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Cardio Exam 3 > 33 - Respiratory System Histology > Flashcards

33 - Respiratory System Histology Flashcards

1
Q

Describe the pulmonary, visceral and parietal pleura

A

Pulmonary pleurae
- The two pleurae of the invaginated sac surrounding each lung and attaching to the thoracic cavity

Visceral pleura
- The delicate serous membrane that covers the surface of each lung and dips into the fissures between the lobes

Parietal pleura
- The parietal pleura is the outer membrane which is attached to the inner surface of the thoracic cavity.

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2
Q

Describe the superior surface of the lung (apex)

A

Extends 2.5 cm (1 inch) above the clavicle and occupies the medial 1/3 of each clavicle

This is the level of C7 in the spine

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3
Q

Describe how we measure the inferior surface of the lung

A

Since the visceral pleura is attached to the lung, they have the same inferior surface

The inferior surfaces get a little complicated… First remember that we will determine the inferior limit of the lung by the rib level it extends to. Since the ribs originate at the spinal cord and angle downward toward the belly button, there will be three different levels depending upon where you are measuring from

1st number: midclavicular line
2nd number: midaxillary line
3rd number: paravertebral line

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4
Q

What is the inferior surface of the viscera/lung

A

Midclavicular line = 6
Midaxillary line = 8
Paravertebral line = 10

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5
Q

What is the inferior surface of the parietal pleura

A

Midclavicular line = 8
Midaxillary line = 10
Paravertebral line = 12

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6
Q

What is a pneumothorax?

A

Air (collapsed lung)

An abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall.

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7
Q

What is a hemothorax?

A

Blood

A collection of blood in the space between the chest wall and the lung (the pleural cavity)

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8
Q

What is a chylothorax?

A

Lymph

  • A type of pleural effusion which results from lymph formed in the digestive system (called “chyle”) which accumulates in the pleural cavity
  • This is due to either disruption or obstruction of the thoracic duct
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9
Q

What is a hydrothorax?

A

Serous fluid

A type of pleural effusion in which serous fluid accumulates in the pleural cavity

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10
Q

What is a thorecentesis?

A
  • Procedure to obtain a sample of pleural fluid to determine the cause of pleural effusion
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11
Q

Where do you insert a needle to perform a thoracentesis?

A
  • Place the patient in the seated position and have them lean forward
  • Puncture site between the 7th, 8th, or 9th intercostal spaces. Optimal site may be confirmed by ultrasound
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12
Q

What do you need to remember when inserting a needle in between the ribs?

A

The neurovascular bundle is located between the ribs

It is attached to the bottom of each rib

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13
Q

Where is the superior primary sulcus located?

A

The concave portion of the thoracic cavity wall - the part that is lined by parietal pleura

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14
Q

What is the name of the tumor that grows in the superior primary sulcus?

A

Pancoast tumor

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15
Q

Describe a pancoast tumor

A

A tumor of the pulmonary apex. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae.

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16
Q

Describe how a pancoast tumor leads to sympathetic complications

A

This is a characteristic of pancoast tumors

  • Compression of a sympathetic ganglion (Stellate ganglion)
  • Resulting in a range of symptoms known as Horner’s syndrome
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17
Q

What is Horner’s syndrome?

A

It is characterized by:

  • Miosis (a constricted pupil)
  • Ptosis (a weak, droopy eyelid)
  • Apparent anhidrosis (decreased sweating)
  • With or without enophthalmus (inset eyeball)
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18
Q

Describe how a pancoast tumor leads to complications with the brachial plexus and subclavian vessels

A

The growing tumor can cause compression of the brachiocephalic plexus and subclavian plexus

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19
Q

Which lung is larger (more massive)?

A

Right lung

  • Right lung has 3 lobes
  • Left lung has 2 lobes
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20
Q

What are the lobes and fissures that exist in the right lung?

A

Lobes

  • Superior
  • Middle
  • Inferior

Fissures

  • Oblique
  • Horizontal
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21
Q

What are the lobes and fissures that exist in the left lung?

A

Lobes

  • Superior
  • Inferior

Fissure
- Oblique

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22
Q

What is unique about the left lung?

A

It has a “tongue” called a lingula

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23
Q

A 32-year-old woman has pneumonia of the middle lobe. Where would you place your stethoscope to listen to
sounds from the middle lobe (all choices are on the right)?

A

4th intercostal space, midclavicular line

Note that you CANNOT hear the middle lobe from the back - only upper and lower lobes can be heard on the back

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24
Q

What are bronchopulmonary segments?

A

Divisions of the lungs where each segment contains an anatomically anatomically separate arterial, venous, and bronchial supply

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25
Q

What is the clinical significance of bronchopulmonary segments?

A

Each distinct component may be surgically resected without harming the other components

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26
Q

How many bronchopulmonary segments are there in each lung?

A 
Right = 10 
Left = 8
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27
Q

What is the hilum of the lung?

A

The “doorway” to the lung

The surface of the lung where structures such as blood vessels and nerves enter (mediastinal surface)

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28
Q

Where is the airway situated anatomically in relation to the pulmonary artery, which is bringing deoxygenated blood from the right ventricle of the heart to the lungs?

A

It is different depending on which lung you are looking at

Remember the mnemonic RALS

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29
Q

What does RALS stand for

A

Right lung
Anterior artery
Left lung
Superior artery

This means that in the right lung, the pulmonary artery is anterior to the bronchus (airway)

In the left lung, the pulmonary artery is superior to the bronchus (airway)

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30
Q

What are the components of the conducting airway?

A
  • Everything upstream of the respiratory bronchioles

- Both extrapulmonary and intrapulmonary sections

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31
Q

What is the general function of the conducting airway?

A

Their function is to filter, warm, and moisten air and conduct it into the lungs.

32
Q

What are the extrapulmonary components of the conducting airway

A

The portions outside of the lung

  • Nasal vestibule and nasal cavity
  • Nasopharynx and oropharynx
  • Larynx
  • Trachea and pulmonary bronchi
33
Q

What level does the trachea begin and end at?

A
  • begins at C6 vertebral level

- ends at T4-5 vertebral level

34
Q

How long is the trachea?

A

10-11 cm in length

4 inches

35
Q

Describe the shape of the right pulmonary bronchus compared to the left

A

The right pulmonary bronchus is more vertical, wider and shorter (by about 2.5 cm) compared to the left primary bronchus

36
Q

What are the intrapulmonary components of the conducting airway?

A

The portions inside of the lung

  • Secondary (lobar) bronchi
  • Tertiary (segmental) bronchi
  • Primary (lobular) bronchioles which supply the secondary pulmonary lobules
  • Terminal bronchioles
37
Q

What is the second portion of the airway?

A

The respiratory airway

first portion was the conducting airway

38
Q

What are the components of the respiratory airway?

A
  • Respiratory bronchioles
  • Alveolar ducts
  • Alveolar sacs
  • Alveoli
39
Q

Describe the epithelium of the larynx

A
  • Ciliated, pseudostratified columnar with goblet cells
  • Simply referred to as respiratory epithelium
  • This type of epithelium is important in mucociliary clearance on the inner aspects of the larynx
40
Q

Where is the epithelium different?

A

On portions of the larynx that get a little more “wear and tear”

  • Vocal folds
  • Anterior surface of the epiglottis
  • Exterior laryngeal surface

They instead are covered by non-keratinized, stratified squamous epithelium

41
Q

What two layers are found under the epithelium?

A

Basal lamina and lamina propria

42
Q

Why is the lamina propria clinically significant?

A

Because the vocal ligament and Reinke’s space if found within the lamina propria

43
Q

What is Reinke’s edema?

A
  • Expansion of fluid and a ballooning out of the lamina propria
  • Very heavy weight on the vocal folds
44
Q

Describe the basic histological architecture of the trachea and bronchi epithelium

A
  • Still respiratory epithelium (ciliated, pseudostratified columnar with goblet cells)
  • Ciliated columnar cells are the drivers of mucociliary clearance
  • Goblet cells
  • Brush cells
  • Basal cells (regenerative cells)
  • Neuroendocrine cells of Kulchitsky
  • Intraepithelial lymphocytes (mainly T cells)
  • Mast cells
45
Q

Describe the goblet cells of the trachea and bronchi

A
  • Extend from the trachea to the primary bronchioles; normally absent in terminal and respiratory bronchioles
  • Goblet cells increase in number and extend into the smaller bronchioles when irritated
46
Q

Describe the brush cells of the trachea and bronchi

A

Brush cells have microvilli and have a sensory receptor function

47
Q

Describe the neuroendocrine cells of Kulchitsky

A

Neuroendocrine cells (of Kulchitsky) – are most numerous in fetal lungs then decrease substantially after birth. Proliferate in certain diseases of the pulmonary system.

48
Q

What supports the epithelium of the trachea and bronchi that we just described?

A

Basement membrane

  • Unusually thick in trachea
  • Becomes thicker in response to chronic insult

Lamina propria

Remember that the epithelium, basement membrane and lamina propira are all part of the mucosa. The submucosa is found below the mucosa.

49
Q

Where is the smooth muscle of the trachea and bronchi found?

A

Smooth muscle bundles are found at the interface of the lamina propria and submucosa of intrapulmonary bronchi.

50
Q

What is found in the submucosa of the trachea and bronchi?

A

SUBMUCOSA contains seromucous glands that are responsible for secreting:

  • Mucins
  • Bacteriostatic substances (lactoferrin and lysozyme)
  • IgA produced by plasma cells
  • Protease inhibitors (e.g., α1-antitrypsin)
51
Q

What is the funciton of α1-antitrypsin?

A

Degredation of proteases released by leukocytes

- A deficiency of α1-antitrypsin leads to the development of a form of emphysema

52
Q

What is found under the submucosa?

A

Cartilage

53
Q

Describe the cartilage of the trachea and bronchi

A
  • C-shaped rings of hyaline cartilage in the trachea and primary (extrapulmonary) bronchi. Smooth muscle bridges the ends of the rings.
  • Intrapulmonary bronchi contain discontinuous plates of cartilage
54
Q

What is the last layer of the treachea and bronchi which is found under the cartilage?

A

Adventitia

Adventitia is the outermost connective tissue covering of an organ, vessel, or other structure

55
Q

What remodeling occurs in the wall of the trachea and bronchi due to asthma?

A

KNOW THIS
1 - Increase in mucus
2 - Increase in the thickness of the basal lamina (basement membrane)
3 - Increase in the thickness of the lamina propria due to edema and emigration of inflammatory cells (eosinophils, mast cells, etc.)
4 - Increase in the thickness of muscularis (smooth muscle hypertrophy)
5 - Increase in the number of glands in the submucosa (hypertrophy)

56
Q

What remodeling occurs in the wall of the trachea and bronchi due to chronic bronchitis?

A

Similar type of remodeling as seen in asthma

- Use Reid index to determine chronic bronchitis

57
Q

What is the Reid index?

A

A ratio of the trachea and bronchi wall for CHRONIC BRONCHITIS

  • It is defined as ratio between the thickness of the submucosal mucus-secreting glands and the thickness between the epithelium and cartilage that covers the bronchi
  • Pretty much, the amount of the entire wall which is mucus-secreting glands
  • If it is high, it means that there has been a lot of hypertrophy of mucus-secreting glands and there is a lot of excess mucus in the airway

Normal = 0.5 (more than half of the airway wall is mucus-secreting glands)

58
Q

What is bronchiectasis?

A

Abnormal widening of the bronchi or their branches, causing a risk of infection

59
Q

Where do most primary lung cancers originate from?

A

75% of lung cancers originate from 1st, 2nd, and 3rd order bronchi.

60
Q

What is a bronchiole?

A

-

61
Q

Describe the epithelium of bronchioles

A
  • Respiratory epithelium in large bronchioles
  • Transitions to simple columnar epithelium and progressively diminishes in height until it is simple cuboidal in respiratory bronchioles
  • The cells are ciliated, though some of the cuboidal cells are non-ciliated
  • Goblet cells are found in the large bronchioles, but normally not in small bronchioles
  • Clara (club) cells are present in terminal and respiratory bronchioles
62
Q

What changes do we see in the goblet cell population of smokers?

A

Goblet cell numbers increase, for example, in smokers and may be found in smaller bronchioles.

63
Q

What is the function of clara (club) cells?

A
  • Clara cells are present in terminal and respiratory bronchioles
  • They secrete surfactant (differs in chemical composition from that of type II alveolar cells)
  • May also regulate ion transport
  • Able to divide
64
Q

Describe the lamina propria of the bronchioles

A

Glands are ABSENT

65
Q

What layers follow the lamina propria?

A
  • Smooth muscle
  • Adventitia

Note that submucosa and cartilage are ABSENT form the bronchioles

66
Q

Describe the respiratory surface

A
  • Delicate thin-walled alveoli are associated with respiratory bronchioles, alveolar ducts, and alveolar sacs
67
Q

What are type I alveolar cells (pneumocytes)?

A

Type I alveolar cells (pneumocytes)

  • Form over 90% of the alveolar surface area
  • Simple squamous cells that are attenuated to facilitate gaseous diffusion between blood and alveolus. ***
  • Type I cells are connected to one another by tight junctions.
  • Not capable of cell division
68
Q

What are type II alveolar cells (pneumocytes)?

A
  • More numerous than type I, but contribute less than 10% of the total alveolar surface area
  • Cuboidal cells with short microvilli
  • Their signature feature is the presence of lamellar bodies which contain its secretory product, pulmonary surfactant
  • Type II pneumocytes are capable of cell division to regenerate them and type I pneumocytes
69
Q

Describe alveolar macrophages

A
  • Found in the alveolar lumen and migrate over the epithelial surface
  • Form “heart failure cells”
70
Q

What are heart failure cells?

A

Hemosiderin-laden macrophages
- You will see these in the sputum of a patient with heart failure
The brownish deposits in the cells identify them as heart failure cells

71
Q

What is the interalveolar septum?

A
  • Space between adjacent alveolar epithelium
  • Contains continuous capillary or in wider areas, type III collagen and elastic fibers.
  • Chronic insult by injurious agents can lead to fibrosis.
72
Q

The lungs are supplied by what two arterial circulations?

A

pulmonary and bronchial

73
Q

Describe the clinical significance of pulmonary arteries

A

Pulmonary arteries – most (over 95%) pulmonary emboli originate from deep venous thrombi in the lower limbs

74
Q

Describe the function of bronchial arteries

A

Bronchial arteries supply oxygen and nutrients to the lung parenchyma

75
Q

The lungs are drained by what two venous circulations?

A

Pulmonary and bronchial

76
Q

What is the general trend of airway cell diversity?

A

The larger the airway, the more diverse the cells

Cardio Exam 3 (13 decks)

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