Anatomy & Physiology of the Respiratory System

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.

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).

Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to form very narrow terminal bronchioles,
which terminate in the alveoli. There are millions of alveloi in each lung, and these are the areas
responsible for gaseous exchange, presenting a massive surface area for exchange to occur over.

Each alveolus is very closely associated with a network of capillaries containing deoxygenated blood
from the pulmonary artery. The capillary and alveolar walls are very thin, allowing rapid exchange of
gases by passive diffusion along concentration gradients.

CO2 moves into the alveolus as the concentration is much lower in the alveolus than in the blood, and
O2 moves out of the alveolus as the continuous flow of blood through the capillaries prevents saturation
of the blood with O2 and allows maximal transfer across the membrane.

Significant Parts and organs involved:

 The nose consists of the visible external nose and the internal nasal cavity. The nasal septum
divides the nasal cavity into right and left sides. Air enters two openings, the external nares
(nostrils; singular, naris), and passes into vestibule and through passages called meatuses. The
bony walls of the meatuses, called concha, are formed by facial bones (the inferior nasal concha
and the ethmoid bone). From the meatuses, air then funnels into two (left and right) internal
nares. Hair, mucus, blood capillaries, and cilia that line the nasal cavity filter, moisten, warm, and
eliminate debris from the passing air.
 The pharynx (throat) consists of the following three regions, listed in order through which
incoming air passes:
 The nasopharynx receives the incoming air from the two internal nares. The two auditory tubes
that equalize air pressure in the middle ear also enter here. The pharyngeal tonsil (adenoid) lies
at the back of the nasopharynx.
 The oropharyrnx receives air from the nasopharynx and food from the oral cavity. The palatine
and lingual tonsils are located here.
 The laryngopharynx passes food to the esophagus and air to the larynx.

 The larynx receives air from the laryngopharynx. It consists of several pieces of cartilage that are
joined by membranes and ligaments.
 The epiglottis, the first piece of cartilage of the larynx, is a flexible flap covers the glottis, the
upper region of the larynx, during swallowing toprevent the entrance of food.
 The thyroid cartilage protects the front of the larynx. A forward projection of this cartilage
appears as the Adam's apple (anatomically known as the laryngeal prominence).
 The paired arytenoid cartilages in the rear are horizontally attached to thethyroid cartilage in the
front by folds of mucous membranes. The upper vestibular folds (false vocal cords) contain
muscle fibers that bring the folds together and allow the breath to be held during periods of
muscular pressure on the thoracic cavity (straining while defecating or lifting a heavy object, for
example). The lower vocal folds (true vocal cords) contain elastic ligaments that vibrate when
skeletal muscles move them into the path of outgoing air. Various sounds, including speech, are
produced in this manner.
 The cricoid cartilage, the paired cuneiform cartilages, and the paired corniculate cartilages are
the remaining cartilages supporting the larynx.

 The trachea (windpipe) is a flexible tube, 10 to 12 cm (4 inches) long and 2.5 cm (1 inch) in
diameter.
 The mucosa is the inner layer of the trachea. It contains mucus-producing goblet cells and
pseudostratified ciliated epithelium. The movement of the cilia sweeps debris away from the
lungs toward the pharynx.
 The submucosa is a layer of areolar connective tissue that surrounds the mucosa.
 Hyaline cartilage forms 16 to 20 C-shaped rings that wrap around the submucosa. The rigid rings
prevent the trachea from collapsing during inspiration.
 The adventitia is the outermost layer of the trachea. It consists of areolar connective tissue.
 The primary bronchi are two tubes that branch from the trachea to the left and right lungs.
 Inside the lungs, each primary bronchus divides repeatedly into branches of smaller diameters,
forming secondary (lobar) bronchi, tertiary (segmental) bronchi, and numerous orders of
bronchioles (1 mm or less in diameter), including terminal bronchioles (0.5 mm in diameter) and
microscopic respiratory bronchioles. The wall of the primary bronchi is constructed like the
trachea, but as the branches of the tree get smaller, the cartilaginous rings and the mucosa are
replaced by smooth muscle.
 Alveolar ducts are the final branches of the bronchial tree. Each alveolar duct has enlarged,
bubblelike swellings along its length. Each swelling is called an alveolus. Some adjacent alveoli
are connected by alveolar pores.
 The respiratory membrane consists of the alveolar and capillary walls. Gas exchange occurs
across this membrane. Characteristics of this membrane follow:
 Type I cells are thin, squamous epithelial cells that constitute the primary cell type of the
alveolar wall. Oxygen diffusion occurs across these cells.
 Type II cells are cuboidal epithelial cells that are interspersed among the type I cells. Type II cells
secrete pulmonary surfactant (a phospholipid bound to a protein) that reduces the surface
tension of the moisture that covers the alveolar walls. A reduction in surface tension permits
oxygen to diffuse more easily into the moisture. A lower surface tension also prevents the
moisture on opposite walls of an alveolus or alveolar duct from cohering and causing the minute
airway to collapse.
 Alveolar macrophage cells (dust cells) wander among the other cells of the alveolar wall,
removing debris and microorganisms.
 A thin epithelial basement membrane forms the outer layer of the alveolar wall.
 A dense network of capillaries surrounds each alveolus. The capillary walls consist of endothelial
cells surrounded by a thin basement membrane. The basement membranes of the alveolus and
the capillary are often so close that they fuse.
 Predisposing Factor: Precipitating Factor

Age, Weather, Genetics  Environment

Aspiration of microbes

Failure of defenses

Invasion of lower respiratory tract

Pathophysiology of PCAP
 Increase capillary permeability

Escape of plasma Escape of RBC serum and Transportation of phagocyting cells

Fibrin

Engulfing of Antigen
Edema Exudate formation

Activation of B-cells

Release of antibodies

Antigen-Antibody reaction

Antigen Antibody Complex Adhere to the Mucosal Initiation of immune system

Lining of the lower respiratory tract

Mucosal irritation Vasodilation

Increase mucus production

Increased blood flow

Accumulation of mucus
Vaso-congestion

Productive cough

Increase plasma Hydrostatic Pressure

Ineffective airway
 Cell becomes infected
Narrowing of airways
Filling of bronchi and
alveoli Detection of the infected cell by
the T-cells
Use of accessory muscles

Consolidation of lung
Effector T-cells destroy
antigen
Increase respiration

Regulatory T-cells strengthen

Decrease lung act of effector cells
Asymmetrical chest inflation

Effector and regulatory cells synthesize

and release cytokinase

Ineffective breathing pattern

Altered temperature regulating

mechanism in the hypothalamus

Hyperthermia