CHAPTER 2.

4 ANATOMY AND PHYSIOLOGY This case primarily involves the respiratory and skeletal system focusing on the structures of lungs, pleural cavities and the calvicles. LUNGS The lungs are paired, cone-shaped organs that are surrounded by a pleural membrane, made of elastic tissue, and divided into lobes. They consist of airways (trachea and bronchi) that divide into smaller and smaller branches until they reach the air sacs, called alveoli. The airways conduct air down to the alveoli where gas exchange takes place. RESPIRATORY ZONE Alveoli are cup shaped structures at the end of the bronchioles that resemble bunches of grapes; are in direct contact with capillaries (gas exchange); covered with surfactant that keep them from collapsing. They are surrounded by elastic fibers, interconnected by way of alveolar pores, and has internal surfaces for free movement of alveolar macrophages. The alveoli consists of threekinds of cells namely Type I- simple squamous cells forming the lining and Type II or the septal cells that secrete surfactantn and lastly, the alveolar macrophages responsible for clearing the air spaces of infectious, toxic, or allergic particles that have evaded the mechanical defenses of the respiratory tract, such as the nasal passages, the glottis, and the mucociliary transport system by secreting oxygen metabolites, lysozyme, antimicrobial peptides and proteases, and through processes of phagocytosis and intracellular killing. RESPIRATION Respiration is a passive, involuntary activity. Air moves in and out of the thorax due to pressure changes. When the diaphragm, the major muscle of respiration, is stimulated, it contracts and moves downward. At the same time, the external intercostals move the rib cage up and

out. The chest wall and parietal pleura move out, pulling the visceral pleura and the lung with it. As the volume within the thoracic cavity increases, the pressure within the lung decreases. Intrapulmonary pressure is now lower than atmospheric pressure; thus air flows into the lung inhalation. When the diaphragm returns to its normal, relaxed state, the intercostal muscles also relax and the chest wall moves in. The lungs, with natural elastic recoil, pull inward as well and air flows out of the lungs exhalation. The lungs should never completely collapse for there is always a small amount of air, called residual volume, in them. Under normal conditions, there is always negative pressure in the pleural cavity. This negative pressure between the two pleurae maintains partial lung expansion by keeping the lung pulled up against the chest wall. The degree of negativity, however, changes during respiration. During inhalation, the pressure is approximately 8 cm H2O; during exhalation, approximately 4 cm H2O. If a patient takes a deeper breath, the intrapleural pressure will be more negative. Under normal conditions, the mechanical attachment of the pleurae, plus the residual volume, keep the lungs from collapsing.

The lung itself is covered with a membrane called the visceral (or pulmonary) pleura. The visceral pleura is adjacent to the lining of the thoracic cavity which is called the parietal pleura. Between the two membranes is a thin, serous fluid which acts as a lubricant reducing friction as the two membranes

slide across one another when the lungs expand and contract with respiration. The surface tension of the pleural fluid also couples the visceral and parietal pleura to one another, thus preventing the lungs from collapsing. Since the potential exists for a space between the two membranes, this area is called the pleural cavity or pleural space (figure 6).

Thoracic Cage Protects the vital organs within the thorax and prevents the collapse of the thorax during respiration. It consists of the thoracic vertebrae, the ribs with their associated cartilages, and the sternum. Ribs and Costal Cartilages The 12 pairs of ribs can be divided into true and false ribs. The true ribs, attach directly to the sternum by means of costal cartilages. For the false ribs, three pairs, ribs 8 through 10 attach to the sternum by common cartilage, two pairs, ribs 11 and 12, called the floating ribs, do not attach to the sternum. Sternum

Also known as the breastbone is divided into three parts: the manubrium, the body, and the xiphoid process. The superior end of the sternum, a depression called the jugular notch, is located between the ends of the clavicles where they articulate at the sternum. A slight elevation, called sterna angle, can be felt at the junction of the manubrium and the body of the sternum. This junction is important landmark because it identifies the location of the second rib. This identification allows the ribs to be counted and, for example, allows location of the apex of the heart, which is located between the fifth and sixth ribs. The xiphoid process is also an important landmark during cardiopulmonary resuscitation (CPR). It is imperative that the person doing the CPR must placed his hands on the sternum; if it is placed on the xiphoid process, CPR could break it and drive it into an underlying abdominal organ such as the liver, causing internal bleeding. APPENDICULAR SKELETON: Pectoral Girdle Also known as pectoral shoulder, consists of four bones, two scapulae and two clavicles, which attach the upper limb to the body: the scapula or shoulder blade and the clavicle or collarbone. THE scapula is a flat, triangular bone with three large fossae, where muscles extending to the arm are attached. A fourth fossa, the glenoid cavity, is where the head of the humerus connects to the scapula. A ridge, called the spine, runs across the posterior surface of the scapula. A projection, called the acromion process, extends from the scapular spine to form the point of the shoulder. The clavicle articulates with the scapula at the acromion process. The proximal end of the clavicle is attached to the sternum, providing the only bony attachment of the scapula to the remainder of the skeleton. The coracoid process curves below the clavicle and provides attachment for arm and chest muscles.