INHOUD
Hoofdstuk 1: inleiding ....................................................................................................................................... 4
Algemene functies ........................................................................................................................................ 4
Gasgeleidingsstelsel .................................................................................................................................. 4
Gasuitwisselingsstelsel .............................................................................................................................. 4
Larynx ........................................................................................................................................................... 4
stembanden (plicae) .................................................................................................................................. 5
Hoofdstuk 2: anatomie ..................................................................................................................................... 6
Neus ............................................................................................................................................................. 6
Neusholte ................................................................................................................................................. 6
Functies neus en conchae .......................................................................................................................... 6
Reukzone .................................................................................................................................................. 7
Vascularisatie ............................................................................................................................................ 7
Paranasale sinussen ...................................................................................................................................... 7
Sinus frontalis ........................................................................................................................................... 7
Sinus ethmoidalis ...................................................................................................................................... 7
Sinus maxillaris.......................................................................................................................................... 7
Sinus sphenoidalis ..................................................................................................................................... 8
Sinusitis..................................................................................................................................................... 8
Farynx........................................................................................................................................................... 8
Larynx ........................................................................................................................................................... 9
Larynxskelet .............................................................................................................................................. 9
Ligamenten ............................................................................................................................................. 10
Spieren.................................................................................................................................................... 11
Bloedvaten.............................................................................................................................................. 12
Zenuwen ................................................................................................................................................. 12
Trachea en stambronchii ............................................................................................................................. 12
trachea ................................................................................................................................................... 12
Stambronchi............................................................................................................................................ 12
Pleura ......................................................................................................................................................... 13
Longen........................................................................................................................................................ 13
Algemene opbouw .................................................................................................................................. 13
Longhilus................................................................................................................................................. 14
Bronchi ................................................................................................................................................... 14
Bronchioli................................................................................................................................................ 14
Lobuli en acini ......................................................................................................................................... 15
1
, Functie longluchtwegen .......................................................................................................................... 15
Bloedvaten (longen) .................................................................................................................................... 15
Pulmonale bloedvaten............................................................................................................................. 16
Bronchiale bloedvaten............................................................................................................................. 16
Broncho-vasculaire bundel ...................................................................................................................... 16
Verbindingen tussen pulmonale en bronchiale bloedsomloop ................................................................. 17
Zenuwen (longen) ....................................................................................................................................... 17
Lymfestelse (longen) ................................................................................................................................... 17
Lymfevaten ............................................................................................................................................. 17
Lymfeklieren ........................................................................................................................................... 17
Mediastinum .............................................................................................................................................. 18
Mediastinum superius ............................................................................................................................. 18
Mediastinum anterius ............................................................................................................................. 18
Mediastinum medius............................................................................................................................... 18
Mediastinum posterius............................................................................................................................ 18
Longkanker ............................................................................................................................................. 19
Hoofdstuk 3: histologie ................................................................................................................................... 20
Gasgeleidingsstelsel: algemene opbouw...................................................................................................... 20
Lamina propria ........................................................................................................................................ 20
Seromucineuze klieren ............................................................................................................................ 20
Glad spierweefsel .................................................................................................................................... 20
Kraakbeen – bot ...................................................................................................................................... 20
Adventitia ............................................................................................................................................... 20
Epitheel ...................................................................................................................................................... 21
Vestibulum nasi....................................................................................................................................... 21
Neus ....................................................................................................................................................... 21
Conchae .................................................................................................................................................. 21
Nasofarynx .............................................................................................................................................. 21
Orofarynx................................................................................................................................................ 21
Slijmvlies epitheel ....................................................................................................................................... 22
Squameus epitheel .................................................................................................................................. 22
Respiratoir epitheel ................................................................................................................................. 22
Reukslijmvlies – olfactoire mucosa .......................................................................................................... 23
Slijmvlies larynx .......................................................................................................................................... 24
Meerlagig niet-verhoornd plaveiselepitheel............................................................................................. 24
Respiratoir epitheel ................................................................................................................................. 24
Trachea en stambronchi .............................................................................................................................. 25
2
, Respiratoir epitheel ................................................................................................................................. 25
Pleura ......................................................................................................................................................... 25
Longparenchym .......................................................................................................................................... 25
Luchtwegen ................................................................................................................................................ 26
bronchi ................................................................................................................................................... 26
Bronchioli................................................................................................................................................ 26
Overgangstype: respiratoire bronchiolen ................................................................................................. 27
Alveolen .................................................................................................................................................. 27
Afweersysteem ........................................................................................................................................... 30
Bovenste luchtwegen en bronchi (gasgeleiding)....................................................................................... 30
Alveoli (gasuitwisseling) .......................................................................................................................... 30
Hoofdstuk 4: transversale doorsneden ............................................................................................................ 31
Hoofdstuk 5: klinische gevallen ....................................................................................................................... 32
TNM-stembanden (glottis) .......................................................................................................................... 32
respiratoir distress syndroom ...................................................................................................................... 32
Longtumoren .............................................................................................................................................. 33
3
, ADEMHALING: MORFOLOGIE
HOOFDSTUK 1: INLEIDING
ALGEMENE FUNCTIES
- Ademhalingsstelsel
o Gasgeleidingsstelsel
o Gasuitwisselingsstelsel
- Neus
o Verwarmen, bevochtigen en reinigen van ingeademde lucht
o Reukorgaan
o Resonantiefunctie → bepalen timbre (klankkleur)
- Sinus
o Resonantiefunctie
o Temperatuurregeling van hersenen
- Mondholte
o Spraakorgaan
GASGELEIDINGSSTELSEL
- Buisvormige structuren
o Neus en mondholte
o Nasofarynx
o Larynx
o Trachea
o Bronchi en bronchioli
▪ Secundaire bronchioli
▪ Tertiaire bronchioli
- Functie
o Geleiding van lucht
o Opwarming van lucht
o Vochtigheid van lucht
o Zuivering van ingeademde lucht
GASUITWISSELINGSSTELSEL
- Longalveolen: zakvormige structuren die deel uitmaken van longparenchym
o Terminale bronchioli
o Ductuli alveolares
o Sacculi alveolares
- Functie
o Uitwisseling ingeademde zuurstof met koolzuurgas vanuit bloed
LARYNX
- ‘strottenhoofd’
- Opgebouwd uit kraakbeen en ligamenten
o Dragen van dwars gestreepte spieren
- Hol orgaan, bedekt met slijmvlies
4
, - Functies
o Klepfunctie → voedsel komt niet in luchtweg bij slikken
o Rol bij verhogen van intra-thoracale of intra-abdominale druk (hoesten, persen…)
o Rol in fonatie (= produceren van stemhebbende klanken)
▪ Sagittaal geplaatste stembanden wordt in trilling gebracht door expiratoire
luchtstroom
▪ Toonhoogte:
• Afh van dikte
• Afh van spanning
• Afh van lengte van trillende delen van stembanden
- Laryngoscopie.
STEMBANDEN (PLICAE)
- < 2 paar slijmvliesplooien
- Thv adamsappel met kleine spiertjes aan kraakbeen van larynx
- Bovenste 2 → valse stembanden
o Niet in trilling brengen
- Onderste 2 → ware stembanden
o < spiervezels
o Wel in trilling brengen
- °stemspleet: kleine opening die breder en smaller kan worden gemaakt
o Spiertjes → stembanden naar elkaar toe bewegen → regelen breedte van opening
o Lucht stroom door de opening → stembanden trillen → geluid
o Keel, tong en lippen zetten geluid om in taal
- Vrouwen: hogere stem
o Korte stembanden
o Hogere frequentie
- Mannen: lagere stem
o Lange stembanden
o Lagere frequentie
5
, HOOFDSTUK 2: ANATOMIE
NEUS
- Uniek in samenstelling
- < bot
- < kraakbeen
- Uitwendige neus
o Radix nasi
o Apex nasi
o Dorsum nasi
o Alae nasi
NEUSHOLTE
- 2 bilaterale, symmetrische holtes → verdeeld door septum (bot + kraakbeen)
- Neusgat → choanae → nasofarynx
- 2 compartimenten:
o Vestibulum nasi → huid in prox deel
o Nasale fossa → respiratoir epitheel
- 3 conchae (botschelpen)
o Concha superior > os ethmoïdale
o Concha media > os ethmoïdale
o Concha inferior > apart botstuk
- Neusgang telkens onder concha
o Meatus superior
▪ Uitmonden 1-2 cellulae ethmoidales posteriores
o Meatus media
Opening ductus nasolacrimalis
▪ Cellulae etmoidalis anteriores
▪ Sinus frontalis → via hiatus semilunares, zichtbaar bij verwijderen concha media
▪ Sinus maxillaris → via hiatus semilunares, zichtbaar bij verwijderen concha media
o Meatus inferior
▪ Uitmonden ductus nasolacrimalis → afvoeren traanvocht Hiatus semilunares
FUNCTIES NEUS EN CONCHAE
- Opwarmen ingeademde lucht
o Groot contactoppervlak tussen ingeademde lucht en mucosa
o Turbulentie ingeademde lucht
o Plexussen van capillairen en venen onder neusepitheel
▪ Opzwellen bij koude lucht
o Hoeveelheid energie, afh van temperatuur en vochtigheid
van de ingeademde lucht (10% van totale lichaamswarmte
verlies via neus)
- Bevochtigen ingeademde lucht
o Heropname van vocht bij uitademen → 1/3 wordt gerecupereerd
▪ Door condensatie van vocht op slijmvlies bij uitademen
o Drainage van nasolacrimale buizen
o Secreties van paranasale sinussen
6
Hoofdstuk 1: inleiding ....................................................................................................................................... 4
Algemene functies ........................................................................................................................................ 4
Gasgeleidingsstelsel .................................................................................................................................. 4
Gasuitwisselingsstelsel .............................................................................................................................. 4
Larynx ........................................................................................................................................................... 4
stembanden (plicae) .................................................................................................................................. 5
Hoofdstuk 2: anatomie ..................................................................................................................................... 6
Neus ............................................................................................................................................................. 6
Neusholte ................................................................................................................................................. 6
Functies neus en conchae .......................................................................................................................... 6
Reukzone .................................................................................................................................................. 7
Vascularisatie ............................................................................................................................................ 7
Paranasale sinussen ...................................................................................................................................... 7
Sinus frontalis ........................................................................................................................................... 7
Sinus ethmoidalis ...................................................................................................................................... 7
Sinus maxillaris.......................................................................................................................................... 7
Sinus sphenoidalis ..................................................................................................................................... 8
Sinusitis..................................................................................................................................................... 8
Farynx........................................................................................................................................................... 8
Larynx ........................................................................................................................................................... 9
Larynxskelet .............................................................................................................................................. 9
Ligamenten ............................................................................................................................................. 10
Spieren.................................................................................................................................................... 11
Bloedvaten.............................................................................................................................................. 12
Zenuwen ................................................................................................................................................. 12
Trachea en stambronchii ............................................................................................................................. 12
trachea ................................................................................................................................................... 12
Stambronchi............................................................................................................................................ 12
Pleura ......................................................................................................................................................... 13
Longen........................................................................................................................................................ 13
Algemene opbouw .................................................................................................................................. 13
Longhilus................................................................................................................................................. 14
Bronchi ................................................................................................................................................... 14
Bronchioli................................................................................................................................................ 14
Lobuli en acini ......................................................................................................................................... 15
1
, Functie longluchtwegen .......................................................................................................................... 15
Bloedvaten (longen) .................................................................................................................................... 15
Pulmonale bloedvaten............................................................................................................................. 16
Bronchiale bloedvaten............................................................................................................................. 16
Broncho-vasculaire bundel ...................................................................................................................... 16
Verbindingen tussen pulmonale en bronchiale bloedsomloop ................................................................. 17
Zenuwen (longen) ....................................................................................................................................... 17
Lymfestelse (longen) ................................................................................................................................... 17
Lymfevaten ............................................................................................................................................. 17
Lymfeklieren ........................................................................................................................................... 17
Mediastinum .............................................................................................................................................. 18
Mediastinum superius ............................................................................................................................. 18
Mediastinum anterius ............................................................................................................................. 18
Mediastinum medius............................................................................................................................... 18
Mediastinum posterius............................................................................................................................ 18
Longkanker ............................................................................................................................................. 19
Hoofdstuk 3: histologie ................................................................................................................................... 20
Gasgeleidingsstelsel: algemene opbouw...................................................................................................... 20
Lamina propria ........................................................................................................................................ 20
Seromucineuze klieren ............................................................................................................................ 20
Glad spierweefsel .................................................................................................................................... 20
Kraakbeen – bot ...................................................................................................................................... 20
Adventitia ............................................................................................................................................... 20
Epitheel ...................................................................................................................................................... 21
Vestibulum nasi....................................................................................................................................... 21
Neus ....................................................................................................................................................... 21
Conchae .................................................................................................................................................. 21
Nasofarynx .............................................................................................................................................. 21
Orofarynx................................................................................................................................................ 21
Slijmvlies epitheel ....................................................................................................................................... 22
Squameus epitheel .................................................................................................................................. 22
Respiratoir epitheel ................................................................................................................................. 22
Reukslijmvlies – olfactoire mucosa .......................................................................................................... 23
Slijmvlies larynx .......................................................................................................................................... 24
Meerlagig niet-verhoornd plaveiselepitheel............................................................................................. 24
Respiratoir epitheel ................................................................................................................................. 24
Trachea en stambronchi .............................................................................................................................. 25
2
, Respiratoir epitheel ................................................................................................................................. 25
Pleura ......................................................................................................................................................... 25
Longparenchym .......................................................................................................................................... 25
Luchtwegen ................................................................................................................................................ 26
bronchi ................................................................................................................................................... 26
Bronchioli................................................................................................................................................ 26
Overgangstype: respiratoire bronchiolen ................................................................................................. 27
Alveolen .................................................................................................................................................. 27
Afweersysteem ........................................................................................................................................... 30
Bovenste luchtwegen en bronchi (gasgeleiding)....................................................................................... 30
Alveoli (gasuitwisseling) .......................................................................................................................... 30
Hoofdstuk 4: transversale doorsneden ............................................................................................................ 31
Hoofdstuk 5: klinische gevallen ....................................................................................................................... 32
TNM-stembanden (glottis) .......................................................................................................................... 32
respiratoir distress syndroom ...................................................................................................................... 32
Longtumoren .............................................................................................................................................. 33
3
, ADEMHALING: MORFOLOGIE
HOOFDSTUK 1: INLEIDING
ALGEMENE FUNCTIES
- Ademhalingsstelsel
o Gasgeleidingsstelsel
o Gasuitwisselingsstelsel
- Neus
o Verwarmen, bevochtigen en reinigen van ingeademde lucht
o Reukorgaan
o Resonantiefunctie → bepalen timbre (klankkleur)
- Sinus
o Resonantiefunctie
o Temperatuurregeling van hersenen
- Mondholte
o Spraakorgaan
GASGELEIDINGSSTELSEL
- Buisvormige structuren
o Neus en mondholte
o Nasofarynx
o Larynx
o Trachea
o Bronchi en bronchioli
▪ Secundaire bronchioli
▪ Tertiaire bronchioli
- Functie
o Geleiding van lucht
o Opwarming van lucht
o Vochtigheid van lucht
o Zuivering van ingeademde lucht
GASUITWISSELINGSSTELSEL
- Longalveolen: zakvormige structuren die deel uitmaken van longparenchym
o Terminale bronchioli
o Ductuli alveolares
o Sacculi alveolares
- Functie
o Uitwisseling ingeademde zuurstof met koolzuurgas vanuit bloed
LARYNX
- ‘strottenhoofd’
- Opgebouwd uit kraakbeen en ligamenten
o Dragen van dwars gestreepte spieren
- Hol orgaan, bedekt met slijmvlies
4
, - Functies
o Klepfunctie → voedsel komt niet in luchtweg bij slikken
o Rol bij verhogen van intra-thoracale of intra-abdominale druk (hoesten, persen…)
o Rol in fonatie (= produceren van stemhebbende klanken)
▪ Sagittaal geplaatste stembanden wordt in trilling gebracht door expiratoire
luchtstroom
▪ Toonhoogte:
• Afh van dikte
• Afh van spanning
• Afh van lengte van trillende delen van stembanden
- Laryngoscopie.
STEMBANDEN (PLICAE)
- < 2 paar slijmvliesplooien
- Thv adamsappel met kleine spiertjes aan kraakbeen van larynx
- Bovenste 2 → valse stembanden
o Niet in trilling brengen
- Onderste 2 → ware stembanden
o < spiervezels
o Wel in trilling brengen
- °stemspleet: kleine opening die breder en smaller kan worden gemaakt
o Spiertjes → stembanden naar elkaar toe bewegen → regelen breedte van opening
o Lucht stroom door de opening → stembanden trillen → geluid
o Keel, tong en lippen zetten geluid om in taal
- Vrouwen: hogere stem
o Korte stembanden
o Hogere frequentie
- Mannen: lagere stem
o Lange stembanden
o Lagere frequentie
5
, HOOFDSTUK 2: ANATOMIE
NEUS
- Uniek in samenstelling
- < bot
- < kraakbeen
- Uitwendige neus
o Radix nasi
o Apex nasi
o Dorsum nasi
o Alae nasi
NEUSHOLTE
- 2 bilaterale, symmetrische holtes → verdeeld door septum (bot + kraakbeen)
- Neusgat → choanae → nasofarynx
- 2 compartimenten:
o Vestibulum nasi → huid in prox deel
o Nasale fossa → respiratoir epitheel
- 3 conchae (botschelpen)
o Concha superior > os ethmoïdale
o Concha media > os ethmoïdale
o Concha inferior > apart botstuk
- Neusgang telkens onder concha
o Meatus superior
▪ Uitmonden 1-2 cellulae ethmoidales posteriores
o Meatus media
Opening ductus nasolacrimalis
▪ Cellulae etmoidalis anteriores
▪ Sinus frontalis → via hiatus semilunares, zichtbaar bij verwijderen concha media
▪ Sinus maxillaris → via hiatus semilunares, zichtbaar bij verwijderen concha media
o Meatus inferior
▪ Uitmonden ductus nasolacrimalis → afvoeren traanvocht Hiatus semilunares
FUNCTIES NEUS EN CONCHAE
- Opwarmen ingeademde lucht
o Groot contactoppervlak tussen ingeademde lucht en mucosa
o Turbulentie ingeademde lucht
o Plexussen van capillairen en venen onder neusepitheel
▪ Opzwellen bij koude lucht
o Hoeveelheid energie, afh van temperatuur en vochtigheid
van de ingeademde lucht (10% van totale lichaamswarmte
verlies via neus)
- Bevochtigen ingeademde lucht
o Heropname van vocht bij uitademen → 1/3 wordt gerecupereerd
▪ Door condensatie van vocht op slijmvlies bij uitademen
o Drainage van nasolacrimale buizen
o Secreties van paranasale sinussen
6
