Anatomy And Physiology Of The Human

Lung
The lungs are the primary organs of the respiratory system. The main function of the human respiratory system is to transport oxygen from the
atmosphere into the blood, and to expel carbon dioxide from the body. Healthy levels of oxygen are absolutely crucial for the human body, as
oxygen gives our cells energy and helps them regenerate.
The Anatomy Of The Lung
Each lung is divided into lobes. The right lung, which has three lobes, is slightly larger than the left, which has two. The lungs are housed in the
chest cavity, or thoracic cavity, and covered by a protective membrane called the pleura. The diaphragm, the primary muscle involved in
respiration, separates the lungs from the abdominal cavity.
The pulmonary arteries carry de-oxygenated blood from the right ventricle of the heart to the lungs. The pulmonary veins, on the other hand,
carry oxygenated blood from the lungs to the heart, so it can be pumped to the rest of the body.

How The Lungs Work
The lungs expand upon inhalation, or inspiration, and fill with air. They then return to their resting volume and push air out upon exhalation, or
expiration. These two movements make up the process of breathing, or respiration.
The respiratory system contains several structures. When you breathe, the lungs facilitate this process:
1. Air comes in through the mouth and/or nose, and travels down through the trachea, or
"windpipe." This air travels down the trachea into two bronchi, one leading to each lung.
The bronchi then subdivide into smaller tubes called bronchioles. The air finally fills the
alveoli, which are the small air sacs at the ends of the bronchioles.
2. In the alveoli, the lungs facilitate the exchange of oxygen and carbon dioxide to and from
the blood. Adult lungs have hundreds of alveoli, which increase the lungs' surface area and
speed this process. Oxygen travels across the membranes of the alveoli and into the blood
in the tiny capillaries surrounding them.
3. Oxygen molecules bind to hemoglobin in the blood and are carried throughout the body.
This oxygenated blood can then be pumped to the body by the heart.
4. The blood also carries the waste product carbon dioxide back to the lungs, where it is
transferred into the alveoli in the lungs to be expelled through exhalation.
Smoking can damage the alveoli and make breathing labor intensive, resulting in emphysema or lung cancer.
Types Of Respiration
Two types of respiration exist:
y Quiet respiration happens when the body is at rest. During quiet respiration, the diaphragm
contracts and pulls down, lowering the pressure in the lungs and causing air to enter the
lungs through the mouth and nose to equalize the pressure. When the diaphragm relaxes, it
moves back up, pushing air back out of the lungs. The lungs and chest walls also return to
their resting positions. This also reduces the size of the chest cavity and helps to push air out
of the lungs.
y Active respiration occurs when the body is active and requires higher levels of oxygen to
the blood than when resting. During active respiration, the muscles around the ribs raise
and push out the ribs and sternum, which increases thoracic volume, helping the lungs take
in more air. During exhalation, the intercostals force the ribs to contract, and the abdominal
muscles contract, forcing the diaphragm to rise. Both these movements make the thoracic
cavity contract, and help push air out of the lungs.
The Lungs' Protections
Several lung parts and functions act as protective mechanisms to keep out irritants and foreign particles. The hairs and mucus in the nose
prevent foreign particles from entering the respiratory system.
The breathing tubes in the lungs secrete mucus, which also helps protect the lungs from foreign particles. This mucus is naturally pushed up
toward the epiglottis, where is passed into the esophagus and swallowed. Coughing up any of this mucus is usually an indication of a respiratory
infection, or a condition such as bronchitis or chronic obstructive pulmonary disease (COPD). Irritants can also cause bronchospasm, in which
the muscles around the bronchial tubes constrict in order to keep out irritants. Asthma involves inflammation and constriction of the bronchial
tubes, and is often triggered by environmental irritants. Bronchial constriction causes breathing difficulties.
About Breathing Difficulties
Damage to any part of the respiratory pathway can also cause breathing difficulties. Understanding human lung anatomy and physiology makes
clear how the different lung parts are affected in disease.
In people with bronchitis, the bronchial tubes become inflamed and irritated. They produce mucus, resulting in a cough. Bronchitis can be
acute, with a sudden onset and quick recovery, or chronic, and last much longer.
Chronic obstructive pulmonary disease (COPD) involves symptoms of both chronic bronchitis and emphysema. Blockage in the bronchioles and
alveoli make it difficult to exhale. This traps air in the lungs and in turn makes proper inhalation difficult.
Interstitial lung disease, including pulmonary fibrosis, causes a buildup of scar tissue in the lungs and reduces lung function. Any of these
conditions affect not only the lungs, but the entire body, as the healthy respiration is required to supply oxygen to the body and its organs.

LUNGS - Anatomy and Physiology
The cardinal function of normal lungs is the exchange of gases between inspired air and the blood.
The right lung is divided into 3 lobes and left lung has 2 lobes.
The main right and left bronchi arise from the trachea and then branch progressively forming smaller airways.
The right main bronchus is more vertical and more directly in line with the trachea than is the left.
As a result, aspirated foreign material, such as vomitus, blood, foreign bodies enters the right lung rather than the
left.
The lungs have double blood supply through pulmonary and bronchial arteries.
Bronchial arteries of aortic origin can sustain the vitality of the pulmonary parenchyma when pulmonary arterial
supply is shut off, as by emboli.
Bronchi are lined by pseudostratified epithelium and most of the cells are ciliated.
Bronchial mucosa contains mucus-secreting goblet cells.
Neuroendocrine cells are present in the bronchial basal layer secrete a variety of hormones e.g. serotonin,
calcitonin and gastrin-releasing peptide (bombesin).
Progressive branching of the bronchi forms bronchioles which differ from bronchi in that they contain neither
cartilage nor mucus-secreting glands.
Distal part of the bronchiole is called terminal bronchioles.
Distal part of the terminal bronchiole is called acinus which contains alveoli.
Alveoli are lined by type I and type II cells.
Capillaries of the alveolar wall are the site of gas exchange.
Alveoli are lined by 2 types of epithelium:
1. Type-I pneumocytes (40 %), which are thin with large surface area and facilitates gas exchange. They cover 95 %
of alveolar surface.
2. Type-II pneumocytes (60 %) covers only 5 % of alveolar surface.
These cells have two functions:
i) They are the source of pulmonary surfactant, which maintains the patency of alveoli.
ii) They repair the alveolar epithelium after destruction of Type-I cells, which are easily destroyed by injury.
Type-II cells multiply and differentiate to form Type-I cells, reconstituting alveolar surface area.
Alveolar macrophages are loosely attached to the alveolar epithelium or lying free within the alveolar space and
phagocytose carbon and other foreign particles.
Alveolar walls are perforated by numerous pores of Kohn, which permit the passage of bacteria and exudates
between adjacent alveoli.
Defense mechanism of respiratory tract:
Airway epithelium is protected by the mucociliary blanket that drives the particles, deposited on it, towards
trachea, which are then removed by swallow or coughing out.
Smaller particles entering the alveolar spaces are swallowed by the alveolar macrophages and removed.
Very small particles behave as gas and are exhaled.
Photos :



Anatomy of the Respiratory System

The respiratory system consists of two tracts: The upper respiratory tract includes the nose (nasal cavity,
sinuses), mouth, larynx, and trachea (windpipe). The lowerrespiratory tract includes the lungs, bronchi,
and alveoli.
The two lungs, one on the right and one on the left, are the body's major respiratory organs. Each lung is
divided into upper and lower lobes, although the upper lobe of the right lung contains a third subdivision
known as the right middle lobe. The right lung is larger and heavier than the left lung, which is
somewhat smaller in size because of the predominately left-side position of the heart.
A clear, thin, shiny coating -- the pleura -- envelopes the lungs. The inner, visceral layer of the pleura
attaches to the lungs; the outer, parietal layer attaches to the chest wall (thorax). Pleural fluid holds both
layers in place, in a manner similar to two microscope slides that are wet and stuck together. The lungs
are separated from each other by the mediastinum, an area that contains the heart and its large vessels,
the trachea (windpipe), esophagus, thymus, andlymph nodes. The diaphragm, the muscle that contracts
and relaxes in breathing, separates the thoracic cavity from the abdominal cavity.
Air Distribution
On inspiration, air enters the body through the nose and the mouth. Nasal hairs and mucosa (mucus)
filter out dust particles and bacteria and warm and moisten the air. Less warming, filtering, and
humidification occur when air is inspired through the mouth.
Air travels down the throat, or pharynx, where two openings exist, one into the esophagus for passage of
food, and the other into the larynx (voice box) and trachea (windpipe) for continued airflow. When food is
swallowed, the opening of the larynx (the epiglottis) automatically closes, preventing food from being
inhaled. When air is inspired, the walls of the esophagus are collapsed, preventing air from entering the
stomach. The larynx, which also contain the vocal cords, is lined with mucus that further warms and
humidifies the air.
Air continues continues down the trachea, which branches into the right
and left bronchi. The main-stem bronchi divide into smaller bronchi, then
into even smaller tubes called bronchioles. The bronchial structures
contain hair-like, epithelial projections, called cilia, that beat rythmically
to sweep debris out of the lungs toward the pharynx for expulsion. Once
in the bronchioles, the air is at body temperature,
contains 100%
humidity, and is
(hopefully)
completely
filtered.

Bronchioles end in air sacs called alveoli --
small, thin-walled "balloons," arranged in
clusters. When you breathe in, enlarging the
chest cavity, the "balloons" expand as air rushes in to fill the
vacuum. When you breathe out, the "balloons" relax and air moves out of the lungs. It is at the alveoli
that gas exchange occurs. Tiny blood vessels, capillaries, surround each of the alveoli. On inspiration, the
concentration of dissolved oxygen is greater in the alveoli than in the capillaries. Oxygen, therefore,
diffuses across the alveolar walls into the blood plasma. In the reverse process, carbon dioxide
concentration is greater in the blood than the alveoli, so it passes from the blood into the alveoli and is
ultimately breathed out.
As oxygen diffuses into the plasma, hemoglobin in the red blood cell picks up the oxygen, permitting more
to flow into the plasma. The oxygen-carrying capacity of hemoglobin allows the blood to carry over 70
times more oxygen than if the oxygen were simply dissolved in the plasma alone. Therefore, the total
oxygen uptake depends on: 1) the difference in oxygen concentration between the blood and alveoli, 2)
the healthy functioning of the alveoli, and 3) the rate of respiration.
Pathophysiology
Once inhaled, the infectious droplets settle throughout the airways. The majority of the bacilli
are trapped in the upper parts of the airways where the mucus-secreting goblet cells exist. The
mucus produced catches foreign substances, and the cilia on the surface of the cells constantly
beat the mucus and its entrapped particles upward for removal.
8
This system provides the body
with an initial physical defense that prevents infection in most persons exposed to
tuberculosis.
9

Bacteria in droplets that bypass the mucociliary system and reach the alveoli are quickly
surrounded and engulfed by alveolar macrophages,
7,8
the most abundant immune effector cells
present in alveolar spaces.
10
These macrophages, the next line of host defense, are part of the
innate immune system and provide an opportunity for the body to destroy the invading
mycobacteria and prevent infection.
11
Macrophages are readily available phagocytic cells that
combat many pathogens without requiring previous exposure to the pathogens. Several
mechanisms and macrophage receptors are involved in uptake of the mycobacteria.
11
The
mycobacterial lipoarabinomannan is a key ligand for a macrophage receptor.
12
The complement
system also plays a role in the phagocytosis of the bacteria.
13
The complement protein C3 binds
to the cell wall and enhances recognition of the mycobacteria by macrophages. Opsonization by
C3 is rapid, even in the air spaces of a host with no previous exposure to M tuberculosis.
14
The
subsequent phagocytosis by macrophages initiates a cascade of events that results in either
successful control of the infection, followed by latent tuberculosis, or progression to active
disease, called primary progressive tuberculosis.
8
The outcome is essentially determined by the
quality of the host defenses and the balance that occurs between host defenses and the
invading mycobacteria.
11,15

After being ingested by macrophages, the mycobacteria continue to multiply slowly,
8
with
bacterial cell division occurring every 25 to 32 hours.
4,7
Regardless of whether the infection
becomes controlled or progresses, initial development involves production of proteolytic
enzymes and cytokines by macrophages in an attempt to degrade the bacteria.
11,12
Released
cytokines attract T lymphocytes to the site, the cells that constitute cell-mediated immunity.
Macrophages then present mycobacterial antigens on their surface to the T cells.
11
This initial
immune process continues for 2 to 12 weeks; the microorganisms continue to grow until they
reach sufficient numbers to fully elicit the cell-mediated immune response, which can be
detected by a skin test.
4,8,11

For persons with intact cell-mediated immunity, the next defensive step is formation of
granulomas around the M tuberculosis organisms
16
(Figure 1). These nodular-type lesions form
from an accumulation of activated T lymphocytes and macrophages, which creates a micro-
environment that limits replication and the spread of the mycobacteria.
8,12
This environment
destroys macrophages and produces early solid necrosis at the center of the lesion; however,
the bacilli are able to adapt to survive.
18
In fact, M tuberculosisorganisms can change their
phenotypic expression, such as protein regulation, to enhance survival.
13
By 2 or 3 weeks, the
necrotic environment resembles soft cheese, often referred to caseous necrosis, and is
characterized by low oxygen levels, low pH, and limited nutrients. This condition restricts
further growth and establishes latency. Lesions in persons with an adequate immune system
generally undergo fibrosis and calcification, successfully controlling the infection so that the
bacilli are contained in the dormant, healed lesions.Lesions in persons with less effective
immune systems progress to primary progressive tuberculosis.
4,8,13,18






Puthophyslology of tuberculosls: lnhulutlon of bucllll (A), contulnment ln u grunulomu (B), und
breukdown of the grunulomu ln less lmmunocompetent lndlvlduuls (C).










Pathophysiology of Pulmonary Tuberculosis
























High Risk Factors:
1. Old Age
2. Infants
3. Children
4. Low Socio-
Economic Status
5. Drug Addicts
6. HIV Positive
7. Severely
Malnourished
8. Health Care
Workers
Etiological Agent:
Mycobacterium
tuberculosis

Environmental Factors:
1. High-Risk
Communities
2. Low income
Communities
3. Health Care
Facilities

Diagnostic Procedures:
1. Medical History
2. Physical
Examination
3. Chest Radiography
4. Mantoux tuberculin
skin test
5. Microbiological
smears and cultures
Mode of Entry:
Respiratory Tract








Signs and Symptoms
1. Fever 10. Anxiety
2. Fatigue 11. Low Self-Esteem
3. Anorexia 12. Elevated WBC
4. Hemoptysis
5. Productive Cough
6. Night Sweats
7. Pallor
8. Chest Pain
9. Dyspnea

Death
Treatment
1. Anti-TB
Drugs
2. Surgery

Cure