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1、Respiratory System,Wu XiaohongPulmonary division,internal departmentSir Run Run Shaw Hospital,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 an
2、d body cells.The process is called respiration.External respiration(breathing)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
3、and atmosphereGas Exchange in pulmonary capillariesBreathing largely involuntary 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 se
4、ptummucous membranemucusciliaolfactory receptors,Structures of the Nasal Passages 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
5、 lid or flap that covers the larynx and trachea(airway)so food does not enter 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:bronchin
6、o gaseous exchange,Bronchi,Bronchus,singularc-shaped cartilage rings with smooth 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
7、 tree).bronchioles:smallest subdivision of the bronchial treealveolus:air sacs 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 Bronc
8、hoscope leading invasive tool for evaluation,diagnosis and treatment of disorders 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 forei
9、gn bodiesTissue may be biopsied(removed for microscopic observation),Normal view through the vocal cords into the subglottis,Thoracic Cavity,thoracicthoraxmediastinumheartaortaesophagusbronchithymus,Alveoli,air sacsalveolar wall membranes one cell thick and surrounded by capillariesgaseous exchange
10、takes place here,Right-3 lobes,Left-2 lobes,Lungs,trachea,Pleura,each lung 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
11、 inexpiration,diaphragm relaxes and decreases thoracic spaceair flows outphrenic 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,a
12、denoid/o alveol/o bronch/i,bronch/o diaphragmat/o epiglott/o laryng/o,lob/o 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 C
13、ommonly Used with Respiratory System Terms,atel/o capn/ohem/o,hemat/omuc/oorth/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-sp
14、asm-stenosis-stomy,-thorax-tomy-osmia-ptysis-thorax,Word Parts Meaning Breathing,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 atelectas
15、is bronchogenic carcinoma hemothorax pansinusitis pneumonitis pneumothorax 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 a
16、pnea(OSA)pulmonary embolismtuberculosis(TB),Surgical Terms Built from Word Parts,bronchoplasty laryngocentesis lobectomy pleuropexy pneumobronchotomy thoracocentesis or thoracentesis thoracotomy tracheostomy,(chest)/cv/(surgical puncture to remove fluid),Types of Diagnostic Procedures,radiography:x-
17、ray images of internal organs using ionizing radiationnuclear medicine:scans 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
18、tomography(CT scans):computerized images of body organs in slices,horizontallymagnetic 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 instrume
19、nts,are used for visual examination of a hollow organ or body cavitylaboratory: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
20、endoscopic endoscopy laryngoscopy thoracoscope thoracoscopy,oximeterpolysomnographyspirometerspirometry,Pulse Oximetry,Spirometer,Diagnostic Terms Not Built from Word Parts,Diagnostic imagingchest CT(computed tomography)scanchest x-rayventilation-perfusion scanningLaboratory procedureacid-bacilli(AF
21、B)smear,Diagnostic Terms Not Built from Word Parts(contd),Pulmonary functionarterial 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 Term
22、s Built from Word Parts(contd),eupnea hypercapnia hypocapnia hypoxemia hypoxia laryngeal nasopharyngeal rhinorrhea,Complementary Terms Not Built from Word Parts,airway asphyxia aspirate bronchoconstrictor bronchodilator hyperventilation hypoventilation mucopurulent,Complementary Terms Not Built from
23、 Word Parts(contd),nebulizer nosocomial infection patent sputum ventilator,Abbreviations,ABGsAFBARDSCFCOPDCTCXRCO2,LLLLTBLULO2OSAPCP,Abbreviations(contd),PEPFTsPSGRLL,RULTBURI,PathologyBreathing Disorders,Chronic Obstructive Pulmonary DiseaseCOPD(COLD)DyspneaBradypneaTachypnea,Respiratory tracts inf
24、ections,Diphtheria DiphtheriaMeningococcal meningitisMeaslesPertussis PertussisScarlet feverRubella RubellaMumpsChicken poxTuberculosis influenza,COPD,Asthmabronchospasms,parosysmal,productive cough,mucolytics,bronchodilatorsChronic Bronchitismucosal swelling,productive cough,chest painexpectorants,
25、bronchodilators,steroidsEmphysemabarrel-chest,dyspnea,orthopnea,Influenza,Acute 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
26、,traumadiagnosisauscultation,percussionEmpyema,hydrothorax,hemothorax,pnrumothorax,pyopneumothoraxthoracentesis,Tuberculosis,Infectious,highly communicable diseaseaerosol transmissionprimary tuberculosis,tuberclesimmunocompromisedeffects other organ systemsdrug resistant strains,Bronchopneumonia,Inf
27、lammatory disease of lungslobar,bilateralhemoptyisisconsolidationPneumocystis carinii lavage,Cystic Fibrosis,Hereditary disorder,affects exocrine glandssystemic involvementlungs,pancreas,digestive tractViscous mucus blocks bronchiolesGas exchange impaired,Respiratory Distress Syndrome,Surfactantdecr
28、eases the surface tension of the alveolineeded for alveoli to fill with air 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:epithe
29、lium of bronchibronchogenic carcinomamasses form and block air passagesmetastasizes 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,
30、Wu Xiaohong,Internal medicine departmentSir Run Run Shaw Hospital,history,A 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-streake
31、d sputum.,On review of her symptoms,she reports increased fatigue,decreased 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
32、not had any significant mental illness.She worked in a library in the New England 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 ra
33、te is 16 breaths per minute,and her temperature is 99.2F.Her neck examination 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,gallop
34、s,or murmurs.,The abdomen is benign with no hepatosplenomegaly.Examination 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 symptom
35、s:Coughing out red blood and blood-streaked sputum Time:1 dayMore concise one?,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 n
36、onproductive cough,and more recently,some blood-streaked sputum.,Summary 2,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 wheeze
37、s or crackles.She has clubbing of the fingers.,Chief complaint,Hemoptysis for 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
38、 of conditions,including congenital heart disease and a number of pulmonary 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,suc
39、h as bronchiectasis or lung abscess.,Horner syndrome,Horner syndrome:symptoms 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 syndr
40、ome(SVCS):obstruction of venous drainage leads to dilation of collateral veins 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 cough
41、ing up blood as a result of bleeding from the respiratory tract.It is an alarming 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,H
42、emoptysis,particularly if in large quantity or recurrent,is a potentially fatal 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 fr
43、om blood dripping into the bronchial passages from the nose,mouth,and nasopharynx.,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.,Diagn
44、ostic steps 1,History is an important diagnostic step:blood-streaked purulent 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 h
45、emoptysis should undergo a chest X-ray to look for a mass lesion,evidence of 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 endobron
46、chial lesion.,Diagnostic steps,Patients with massive hemoptysis require measures 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.,Xiexie!,
