Respiratory System I Anatomy Definition: Respiration (see Vander p. 442) Internal Respiration vs.

. Pulmonary Physiology Overview of Respiratory System Functions: Gas Exchange: Provide O2 Eliminate CO2 Regulate blood pH Speech Defense

Major Components Upper Respiratory Tract Lower Respiratory Tract

Gross Anatomy Upper Respiratory Tract Nose, sinuses

Pharynx Lower Respiratory Tract Larynx Trachea Bronchial Tree Thoracic Cavity Lungs Pleural Membranes

Functional Divisions Conducting Zone: Transports Air Nose, nasal cavity Pharynx Larynx Trachea Bronchi Bronchioles Terminal Bronchioles Respiratory Zone: Gas Exchange Respiratory bronchioles Alveolar Ducts Alveoli Gross Anatomy

Conducting Zone Nose, sinuses: air conditioning Pharynx Common to respiratory and digestive systems Larynx Voice box

Trachea (Conducting Zone) Incomplete cartilage rings Pseudostratified ciliated columnar epithelium Bronchi Primary Bronchi Secondary Bronchi Tertiary Bronchi Bronchioles Terminal Bronchioles Tissue Transitions from Primary Bronchi to Terminal Bronchioles: (see Table 25.2M) Cartilage: Epithelium: Smooth Muscle:

Respiratory Zone Respiratory bronchioles

Alveolar Ducts Alveoli Note Pulmonary Capillaries

Lungs

Alveoli

Three lobes for right lung Two lobes for left lung

Type I Alveolar Cells Type II Alveolar Cells Respiratory Membrane Respiratory Membrane Thickness: ~.2 micron Surface Area of Respiratory Membrane = that of tennis court

Thoracic Cavity Thorax Thoracic vertebrae Ribs (+ intercostal muscles) Sternum Diaphragm = floor

Pleural Sac Double (serous) membrane Visceral pleura Parietal pleura Intrapleural fluid serous (thin, watery) lubrication

Respiratory System Physiology Overview: Respiratory Physiology Ventilation getting lungs ventilated

Gas Exchange Transport of respiratory gases in the blood

Ventilation: Respiratory Mechanics Air moves in and out of lungs by bulk flow:

F = P / R

Pressures**** equations not given on exam

Atmospheric Pressure (PATM) = 0 (by convention) Alveolar Pressure (PALV) inside alveoli; connected with outside; pressure will always equilibrate with
atmospheric pressure (allows us to do ventilation) Intrapleural Pressure (PIP) in between serous membrane (intrapleural fluid); negative with respect to Patm, and Palv; at rest is -4mmHg Transpulmonary Pressure (PTP) = PALV PIP

holding lungs open

Chest wall (PCW) = PIP PATM

Definitions Alveolar Pressure (PALV) Pressure w/in alveoli, equalizes w/ PATM Intrapleural Pressure (PIP) Pressure in intrapleural fluid, about 4 mm Hg less than PATM (and up to ~ 7 mm Hg less during inspiration) Transpulmonary Pressure (PTP = PALV PIP) between alveolar space and intrapleural space Pressure across lung wall Holds lungs open PCW = PIP PATM ; pressure across chest wall (ribs, muscle, etc; outside chest wall). Since P ATM > PIP, chest wall is actually slightly compressed.

Mechanism of Negative Pressure in Intrapleural Space (P IP) Two forces try to pull lungs (via visceral pleura) away from thorax wall (parietal pleura) Recoil due to lungs elasticity Surface tension of alveolar fluid (tries to collapse alveoli)

Transpulmonary Pressure - opposing force that keeps lungs open: Note: surface tension created by pleural fluid glues visceral pleura (and lungs) to parietal pleura

As lungs try to collapse (due to elasticity and alveolar fluid surface tension) and thoracic wall tries to expand (recall, it is compressed by higher outside P ATM), the tiny enlargement of fluid-filled intrapleural space drops the pressure below PATM Pneumothorax Accumulation of air in pleural space

Caused by trauma or some medical conditions Dyspnea and sharp pain on one side Absent or decreased breath sounds on one side Gunshot or stab wound to chest wall Sucking Wound and collapse of lung Spontaneous Pneumothorax small tear in lung

Ventilation and Lung Mechanics Bulk Flow: F = P / R

Apply to ventilation:

F = (PALV PATM)/ R

Boyles Law: With a closed container and a fixed # of gas molecules:

Inverse relationship between pressure and volume

Boyles Law means: V P FLOW (of air)

Increase in (thoracic) volume decrease in (thoracic) pressure Air Flows IN Decrease in volume increase in pressure Air Flows OUT

Rhythmic Breathing at Rest Humans, like all mammals, are negative pressure breathers (Figs. 13.12, 13.15V; 25.5M) Diaphragm Like all respiratory muscles, a skeletal muscle Innervated by phrenic nerve (C3-C4) Normal quiet (resting) inspiration (accomplished by diaphragm, I ? need for intercostals)

Expiration Passive process, due to relaxation of Diaphragm + lungs elasticity

**Summary of PIP, Palv and PTP changes and air flow during respiratory cycle (fig. 13.13V)

Note: A transpleural pressure drop of approximately 3 mmHg was all that was required for the lungs to expand enough for a tidal breath of 500 ml! Accessory Muscles of Inspiration and Expiration accomplish Forced Inhalation/Exhalation Forced Inspiration (Inhalation): Diaphragm increases superior-inferior dimension of thorax External intercostals contraction increases antero-posterior (AP) dimension Add accessory muscles of inspiration: Sternocleidomastoid Scalene (neck) muscles Trapezius Erector spinae

Hyperdevelopment of these accessory muscles may be seen in patients with chronic obstructive pulmonary disease (COPD) Forced Expiration (Exhalation) Internal intercostals

Abdominal muscles Latissimus dorsi

Quadratus lumborum Recall that passive expiration requires no muscular effort Physical Factors Influencing Pulmonary Ventilation Respiratory Passageway Resistance Should be insignificant Greatest resistance in medium-sized bronchi

Diameter of bronchioles Controlled by smooth muscle Parasympathetic stimulation: constricts Sympathetic stimulation; EPI: dilate bronchioles Asthma

airflow

Increased smooth muscle constriction (and airway constriction) increased resistance to Increased mucus Smoke, stress, exercise can exacerbate

Lung Compliance A measure of distensibility:

C = V / P

How easy it is for lungs to stretch How much of a pressure change is required? Normally, only a few mm Hg

Factors Determining Lung Compliance Lung elasticity

Alveolar surface tension Water coating alveoli tends to collapse alveoli surface tension forces Surfactant prevents this Lipoprotein with detergent action to decrease surface tension Produced by type II (cuboidal) alveolar epithelial cells Elasticity of thoracic cage is also important

Factors Decreasing Compliance Anything decreasing lung elasticity Emphysema

Obstructions of bronchi or small passageways COPD Chronic bronchitis and/or Emphysema What is COPD? Chronic Obstructive Pulmonary Disease Two main forms Chronic bronchitis long term cough with mucus Emphysema Symptoms: Cough (with mucus), dyspnea (SOB); Fatigue, Frequent respiratory infections; Wheezing Main cause: Smoking

Factors Decreasing Compliance Anything decreasing lung elasticity

Increased surface tension of alveolar fluid Respiratory Distress Syndrome In adult, many causes Sepsis, shock, gastric aspiration, etc. Epithelial damage inflammation loss of surfactant Lungs become stiff and difficult to inflate Newborn: Prematurity Immature lungs do not yet produce surfactant Very strenuous to breathe Decreased elasticity of chest wall/flexibility of thorax Severe scoliosis