PATHOPHYSIOLOGY & ANATOMY AND PHYSIOLOGY

A. ANATOMY AND PHYSIOLOGY

The respiratory system is situated in the thorax, and is responsible for gaseous
exchange between the circulatory system and the outside world. Air is taken in via the
upper airways (the nasal cavity, pharynx and larynx) through the lower airways (trachea,
primary bronchi and bronchial tree) and into the small bronchioles and alveoli within the
lung tissue.
Move the pointer over the coloured regions of the diagram; the names will appear at the
bottom of the screen)

The lungs are divided into lobes; The left lung is composed of the upper lobe, the lower
lobe and the lingula (a small remnant next to the apex of the heart), the right lung is
composed of the upper, the middle and the lower lobes.

Mechanics of Breathing

To take a breath in, the external intercostal muscles contract, moving the ribcage up
and out. The diaphragm moves down at the same time, creating negative pressure
within the thorax. The lungs are held to the thoracic wall by the pleural membranes, and
so expand outwards as well. This creates negative pressure within the lungs, and so air
rushes in through the upper and lower airways.

Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if
they are not held against the thoracic wall. This is the mechanism behind lung collapse
if there is air in the pleural space (pneumothorax).

Respiration is carried on by the expansion and contraction of the lungs; the process and
the rate at which it proceeds are controlled by a nervous center in the brain.

In the lungs, oxygen enters tiny capillaries, where it combines with hemoglobin in the
red blood cells and is carried to the tissues. Simultaneously, carbon dioxide, which
entered the blood in its passages through the tissues, passes through capillaries into
the air contained within the lungs. Inhaling draws into the lungs air that is higher in
oxygen and lower in carbon dioxide; exhaling forces from the lungs air that is high in
carbon dioxide and low in oxygen. Changes in the size and gross capacity of the chest
are controlled by contractions of the diaphragm and of the muscles between the ribs.

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 PATHOPHYSIOLOGY OF COPD Exacerbation
Definition: COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive disease that makes it hard
to breathe. "Progressive" means the disease gets worse over time.

Chronic Obstructive Pulmonary Disease (COPD)

Precipitating
Predisposing Factors:
Factors: Smoking (56
Age years)
Gender Air Pollution
Race

Chronic
Inflammatory
Factors Process in the
Disease Process Airway
Signs and Syptoms
Complication Body attempts to
repair the
damage areas Typical posture:
due to the The patient tends
Productive Cough inflammation to lean forward.
w/ yellowish C
phlegm for at H
least 3 months R Over time, this Use of accessory
O Causes over Causes over muscles of
(since October stimulate of Goblet injury-and-repair distension of
N E respiration to
2010) I Cells that triggers process causes alveoli walls M breath.
C over production of scar tissue leading to the P
Mucous. formation. destruction. HY
Shortness of B S Uses the
R E
Breath (SOB) shoulder girdle
O M
when ambulating N Decrease alveolar upward and
Narrowing of the A
and straining C surface area. causing the
bronchial lumen &
H Increased dead supraclavicular
I plugging of the
space & impaired fossae to retract
T airway
I O2 diffusion on inspiration.
S
Weight loss
 Hypoxemia, Increases Pulmonary
Congestion,
respiratory Artery Pressures-
dependent edema
acidosis, Right Sided Heart
on both feet
destruction of Failure
(Ankle edema)
capillary beds. (cor pulmonae)

Respiratory
insufficiency &
failure