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Respiratory System Main function- supplies oxygen to the blood while removing carbon dioxide.

>The respiratory system organs oversee the gas exchanges that occur between the blood and the external environment. Using blood as the transporting fluid, the cardiovascular system organs transport respiratory gases between the lungs and the tissue cells.

Pediatric respiratory anatomy Differences between Pediatric and Adult Airway More rostral larynx Relatively larger tongue Angled vocal cords- Infant s vocal cords have more angled attachment to trachea, whereas adult vocal cords are more perpendicular Differently shaped epiglottis- Adult epiglottis broader, axis parallel to trachea; Infant epiglottis ohmega ( ) shaped and angled away from axis of trachea

unneled shaped larynx-narrowest part of pediatric airway is cricoid cartilage; narrowest part of infant s larynx is the undeveloped cricoid cartilage, whereas in the adult it is the glottis opening (vocal cord)

Divisions of the respiratory tract A. Structural a. Upper respiratory tract( nose larynx) b. Lower respiratory tract (bronchi- alveoli)  Because gas exchanges with the blood happen only in the alveoli, the other respiratory system structures are really just conducting passageways that allow air to reach the lungs. They also have important jobs namely, to purify, humidify, and warm incoming air. Upper respiratory tract  Nose a. External y External nares or nostrils- where air enters during breathing. b. Internal y Nasal septum- divides the interior nasal cavity. y Olfactory receptors- located in the mucosa in the slit like superior part of the nasal cavity, just beneath the ethmoid bone. y Respiratory mucosa- the rest of the mucosa lining the nasal cavity; Rests on a rich network of thin walled veins that warms the air as it flows past. Moistens the air and traps incoming bacteria and other debris by the sticky mucus produced by the mucosa s gland and lysozyme enzymes in the mucus destroys bacteria chemically.

Conchae- greatly increase the surface area of the mucosa exposed to the air. It also increase the air turbulence in the nasal cavity. y Palate- separates the nasal cavity from the oral cavity. o Hard palate- anteriorly, where the palate is supported by bone. o Soft palarte- the unsupported posterior part. y Paranasal sinuses(frontal, maxillary, ethmoidal and sphenoidal) lighten the skull, and they act as resonance chambers for speech. y Nasolacrimal ducts- drains tears from the eyes, also empty into the nasal cavities.  Pharynx y The pharynx is a muscular passageway also known as the throat. Common passage way for food and air. It is continuous with the nasal cavity anteriorly via the posterior nasal aperture. Air enters the superior portion, the nasopharynx, from the nasal cavity and then descends through the oropharynx and laryngopharynx to enter the larynx. The pharyngeal, palatine, and the lingual tonsils are found in the pharynx.  Larynx or voice box y Larynx composed of hyoid bone and a series of cartilages y Single: thyroid, cricoid, epiglottis y Paired: arytenoids, corniculates, and cuneiform y It routes air and food into the proper channels and plays a role in speech. It is formed by rigid hyaline cartilages and a spoon flap of elastic cartilage, the epiglottis. y Thyroid cartilage- The largest of the hyaline cartilages, which protrudes anteriorly and is commonly known as the Adam s apple. y Epiglottis - protects the superior opening of the larynx. When we swallow food or fluids, the larynx is pulled upward and the epiglottis tips, forming a lid over the larynx. The food is now rerouted to the esophagus. y Vocal cords- Part of the mucous membrane of the larynx, which vibrate with expelled air. This ability of the vocal folds to vibrate allows us to speak. y Glottis- The slit like passageway between the vocal folds. y Laryngeal folds consist of: y Paired aryepiglottic folds extend from epiglottis posteriorly to superior surface of arytenoids y Paired vestibular folds (false vocal cords) extend from thyroid cartilage posteriorly to superior surface of arytenoids y Paired vocal folds (true vocal cords) extend from posterior surface of thyroid plate to anterior part of arytenoids y Interarytenoid fold bridging the arytenoid cartilages y Thyrohyoid fold extend from hyoid bone to thyroid cartilage y  Trachea airly rigid because its walls are reinforced with C-shaped rings of hyaline cartilage. These y rings serve a double purpose. The open parts of the rings about the esophagus and allow it to expand when we swallow a large piece of food. The solid portion support the trachea walls and keep it patent, or open, in spite of the pressure changes that occur during breathing. y Divides into main bronchi.  Main bronchi

y y y

The right and the left are formed by the division of the trachea. Each main bronchus runs obliquely before it plunges into the medial depression of the lung on its own side. The right main bronchus is wider, shorter, and straighter than the left. It is the more common site for an inhaled foreign object to become lodged. By the time incoming air reaches the bronchi, it is warm, cleansed of most impurities, and well humidified.

 Lungs y They occupy the entire thoracic cavity except for the most central area, the mediastinum, which houses the heart, the great blood vessels, bronchi, esophagus, and other organs. y Apex-the narrow superior portion of each lung is just deep to the clavicle. y Base- The broad lung area resting on the diaphragm. y Each lung is divided into lobes by fissures; the left lung has two lobes, and the right lung has three. y The surface of each lung is covered with a visceral Serosa called the pulmonary, or visceral pleura, and the walls of the thoracic cavity are lined by the parietal pleura. y Pleural fluid- produced by the pleural membranes ; a slippery serous secretion which allows the lungs to glide easily over the thorax wall during breathing movements and causes the two pleural layers to cling together.  Bronchioles y After the primary bronchi enter the lungs, they subdivided into smaller branches, finally ending in the smallest of the conducting passageways, the bronchioles. Because of these branching passageways, the network formed is often referred as the respiratory tree. The terminal bronchioles lead into the respiratory zone structures which eventually terminate into the alveoli.  Alveoli y The alveoli are the final branchings of the respiratory tree and act as the primary gas exchange units of the lung. The gas-blood barrier between the alveolar space and the pulmonary capillaries is extremely thin, allowing for rapid gas exchange. To reach the blood, oxygen must diffuse through the alveolar epithelium, a thin interstitial space, and the capillary endothelium; CO2 follows the reverse course to reach the alveoli. The final line of defense for the respiratory tract is found in the alveoli. Macrophages also known as dust cells wander in and out of the alveoli picking up bacteria, carbon particles, and other debris. Most of the alveolar walls contain cuboidal cells which produce a lipid molecule called the surfactant. It coats the gas-exposed alveolar surfaces and lowers surface tension of the film of water lining the each alveolar sac so that they do not collapse between each breath. FUNCTIONS OF THE RESPIRATORY SYSTEM The major function of the respiratory system is to supply the body with oxygen and to dispose of carbon dioxide. To do this, at least four distinct events, collectively called respiration, must occur: y Pulmonary ventilation: Air must move into and out of the lungs so that the gases in the air sacs are continuously refreshed. Commonly called breathing. y External respiration: gas exchange occurs between the pulmonary blood and alveoli. y Respiratory gas transport: oxygen and carbon dioxide are transported to and from the lungs and tissue cells via the bloodstream

y Control

Internal Respiration: gas exchange occurs at systemic capillaries between the blood and tissue cells.

Ventilation occurs under the control of the autonomic nervous system from parts of the brain stem, the medulla oblongata and the pons. This area of the brain forms the respiration regulatory center, a series of interconnected brain cells within the lower and middle brain stem which coordinate respiratory movements. The sections are the pneumotaxic center, the apneustic center, and the dorsal and ventral respiratory groups. Inspiration Inhalation is initiated by the diaphragm and supported by the external intercostal muscles. Normal resting respirations are 10 to 18 breaths per minute, with a time period of 2 seconds. During vigorous inhalation (at rates exceeding 35 breaths per minute), or in approaching respiratory failure, accessory muscles of respiration are recruited for support. These consist of sternocleidomastoid, platysma, and the scalene muscles of the neck. Under normal conditions, the diaphragm is the primary driver of inhalation. When the diaphragm contracts, the ribcage expands and the contents of the abdomen are moved downward. This results in a larger thoracic volume and negative (suction) pressure (with respect to atmospheric pressure) inside the thorax. As the pressure in the chest falls, air moves into the conducting zone. Here, the air is filtered, warmed, and humidified as it flows to the lungs. During forced inhalation, as when taking a deep breath, the external intercostal muscles and accessory muscles aid in further expanding the thoracic cavity. Expiration Exhalation is generally a passive process; however, active or forced exhalation is achieved by the abdominal and the internal intercostal muscles. During this process air is forced or exhaled out. The lungs have a natural elasticity: as they recoil from the stretch of inhalation, air flows back out until the pressures in the chest and the atmosphere reach equilibrium. During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles, generate abdominal and thoracic pressure, which forces air out of the lungs. Inspiration Expiration

Circulation The right side of the heart pumps blood from the right ventricle through the pulmonary semilunar valve into the pulmonary trunk. The trunk branches into right and left pulmonary arteries to

the pulmonary blood vessels. The vessels generally accompany the airways and also undergo numerous branchings. Once the gas exchange process is complete in the pulmonary capillaries, blood is returned to the left side of the heart through four pulmonary veins, two from each side. The pulmonary circulation has a very low resistance, due to the short distance within the lungs, compared to the systemic circulation, and for this reason, all the pressures within the pulmonary blood vessels are normally low as compared to the pressure of the systemic circulation loop.

Gas exchange The major function of the respiratory system is gas exchange between the external environment and an organism's circulatory system. In humans and mammals, this exchange facilitates oxygenation of the blood with a concomitant removal of carbon dioxide and other gaseous metabolic wastes from the circulation. As gas exchange occurs, the acid-base balance of the body is maintained as part of homeostasis. If proper ventilation is not maintained, two opposing conditions could occur: 1) respiratory acidosis, a life threatening condition, and 2) respiratory alkalosis Upon inhalation, gas exchange occurs at the alveoli, the tiny sacs which are the basic functional component of the lungs. It occurs by simple diffusion through the respiratory membrane. The alveolar walls are extremely thin (approx. 0.2 micrometres). These walls are composed of a single layer of epithelial cells (type I and type II epithelial cells) in close proximity to the pulmonary capillaries which are composed of a single layer of endothelial cells. The close proximity of these two cell types allows permeability to gases and, hence, gas exchange. Oxygen is transported in the blood in two ways. Most attach to hemoglobin molecules to form oxyhemoglobin. The other amount of oxygen is carried and dissolved in plasma. Most carbon dioxide is transported in plasma as the bicarbonate ion, which plays a very important role in the blood buffer system. A smaller amount of Carbon dioxide is carried inside the RBCs bound to hemoglobin at a different site than oxygen does, and so it doesn t interfere in any way with oxygen transport. Before carbon dioxide can diffuse out of the blood into the alveoli, it must first be released from its bicarbonate ion form. For this to occur, bicarbonate ions must enter the RBC where they combine with hydrogen ion to form carbonic acid. Carbonic acid quickly splits to form water and carbon dioxide, which diffuses from the blood and enters the alveoli.