar cartilages (paired)

    • Nasal part of frontal boneSeptalcartilage (single)


Vincent van gogh skull with cigarette 1886

NasalcavITIES

uppermost parts of the respiratory tract

olfactory receptors

  • separatedfrom:

  • each other by a midline nasal septum

  • oral cavity below by the hard palate

  • cranial cavity above by parts of the frontal, ethmoid, &sphenoid bones.

Posteriorly, each nasal cavity communicates with the nasopharynx through two openings choana.


Vincent van gogh skull with cigarette 1886

  • Each nasal cavity consists of 3regions.

  • nasal vestibuleinternal to the naris

  • respiratory regionlargest , rich neurovascular supply

  • olfactory region @ apex of each nasal cavity, olfactory receptors

3

2

1


Vincent van gogh skull with cigarette 1886

the most anterior part of the nasal cavity.


Vincent van gogh skull with cigarette 1886

Functions of the

nose & nasal cavities

  • Olfaction (sense of smell)

  • Respiration

  • Filtration of the dust in the inspired air

  • Humidification and warming of the inspired air (cooling the internal carotid artery for brain)

  • Reception of the secretions from the paranasal sinuses and nasolacrimal ducts


Vincent van gogh skull with cigarette 1886

2. PARANASAL SINUSES

air filled spaces lying within the bones around the nasal cavity

lined by respiratory mucosa.

open into the nasal cavities

innervated by branches of the trigeminal nerve [V].

  • Frontal sinuses

  • Ethmoid sinuses

  • Sphenoid sinuses

  • Maxillary sinuses


Vincent van gogh skull with cigarette 1886

3. LARYNX

between C3-C6

organ of phonation (vocalization)

continuous below with the trachea

above opens into the pharynx

immediately posterior & slightly inferior to the tongue

Cartilage

Muscles

Connectivetissue


Vincent van gogh skull with cigarette 1886

SKELETON OF LARYNX

LARYNGEAL CARTILAGES

  • Paired cartilages

    • Arytenoid

    • Corniculate

    • Cuneiform

  • Unpaired cartilages

    • Thyroid cartilage (biggest)

    • Cricoid cartilage

    • Epiglottic cartilage


Vincent van gogh skull with cigarette 1886

Thyroid cartilage

largest cartilage of the larynx

2 laminaewhich fuse anteriorly at the thyroid angle & form

laryngeal prominence (Adam’s apple)


Vincent van gogh skull with cigarette 1886

Cricoid cartilage

a ring shaped cartilage, most inferior of the laryngeal cartilages

Inferiorly attaches to 1st tracheal ring viacricotrachealligament.

Completelyencircles the airway

Broadlamina of cricoidcartilageposteriorly

Narrowerarch of cricoidcartilageanteriorly


Vincent van gogh skull with cigarette 1886

Arytenoid cartilages

pyramidal in shape

3 processes

Apex (superior) articulation w/corniculatecartilage

Vocal process (anterior)vocal ligament attaches here

Muscular process (lateral)

posterior & lateral crico-arytenoid muscles


Vincent van gogh skull with cigarette 1886

Epiglottic cartilage (Epiglottis)

a leaf-shaped cartilage

attached by its stem to the posterior aspect of the thyroid cartilage

@the angle

Most superior end is free.


Vincent van gogh skull with cigarette 1886

Corniculate&cuneiform cartilages

corniculatecartilagestwo small conical cartilages

Located on thearytenoid cartilages

cuneiform cartilagessmall cartilagesanterior to corniculatecartilages

lie in the posterior part of

the aryepiglottic fold.


Vincent van gogh skull with cigarette 1886

EXTRINSIC LIGAMENTS OF THE LARYNX

.

Thyrohyoid membrane

Belowsuperiormargin of thethyroidcartilage, abovehyoid bone

lateralthyrohyoidligament

(posteriorthickening),triticeal cartilage

medianthyrohyoidligament

(midlinethickening)

Hyo-epiglottic ligament

fromthemidline of theepiglottistothe body of hyoid bone

Cricotrachealligament

between lower border of cricoid cartilage & upper border of 1st tracheal cartilage


Vincent van gogh skull with cigarette 1886

INTRINSIC LIGAMENTS OF THE LARYNX

.

Fibroelastic membrane of the larynx

lies under the mucosa of the larynx

links together the laryngeal cartilages

completes the architectural framework of the laryngeal cavity

forms some of the ligaments between the cartilages.


Vincent van gogh skull with cigarette 1886

INTRINSIC LIGAMENTS OF THE LARYNX

.

Fibroelastic membrane of the larynx

2parts

lower conuselasticus

upper quadrangular membrane


Vincent van gogh skull with cigarette 1886

Conuselesticus

cricothyroidligament, cricovocal membrane, cricothyroidmembrane

Freeuppermarginthickens & formsvocalligament vocalfold

opening between the 2 vocal folds

(rima) glottis

median cricothyroidligamentanteriormidlinethickening of conuselasticus


Vincent van gogh skull with cigarette 1886

Conus elasticus

cricothyroidligament, cricovocal membrane, cricothyroidmembrane

Each vocal ligamentfreeuppermargin

attaches to anterior part of inner surface of thyroid cartilage

@ thyroid angle

posteriorly attach to vocal processes of the arytenoid cartilages.


Vincent van gogh skull with cigarette 1886

Rima glottis

Inspiration

Widens

Phonation

Narrows- 2 vocalfoldcometogether

Pitch increases with tensing, decreases by relaxation.

Intensity of expiration determines the loudness of sound.


Vincent van gogh skull with cigarette 1886

Quadrangular membrane

.

vestibular ligament

attached

posteriorly arytenoid cartilage

anteriorly thyroid angle

superior to the attachment of the vocal ligament.

lateralmargin of epiglottis

free lower margin is thickened

anterolateral surface


Vincent van gogh skull with cigarette 1886

Quadrangular membrane

.

vestibular ligament

attached

posteriorly arytenoid cartilage

anteriorly thyroid angle

superior to the attachment of the vocal ligament.


Vincent van gogh skull with cigarette 1886

LARYNGEAL CAVITY

tubular

architectural support

fibro-elastic membrane of the larynx

laryngeal cartilages

.


Vincent van gogh skull with cigarette 1886

superior aperture (laryngeal inlet)V.S. inferioraperture

1)

opens into anterior aspect of pharynx

just below and posterior to the tongue

continuous with the lumen of trachea

completely encircled by cricoid cartilage


Vincent van gogh skull with cigarette 1886

superior aperture (laryngeal inlet)V.S. inferioraperture

2)

obliqueand points posterosuperiorly into the pharynx

horizontal in position


Vincent van gogh skull with cigarette 1886

superior aperture (laryngeal inlet)V.S. inferioraperture

  • 3)

  • can be closed by downward movement of the epiglottis.

  • continuouslyopen


Vincent van gogh skull with cigarette 1886

LARYNGEAL CAVITY

vestibular and vocal foldsdivide into three major regions

Vestibule

betweenlaryngeal inlet & vestibularfolds

Middlepart

between vestibular folds & vocal folds

Infraglotticspace

between the vocal folds & inferior opening of the larynx


Vincent van gogh skull with cigarette 1886

Rimaglottidis

between vocal folds

separates middle chamber from infraglottic cavity.

base

formed byinterarytenoid fold @ bottom of interarytenoidnotch.

.


Vincent van gogh skull with cigarette 1886

FUNCTIONAL ANATOMY OF THE LARYNX

Respiration

Quiet: laryngeal inlet, rimaglottidisopen

arytenoidcartilagesabducted

Forced: rimaglottidiswidens

arytenoidcartilagesrotatedlaterally, vocalfoldsabducted


Vincent van gogh skull with cigarette 1886

FUNCTIONAL ANATOMY OF THE LARYNX

Effortclosure

occurs when air is retained in the thoracic cavity to stabilize the trunk

increasing intra-abdominal pressure

Rimaglottidis is completely closed.

Completelyand forcefully shut the airway


Vincent van gogh skull with cigarette 1886

FUNCTIONAL ANATOMY OF THE LARYNX

Phonation

arytenoid cartilages & vocal folds adducted

rimaglottidisclosed

Air is forcedthroughtheclosedrimaglottidis

Vocal folds vibrate against each other and produce sounds.

Tension in the vocal folds adjusted by vocalis& cricothyroidmuscles


Vincent van gogh skull with cigarette 1886

FUNCTIONAL ANATOMY OF THE LARYNX

Swallowing

Rimaglottidisclosed.

Laryngeal inlet narrowed

Larynxmovesup & forward – openstheesophagus

attachedtotheposterioraspect of thelamina of cricoidcartilage

Epiglottisgoesdowntowardthearytenoidcartilages

laryngeal inlet narrowedorclosed

.


Vincent van gogh skull with cigarette 1886

.

from the inferior end of larynx to the level of T5-T6

Terminatesby dividing into right &left main bronchi @ sternal angle.

Mainbronchi give branches inside the lungs & form bronchial tree.


Vincent van gogh skull with cigarette 1886

formed of tracheal rings which are incomplete posteriorly

Posterior parts of the tracheal rings closed by

smooth muscle trachealis muscle.

.


Vincent van gogh skull with cigarette 1886

5. PLEURA

coversthepulmonarycavitiesandexternalsurfaces of thelungs in thesecavities

visceral pleurainvests all surfaces of the lungs

parietal pleuralines the pulmonary cavities & thorax’sinner surface


Vincent van gogh skull with cigarette 1886

Visceral pleura insensitive to pain

Parietal pleura extremely sensitive to pain

Irritation causes local pain or referred pain

projecting to the dermatomes supplied by the same spinal nerve.


Vincent van gogh skull with cigarette 1886

pleural cavity

potential space between the layers of pleura

contains a capillary layer of serous pleural fluid

lubricates the pleural surfaces

allows layers of pleura slide smoothly over each other during respiration.

lung surface in contact with thoracic wall

lung expands fills with air when thorax expands


Vincent van gogh skull with cigarette 1886

5. LUNGS

organs of respiration

lie on either side of the mediastinum

surrounded by right & left pleural cavities


Vincent van gogh skull with cigarette 1886

5. LUNGS

Air enters and leaves the lungs via main bronchi

branches of trachea

Inspiredair into close relation with venous blood

in pulmonary capillaries.


Vincent van gogh skull with cigarette 1886

5. LUNGS

Apexupper pole

3 surfaces costal, mediastinal and diaphragmatic

Root of the lung

2 lobesin the left lung oblique fissure

3 lobes in the right lung horizontal &oblique fissures


Vincent van gogh skull with cigarette 1886

Tracheobronchial Tree

sublaryngeal airway

Trachea @ superiormediastinumTRUNK OF THE TREE

Bifurcation @ sternalangleMain bronchi

Right main bronchus & Left main bronchusenterhilum of thelung

Branches of thetracheobranchialtree


Vincent van gogh skull with cigarette 1886

Tracheobronchial Tree

Main (primary) bronchus

Secondary (lobar) bronchi

2 on theleft, 3 on theright

Tertiary (segmental) bronchi

.


Vincent van gogh skull with cigarette 1886

BRONCHOPULMONARY SEGMENTS

largest subdivisions of a lobe

  • Pyramidal-shaped segments of the lung

  • apices facing the root of the lung.

  • Separated from adjacent segments by connective tissue septa.


Vincent van gogh skull with cigarette 1886

BRONCHOPULMONARY SEGMENTS

largest subdivisions of a lobe

  • Segmental bronchus &Tertiary branch of pulmonary artery

  • Drained by intersegmental parts of the pulmonary veins


Vincent van gogh skull with cigarette 1886

BRONCHOPULMONARY SEGMENTS

largest subdivisions of a lobe

  • Named according to the segmental bronchi supplying them.

  • Usually 18-20 in number

  • Surgically resectable.


Vincent van gogh skull with cigarette 1886

tertiary segmental bronchi

conducting (lobular) bronchioles

end as terminal bronchioles

respiratory bronchioles

pulmonary alveolus

basic structural unit of gas exchange in the lung


Vincent van gogh skull with cigarette 1886

  • Branching of the bronchial tree

    • Trachea

    • Principal bronchus

    • Lobar bronchi (secondary bronchi)

    • Segmental bronchi (tertiary bronchi)

    • Terminal bronchiol

    • Respiratory bronchiol

    • Alveolar duct

    • Alveolar sac

    • Alveolus


Vincent van gogh skull with cigarette 1886

root of the lung

T5to TV7

mediastinalpleura reflects off mediastinum

a sleeve-likecoveringfor

airway, vessels, nerves, lymphaticswhichpass between the lung and mediastinum


Vincent van gogh skull with cigarette 1886

hilum of lung

Theroot of thelungjoins medial surface of thelung here!

mediastinalpleura continuous with visceral pleura@ hilum of thelung.


Vincent van gogh skull with cigarette 1886

Vasculature of pleaura& lungs

1 LUNG

1 pulmonaryartery(venousblood)

2 pulmonaryveins(arterialblood)

Each lobe and segment its own artery

Branching of the arteries follow the bronchial tree

Terminateas capillaries around the alveols.


Vincent van gogh skull with cigarette 1886

Vasculature of pleaura& lungs

Veins of the parietal pleura drain into systemic veins

mainly through the intercostal veins.


Vincent van gogh skull with cigarette 1886

BRONCHIAL ARTERIES

follow bronchial tree as far as respiratory bronchioles.

Left bronchial arteries

from thoracic aorta

paired

Rightbronchial artery

usually arises from 3rd posterior intercostal artery

single artery.


Vincent van gogh skull with cigarette 1886

BRONCHIAL VEINS

Right bronchial vein into azygos vein

Leftbronchial vein into accessoryhemiazygosvein.


Vincent van gogh skull with cigarette 1886

pulmonary plexuses

parasympathetic innervation vagus nerve

bronchoconstrictor, vasodilator to the lung vessels, secretomotor to the glands

sympatheticsympathetictrunk

bronchodilator, vasoconstrictor to the lung vessels, inhibitor to glands

parietal pleura intercostal &phrenic nerves


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