Respiratory System * Conducting portion Nasal cavity Paranasal sinus Pharynx Larynx Trachea Bronchus Bronchioles Terminal bronchioles *Respiratory portion Respiratory bronchioles Alveolar ducts Alveolar sacs Alveoli Speaker: 陳玉怜 Functions: Modifies inspired air (cleaned, warmed, cooled, and moistened) Facilitates olfaction, respiratory gas exchange, & sound production
Trachea Main bronchus (Primary bronchus) -intrapulmonary Secondary (lobar) bronchus Tertiary (segmental) bronchus (bronchopulmonary segment) Bronchiole Terminal bronchiole Respiratory bronchiole Alveolar duct Alveolar sac Alveoli
*Secondary (lobar) bronchus *Tertiary (segmental) bronchus
Summary Trachea Bronchus Bronchiole (larger) Bronchiole (terminal) Bronchiole (respiratory) Epithelium Goblet cells Glands Cartilage Smooth muscle Elastic fibers
Trachea and Extrapulmonary Bronchi Mucosa epithelium ciliated pseudostratified columnar epi. with goblet cells (laryngobronchial epi) thick basement membrane (25-40μm) lamina propria longitudinal elastic fibers Submucosa C.T., submucosal gland (mucous & serous mixed glands) Cartilage layer trachea cartilage C-shaped hyaline cartilage trachealis muscle (SMC) Adventitia
Ossification of hyaline cartilage occurs in aging Metaplasia of epithelium
Trachea
B-44 O-5-f Trachea, human, Orcein-Picroindigocarmine-carmine Tracheal glands Mucosa Submucosa Hyaline cartilage (HC) Orcein: elastic fiber Indigocarmine: collagenous fiber reticular fiber Picric acid: muscle, epithelium
B-44 O-5-f Trachea, human, Orcein-Picroindigocarmine-carmine basement membrane Lamina propria Elastic fibers Tracheal glands
Trachea epithelium 1. Ciliated columnar cells Mucociliary escalator 2. Mucous (Goblet) cells 3. Basal cells 4. Brush cells epitheliodendritic synapse 5. Small granule cells
Mucociliary escalator Laryngobronchial epi (1) (1) (2) (1) (4) (4) (2) (5) (3) (3) Basal (3) (3)
Trachea epithelium 1. Ciliated columnar cells Mucociliary escalator 2. Mucous (Goblet) cells 3. Basal cells 4. Brush cells epitheliodendritic synapse 5. Small granule cells
Brush cells receptor cell Small granule cells enteroendocrine cells
Brush cells chemoreceptor Small granule cells enteroendocrine
trachea Mucosa epi: height goblet cells: No. elastic fibers main (primary) bronchus smooth muscle submucosal glands: No. lobar bronchus segmental bronchus cartilage: C plates chips
bronchus trachea
Bronchus
Bronchus
Bronchus (dog, Orcein-Picroindigocarmine-carmine) MG N SM Orcein: elastic fiber Indigocarmine: collagenous fiber reticular fiber Picric acid: muscle, epithelium HC
Primary bronchus Tertiary (segmental) bronchus
Bronchus: cartilage Bronchiole : cartilage
Mucosa pesudostratified epi simple ciliated columnar non-ciliated (Clara) cells neuroendocrine (N) cells serotonin, bombesin (Goblet cells) thick smooth muscle Bronchiole Submucosa no glands Cartilage no cartilage
Bronchus Bronchiole (larger) Epithelium Goblet cells Glands Cartilage pseudostratified columnar ciliated present few present few plates chips pseudostratified columnar ciliated, simple ciliated columnar scatter none none Smooth muscle interlacing bundles Elastic fibers abundant abundant
Trachea Main bronchus (Primary bronchus) -intrapulmonary Secondary (lobar) bronchus Tertiary (segmental) bronchus (bronchopulmonary segment) Bronchiole Terminal bronchiole Respiratory bronchiole Alveolar duct Alveolar sac Alveoli
Terminal bronchiole
Clara cells non-ciliated cuboid epi. reserve cells round nucleus Golgi, rer & ser mitochondria secretory vesicles surface-active agent Clara cell secretory protein CC16 - lipoprotein surfactant detoxyfication
Terminal bronchiole Respiratory bronchiole Alveolar duct Alveolar sac Alveoli
Respiratory bronchiole tree Alveolar duct alveolar sac alveoli
Respiratory bronchiole
Eipthelium Goblet cells terminal bronchiole simple ciliated cuboidal none respiratory bronchiole simple ciliated cuboidal, clara cells, alveoli none Glands Cartilage none none none none Smooth muscle interlacing bundles Elastic fibers abundant abundant
Trachea Main bronchus (Primary bronchus) -intrapulmonary Secondary (lobar) bronchus Tertiary (segmental) bronchus (bronchopulmonary segment) Bronchiole Terminal bronchiole Respiratory bronchiole Alveolar duct Alveolar sac Alveoli
Respiratory bronchiole Alveolar sac Alveolar sac Alveolar duct Alveolar sac Respiratory bronchiole alveolar duct
Alveoli Alveolar cells (pneumocytes) Type I Type II (inter) alveolar septum Capillaries Endothelial cells Alveolar macrophages Fibroblasts Collagen, elastic, and reticular fibers.
Schematic of alveoli and interalveolar septum
Alveoli & type I alveolar cells 40% in total population 95% of alveolar surface thin squamous cell Air-blood barrier
Alveolar-capillary barrier (Air-blood barrier) CO2 O2 O2 CO2 1. thin area of type-i cells 2. fused basal lamina 3. capillary endothelia
Type II alveolar cells: septal cells, surfactant cells 60% in total population 5% of alveolar surface cuboid cell dome apical surface with microvilli
membrane-bound granules lamellar bodies Surfactant : phospholipid + hydrophobic proteins
Surfactant : An oily mixture of protein, phospholipid & neutral lipid Type II alveolar cells
Alveolar macrophage Remove inhaled particulate matter Phagocytize RBC Dust cells hemosiderin
Alveolar pore (of Kohn) openings in the interalveolar septa
Collateral air circulation through alveolar pores allows air to pass between alveoli
Trachea Main bronchus (Primary bronchus) -intrapulmonary Secondary (lobar) bronchus Tertiary (segmental) bronchus (bronchopulmonary segment) Bronchiole Terminal bronchiole Respiratory bronchiole Alveolar duct Alveolar sac Alveoli
Double blood supply to the lungs Pulmonary circulation 1. Pulmonary arteries (deo 2 ) accompany branch of bronchi respiratory bronchioles alveolar ducts Alveolar capillary network (gas exchange) Venules (Pulmonary vein plexus, O 2 ) Pulmonary veins (in intersegmental C.T.)
Pulmonary vein plexus Pulmonary veins Bronchial circulation 2. Descending aorta and Upper intercostal arteries bronchial arteries (O 2 ) wall of respiratory tree pleura & interlobular C.T. respiratory bronchioles bronchial veins azygos and sup. intercostal vein
Terminal bronchiole Bronchial artery Pulmonary artery Respiration bronchioles Pulmonary vein Capillary plexuses Capillary bed within alveolar wall
PV PA PA
全球聯合訂定每年 11 月份為 世界慢性阻塞性肺疾病日, 提醒大家重視慢性阻塞性肺病的嚴重性和疾病所帶來的影響, 醫師提醒民眾, 抽菸與空氣汙染不僅危害身體健康, 也會導致慢性阻塞性肺病 與抽菸時間長短有極大相關性依據 WHO 公佈慢性阻塞性肺疾病 ( Chronic Obstructive Pulmonary Disease, COPD), 預估 COPD 至 2020 年將成為導致人類死亡的第 3 大疾病 COPD 最主要原因為抽菸, 此疾病與抽菸時間長短有極大相關性, 其不止死亡率及盛行率高, 病人同時需面對反覆入院及呼吸困難等問題 恐伴隨心血管疾病 骨質疏鬆 糖尿病 COPD 在臺灣是 10 大死因中的第 7 位,40 歲以上成人當中, 平均每 6~8 人就有 1 人罹病, 吸菸者中有近 4 成為 COPD 患者, 但診斷率卻僅超過 1 成, 由於 COPD 隨年齡增長而增加且症狀緩慢進行, 察覺不易, 一旦罹患 COPD, 更可能伴隨心血管疾病 骨質疏鬆 糖尿病 肺癌等共病, 而讓生活品質更差, 壽命縮短 引發 COPD 還包含 PM2.5 等懸浮微粒早期 COPD 患者多與習慣病患約占 1 至 2 成, 幾乎都是長期暴露在二手菸的環境, 除了香菸, 引發 COPD 的有害物質還包括 PM2.5 等懸浮微粒, 只要空氣品質變差, 喘 咳嗽 胸悶等症狀就會加劇 長期暴露會提高肺癌 心血管疾病 2013 年, 國際癌症研究署已將 PM2.5 列為人類致癌物, 長期暴露在 PM2.5 的環境中, 除了可能提高肺癌 心血管疾病, 更可能造成癌症導致死亡
Chronic Obstructive Pulmonary Disease 肺氣腫
Summary Trachea Bronchus Bronchiole (larger) Bronchiole (terminal) Bronchiole (respiratory) Epithelium Goblet cells Glands Cartilage Smooth muscle Elastic fibers