Respiratory System by Dr. Vincent-Jr

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HISTOLOGY OF THE

RESPIRATORY SYSTEM
By
Dr. Igben O. Vincent Jr
A patient who has a cough with abundant mucus production for 18
days should be suspected of having which condition?
(A) Pneumonia
(B) Acute tracheitis
(C) Chronic bronchitis
(D) COPD
(E) Small cell carcinoma of the lung
What type of epithelium is found in the trachea?
A. Squamous cells epithelium
B. Ciliated Pseudocolumnar epithelium
C. Transitional epithelium
D. None of the above
E. All of the above
The respiratory tract is lined with what type of muscle?
A. Smooth muscle
B. Cardiac muscle
C. Skeletal muscle
D. None of the above
E. All of the above
• The respiratory system, consist of
the the lungs and a series of
airways that connect the lungs to
the external environment, can be
functionally classified into two
major subdivisions:

Conducting portion: consisting of


airways that deliver air to the lungs

Respiratory portion: consisting of


structures within the lungs in which
oxygen in the inspired air is
exchanged for carbon dioxide in the
blood.
Conducting Portion
• This portion of the respiratory system includes the nose,
nasopharynx, larynx, trachea, bronchi, and bronchioles of decreasing
diameters, including and ending at the terminal bronchioles.

Functions
These structures
• warm, moisten, and filter the air before it reaches the respiratory
components, where exchange of gases occurs
The nasal cavity
Subdivided by the median nasal septum into right and left nasal
cavities, each leading to the para nasal sinuses, thus providing a large
surface area for filtering, moistening, and warming the inspired air.
Nares
These are the nostrils; their outer portions are lined by thin skin.
a. They open into the vestibule, the first portion of the nasal cavity,
where the epithelial lining becomes non keratinized.

• Posteriorly, the lining changes to respiratory epithelium


(pseudostratified ciliated columnar epithelium with goblet cells).

b. The vestibule has vibrissae (thick, short hairs), which filter large
particles from the inspired air and a richly vascularized lamina propria
(many venous plexuses) and contain sero-mucous glands.
• 2. Each nasal cavity contains bony shelves that originate from the
lateral nasal wall and project into the nasal cavity. These are the
superior, middle, and inferior conchae (turbinate bones).

Functions
• Divides it into separate regions
• Creates airflow turbulence
• Increases the surface area for warming, filtering, and moistening the
inspired air respiratory epithelium due to the presence of respiratory
epithelium
Clinical case
Abuse of cocaine by inhalation has long been known to result in the
perforation of the nasal septum.

Other recreational drugs, such as heroin, benzodiazepines,


methamphetamine, and other opioids

Moreover, a 34-year-old male who abused acetaminophen by


inhalation reportedly suffered severe damage to his soft palate, partial
destruction of the hard palate, and perforation of his nasal septum.
Paranasal sinuses
• These are air-filled, hollowed-out portions of the skull, they are lined by a thin
respiratory epithelium
• sphenoid, frontal, ethmoid, and maxillary bones.

Function
precise function of the paranasal sinuses is not known.

The olfactory epithelium,


located in the roof of the nasal cavity, on either side of the nasal septum and on the
superior nasal conchae,
Lined by pseudostratified columnar epithelium (olfactory cells, supporting
(sustentacular) cells, and basal cells ( stem cells)

Other components: lamina propria that contains many veins and unmyelinated nerves
and houses Bowman glands.
Characteristic
Olfactory cells are bipolar nerve cells characterized by a bulbous apical projection (
olfactory vesicle) from which several modified cilia, known as olfactory cilia ( olfactory
hairs), extend.
Olfactory cilia are very long, non motile cilia that extend over the surface of the olfactory epithelium and act
as receptors for odor.
NB. Contain microtubules

b. Supporting ( sustentacular) cells possess nuclei that are more apically located than those of the other two
cell types. They have many microvilli and a prominent terminal web of filaments.

c. Basal cells form an incomplete layer of cells that rest on the basal lamina but do not extend to the surface.
They are believed to be regenerative for all three cell types.

d. Bowman glands (serous glands) lie deep to the epithelium and produce a thin, watery secretion that is
released onto the olfactory epithelial surface via narrow ducts.

I. Disolution of odorous substances (known as odorants)


II. Production of secretions which flushes the epithelial surface
• B. The nasopharynx, the posterior continuation of the nasal cavities, becomes continuous with the
oropharynx at the level of the soft palate. It is lined by respiratory epithelium, whereas the oropharynx and
laryngopharynx are lined by stratified squamous nonkeratinized epithelium.

1. The lamina propria of the nasopharynx, located beneath the respiratory epithelium, contains mucous and
serous glands as well as an abundance of lymphoid tissue known as Waldeyer's ring, including the
pharyngeal tonsil.
CCR: Adenoid.

C. The larynx connects the pharynx with the trachea. It functions to produce sounds and close the air passage
during swallowing.
Component:
1. hyaline cartilages (thyroid, cricoid, and lower part of arytenoids) and elastic cartilages (epiglottis,
corniculate, and tips of arytenoids) skeletal muscle, connective tissue, and glands.
2. The vocal cords consist of skeletal muscle (the vocalis muscle), the vocal ligament (formed by a band of
elastic fibers), and a covering of stratified squamous non-keratinized epithelium.
b. Inferior to the vocal cords, the
lining epithelium changes to
respiratory epithelium, which lines
air passages down through the
trachea and intrapulmonary
bronchi.

3. Vestibular folds (false vocal


cords), lying superior to the vocal
cords, are folds of loose connective
tissue that contain glands,
lymphoid aggregations, and fat cells
and are covered by a mixture of
non-stratified and stratified
squamous nonkeratinized
epithelium.
D. The trachea is the largest
conducting section of the respiratory
system.
• The trachea bifurcates into the right
and left primary bronchi

• The walls of the trachea, composed


of a mucosa, submucosa, and
adventitia, are supported by C-
shaped hyaline cartilages (C-rings)
• Smooth muscle (trachealis muscle in
the trachea)
• Dense fibroelastic connective tissue
is located between adjacent C-rings,
permitting elongation of the trachea
during inhalation.
A light micrograph of the human trachea displays its lumen (L) lined by a pseudostratified
ciliated columnar epithelium IE). Deep to the epithelium is the lamina propria (LP) and
seromucous glands (GI) in the submucosa. The trachea is supported by C-shaped rings of
hyaline cartilage IC-ring), which is surrounded by a perichondrium (PC) (X132).
Clinical correlates
In rare circumstances, congenital enlargement of the trachea and the
bronchi occurs, a condition known as tracheobronchomegaly (Mounier-
Kuhn syndrome),

• Autosomal recessive trait


• Tracheal diameter (M> 2.5 cm F> 2.1 cm)
Pathophysiology:
• Compromise normal respiration
• Long-term respiratory tract infections
• Abundant of a mixture of mucus and pus
• Widening of smaller airway passages
Mucosa is composed of two layers, the respiratory epithelium and the lamina propria, with an intervening basement membrane.
• Extrapulmonary (primary) bronchi are the continuation of the
trachea as it divides into the left and right bronchi.
• Left bronchus is approximately 4.1-4.7 cm x 16 mm in width and
diverges at an angle of 45°
• Right bronchus is 2.5 -3.4 cm x 18 mm and diverges at an angle of
25°.

3R2L the bishop is not always right


Clinical correlate
• The right primary bronchus is shorter, wider, and straighter, coming off the
trachea, than the left bronchus; therefore, if a foreign object, such as food,
is aspirated, the chances are that it will be lodged in the right primary
bronchus rather than in the left primary bronchus.

• CCR: Actute tracheitis and acute bronchitis (chest cold)


• Symptoms: coughing and mucus production
• Chronic bronchitis: The most common form of chronic bronchitis is chronic
obstructive pulmonary disease (COPD) and is the result of long-term
inhalation of tobacco smoke, coal dust (in coal miners), textile dust (in
textile workers), grain dust (in millers), or working in other dust-laden
environments.
• Secondary bronchi are lined by respiratory epithelium-, they arise
from subdivisions of the primary bronchi as these enter the hilum of
the lung.
Characteristics:
• Spiraling smooth muscle bundles
• Lamina propria separarting the muscle bundles
• Seromucous glands
• Plates of irregularly shaped cartilage
Division: Intrapulmonary bronchi divide many times and give rise to
lobar and segmental bronchi
A light micrograph of an intrapulmonary bronchus cut in cross section. Lining its lumen is a pseudostratified ciliated columnar
epithelium with goblet cells (E). Beneath the epithelium in the lamina propria of loose, fibroelastic connective tissue are
bundles of smooth muscle (SM) cells wrapped in a spiraling arrangement around the lumen. In the submucosal connective
tissue outside of the SM are irregular plates of cartilage (C), seromucous glands (G), and lymphoid tissue (L). Alveoli (A) are
evident in the nearby respiratory tissue ( X75
Lung cancer
• Small cell (oat cell) carcinoma
• Non-small cell carcinoma
• Squamous cell carcinoma
• Adenocarcinomas
• Large cell carcinomas
A light micrograph of a bronchiole in cross section. A simple columnar epithelium (El lines its lumen, and smooth muscle (SMI
cells support its wall. Surrounding the bronchiole is lung tissue with alveoli, and no cartilage or glands are present. Nearby, a
muscular artery (MAI is evident
G. Primary and terminal bronchioles lack glands in their submucosa. Their walls contain
smooth muscle rather than cartilage plates

1. Primary bronchioles have a diameter of 1 mm or less and are lined by epithelium that
varies from ciliated columnar with goblet cells in the larger airways to ciliated cuboidal
with club cells (formerly known as Clara cells) in the smaller passages.
a. They divide to form several terminal bronchioles after entering the pulmonary lobules.

2. Terminal bronchioles, the most distal part of the conducting portion of the respiratory
system, are lined by a simple cuboidal epithelium that contains mostly club cells, some
ciliated cells, and no goblet cells and have a diameter of less than 0.5 mm.

a. Club cells divide, and some of them differentiate to form ciliated and non ciliated cells.
(1) They secrete a surfactant-like material that reduces alveolar surface tension
preventing the collapse of alveoli. They also produce club cell secretory protein whose
function is assumed to be the protection of the respiratory epithelium.

(2) They metabolize airborne toxins, a process that is carried out by cytochrome P450
enzymes in their abundant smooth endoplasmic reticulum.
RESPIRATORY PORTION
• This portion of the respiratory system includes the respiratory
bronchioles, alveolar ducts, alveolar sacs, and alveoli, all in the lung.
The exchange of gases takes place in this portion of the respiratory
system.
Components of the respiratory portion of the respiratory system, including a respiratory bronchiole, alveolar duct, and
alveolar sac, are illustrated, as well as the exchange of oxygen (021 and carbon dioxide (CO21 across the blood-gas barrier.
(From Gartner LP. Color Atlas of Histology. 7th ed. Baltimore, MO: Wolters Kluwer; 2018:331 .I)
• Respiratory bronchioles mark the transition from the conducting to the
respiratory portion of the respiratory system.

• Characteristic
• Lined by a simple cuboidal epithelium that contains mostly club cells and
some ciliated cells, except where their walls are interrupted by alveoli,

• B. Alveolar ducts are linear passageways continuous with the respiratory


bronchioles whose walls consist of adjacent alveoli, which are separated
from one another only by an interalveolar septum.
Alveolar ducts, lined by type II pneumocytes and simple squamous
epithelium of type I pneumocytes,

smooth muscle cells, which rim the openings of adjacent alveoli

C. Alveolar sacs are expanded out pouchings of numerous alveoli at


the distal ends of alveolar ducts

Xtics
have thin walls which oxygen and carbon dioxide diffuison
Large surface area (About 500 million alveoli exist in the lung)
A low-magnification electron micrograph showing part of a terminal or respiratory bronchiole lined by a simple cuboidal
epithelium composed of two cell types: club cells (CLI and ciliated cells (Cl. In the wall of the bronchiole, smooth muscle cells
(Ml and elastic tissue (El are present. A venule (VI containing a white blood cell, several capillaries (arrowheadsl cleared of
blood cells, and alveoli (Al lined by the markedly thin cytoplasm of type I pneumocytes (Pl I are also present ( x 1,5001.
A light micrograph of an alveolar duct (AD) leading from a respiratory bronchiole into an alveolar sac (AS). The
alveolar duct consists of adjacent alveoli, separated from one another only by an inter-alveolar septum. At the rims of
the adjacent alveoli are a few smooth muscle cells (arrow) that appear as knobs in histologic sections. Notice that the
rims of alveoli (A) in the alveolar sac do not contain smooth muscle
Alveolar cells

Type I pneumocytes (type I alveolar cells)


Xtics:
1. Extremely thin cytoplasm
2. Form part of the blood-gas barrier
3. They form tight junctions with adjacent cells
4. May have phagocytic capabilities
5. Not able to divide.

b. Type II pneumocytes (type II alveolar cells, great alveolar cells, granular pneumocytes,
and septal cells) are cuboidal and are most often found near septal intersections.
Xtics:
1. Free surface that contains short microvilli
2. form tight junctions with adjacent cells.
• (1) These cells not only divide and regenerate both types of alveolar
pneumocytes but also synthesize pulmonary surfactant, which is
stored in cytoplasmic lamellar bodies.

(a) Pulmonary surfactant consists of phospholipids,


dipalmitoylphosphatidylcholine, the four apolipoproteins,
surfactant-associated proteins (known as SP-A, SP-B, SP-C, and SP-
D), and cholesterol.

Function: Reduction of surface tension


Electron micrograph of a type II pneumocyte that synthesizes surfactant and stores it in lamellar bodies (LB) in its
cytoplasm. Type II pneumocytes are present mainly near the septa I intersections and line only small portions of
the alveoli (A). They possess microvilli (arrowhead') and are cuboidal in shape (x7,000
Clinical correlate
Neonatal respiratory distress syndrome (RDS), previously known as
hyaline membrane disease, is frequently observed in premature
infants (<28 weeks' gestational age)

Spontaneous pneumothorax is the collection of gas in the pleural


cavity, the potential space between the visceral and parietal pleurae. It
causes sudden sharp, severe chest pain on the same side as the
affected lung and leads to shortness of breath. The condition occurs
most often in young people who have no known underlying pulmonary
disease. But computed tomography scans typically
• Alveolar macrophages (alveolar phagocytes; dust cells)are the
principal mononuclear phagocytes of the alveolar surface.

• They remove inhaled dust, bacteria, and other particulate matter


trapped in the pulmonary surfactant, thus providing a vital line of
defense in the lungs.
Clinical correlate
• Asbestosis
Xtics: Interstitial pulmonary fibrosis
• Emphysema results from destruction of alveolar walls and formation of
large cyst-like sacs, reducing the surface area available for gas exchange. It
is marked by decreased elasticity of the lungs, which are unable to recoil
adequately during expiration.

• Cause: Cigarette smoke and other substances that inhibit cx,-antitrypsin,


a protein that normally protects the lungs from the action of elastase
produced by alveolar macrophages
• It can be a hereditary condition resulting from a defective a1-antitrypsin. In
such cases, gene therapy with recombinant a 1-antitrypsin is being used in
an effort to correct the problem and it has recently been successful in
boosting the availability of this protective protein.
The interalveolar septum
• The wall, or partition, between two adjacent alveoli, is bounded on
its outer surfaces by the extremely thin simple squamous
epithelium lining the alveoli.

• contains many elastic and reticular fibers and houses continuous


capillaries in its central (interior) region.

• The interalveolar septum accommodates the blood-gas barrier, which


separates the alveolar airspace from the capillary lumen.
Blood-gas barrier
(1) The thinnest regions of the blood-gas barrier are 0.2 μm or less in thickness and
consist of the following layers:
(a) Type I pneumocytes and layer of surfactant lining the alveolar airspace
(b) Fused basal laminae of type I pneumocytes and capillary endothelial cells
(c) Endothelium of the continuous capillaries within the interalveolar septum

(2) Thicker regions of the barrier measure as much as 0.5 μm across and have an
interstitial area interposed between the two unjused basal laminae.

Function. The blood-gas barrier permits the diffusion of gases between the
alveolar airspace and the blood.
Clinical correlate
• Carbon monoxide poisoning
QUESTION & ANSWER

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