Main bronchi, right and left, bronchi principales dexter et sinister , depart from the bifurcation of the trachea and go to the gates of the lungs. The right main bronchus has a more vertical direction, wider and shorter than the left bronchus. The right bronchus consists of 6-8 cartilaginous half-rings, the left - 9-12 half-rings. Above the left bronchus lie the aortic arch and the pulmonary artery, below and anteriorly there are two pulmonary veins. The right bronchus is surrounded by the azygos vein from above, and the pulmonary artery and pulmonary veins pass below. The mucous membrane of the bronchi, like the trachea, is lined with stratified ciliated epithelium and contains mucous glands and lymphatic follicles. At the hilum of the lungs, the main bronchi are divided into lobar bronchi. Further branching of the bronchi occurs inside the lungs. The main bronchi and their branches form the bronchial tree. Its structure will be discussed when describing the lungs.

Lung

Lung, pulmo (Greek pneumonia ), is the main organ of gas exchange. The right and left lungs are located in the chest cavity, occupying its lateral sections together with their serous membrane - the pleura. Each lung has top, apex pulmonis , And base, basis pulmonis . The lung has three surfaces:

1) costal surface, facies costalis , adjacent to the ribs;

2) diaphragmatic surface, facies diaphragmatica , concave, facing the diaphragm;

3) medial surface, facies medialis . The medial surface in its anterior part borders mediastinum – pars mediastinalis , and in its rear part – with spinal column, pars vertebralis .

Separates the costal and medial surfaces anterior edge of the lung, margo anterior ; in the left lung the anterior edge forms heart tenderloin, incisura cardiaca , which is bounded below uvula of the lung, lingula pulmonis . The costal and medial surfaces are separated from the diaphragmatic surface the lower edge of the lung, margo inferior . Each lung is divided into lobes by interlobar fissures, fissurae interlobares . Oblique slot, fissura obliqua , begins on each lung 6-7 cm below the apex, at the level of the III thoracic vertebra, separating the upper from the lower lung lobes, lobus pulmonis superior et inferior . Horizontal slot, fissura horizontalis , present only in the right lung, located at the level of the IV rib, and separates the upper lobe from the middle lobe, lobus medius . The horizontal gap is often not expressed throughout its entire length and may be completely absent.

The right lung has three lobes - upper, middle and lower, and the left lung has two lobes - upper and lower. Each lobe of the lungs is divided into bronchopulmonary segments, which are the anatomical and surgical unit of the lung. Bronchopulmonary segment- this is a section of lung tissue surrounded by a connective tissue membrane, consisting of individual lobules and ventilated by a segmental bronchus. The base of the segment faces the surface of the lung, and the apex faces the root of the lung. In the center of the segment there are a segmental bronchus and a segmental branch of the pulmonary artery, and in the connective tissue between the segments there are pulmonary veins. The right lung consists of 10 bronchopulmonary segments - 3 in the upper lobe (apical, anterior, posterior), 2 in the middle lobe (lateral, medial), 5 in the lower lobe (upper, anterior basal, medial basal, lateral basal, posterior basal). The left lung has 9 segments - 5 in the upper lobe (apical, anterior, posterior, superior lingular and inferior lingular) and 4 in the lower lobe (superior, anterior basal, lateral basal and posterior basal).

On the medial surface of each lung at the level of the V thoracic vertebra and II-III ribs are located gate of the lungs, hilum pulmonis . Gate of the lungs- this is the place where the root of the lung enters, radix pulmonis , formed by a bronchus, vessels and nerves (main bronchus, pulmonary arteries and veins, lymphatic vessels, nerves). In the right lung, the bronchus occupies the highest and dorsal position; the pulmonary artery is located lower and more ventral; even lower and more ventral are the pulmonary veins (PAV). In the left lung, the pulmonary artery is located highest, lower and dorsal is the bronchus, and even lower and ventral are the pulmonary veins (PV).

Bronchial tree, arbor bronchialis , forms the basis of the lung and is formed by the branching of the bronchus from the main bronchus to the terminal bronchioles (XVI-XVIII orders of branching), in which air movement occurs during breathing (Fig. 1).

Rice. 1. Bronchial tree (according to Ivanitsky M.F., 1985)

The total cross-section of the respiratory tract increases from the main bronchus to the bronchioles by 6,700 times, so as air moves during inhalation, the speed of the air flow decreases many times. The main bronchi (1st order) at the gates of the lung are divided into lobar bronchi, btonchi lobares . These are the bronchi of the second order. The right lung has three lobar bronchi - upper, middle, lower. The right upper lobar bronchus lies above the pulmonary artery (epiarterial bronchus), all other lobar bronchi lie below the corresponding branches of the pulmonary artery (hypoarterial bronchi).

The lobar bronchi are divided into segmental bronchi(3 orders), bronchi segmentales , ventilating bronchopulmonary segments. Segmental bronchi are divided dichotomously (each into two) into smaller bronchi of 4-9 orders of branching; included in the lobules of the lung, these are lobular bronchi, bronchi lobulares . lobe of lung, lobules pulmonis, is a section of lung tissue limited by a connective tissue septum, with a diameter of about 1 cm. There are 800-1000 lobules in both lungs. The lobular bronchus, having entered the lung lobule, gives off 12-18 terminal bronchioles, bronchiole terminals . Bronchioles, unlike bronchi, do not have cartilage and glands in their walls. Terminal bronchioles have a diameter of 0.3-0.5 mm; smooth muscles are well developed in them, with the contraction of which the lumen of the bronchioles can decrease by 4 times. The mucous membrane of the bronchioles is lined with ciliated epithelium.

Each terminal bronchiole is divided into respiratory bronchioles, bronchiole respiratorii , on the walls of which pulmonary vesicles appear, or alveoli, alveolae pulmonales . The respiratory bronchioles form 3-4 orders of branching, after which they are radially divided into alveolar ducts, ductuli alveolares . The walls of the alveolar ducts and sacs consist of pulmonary alveoli with a diameter of 0.25-0.3 mm. The alveoli are separated by septa in which networks of blood capillaries are located. Through the wall of the alveoli and capillaries, exchange takes place between blood and alveolar air. The total number of alveoli in both lungs is about 300 million in an adult, and their surface is about 140 m2. Respiratory bronchioles, alveolar ducts and alveolar sacs with alveoli make up alveolar tree, or respiratory parenchyma of the lung. The functional and anatomical unit of the lung is considered acini. It is part of the alveolar tree into which one terminal bronchiole branches (Fig. 2). Each lung lobe contains 12-18 acini. The total number of branches of the bronchial and alveolar tree from the main bronchus to the alveolar sacs is 23-25 ​​orders of magnitude in an adult.

Rice. 2. Acinus: 1 – pulmonary artery; 2 – bronchial artery; 3 – bronchiole; 4 – bronchial vein; 5 – pulmonary vein; 6 – respiratory bronchiole; 7 – alveolar sac; 8 – alveolus.

The structure of the lung ensures that during breathing movements there is a constant change of air in the alveoli and contact of alveolar air with blood. This is achieved by respiratory excursions of the chest, contraction of the respiratory muscles, contraction of the respiratory muscles, including the diaphragm, as well as the elastic properties of the lung tissue itself.

Age characteristics. The lungs of a non-breathing fetus differ from the lungs of a newborn baby in their specific gravity. In the fetus it is above one, and the lungs drown in water. The specific gravity of a breathing lung is 0.49, and it does not sink in water. The lower borders of the lungs in newborns and infants are located one rib lower than in adults. In the lungs, elastic tissue and interlobar septa are well developed, so the boundaries of the lobules are clearly visible on the surface of the lung.

After birth, lung capacity increases rapidly. The vital capacity of a newborn is 190 cm 3 , by the age of 5 it increases five times, by the age of 10 – ten times. Up to 7-8 years, new alveoli are formed and the number of branching orders of the alveolar tree increases. The dimensions of the alveoli are 0.05 mm in a newborn, 0.2 mm in an 8-year-old child, and 0.3 mm in an adult.

In old and senile age, atrophy of the mucous membrane of the bronchi, glands and lymphoid formations occurs, the cartilage in the walls of the bronchi becomes calcified, the elasticity of the connective tissue decreases, and ruptures of the interalveolar septa are observed.

Anomalies of the bronchi and lungs

Agenesis and aplasia of the main bronchus and lung.

Absence of one of the lobes of the lung along with the lobar bronchus.

Bronchial atresia with congenital atelectasis (collapse) of the corresponding part of the lung (lobe or segment).

Accessory lobes located outside the lung, not connected to the bronchial tree and not involved in gas exchange.

Unusual division of the lung into lobes in the absence of a horizontal fissure in the right lung or when the upper part of the lower lobe is separated by an additional fissure.

An abnormal lobe of the azygos vein, lobus venae azygos, is formed when the azygos vein passes through the apex of the right lung.

The origin of the right upper lobe bronchus directly from the trachea (tracheal bronchus).

Broncho-esophageal fistulas. They have the same origin as tracheal-esophageal fistulas.

Bronchopulmonary cysts are congenital dilatations of the bronchi (bronchiectasis) with liquid contents.

Pleura

Pleura, pleura , is the serous membrane of the lung, consisting of visceral and parietal plates. Visceral(pulmonary) pleura, pleura visceralis (pulmonalis), fuses with the lung tissue and extends into the interlobar fissures. Forms pulmonary ligament, lig . R ulmonale , which goes from the root of the lung to the diaphragm. It has villi that secrete serous fluid. This liquid adheres the visceral pleura to the parietal pleura, reduces friction of the surfaces of the lungs during breathing, and has bactericidal properties. At the root of the lung, the visceral pleura transforms into the parietal pleura.

parietal pleura, pleure parietalis , fuses with the walls of the chest cavity, it has microscopic openings (stomata), through which serous fluid is absorbed into the lymphatic capillaries.

The parietal pleura is topographically divided into three parts:

1) costal pleura, pleura costalis , covers the ribs and intercostal spaces;

2) diaphragmatic pleura, pleura diaphragmatica covers the diaphragm;

3) mediastinal pleura, pleura mediastinalis , goes in the sagittal cavity, limiting the mediastinum. Above the apex of the lung, the parietal pleura forms the pleural dome.

In places where one part of the parietal pleura transitions to another, depressions are formed - pleural sinuses, sinus pleuralis . These are reserve spaces into which the lungs enter when inhaling deeply. Serous fluid can also accumulate in them during inflammation of the pleura, when the processes of its formation or absorption are disrupted.

1. Costophrenic sinus, recessus costodiaphragmaticus , paired, formed at the transition of the costal pleura to the mediastinal pleura, expressed on the left in the area of ​​the cardiac notch of the lung.

2. Phrenic-mediastinal sinus, recessus phrenicomediastinalis , paired, located at the transition of the mediastinal pleura to the diaphragmatic one.

3. Costomedial sinus, recessus costomediastinalis , located at the point of transition of the costal pleura (in its anterior section) into the mediastinal; poorly expressed.

Pleural cavity, cavitas pleurae , - this is a slit-like space between two visceral or between two parietal layers of the pleura with a minimal amount of serous fluid.

Boundaries of the lungs and pleura

There are upper, anterior, lower and posterior borders of the lungs and pleura.

Upper the border is the same for the right and left lungs and the dome of the pleura is 2 cm above the collarbone or 3-4 cm above the first rib; posteriorly it is projected at the level of the spinous process of the VII cervical vertebra.

Front the border passes behind the sternoclavicular joint to the junction of the manubrium and the body of the sternum and from here descends along the sternum line to the cartilage of the VI rib on the right and the cartilage of the IV rib on the left. On the right, at the level of the cartilage of the sixth rib, the anterior border becomes the lower border.

On the left, the border of the lung runs horizontally behind the IV rib to the midclavicular line, and the border of the pleura is at the same level to the parasternal line. From here, the borders of the left lung and hymen descend vertically down to the VI rib, where they pass into their lower borders.

Two triangular spaces are formed between the anterior borders of the right and left pleura:

1) superior interpleural space field, area interpleurica superior , located behind the manubrium of the sternum, the thymus gland is located here;

2) inferior interpleural field, area interpleurica inferior , located behind the lower third of the sternum, here between the right and left pleura lies the heart with the pericardium.

The lower border of the right lung crosses the VI rib along the midclavicular line, the VII rib along the anterior axillary line, the VIII rib along the middle axillary line, the IX rib along the posterior axillary line, the X rib along the scapular line, and the paravertebral line ends at the level of the neck of the XI rib. (Table 1). The lower border of the left lung is basically the same as on the right, but approximately the width of the rib below (along the intercostal spaces). The lower border of the pleura corresponds to the junction of the costal pleura and the diaphragmatic pleura. On the left it is also located slightly lower than on the right, crossing the VII-XI intercostal spaces along the lines described above.

21973 0

The carina of the trachea divides it into the main bronchi, which in turn branch into lobar, segmental, subsegmental and smaller bronchi (Fig. 1.12). The right main bronchus extends at an angle of 20-30° to the axis of the trachea, being, as it were, its continuation. Its length in adults averages 2.5 cm, and its maximum diameter is 13 mm. On the lateral wall of the right main bronchus, 2 cm from the bifurcation, there is the opening of the upper lobe bronchus (Fig. 1.13). Its length does not exceed 1.0-1.5 cm, and it is divided into 3 segmental bronchi: apical (apical, B), posterior (Bp) and anterior (B1P). Sometimes, together with the anterior bronchus, the so-called axillary (axillary) bronchus departs from the upper lobe, but more often it is a branch of the anterior segmental bronchus (Fig. 1.14).

Rice. 1.12. Branches of the trachea and bronchi.

1 - right lower lobe bronchus; 2 - middle lobe bronchus; 3 - intermediate bronchus; 4 - right main bronchus; 5 - right upper lobe bronchus; 6 - trachea; 7 - upper branch of the left upper lobe bronchus; 8 - left upper lobe bronchus; 9 - lower (lingular) branch of the left upper lobe bronchus; 10 - left lower lobe bronchus. The letters indicate segmental and subsegmental bronchi in accordance with the classification of K. Oho, R. Amemiya (1984).

Rice. 1.13. The mouth of the right upper lobe bronchus (bronchoscopy with the patient in a sitting position).
1 - mouth of the upper lobe bronchus; 2 - intermediate bronchus.

Rice. 1.14. The orifices of the segmental bronchi of the upper lobe of the right lung (bronchoscopy with the patient in a sitting position). 1 - posterior (dorsal, B) bronchus; 2 - apical (apical, B) bronchus; 3 - anterior (ventral, Bsh) bronchus.

Rice. 1.15. Trachea, bronchi, large vessels and nerves of the mediastinum below the tracheal bifurcation. The designations are the same as in Fig. 1.8.

Rice. 1.16. Branches of the right main bronchus and pulmonary artery and vein.
21 - right superior pulmonary vein. The remaining symbols are the same as in Fig. 1.8.

Rice. 1.17. The orifices of the bronchi of the middle and lower lobes of the right lung (bronchoscopy with the patient in a sitting position). 1 - mouth of the middle lobe bronchus; 2 — the mouth of the apical bronchus (BU); 3—ostia of the bronchi of the basal segments.

Rice. 1.18. The orifices of the segmental bronchi of the middle lobe of the right lung (bronchoscopy with the patient in a sitting position).
1 - lateral bronchus (L1U); 2 - medial bronchus (Bu).

Rice. 1.19. The orifices of the basal segmental bronchi of the lower lobe of the right lung (bronchoscopy with the patient in a sitting position).
1 — the mouth of the anterior basal bronchus (Bu,c); 2—the mouth of the lateral basal bronchus (B|X); 3 — the mouth of the posterior basal bronchus (Bx); 4 — the mouth of the medial basal bronchus (BU c).

Rice. 1.20. Right lower lobe bronchus, pulmonary artery and veins.
22 - right inferior pulmonary vein. The remaining symbols are the same as in Fig. 1.8 and 1.16.

Rice. 1.21. The mouth of the left upper lobe bronchus (bronchoscopy with the patient in a sitting position). 1 — the mouth of the bronchus of the lower lobe; 2 — the mouth of the own bronchus of the upper lobe; 3 - mouth of the inferior lingular bronchus (Bu); 4 - the mouth of the superior lingular bronchus (B|U).

Rice. 1.22. The orifices of the segmental bronchi of the upper lobe of the left lung (bronchoscopy with the patient in a sitting position). 1 - the mouth of the lingular bronchi; 2 — common mouth of the upper and posterior segmental bronchi (B, Bp); 3 — the mouth of the anterior segmental bronchus (Bsh).

Rice. 1.23. Branches of the left main bronchus, pulmonary artery and veins.
23 - left superior pulmonary vein. The remaining symbols are the same as in Fig. 1.8.

Rice. 1.24. “Crossroads” of the bronchi of the left lung (bronchoscopy with the patient in a sitting position). 1 — ostia of the bronchi of the basal segments of the lower lobe; 2 — the mouth of the upper segment of the lower lobe (BU|).

Rice. 1.25. The orifices of the basal segments of the lower left lung lobe (bronchoscopy with the patient in a sitting position). 1 — the mouth of the anteriobasal bronchus (Bush); 2 — the mouth of the posterobasal bronchus (Bx); 3 - mouth of the lateral basal bronchus (B, x).

Rice. 1.26. Left lower lobe bronchus and pulmonary arteries and veins.
24 - left inferior pulmonary vein. The remaining symbols are the same as in Fig. 1.8.

The bronchial tree is the main system on which the breathing of a healthy person is built. It is known that there are respiratory tracts that supply oxygen to humans. They are naturally structured in such a way that some semblance of a tree is formed. When talking about the anatomy of the bronchial tree, it is imperative to analyze all the functions assigned to it: air purification, humidification. The correct functioning of the bronchial tree provides the alveoli with an influx of easily digestible air masses. The structure of the bronchial tree is an example of nature's minimalism with maximum efficiency: an optimal structure, ergonomic, but coping with all its tasks.

Features of the structure

Different sections of the bronchial tree are known. In particular, there are eyelashes. Their task is to protect the alveoli of the lungs from small particles and dust polluting the air masses. With the effective and coordinated work of all departments, the bronchial tree becomes a protector of the human body from a wide range of infections.

The functions of the bronchi include the sedimentation of microscopic life forms that have leaked through the tonsils and mucous membranes. At the same time, the structure of the bronchi in children and the older generation is somewhat different. In particular, the length is noticeably longer in adults. The younger the child, the shorter the bronchial tree, which provokes various diseases: asthma, bronchitis.

Protecting yourself from troubles

Doctors have developed methods to prevent inflammation in the respiratory system. The classic option is rehabilitation. It is performed conservatively or radically. The first option involves therapy with antibacterial medications. To increase effectiveness, medications are prescribed that can make sputum more liquid.

But radical therapy is an intervention using a bronchoscope. The device is inserted through the nose into the bronchi. Through special channels, medications are released directly onto the mucous membranes inside. To protect the respiratory system from diseases, mucolytics and antibiotics are used.

Bronchi: term and features

Bronchi are branches of the windpipe. An alternative name for the organ is the bronchial tree. The system contains a trachea, which is divided into two elements. The division in female representatives is at the level of the 5th vertebra of the chest, and in the stronger sex it is a level higher - at the 4th vertebra.

After division, the main bronchi are formed, which are also known as left, right. The structure of the bronchi is such that at the point of division they go at an angle close to 90 degrees. The next part of the system is the lungs, into which the bronchi enter.

Right and left: two brothers

The bronchi on the right are slightly wider than on the left, although the structure and structure of the bronchi are generally similar. The difference in size is due to the fact that the lung on the right is also larger than on the left. However, the differences between the “almost twins” are not exhausted: the bronchus on the left relative to the right is almost 2 times longer. The features of the bronchial tree are as follows: on the right, the bronchus consists of 6 rings of cartilage, sometimes eight, but on the left there are usually at least 9, but sometimes the number reaches 12.

The bronchi on the right, in comparison with the left, are more vertical, that is, they actually simply continue the trachea. On the left, under the bronchi, the arcuate aorta passes. To ensure the normal performance of the functions of the bronchi, nature provides for the presence of a mucous membrane. It is identical to the one that covers the trachea, in fact, it continues it.

The structure of the respiratory system

Where are the bronchi located? The system is located in the human sternum. The beginning is at the level of 4-9 vertebrae. Much depends on gender and individual characteristics of the body. In addition to the main bronchi, lobar bronchi also branch off from the tree; these are first-order organs. The second order is composed of zonal bronchi, and from the third to the fifth - subsegmental, segmental. The next step is the small bronchi, occupying levels up to the 15th. The smallest and farthest from the main bronchi are the terminal bronchioles. After them, the following organs of the respiratory system are already starting - respiratory, which are responsible for the exchange of gases.

The structure of the bronchi is not uniform throughout the entire length of the tree, but some general properties are observed throughout the entire surface of the system. Thanks to the bronchi, air flows from the trachea to the lungs, where it fills the alveoli. The processed air masses are sent back the same way. The bronchopulmonary segments are also indispensable in the process of cleaning inhaled volumes. All impurities deposited in the bronchial tree are expelled through it. To get rid of foreign elements and microbes found in the respiratory tract, cilia are used. They can perform oscillatory movements, due to which the secretion of the bronchi moves into the trachea.

We examine: is everything normal?

When studying the walls of the bronchi and other elements of the system, performing bronchoscopy, be sure to pay attention to the colors. Normally, the mucous membrane is gray in color. The cartilage rings are clearly visible. During the study, be sure to check the angle of tracheal divergence, that is, the place where the bronchi originate. Normally, the angle is similar to a ridge protruding above the bronchi. It runs along the midline. During breathing, the system fluctuates somewhat. This happens freely, without tension, pain or heaviness.

Medicine: where and why

Doctors responsible for the respiratory system know exactly where the bronchi are located. If an individual feels that he may have problems with the bronchi, he needs to visit one of the following specialists:

• therapist (he will tell you which doctor will help better than others);
• pulmonologist (treats most respiratory diseases);
• oncologist (relevant only in the most severe case - diagnosing malignant neoplasms).

Diseases affecting the bronchial tree:

• asthma;
• bronchitis;
• dysplasia.

Bronchi: how does it work?

It is no secret that a person needs lungs to breathe. Their component parts are called shares. Air enters here through the bronchi and bronchioles. At the end of the bronchiole there is an acinus, actually a collection of bundles of alveoli. That is, the bronchi are a direct participant in the breathing process. It is here that the air warms up or cools down to a temperature that is comfortable for the human body.

Human anatomy was not formed by chance. For example, the division of the bronchi ensures an effective supply of air to all parts of the lungs, even the most distant ones.

Under protection

The human chest is the place where the most important organs are concentrated. Since damage to them can cause death, nature has provided an additional protective barrier - ribs and a muscle corset. Inside it there are numerous organs, including the lungs and bronchi, connected to each other. At the same time, the lungs are large, and almost the entire surface area of ​​the sternum is allocated for them.

The bronchi and trachea are located almost in the center. They are parallel to the front of the spine. The trachea is located just below the front of the spine. The location of the bronchi is under the ribs.

Bronchial walls

The bronchi contain rings of cartilage. From a scientific point of view, this is called the term “fibrous-muscular-cartilaginous tissue.” Each subsequent branch is smaller. At first these are regular rings, but gradually they become half rings, and the bronchioles do without them. Thanks to the cartilaginous support in the form of rings, the bronchi are held in a rigid structure, and the tree protects its shape, and with it, functionality.

Another important component of the respiratory system is a corset of muscles. When muscles contract, the size of organs changes. This is usually caused by cold air. Compression of organs provokes a decrease in the speed of air passage through the respiratory system. Over a longer period of time, air masses have more opportunities to warm up. With active movements, the lumen becomes larger, which prevents shortness of breath.

Respiratory tissues

The bronchial wall consists of a large number of layers. Following the two described is the epithelial level. Its anatomical structure is quite complex. Different cells are observed here:

• Cilia that can clear air masses of unnecessary elements, push dust out of the respiratory system and move mucus into the trachea.
• Goblet-shaped, producing mucus designed to protect the mucous membrane from negative external influences. When dust ends up on the tissues, secretion is activated, a cough reflex is formed, and the cilia begin to move, pushing the dirt out. Mucus produced by organ tissues makes the air more humid.
• Basal, capable of restoring internal layers when damaged.
• Serous, forming a secretion that allows you to clean the lungs.
• Clara, producing phospholipids.
• Kulchitsky, having a hormonal function (included in the neuroendocrine system).
• The outer ones are actually connective tissue. It is responsible for contact with the environment around the respiratory system.

Throughout the entire volume of the bronchi there is a huge number of arteries supplying blood to the organs. In addition, there are lymph nodes that receive lymph through the lung tissue. This determines the range of functions of the bronchi: not only transportation of air masses, but also cleaning.

Bronchi: the focus of medical attention

If a person is admitted to the hospital with suspected bronchial disease, diagnosis always begins with an interview. During the survey, the doctor identifies complaints and determines the factors that affected the patient’s respiratory organs. So, it is immediately obvious where problems with the respiratory system come from if someone who smokes a lot, is often in dusty rooms, or works in chemical production comes to the hospital.

The next step is to examine the patient. The color of the skin of someone seeking help can tell a lot. They check for shortness of breath, cough, and examine the chest to see if it is deformed. One of the signs of a disease of the respiratory system is a pathological form.

Chest: signs of disease

The following types of pathological deformities of the chest are distinguished:

• Paralytic, observed in those who often suffer from pulmonary diseases, pleura. In this case, the cell loses its symmetry, and the spaces between the ribs become larger.
• Emphysematous, appearing, as the name suggests, with emphysema. The shape of the patient's chest resembles a barrel; due to coughing, the upper zone greatly increases.
• Rachitic, characteristic of those who had rickets in childhood. It resembles a bird's keel, protruding forward as the sternum protrudes.
• “Shoemaker”, when the xiphoid process, the sternum, seems to be in the depths of the cage. Usually pathology from birth.
• Scaphoid, when the sternum seems to be in depth. Usually caused by syringomyelia.
• “Round back”, characteristic of those suffering from inflammatory processes in bone tissue. Often affects the performance of the lungs and heart.

Studying the lung system

To check how severe the disturbances in lung function are, the doctor feels the patient’s chest, checking to see if there are any new growths under the skin that are not typical for this area. Voice tremors are also studied - whether it weakens or becomes stronger.

Another method of assessing the condition is listening. To do this, an endoscope is used when the doctor listens to how air masses move in the respiratory system. Assess for the presence of unusual noises and wheezing. Some of them, which are not characteristic of a healthy body, immediately allow one to diagnose a disease, others simply show that something is wrong.

X-rays are the most effective. Such a study allows you to obtain maximum useful information about the state of the bronchial tree as a whole. If there are pathologies in the cells of an organ, the easiest way to identify them is on an x-ray. Abnormal narrowings, expansions, thickenings characteristic of certain parts of the tree are reflected here. If there is a tumor or fluid in the lungs, it is the x-ray that most clearly shows the problem.

Features and Research

Perhaps the most modern way to study the respiratory system is computed tomography. Of course, such a procedure is usually expensive, so it is not available to everyone - in comparison, for example, with a regular x-ray. But the information obtained during such diagnostics is the most complete and accurate.

Computed tomography has a number of features, due to which other systems for dividing the bronchi into parts were introduced specifically for it. Thus, the bronchial tree is divided into two parts: small and large bronchi. The technique is based on the following idea: small and large bronchi differ in functionality and structural features.

It is quite difficult to determine the border: where the small bronchi end and the large ones begin. Pulmonology, surgery, physiology, morphology, as well as specialists specializing in the bronchi, have their own theories on this matter. Consequently, doctors in different areas interpret and use the terms “large” and “small” differently in relation to the bronchi.

What to look for?

The division of bronchi into two categories is based on the difference in size. So, there is the following position: large ones - those that are at least 2 mm in diameter, that is, they can be studied using a bronchoscope. The walls of this type of bronchi contain cartilage, with the main wall being equipped with hyaline cartilage. Usually the rings do not close.

The smaller the diameter, the more the cartilage changes. At first they are just plates, then the nature of the cartilage changes, and then this “skeleton” disappears altogether. However, it is known that elastic cartilage is found in bronchi whose diameter is less than a millimeter. This leads to the problem of classifying bronchi into small and large.

In tomography, the image of large bronchi is determined by the plane in which the image was taken. For example, in diameter it is only a ring filled with air and bounded by a thin wall. But if you study the respiratory system longitudinally, then you can see a pair of parallel straight lines, between which is an air layer. Usually, longitudinal images are taken of the middle, upper lobes, 2-6 segments, and transverse images are needed for the lower lobe, the basal pyramid.

Trachea is a tube with an average length of 14 cm in men, 12 cm in women, with a diameter of 1.5-2.5 cm. The frontal diameter is larger than the sagittal one at V4. The trachea begins from the larynx at the level between the VI and VII cervical vertebrae and ends in division into the main bronchi at the level between the IV and V thoracic vertebrae (in the supine position). The bifurcation is slightly shifted to the right, in its place there is a protrusion facing the lumen - the tracheal spur (carina).

Bronchi . The right main bronchus departs from the trachea at a more obtuse angle than the left; its length is 3 cm, diameter is about 1.5 cm. The left main bronchus is 4-5 cm long and about 1.2 cm in diameter. The angle formed by the main bronchi is about 70°.

Towards the periphery, the bronchi are dichotomously divided. In practice, there is an incorrect dichotomy, i.e., varying degrees of dissimilarity of branches in size or in angle of origin. There is a division into 3 or more branches. The right main bronchus is divided into the upper lobe and intermediate bronchi, and the latter, in turn, into the middle lobe and lower lobe bronchi. The left main bronchus is divided into the upper and lower lobar bronchi.

Middle lobe bronchus surrounded by lymph nodes closely adjacent to it, which, with hyperplasia, can compress it, up to disruption of the drainage function of the bronchus (F. G. Uglov et al., 1969) with the development of atelectasis and chronic inflammation of the middle lobe (the so-called middle lobe syndrome).

Equity The bronchi enter the corresponding lobes of the lungs and are divided into segmental, which, in turn, are divided into subsegmental branches, interlobular and intralobular bronchi. In the old literature, numbering began with the lobar bronchi, which were called bronchi of the 1st order, and further branches were called bronchi of the 2nd, 3rd and subsequent orders, respectively. Currently, the calculation of generations of bronchi with the corresponding serial numbers is customary to begin with the main bronchi.

The total maximum number of generations of the respiratory tract, ending with the alveolar sacs, according to Weibel (1970), reaches 23. Of these, the bronchi themselves account for 15 generations, followed by terminal bronchioles, three generations of respiratory bronchioles, vestibules, alveolar ducts and alveolar sacs. The axial airways in the uvula, middle lobe, anterior and posterior basal segments include more generations than, for example, in the apical segment of the upper lobe. In American literature, the term “bronchiole” often also applies to small bronchi that do not contain cartilaginous plates (membranous bronchi).

According to Weibel (1970), the average diameter of the bronchi as they branch decreases from 12 mm in the main bronchi to 1.3 mm in the 10th generation bronchi. In this case, the decrease in diameter in the first 10 generations occurs evenly and is represented in a graphical representation as an almost straight line. In subsequent generations it slows down and graphically turns into a flat curve. The total cross-section of the airways in the first three generations decreases slightly, amounting to about 2 cm2 in the bronchi of the third generation. Further, towards the periphery, the total cross-sectional area steadily increases, reaching about 100 cm2 in the bronchi of the 15th generation and about 12,000 cm2 in the branches of the 23rd generation. Morphometric data are of particular interest in comparison with functional indicators of respiration. Age-related changes in the size of the trachea and main bronchi are described in detail in the works of Engel (1947), V. N. Zhevnov (1971), I. I. Pilger and A. K. Lopat (1972).

Lungs occupy most of the chest cavity. From the surface, each lung, with the exception of the narrow medial part - the root, is surrounded by a duplicative pleura, the inner layer of which covers each lobe and passes into the outer one in the root area. A closed slit-like pleural cavity remains between the layers. The main bronchi, vessels and nerves, surrounded by loose fiber, pass through the root of the lung. The conditional frontal plane, passing through the trachea and roots of the lungs, delimits the anterior and posterior mediastinum.

The right lung is divided into 3, the left - into 2 lobes. This separation is incomplete if the interlobar fissures look like grooves of varying depths. Less common are complete absence of grooves or additional grooves and fissures (Fig. 1).

The lobes of the lungs are divided into segments, which are relatively separate structural and functional units. The bronchopulmonary segment is the area of ​​the lung corresponding to the branches of the segmental bronchus and the segmental branch of the pulmonary artery. The shape of the segment resembles a pyramid, the apex of which faces the root of the lung, and the base borders the pleura.

Rice. 1. Developmental anomaly: additional intersegmental fissure and absence of a normal intersegmental fissure of the left lung.

The boundaries between the segments are formed by layers of connective tissue in which intersegmental veins pass. In children, boundaries are more clearly defined. With age, they smooth out and are difficult to identify in adults, especially in the lower lobes.

The modern classification of bronchopulmonary segments is based on the anatomical nomenclature adopted by the VI International Congress of Anatomists in Paris in 1955 and called the Paris Nomenclature (PNA).

According to the Paris nomenclature, one should distinguish between 10 segments in the right lung and 10 segments in the left. The unequal number of segments in the right and left lungs is explained by the fact that in the left upper lobe the apical and posterior segmental bronchi are usually absent, and the subsegmental branches begin from a common trunk. Thus, the two segments of the upper lobe of the right lung in the left lung usually correspond to a single apical-posterior segment. Segment numbers are not given in the PNA. The scheme recommended by the International Congress of Otolaryngologists (London, 1949) has become widespread, especially among surgeons. This scheme (Fig. 2 and 3) was used in a multi-volume manual on surgery (A. N. Maksimenkov et al., 1960). Compared to PNA, the London Congress scheme does not highlight the subapical segment in the lower lobes of both lungs, and the cardiac segment in the left lower lobe. Otherwise it corresponds to PNA. The following is a list of bronchopulmonary segments taking into account the Paris Anatomical Nomenclature 1 and the numbering of segments adopted by the London International Congress of Otolaryngology in 1949:

a - right side; b - left side (side view).

Fig. 3 Schematic representation of lung segments in accordance with the recommendations of the London International Congress of Otolaryngologists in 1949 (according to A. N. Maksimenkov et al., 1960).

a - front view; b - rear view; c - right lung (side view); d - left lung (side view).

It should be noted that there are a variety of anatomical variants. The subapical segment is inconsistent. Even more often, the medial basal (7th) segment is absent in the left lung, although, according to Yu. B. Vasaitis (1963), it is present in 58-4% of cases. A. I. Klembovsky (1962), without singling out the subapical segment, found 3 typical variants: 1) the most common variant (3/4 of all cases) with 10 segments, in which, however, in the left lung the apical and posterior bronchi of the upper lobe depart from the share not independently, but by a common short trunk; 2) scattered type, in which one of the lobar bronchi is absent, while the corresponding segmental bronchi independently flow into the main one; 3) main type, characterized by the fact that between the segmental basal bronchi and the lower lobe there are two transitional bronchi - the anterior medial and posterolateral legs, which bifurcate towards the periphery into segmental branches.

There are cases of subsegmental bronchi departing not from “their own”, but from the neighboring segmental bronchus. Some features are considered developmental defects.

There are various modifications of bronchopulmonary segment diagrams. Tick, llirsch (1957), Kovats jun and Zcebok (1962) distinguish the axillary segment as a subsegment), in which pathological changes are often localized. In 10% of cases, its bronchus arises independently from the upper lobe, but in most cases it is a large lateral branch of the 2nd or 3rd segmental bronchus. D. G. Rokhlin (1966) distinguishes between segments of 1st, 2nd and 3rd order. Its modification rightly takes into account the inequality of segments as territories aerated by bronchial branches of various orders, but the anatomical differences between the lobe, segment and subsegment of the lung are erased.

Blood vessels . The branches of the pulmonary artery, as a rule, follow the branches of the bronchi and are located next to them. In this case, there is a correspondence in the diameter of the arterial and bronchial branches. Intrasegmental branches of the pulmonary veins, variable in caliber and length, flow into intersegmental veins, each of which collects blood from two adjacent segments. The veins unite into large trunks (two from each lung), flowing into the left atrium. The wall of the large IOH contains striated muscle fibers that are a continuation of the atrial musculature. Features of the internal topography of vessels in individual lobes of the lungs are described by A.I. Klembovsky (1962), the topography of large branches of arteries and veins is described in the monograph by Kovatsjun and Zcebok (1962).

Bronchial arteries, numbering from 2 to 4, start from the thoracic aorta, go to the roots of the lungs and branch instead of the bronchi, reaching the level of the bronchioles. The bronchial arteries are located in the peribronchial connective tissue and give off small branches that form a capillary network that reaches its own mucosal layer. From the capillaries, the blood passes into small veins, which partly flow into the pulmonary vein system, partly (from the large bronchi) into the bronchial veins connected to the azygos vein. Between the branches of the system of pulmonary and bronchial arteries and veins there are anastomoses, the function of which is regulated by the terminal arteries.

Lymphatic vessels The lungs are divided into superficial and deep. The superficial ones form a large and finely looped network located in the thickness of the pleura and anastomosing with deep vessels. The latter are located in the connective tissue layers (interlobar, intersegmental), located mainly around the venous vessels, as well as in the wall of the bronchi and peribronchia. Alveolar septa lack lymphatic capillaries. The latter begin at the level of the vestibules, as well as in the interacinous and interlobular connective tissue and in the adventitia of blood vessels (Yu. F. Vikalyuk, 1974).

On the paths of lymph outflow towards the roots of the lungs there are several groups of bronchopulmonary lymph nodes lying along the course and mainly in the places where the bronchi branch. Near the main bronchi and trachea, there are lower tracheobronchial, upper right and left tracheobronchial and right and left tracheal (paratracheal) lymph nodes, from which lymph flows into the bronchomediastinal trunk (truncus bronchomediastinalis) and then to the left into the ductus thoracicus, to the right into ductus lymphaticus dexter.

The innervation of the lungs is carried out by the vagus as well as sympathetic nerves arising from the lower cervical and three to four upper thoracic sympathetic ganglia. The nerves form plexuses at the gates of the lungs, anastomosing with the plexuses of the trachea and heart. Peripheral branches follow along the bronchi and vessels. Along the way there are small nodules of nerve cells.

17.Trachea and bronchi, structure, definition of the bronchopulmonary segment.

The trachea tube, 10-11 cm long, consists of 16-20 cartilaginous half-rings connected by annular ligaments, forming a membranous wall at the back, to which the esophagus is adjacent. It begins at the level of the upper edge of the VII cervical vertebra, ends at the level of the upper edge of the V thoracic vertebra, has parts - the cervical to the 2nd thoracic vertebra and the thoracic. In front of the cervical part of the trachea is the thyroid gland, the pretracheal plate of the cervical fascia, the sternohyoid and sternothyroid muscles, behind is the esophagus, and on the sides are the neurovascular bundles of the neck. Adjacent to the thoracic part in front is the aortic arch, the brachiocephalic trunk, the left brachiocephalic vein, the thymus, and the mediastinal pleura on the sides. The place where the trachea divides into two main bronchi is the tracheal bifurcation (5th thoracic vertebra). The tracheal wall consists of the mucous membrane, submucosa, fibrocartilaginous and adventitial membranes.

Main bronchi(bronchi of the 1st order) from the bifurcation of the trachea go to the gates of the lungs as part of the roots of the lungs, where they are divided on the right into three, and on the left into two lobar bronchi (bronchi of the 2nd order). Right bronchus(bronchus principalis dexter) is wider and shorter, consists of 6-8 cartilaginous half-rings, the azygos vein spreads over it, and the right pulmonary artery is located below it. Left main bronchus(bronchus principalis sinister) is narrower and longer, consists of 9-12 cartilaginous half-rings, the left pulmonary artery and aortic arch are located above, the esophagus and the descending aorta are located behind. The main bronchi at the gates of the lungs are divided into lobar, segmental, lobular, terminal - they form bronchial tree - its function is to conduct air.

?? The alveolar tree performs the respiratory function (gas exchange function) it consists of respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli.

The bronchopulmonary segment is a section of the lung parenchyma, cone-shaped, with its apex facing the hilum of the lungs, ventilated by a segmental bronchus (third order). The right lung has 3 lobes, 10 segments; in the upper lobe: apical, anterior and posterior segments; in the middle: medial and lateral; in the lower: apical basal, medial basal, lateral basal, anterior basal, posterior basal. The left lung has 2 lobes, 10 segments: in the upper lobe there are apical, anterior, posterior, superior and inferior lingular segments; in the lower lobe are the same as in the lower lobe of the right lung

Lungs,surfaces, gates. Root of the lung.

Lungs ( pulmo ) right and left, consists of air parenchyma, it contains air and hascone-shaped, top and base, three surfaces - costal, diaphragmatic, mediastinal, and 3 edges - anterior, inferior and posterior. Located in the right and left half of the chest cavity. The right lung is shorter and wider, the left one is narrower and longer, and also on the anterior edge the left lung has a cardiac notch, due to the position of the heart. This notch is limited below by a tongue. On the mediastinal surface there is the gate of the lungs - chyle pulmonis. All anatomical formations going to the gates of the lungs form the roots of the lungs (bronchi, arteries, veins, nerves, lymphatic vessels and nodes); in the root of the right lung, the bronchus occupies a superior position in relation to the pulmonary artery and pulmonary veins - BAV. In the left - the bronchus lies between the pulmonary artery above and pulmonary veins below - ABC.

The lungs are divided into lobes by deep fissures. In the right lung there are oblique and horizontal fissures, which divide the right lung into three lobes (upper, middle, lower), in the left lung - oblique fissure divides left lung on two lobes (upper and lower). As the bronchi and blood vessels divide in the lungs, the following structural and morphological units are distinguished - segments. Each lung has 10 segments. The segments are formed by lobules that are separated septa, the lobular bronchiole approaches the lobule.

Main bronchi at the gates of the lungs they are divided into lobar, segmental, lobular, terminal they form a “bronchial tree”, which performs the function of conducting air. The terminal bronchioles continue to divide (dichotomous division) and form respiratory bronchioles (1st, 2nd, and 3rd order), from which the alveolar ducts arise, they are covered with alveolar vesicles and end in alveolar sacs and constitute the “alveolar tree.” All structures of the alveolar tree, intertwined with a dense network of blood capillaries, form the structural and functional unit of the lung - the acinus (bunch). The acini performs the respiratory function (gas exchange function). The apex of the lung protrudes above the collarbone by 2 cm, above the first rib by 3-4 cm.

??? The anterior border of the right lung runs behind the body of the sternum to the cartilage of the 6th rib to the 11th rib along the paravertebral line. The anterior border of the left lung at the level of the 4th rib turns to the left, then down to the 6th rib and goes slightly lower, to the intercostal space, of the right border.

Pleura, parts, sinuses.

Pleura, a thin serous membrane which has two layers - visceral and parietal.

Visceral pleura covers the lung and grows tightly with its surface, enters deep into the cracks and lines the interlobar surfaces. It forms the inner wall of the pleural cavity and along the root of the lung passes into the parietal pleura, which forms the outer wall of the pleural cavity. Parietal pleura lines the walls of the chest cavity: it is distinguished as mediastinal on the side of the mediastinum, diaphragmatic on the diaphragm and costal on the inner surface of the chest wall; above the apex the pleura forms dome of pleura . !! When one part of the parietal pleura passes into another,pleural sinuses. At the transition of the diaphragmatic pleura to the costal costophrenic sinuses, place of transition of the mediastinal pleura into the costal pleura (in front) costomediastinal sinus; and mediastinal to diaphragmatic (inferior) phrenic-mediastinal sinus. Fluid can accumulate in the sinuses during inflammatory processes. ! Dome of pleura is projected from the neck of the first rib in front to the spinous process of the 7th cervical vertebra in the back. The dome of the pleura rises 3-4 cm above the first rib and 2-3 cm above the collarbone. The upper and anterior boundaries of the pleura coincide with the boundaries of the lungs, the lower boundaries of the pleura are determined one rib below the boundaries of the lungs and extend to the 12th rib along the paravertebral line.

The anterior boundaries of the pleura diverge at the top, forming superior interpleural field, and below inferior interpleural field, triangular in shape to which are adjacent: to the upper - the thymus gland, to the lower - the pericardium and heart.

Mediastinum (mediastinum) sections. Organs of the upper mediastinum.

The mediastinum is a complex of organs located in the chest cavity between the right and left pleural cavities. The boundaries of the mediastinum are in front - the sternum and cartilages of the ribs, behind - the thoracic spine, below - the diaphragm, above - the superior opening of the chest, and on the sides - the mediastinal pleura. The upper mediastinum lies above the horizontal plane, which runs from the posterior surface of the angle of the sternum to the cartilaginous disc between the IV and V thoracic vertebrae, limited in front by the manubrium of the sternum, and behind by the spinal column. Organs of the upper mediastinum: thymus gland, right and left brachiocephalic veins, left common carotid, left subclavian arteries, part of the trachea, esophagus and nerves, upper part of the thoracic lymphatic duct.

Borders and organs of the lower mediastinum.

The inferior mediastinum is the part of the mediastinum limited above by a plane passing from the junction of the manubrium and the body of the sternum to the disc between the 4th and 5th thoracic vertebrae; inferiorly by the tendinous center of the diaphragm. The lower mediastinum is divided into three parts - anterior, middle, posterior. Front lower mediastinum - the space between the sternum and the anterior surface of the pericardium, contains peristernal, prepericardial lymph nodes, internal mammary arteries and veins. Average The lower mediastinum contains the heart in the pericardial sac, intrapericardial sections of large vessels, main bronchi, pulmonary arteries and veins, phrenic nerves, tracheobronchial and lateral pericardial lymph nodes. Rear the lower mediastinum is located between the posterior surface of the pericardium and the spinal column and contains the thoracic aorta, azygos and semi-gyzygos veins, sympathetic trunks, vagus nerves, esophagus, thoracic lymphatic duct, posterior mediastinal, prevertebral lymph nodes.

Kidneys, structure. Renal lobe and cortical lobule. Fixing apparatus of the kidney, blood supply.

The kidney (ren, nephros - Greek) is located in the lumbar region, has surfaces - anterior, posterior, edges - medial, lateral and poles - upper and lower poles. Bud length 10-12cm, width 5-6cm, thickness 3-4cm. The medial edge is concave, there is a depression on it - the renal sinus, here the renal gate is located, where the renal arteries and nerves enter; veins, ureter and lymphatic vessels emerge - all these structures form the renal pedicle. The kidneys are covered with three membranes (fibrous, fatty capsule, renal fascia). Skeletotopy and syntopy of the kidneys, the kidneys are located in the retroperitoneal space on the posterior abdominal wall, on the sides of the spinal column, at the level from the middle of the XI thoracic - to the upper edge of the III lumbar vertebrae, the right kidney is located from the upper edge of the XII vertebra to the middle of the III lumbar vertebra. The right lobe of the liver and the right flexure of the colon are adjacent to the anterior surface of the right kidney, the medial edge is adjacent to the descending part of the duodenum; Adjacent to the left kidney are the stomach, pancreas, and jejunum in front, the spleen on the side, and the left flexure of the colon. Kidney fixation apparatus: renal bed (muscles of the posterior abdominal wall), kidney membranes, renal pedicle, turgor of adjacent organs, intra-abdominal pressure, adhesion forces, mesenteries of the small and large intestines, etc.

Along the division of the renal artery, the kidney is divided into 5 segments: upper, lower, anterior-superior, anterior-inferior, and posterior.

A section of the kidney shows layers of parenchyma - the cortex and medulla. The cortex forms a continuous layer 5 cm thick and renal columns that extend deep into the medulla. The medulla is a pyramid, the base faces the cortex, and the apex faces the renal sinus. The pyramid and the adjacent part of the cortex form the renal lobes (about 15-20). The renal sinus contains the small and large calyces and the renal pelvis. The cortex is located on the periphery and consists of radiate and convoluted parts. One radiate part surrounded by a folded part is called the cortical lobule. The renal lobe contains up to 600 cortical lobes. The cortex consists of nephrons (the structural and functional unit of the kidney), 80% cortical, 20% pericerebral. Each nephron consists of a renal (Malpighian) corpuscle, which is a capsule with a glomerulus, a proximal convoluted tubule, a nephron loop (Henle), and a distal convoluted tubule. The distal convoluted tubules of the nephron empty into the collecting ducts. The convoluted part of the cortex contains the renal corpuscles and proximal and distal convoluted tubules, the radiate part contains the straight renal tubules and the initial sections of the collecting ducts .

Blood supply. The renal arteries (branches of the abdominal aorta), they are successively divided into segmental, interlobar, arcuate, and interlobular arteries, as well as afferent arterioles entering the Shumlyansky-Bowman capsule and efferent arterioles. Venous blood flows through the renal veins into the inferior vena cava.