anatomical basis of airway diseases from sinusitis to copd, from osa to copd...

1. ANATOMICAL BASIS OF DIFFERENT
AIRWAY DISEASES
CHAIRPERSON
PROF. DR. SIBES DAS
SPEAKER
KOUSHIK MUKHERJEE

2. • ANATOMY OF UPPER AIRWAY
• DISEASES OF UPPER AIRWAY
• ANATOMY OF LOWER AIRWAY
• DISEASES OF LOWER AIRWAY
• HISTOLOGY AND DISEASE
• EMBRYOLOGY AND RELATED
DISEASES
• CILIA AND DISEASE

3. • Continuation of the Respiratory System
• Consists of nose, pharynx and larynx
• A multipurpose passage
• Airflow requires a patent upper airway.
• State of consciousness is a major
determinant of pharyngeal patency

4. • Nose
• Nasopharynx
• Oropharynx
• Laryngopharynx
• Laynx

5. • 10,000 L of ambient air passes through
nasal airway per day and 1 L of moisture is
added to this air
• Moisture is partly from transudation of fluid
through mucosal epithelium and from
secretions produced by glands and goblet
cells
• Secretions have bactericidal activity,
foreign body invasion is further reduced by
stiff hairs ( vibrissae ) , ciliated epithelium
and extensive lymphatic drainage

6. • External nose
• Internal nasal cavity

9. • Nasal cavity- three regions
1. vestibular
2. olfactory
3. respiratory
• Frontal, maxillary, sphenoidal, and
ethmoidal sinuses drain into nose.

10. • Funnel-shaped tube of skeletal muscle
that connects to the:
– Nasal cavity and mouth superiorly
– Larynx and esophagus inferiorly
• Extends from the base of the skull to the
level of the sixth cervical vertebra
• divided into three regions
– Nasopharynx
– Oropharynx
– Laryngopharynx

13. • Located just below pharynx; also referred
to as the voice box
• Several pieces of cartilage form framework
• Thyroid cartilage (Adam’s apple) is largest
• Epiglottis partially covers opening into
larynx
• Vocal cords stretch across interior of
larynx; space between cords is the glottis

16. • Posterior cricoarytenoid – abductor of vocal cords
• Lateral cricoarytenoid – adducts arytenoids closing
glottis
• Transverse arytenoid – adducts arytenoid
• Oblique arytenoid – closes glottis
• Aryepiglottic – closes glottis
• Vocalis – relaxes cords
• Thyroarytenoid – relaxes tension cords
• Cricothyroid – tensor of cords
All the muscles of larynx supplied by recurrent
laryngeal nerve except cricothyroid which is supplied
by external laryngeal nerve

17. • Rhinitis—nasal inflammation, as in a cold,
influenza, or allergy
1. Infectious rhinitis—common cold
2. Allergic rhinitis—hay fever
• Sinusitis
• Pharyngitis (sore throat)—inflammation or
infection of the pharynx–
• Laryngitis—inflammation of the larynx
resulting from infection or irritation
• Epiglottis—life threatening

24. • A tube made up of cartilage and enclosed
posteriorly by tracheal muscle and lined
interiorly by ciliated columnar epithelium .
It is about 18mm in diameter and 10-11 cm
in length in adult
• Extent-lower part of larynx ( C6 ) to T5 ,
where it divides into left and right bronchi
• Trachea moves with respiration
• On deep inspiration carina can descend as
much as 2.5 cm
• Right main bronchus is wider and shorter
than left , being only 2.5 cm long

31. • Primary Bronchi
• One to each lung – continuation of
trachea
– Right bronchus is wider and shorter 2.5
cm as opposed to 5 cm and branches
from the trachea at a greater angle
• Secondary bronchi – one to each
lobe, three in right, two in left
• Tertiary – one to each
bronchopulmonary segment –
approximately 10 per lung
• All of the above contains hyaline
cartilage with no ability to change
diameter

32. • Tertiary ( segmental ) bronchi divides
repeatedly to form very small branches
called terminal bronchioles and still
smaller branches called respiratory
bronchioles
• From proximal part of terminal bronchioles
gas exchange begins and extends
throughout succeeding generations of
airways to alveoli.
• Respiarotry bronchiole ends in
microscopic passages : alveolar ducts
containing 2 or more pulmonary alveoli ,
atria and air saccules

34. Clara cells
• Club cells, also known as bronchiolar exocrine
cells, and originally known as Clara cells are
dome-shaped cells with short microvilli, found in
bronchioles of the lungs.
• found in the ciliated simple epithelium
• may secrete glycosaminoglycans, uteroglobin and
a solution similar to the component of the
lung surfactant to protect the bronchiole lining.
• responsible for detoxifying harmful substances
inhaled into the lungs.
• also act as a stem cell, multiplying and
differentiating into ciliated cells to regenerate the
bronchiolar epithelium.

35. • Club cells contain tryptase, which is
believed to be responsible for cleaving
the hemagglutinin surface protein
of influenza A virus, thereby activating it
and causing the symptoms of flu.
• Clara cells may be important in human
disease, both by giving rise to tumours and
by taking part in metaplastic changes in
bronchiolar disease.
• In humans, many forms of lung cancer
may originate from Clara cells, including
adenocarcinoma.

37. • Alveoli – site of gas exchange
• Blind ended (‘cup shaped outpouching)
• Membrane: simple squamous + elastic basement
membrane
• Cells:
• – Type I form continuous lining
• – Type II Produce alveolar fluid contains surfactant
• – Alveolar macrophages (dust cells)

39. Inspiration: (thorax increases in volume and air enters
lungs)
• Diaphragm flattens
• External intercostals
Expiration
• Diaphragm relaxes
• Internal intercostals depress ribs, reduce width of
thoracic cavity
Shallow Breathing: only intercostals involved
• At rest
• During pregnancy (abdominal volume decreases)
Deep Breathing: (Diaphragmatic) –
• contraction of diaphragm

40. Assist in elevating ribs during inspiration
– Sternocleidomastoid
– Serratus anterior
– Pectoralis minor
– Scalenes
Assist in decreasing thoracic volume during
expiration by compressing abdomen:
– Transversus thoracis
– Obliques and Rectus abdominis

42. • Reduces surface tension and therefore
elastic recoil, making breathing easier
• Reduces the tendency to pulmonary
oedema
• Equalises pressure in large and small
alveoli

44. • Asthma
• COPD
• Bronchiectasis
• Cystic fibrosis

51. Few lines about histology
Goblet cell

53. Pseudostratified ciliated cells and mucous (goblet) cells are the two
major components of the epithelium. Cilia beat at 1,000 to 1,500
cycles per minute resulting in movement of the mucus blanket at
0.5-1 mm/min in small airways and 5-20 mm/min in the trachea and
main bronchi.
Trachea
Pseudostratified
epitheliunm

54. Trachea Bronchi Bronchiole

55. Few lines on embryology and
related diseases
• Lung development starts from the gut 24
days after conception; diaphragm forms in
cervical region at 3-4 weeks and moves
progressively downwards carrying the
phrenic nerves with; lung lobes are
identifiable at 12 weeks; bronchial tree is
completed at 16 weeks and alveoli and
capillaries appear at 24 – 28 weeks;
surfactant appears at 35 weeks.

56. diseases

57. Hyaline membrane disease
• caused by developmental insufficiency
of surfactant production and structural
immaturity in the lungs.
• Microscopically, a pulmonary surfactant
deficient lung is characterized by
collapsed air-spaces alternating with
hyper-expanded areas, vascular
congestion and, in time, hyaline
membranes
• Hyaline membranes are composed
of fibrin, cellular debris, red blood cells,
rare neutrophils and macrophages

58. Few lines about cilia

59. Kartagener syndrome
• Triad of-
1. sinusitis
2. bronchiectasis
3. situs inversus
Normal cilia (A) compared with cilia in
Kartagener syndrome with missing dynein
arms (B)

60. A BRIEF ACCOUNT OF ARDS
• ARDS is associated with diffuse alveolar
damage (DAD) and lung capillary
endothelial injury.
• The early phase is described as being
exudative, whereas the later phase is
fibroproliferative in character.
• The main site of injury may be focused on
either the vascular endothelium
(eg,sepsis) or the alveolar epithelium (eg,
aspiration of gastric contents).
• Causes OF ARDS are ARDS