ANATOMY OFTRACHEOBRONCHIAL TREE and CLINICAL APPLICATION

DR.HARITH

Moderator

Dr. INDUBALA

OBJECTIVE PART 1

◦ Anatomy of Tracheobronchial Tree ◦ Clinical application

Part 2◦ Postural Drainage

Tracheobronchial tree◦Anatomical Division◦Physiological Division◦Trachea Anatomy and Its Relation◦Bronchial divisions ◦Bronchopulmonary segments◦Alveoli

RESPIRATORY SYSTEM

ANATOMICAL DIVISION

Physiological Division Conduction zone

◦ Consists of nasal cavity to terminal bronchioles

Respiratory zone◦ Consists of alveoli, alveolar sacs, alveolar ducts and

respiratory bronchioles

C6

T5

11.25cms

2.5cms

During expiration the bifurcation rises by about one vertebral level,

During deep inspiration may be lowered as far as the sixth thoracic vertebra

C6

Pretracheal Fascia

Pre vertebral Fascia

T4

Blood Supply The upper two thirds are supplied by the inferior thyroid

arteries

The lower third is supplied by the bronchial arteries

Lymph Drainage

The lymph drains into the pretracheal and paratracheal lymph nodes and the deep cervical nodes

Nerve Supply The sensory nerve supply is from the vagi and the

recurrent laryngeal nerves

Sympathetic nerves supply the trachealis muscle

Bronchus The trachea bifurcates behind the arch of the aorta into

the right and left principal (Primary, or Main) bronchi

The bronchi divide into several million terminal bronchioles that terminate in one or more respiratory bronchioles

• Right main bronchus– Wider– More vertical– Shorter– 20-30 degree angle

• Left main bronchus– Narrower– More angular– Longer– 40-60 degree angle

BronchoPulmonary Segment

Alveoli •The alveoli are the functional unit of the lungs.

•The bronchioles terminate in the ALVEOLI through an ALVEOLAR DUCT.

•Walls of the alveoli are highly vascularized.

•The alveoli are the terminal branches of the BRONCHIAL TREE. This arrangement allows for a drastic increase in surface area.

Alveoli

•They have a thin wall specialized to promote diffusion of gases between the alveolus and the blood in the pulmonary capillaries.

•Gas exchange can take place in the respiratory bronchioles and alveolar ducts as well as in the alveoli, each lung contains approximately 300 to 400 million alveoli.

•The spongy nature of the lung is due to the packing of millions of alveoli together.

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Type Ipneumocytes-large flattened cells, present a very thin diffusion barrier for gasesType II pneumocytes-secretes surfactant,which decreases the surface tension between thin alveolar wallsType IIImacrophages

HISTOLOGY

CLINICAL APPLICATION

ANGLE OF MAIN BRONCHI

25 45 45 45

A). B).

A: In Adults: Hence more chances of rt bronchial intubationB :In Children (under the age of 3yrs the angulation of the two main bronchi at the carina is equal on both sides.)

LEFTRIGHT Rt Lt

FORGIEN BODYCxR chest

Radiopaque foreign body

Obstructive emphysema

Atelectasis

Mediastinal shift

CHANGE IN CARINA POSITION WITH FLEXION AND EXTENSION

•Lengthening of the trachea during neck extension occurs mainly between the vocal cords and the sternal notch.• ETTs fixed at the mouth ascend on average 2 cm in the trachea with neck extension---- >chance of accidental extubation•During flexion, the tube moves toward the carina or even the bronchus

RELATION B/W POSTURE AND LOCATION OF LUNG ABCESS

Patient Lying On right Side: inhaled materials collect in posterior segment of right upper lobe.

Patient lying on back: inhaled materials collect in apical segment of right lower lobe.

Thoracic surgeryLung isolation techniques:

• Double lumen tube• Bronchial blocker

lung resection : Bronchopulmonary segments are functionally and anatomically distinct from each other ---------------- ----- > a segment of diseased lung can be removed surgically without adversely affecting the rest of the lung

LANDMARKS•Tracheostomy

•Cricothyrotomy

•Percutaneous dilatational tracheostomy

Postural drainage (POSITIONING)

TRACHEOESOPHEAL FISTULA

Airway management goal: ETT just above the carina & just below the fistula

BRONCHOSCOPYDIAGNOSTIC Cough Hemoptysis Wheez Atelectasis Unresolved pnuemonia Diffuse lung dis.

THERAPEUTIC Foreign Bodies Accumulated Secretions Aspiration Lung abcess Reposition endotracheal tubes Placement of endobronchial tubes

LASER surgery for airways.

CHEST X-RAY

ABNORMAL

References : Barash Miller Grays Ellis Tortora And Derickson Department of Thoracic Surgery(Prof Fedrico) university of Roma

Thank

You