PLENARY DISCUSSION

GROUP 14 B

GROUP MEMBERS

Fatimah Putri Az Zahra Aulia Fash Farabi Utari Gestini Rahmi Mustika Febriani Rizona Fauzul Azhim Mega Gusti Ayu Teddy Kurniawan Vivit Erdina Yunita Sari Mulyani Suresh Mariah

1010311014 1010312017 1010312045 1010312073 1010312101 1010313083 1010313018 1010313053 1010313092 1010314014

SCENARIO
BEE NESTS IN THE LUNGS

Prima (18 years) students FK. Semester 1 is very fun to watch videos respiratory system are downloaded from the intra-net on FK Unand provided. Prima clearly can see the tools that form the respiratory system, the movement of the lungs in the thorax cavity and lining respiration system.
At the end of this session Prima clearly see congenital abnormalities of the lungs, which contain many cysts in the lungs in the form of honeycomb lung on x-ray examination. "Apparently the development of congenital great influence on the composition of respiratory morphology in adults", thought Prima. How do you explain the respiratory system based on its anatomy and embryology?

SCHEME
Respiratory organ Respiratory system embriolog y structure anatomy histolog y Lungs contraction and relaxation

congenital

abnormalities

Non-congenital

Clinical correlation

LEARNING OBJECTIVE
The embryology respiratory system. The anatomy of the respiratory system. The histology of respiratory system. The Congenital abnormalities of respiratory system. The non-congenital abnormalities of respiratory system.

THE EMBRYOLOGY RESPIRATORY SYSTEM

The respiratory system develops after the fourth week of gestation. In considering the development of this system it is important to review the development of the foregut, in specific and the development of the endoderm overall. It is also important to consider the development of the respiratory system in terms of its many constituent components. The respiratory system begins at the nasal cavity and consists of a conducting portion and a respiratory portion. The conducting portion includes nasal cavity, pharynx, larynx, trachea, bronchi, and bronchioles. The respiratory portion consists of the respiratory bronchioles, alveolar ducts, alveolar sacs and the alveoli. Gaseous exchange occurs in the alveoli.

LUNG DEVELOPMENT. 1) Pseudoglandular period (5-17 weeks) By week 17 all major elements of the lungs have formed except for those involved with gas exchange. The lungs look like an endocrine organ. No respiration is possible! 2) Canalicular period (16-25 weeks) The lumen of the bronchi and terminal bronchioles become larger and the lungs become vascularized. By week 24, respiratory bronchioles have developed and respiration becomes possible, although the chances of survival are slim. 3) Terminal sac period (24 weeks to birth) More terminal sacs develop and capillaries enter into close relationship with them. They are lined with Type 1 alveolar cells or pneumocytes. Type II pneumocytes secrete surfactant counteracting the surface tension forces and facilitating expansions of the terminal sacs. Surfactant reaches adequate levels 2 weeks before birth.

Adequate pulmonary vasculature and sufficient surfactant are critical to the survival of premature infants. 4) Alveolar period (late fetal period to 8 years) 95% of the mature alveoli develop after birth. A newborn infant has only 1/6 to 1/8 of the adult number of alveoli and the lungs look denser in an x-ray. Developing lungs at birth are half filled with amnotic fluid. The fluids in the lungs are cleared: through mouth and nose by pressure on the thorax during delivery. into the pulmonary capillaries. into the lymphatics and pulmonary arteries and veins. Before birth, the lungs contain: High levels of chloride Low protein Mucus glands originating from bronchus Surfactants are increasing steadily, mainly before 2 weeks of birth.

Larynx The larynx is first seen as an outgrowth from the foregut. The outgrowth of tissue is called the respiratory diverticulum or the lung bud. The formation of the lung bud occurs when two lateral folds of splanchnic mesoderm and endoderm meet in the midline and separate the larynx and trachea from the esophagus. The lung bud is a ventral diverticulum of endoderm that arises from the floor of the foregut caudal to the pharynx. Trachea The trachea develops caudal to the larynx. The epithelium develops from the endoderm and the tracheal cartilage and muscles develop from splanchnic mesoderm. Early in development the trachea bifurcates into the left and right bronchi.

Bronchi and Bronchioles As the bronchi develop they continue to branch. The right bronchus gives off three diverticula and the left bronchus gives off two diverticula. These diverticula become the lobar bronchi and indicate that the right lung will have three lobes and the left lung will have two lobes. Each of the bronchi at this stage will divide into smaller bronchi. The branching of the bronchi continues until the bronchioles begin to form. In all there are 17 divisions of the bronchi until the sixth fetal month is reached. However, by early childhood there will be a total of 24 generations of branching that occurs.

THE ANATOMY OF THE RESPIRATORY SYSTEM

Nasal (nose) Superior was formed by forming a bridge os.nasalis. anterior-inferior of this bridge there is a form of the dorsum nasi cartilago. inferior section there are holes called nostrils or nares externa. Cavum nasal At posterior associated with the nasopharynx through the internal nares or choanae. The anterior section was found vestibule. Pharynx Consisting of: - Nasopharynx - Oropharynx - Laryngo pharynx Nasopharynx located behind the cavum nasi posterior pharyngeal wall was found tonsils auditory tubal ostium connecting the nasopharynx to the middle ear, the function: maintain the air balance.

Oropharynx located posterior cavum oris lateral wall there tonsila palatine tonsila lingua lingual found in basil Laryngo pharynx extending from the os. hyoid to the surface of esophagus Lower respiratory tract. Consisting of:

- Larynx - Trachea conducting Airways - Bronchus - Bronchiolus - Bronchiolus respiratory - Ductus alveolar pars.respiratori - Alveoli

Larynx Also called voice box that connects the pharynx and trachea Its limits: * Top: laryngopharynx * Posterior: esophagus * Inferior: trachea Consisting of 9 cartilago connected by ligaments Trachea

is a rigid tubular organ called the windpipe that connects the larynx to the primary bronchus. shape of the letter C (C-shaped cartilage) Sternal angle as high as, tracheal bronchus forked into primary (primary bronchi). Each bronchus to the lateral to each lung. The lower part of the trachea separates cartilago primary bronchus in origin and form the so-called serration carina.

Bronchial Tree The path traveled by air from the left and right primary bronchus, and bronchiole ends before the end of terminale.

Primary bronchus

enters the lungs through hillus pulmonale together arteries, veins, arteries and nerves lymphe.

Secondary bronchus

primary bronchus branches left lung has 2 pieces and the right lung has 3 pieces.

Tertiary bronchus

secondary bronchus branch that right there are 10 pieces and that left 8 pieces each tertiary bronchus bronchus segment called, because supplying the lungs called bronchopulmoneir segment.

Bronchiole branches of the tertiary bronchus terminale bronchiole is the last segment of the bronchial tree line. Delivers air to the pars respiration of respiration system. Pars respiration of the respiratory system Consisting of: respiratory bronchiole alveolar ductus saccus alveolar Alveoli respiratory bronchiole and alveolar ductus contain pockets called alveoli, which is where gas exchange between alveolar and capillary membrane pulmo through respiration. lungs have 300-400 million alveoli. Respiratory Membrane: thin walls found in the alveolar lumen and capillary.

Consist of: * Plasma membrane of alveolar * Capillary endothelial cells * Basal membrane fusion both Pleura and pleura cavum Is the serous membrane covering the lung surface. Consisting of: parietal pleura is located away from the lungs. visceralis pleura is attached to the lungs. Lungs is the primary organ of respiration, the number of 2 pieces. Conus shape, namely: apex facing upwards and downwards lead base above the diaphragm. The lungs are located inside the cavity thorac, underlined the center and bordered by the mediastinum.

Right lung Consisting of three lobes, namely: Superior lobe of the horizontal fissure Medial lobe Inferior lobe fissure oblique There are 2 pieces of arteries, muscular are thinner because carrying carbon dioxide to the lungs. There are 3 pieces of vena, muscular thicker because it carries oxygen from the lungs. Left lung Consists of 2 lobes, namely: - Superior lobe fissure oblique - Inferior lobe

THE HISTOLOGY OF RESPIRATORY SYSTEM

Cavum nasal 1)Respiratory mucosa Thoracic stratified ciliated epithelium and goblet cells. Lamina propria composed of dense connective tissue collagen. Many blood vessels, cavernous sinus Adrenergic and cholinergic nerve fibers Bone and cartilage 2)Mucosal olfaktoris Olfaktoris epithelial cells, basal, advocates Lamina propia consists of connective tissue and gland serous Bowman. Plexus of blood vessels, lymphatic, and nervous system. Function: receptor olfaktoris and dissolve the odor substance

Nasopharynx Stratified epithelium thoracic Lamina propria consists of: - Seromukosa gland tissue - Lymphoid tissue Sinus paranasalis Epithelial layer of thoracic Lamina propria composed of glandular tissue seromukosa Trachea Mucosa: - Thorax flattened stratified epithelium. - Lamina propia composed of loose connective tissue and elastica membrane. - Tracheal epithelial viewed with an electron microscope: ciliated cells, goblet cells, serous cells, basal cells, cell 1 as acceptor sensory brush, brush 2 as intermedia cells, clara cells as a producer of surfactants, and endocrine cells

Submucosal: connective tissue, collagen in large numbers, mukoserosa. Cartilage: hyaline and collagen. Bone muscularis Adventisia tunica consists of a loose connective tissue. Larings Mucosa: - Layered flat epithelium and stratified thorax. - Lamina propia composed of loose connective tissue, lymph seromucuos Cartilage: hyaline, elastic, fibrous Submucosal: loose connective tissue - Epiglottis: layered flattened epithelium, lamina propria, and cartilage. - Original soundtrack: the epithelial layer and ligaments - Vocal cords false: multilevel thoracic epithelium, lamina propria, and glands. There are a sine curve of the larynx / ventricular laringea

Bronchus Primary bronchus are structurally similar to the trachea Secondary bronchus: Mucosa: - Multilevel thoracic epithelial ciliated and goblet cells - Lamina propria consists of connective tissue elastin in large numbers. Submucosal: connective tissue, glands, mukoserosa Muscularis: circular smooth muscle Hyaline cartilage plate Adventisia tunica consists of connective tissue

Regular bronchial Mucosa: - Multilevel thoracic epithelial ciliated and goblet cells, clara cells, serous cells, intermedia, endocrine. Lamina propia consists of connective tissue elastin in large numbers. Bone muscularis: a thick smooth muscle and circular. No cartilage No glands Adventisia tunica consists of connective tissue.
Respiratory bronchioles 0.5 to 0.2 mm diameter Epithelium of low thoracic / cube, stratified ciliated piston, there clara cells and intermedia Smooth muscle

Terminal bronchioles Mucosa: Epithelial layer of the thorax, ciliated, clara cells, endocrine, serous cells,intermedia - Lamina propia consists of connective tissue elastin in large numbers. Bone muscularis: a thick smooth muscle and circular. Adventisia tunica consists of connective tissue Ciliated epithelium but no goblet cells. Alveolar ductus Many alveoli Low thoracic epithelial spread Little smooth muscle and smooth Connective tissue and endocrine glands

Saccus alveolar Surrounded by the alveoli Epithelial layer of flattened Gland connective tissue, endocrine Alveoli The cell walls consist of pneumosit 1 (small core), pneumosit 2 (a cube, there are vacuoles, sitosum, fosfatidil, and choline), and Kohn pores (10-15 m, collateral) Alveolar septum consists of connective tissue, cells (mast, plasma, lymphocytes, fibroblasts makroag), and capillary

THE CONGENITAL ABNORMALITIES OF RESPIRATORY SYSTEM.

Congenital hernia diafragmatic Disorders where the entry of the abdominal organs into thoracic cavity, which disturb the thoracic organs and growth is not maximal. Atresia koana Disorders where the absence of the nostrils. - Bilateral: both the nose does not have a hole, there was cyanosis but will disappear when crying, difficulty in feeding or drinking Tracheomalacia The start abnormality was detected 6 weeks tops. Cartilage is less developed in the wall so weak respiratory tract. turbulence velocity increase the air flow in the trachea Fistula trakeoesofageal Saliva comes out and hold, choke when given the drink first, and usually occurs in women

Hyaline membrane Desease Baby's lungs filled with fluid and amniotic fluid during labor will be coughed out. If the neonate is weak, then the amniotic fluid will remain in the alveoli. Often occurs in premature infants because the immature lung. Alveolus will be injured and become necrotic and covered by fibrin which serves to produce hyaline membrane, so that the alveoli will be covered by hyaline membranes. The risk is increased in premature male babies born to mothers with diabetes. Prevention is the mother was given steroids while still containing the fetus.

THE NON-CONGENITAL ABNORMALITIES OF RESPIRATORY SYSTEM.

1)Abnormalities in the respiratory tract: -Narrowing of the airways due to asthma / bronchitis -Asthma: airway obstruction due to smooth muscle contraction in the respiratory tract due to dust allergies or psychological pressure. Be decreased to the next generation. Histologically: Hypersecretion of mucus from the mucosa and hyperplastic cells in bronchial mucosa and bronchial glands. Hypertrophy and hyperplasia of bronchial smooth muscle cells. Chronic inflammation in the bronchial wall.

Bronchitis: bronchial mucous fluid, surrounded by inflammation. Sinusitis: inflammation of the upper nasal cavity. Renitis: inflammatory disorders of the nose. Pleuritis: inflammation of the membranes covering the lungs (pleura)

2)Abnormalities of alveolar wall Pneumonia: Diplococcus pneumonia bacterial infection that causes inflammation of the alveolar walls. Tuberculosis: Myobacterium bacterial infection tuberculosis. Starting from local lung inflammation eventually extended to the bronchial lymph gland characterized by necrotizing granuloma formation. The formation of a pimple on the alveolar walls. The entry of water into the alveoli. 3)Air transportation system disorders Contamination of the gas carbon monoxide (CO) and cyanide (CN) Blood hemoglobin concentration is less on the body, causing less oxygen

Chronic obstructive pulmonary disease The same symptoms that occur in smokers, namely: - Chronic bronchitis: Bronchial wall becomes thick-Hyperplasia and hypertrophy of bronchial glands -Chronic inflammation in bronchial mucosa and submucosal -Inflammation extends to the bronchioles and into the trachea Surface-epithelial thickening and goblet cells contain - Emphysema: Loss of lung parenchyma distal to the terminal bronchus. Swelling due to air exposure to blood vessels.

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