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The Respiratory System

Anatomy

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Chapter 22, Respiratory System

Respiratory System

Consists of the respiratory and conducting zones Respiratory zone


Site of gas exchange Consists of bronchioles, alveolar ducts, and alveoli

Chapter 22, Respiratory System

Respiratory System

Conducting zone
Provides rigid conduits for air to reach the sites of gas exchange

Includes all other respiratory structures (e.g., nose, nasal cavity, pharynx, trachea)

Respiratory muscles diaphragm and other muscles that promote ventilation

Chapter 22, Respiratory System

Respiratory System

Chapter 22, Respiratory System

Figure 22.1

Major Functions of the Respiratory System

To supply the body with oxygen and dispose of carbon dioxide Respiration four distinct processes must happen
Pulmonary ventilation moving air into and out of the lungs
External respiration gas exchange between the lungs and the blood
Chapter 22, Respiratory System 5

Major Functions of the Respiratory System

Transport transport of oxygen and carbon dioxide between the lungs and tissues

Internal respiration gas exchange between systemic blood vessels and tissues

Chapter 22, Respiratory System

Function of the Nose


The only externally visible part of the respiratory system that functions by:
Providing an airway for respiration Moistening (humidifying) and warming the entering air

Filtering inspired air and cleaning it of foreign matter


Serving as a resonating chamber for speech Housing the olfactory receptors
Chapter 22, Respiratory System 7

Structure of the Nose


The nose is divided into two regions
The external nose, including the root, bridge, dorsum nasi, and apex The internal nasal cavity

Philtrum a shallow vertical groove inferior to the apex The external nares (nostrils) are bounded laterally by the alae
Chapter 22, Respiratory System 8

Structure of the Nose

Chapter 22, Respiratory System

Figure 22.2a

Structure of the Nose

Chapter 22, Respiratory System

Figure 22.2b 10

Nasal Cavity

Lies in and posterior to the external nose Is divided by a midline nasal septum Opens posteriorly into the nasal pharynx via internal nares The ethmoid and sphenoid bones form the roof

The floor is formed by the hard and soft palates


Chapter 22, Respiratory System 11

Nasal Cavity

Vestibule nasal cavity superior to the nares


Vibrissae hairs that filter coarse particles from inspired air

Olfactory mucosa
Lines the superior nasal cavity Contains smell receptors

Chapter 22, Respiratory System

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Nasal Cavity

Respiratory mucosa
Lines the balance of the nasal cavity Glands secrete mucus containing lysozyme and defensins to help destroy bacteria

Chapter 22, Respiratory System

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Nasal Cavity

Chapter 22, Respiratory System

Figure 22.3b 14

Nasal Cavity

Inspired air is:


Humidified by the high water content in the nasal cavity Warmed by rich plexuses of capillaries

Ciliated mucosal cells remove contaminated mucus

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Nasal Cavity

Superior, medial, and inferior conchae:


Protrude medially from the lateral walls
Increase mucosal area

Enhance air turbulence and help filter air

Sensitive mucosa triggers sneezing when stimulated by irritating particles


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Chapter 22, Respiratory System

Functions of the Nasal Mucosa and Conchae

During inhalation the conchae and nasal mucosa:


Filter, heat, and moisten air

During exhalation these structures:


Reclaim heat and moisture Minimize heat and moisture loss

Chapter 22, Respiratory System

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Paranasal Sinuses

Sinuses in bones that surround the nasal cavity


Sinuses lighten the skull and help to warm and moisten the air

Chapter 22, Respiratory System

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Pharynx

Funnel-shaped tube of skeletal muscle that connects to the:


Nasal cavity and mouth superiorly Larynx and esophagus inferiorly

Extends from the base of the skull to the level of the sixth cervical vertebra

Chapter 22, Respiratory System

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Pharynx

It is divided into three regions


Nasopharynx
Oropharynx

Laryngopharynx

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Nasopharynx
Lies posterior to the nasal cavity, inferior to the sphenoid, and superior to the level of the soft palate Strictly an air passageway

Lined with pseudostratified columnar epithelium


Closes during swallowing to prevent food from entering the nasal cavity The pharyngeal tonsil lies high on the posterior wall Pharyngotympanic (auditory) tubes open into the lateral walls
Chapter 22, Respiratory System 21

Oropharynx
Extends inferiorly from the level of the soft palate to the epiglottis Opens to the oral cavity via an archway called the fauces Serves as a common passageway for food and air The epithelial lining is protective stratified squamous epithelium Palatine tonsils lie in the lateral walls of the fauces Lingual tonsil covers the base of the tongue
Chapter 22, Respiratory System 22

Laryngopharynx

Serves as a common passageway for food and air Lies posterior to the upright epiglottis Extends to the larynx, where the respiratory and digestive pathways diverge

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Larynx (Voice Box)


Attaches to the hyoid bone and opens into the laryngopharynx superiorly Continuous with the trachea posteriorly

The three functions of the larynx are:


To provide a patent airway

To act as a switching mechanism to route air and food into the proper channels
To function in voice production
Chapter 22, Respiratory System 24

Framework of the Larynx


Cartilages (hyaline) of the larynx
Shield-shaped anterosuperior thyroid cartilage with a midline laryngeal prominence (Adams apple) Signet ringshaped anteroinferior cricoid cartilage

Three pairs of small arytenoid, cuneiform, and corniculate cartilages

Epiglottis elastic cartilage that covers the laryngeal inlet during swallowing
Chapter 22, Respiratory System 25

Framework of the Larynx

Chapter 22, Respiratory System

Figure 22.4a, b 26

Vocal Ligaments

Attach the arytenoid cartilages to the thyroid cartilage Composed of elastic fibers that form mucosal folds called true vocal cords
The medial opening between them is the glottis They vibrate to produce sound as air rushes up from the lungs
Chapter 22, Respiratory System 27

Vocal Ligaments

False vocal cords


Mucosal folds superior to the true vocal cords

Have no part in sound production

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Vocal Production
Speech intermittent release of expired air while opening and closing the glottis

Pitch determined by the length and tension of the vocal cords


Loudness depends upon the force at which the air rushes across the vocal cords The pharynx resonates, amplifies, and enhances sound quality Sound is shaped into language by action of the pharynx, tongue, soft palate, and lips
Chapter 22, Respiratory System 29

Movements of Vocal Cords

Chapter 22, Respiratory System

Figure 22.5 30

Sphincter Functions of the Larynx


The larynx is closed during coughing, sneezing, and Valsalvas maneuver

Valsalvas maneuver
Air is temporarily held in the lower respiratory tract by closing the glottis Causes intra-abdominal pressure to rise when abdominal muscles contract

Helps to empty the rectum


Acts as a splint to stabilize the trunk when lifting heavy loads
Chapter 22, Respiratory System 31

Trachea
Flexible and mobile tube extending from the larynx into the mediastinum

Composed of three layers


Mucosa made up of goblet cells and ciliated epithelium Submucosa connective tissue deep to the mucosa Adventitia outermost layer made of C-shaped rings of hyaline cartilage
Chapter 22, Respiratory System 32

Trachea

Chapter 22, Respiratory System

Figure 22.6a 33

Conducting Zone: Bronchi


The carina of the last tracheal cartilage marks the end of the trachea and the beginning of the right and left bronchi Air reaching the bronchi is:
Warm and cleansed of impurities Saturated with water vapor

Bronchi subdivide into secondary bronchi, each supplying a lobe of the lungs Air passages undergo 23 orders of branching in the lungs
Chapter 22, Respiratory System 34

Conducting Zone: Bronchial Tree

Tissue walls of bronchi mimic that of the trachea As conducting tubes become smaller, structural changes occur
Cartilage support structures change Epithelium types change Amount of smooth muscle increases

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Conducting Zone: Bronchial Tree

Bronchioles
Consist of cuboidal epithelium

Have a complete layer of circular smooth muscle


Lack cartilage support and mucus-producing cells

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Respiratory Zone
Defined by the presence of alveoli; begins as terminal bronchioles feed into respiratory bronchioles Respiratory bronchioles lead to alveolar ducts, then to terminal clusters of alveolar sacs composed of alveoli

Approximately 300 million alveoli:


Account for most of the lungs volume

Provide tremendous surface area for gas exchange


Chapter 22, Respiratory System 37

Respiratory Zone

Chapter 22, Respiratory System

Figure 22.8a 38

Respiratory Zone

Chapter 22, Respiratory System

Figure 22.8b 39

Respiratory Membrane
This air-blood barrier is composed of:
Alveolar and capillary walls
Their fused basal laminas

Alveolar walls:
Are a single layer of type I epithelial cells Permit gas exchange by simple diffusion Secrete angiotensin converting enzyme (ACE)

Type II cells secrete surfactant


Chapter 22, Respiratory System 40

Alveoli
Surrounded by fine elastic fibers
Contain open pores that:
Connect adjacent alveoli
Allow air pressure throughout the lung to be equalized

House macrophages that keep alveolar surfaces sterile


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Chapter 22, Respiratory System 41

Respiratory Membrane

Chapter 22, Respiratory System

Figure 22.9b

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Respiratory Membrane

Chapter 22, Respiratory System

Figure43 22.9.c, d

Gross Anatomy of the Lungs


Lungs occupy all of the thoracic cavity except the mediastinum
Root site of vascular and bronchial attachments Costal surface anterior, lateral, and posterior surfaces in contact with the ribs

Apex narrow superior tip


Base inferior surface that rests on the diaphragm

Hilus indentation that contains pulmonary and systemic blood vessels


Chapter 22, Respiratory System 44

Lungs
Cardiac notch (impression) cavity that accommodates the heart
Left lung separated into upper and lower lobes by the oblique fissure Right lung separated into three lobes by the oblique and horizontal fissures There are 10 bronchopulmonary segments in each lung
Chapter 22, Respiratory System 45

Gross Anatomy of Lungs


Base, apex (cupula), costal surface, cardiac notch Oblique & horizontal fissure in right lung results in 3 lobes Oblique fissure only in left lung produces 2 lobes

Chapter 22, Respiratory System

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Mediastinal Surface of Lungs


Blood vessels & airways enter lungs at hilus Forms root of lungs

Covered with pleura (parietal becomes visceral)

Chapter 22, Respiratory System

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Blood Supply to Lungs


Lungs are perfused by two circulations: pulmonary and bronchial Pulmonary arteries supply systemic venous blood to be oxygenated
Branch profusely, along with bronchi

Ultimately feed into the pulmonary capillary network surrounding the alveoli

Pulmonary veins carry oxygenated blood from respiratory zones to the heart
Chapter 22, Respiratory System 48

Blood Supply to Lungs


Bronchial arteries provide systemic blood to the lung tissue
Arise from aorta and enter the lungs at the hilus Supply all lung tissue except the alveoli

Bronchial veins anastomose with pulmonary veins


Pulmonary veins carry most venous blood back to the heart
Chapter 22, Respiratory System 49

Pleurae

Thin, double-layered serosa Parietal pleura


Covers the thoracic wall and superior face of the diaphragm

Continues around heart and between lungs

Chapter 22, Respiratory System

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Pleurae

Visceral, or pulmonary, pleura


Covers the external lung surface Divides the thoracic cavity into three chambers The central mediastinum Two lateral compartments, each containing a lung

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Breathing

Breathing, or pulmonary ventilation, consists of two phases


Inspiration air flows into the lungs

Expiration gases exit the lungs

Chapter 22, Respiratory System

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Pressure Relationships in the Thoracic Cavity

Respiratory pressure is always described relative to atmospheric pressure Atmospheric pressure (Patm)
Pressure exerted by the air surrounding the body Negative respiratory pressure is less than Patm Positive respiratory pressure is greater than Patm
Chapter 22, Respiratory System 53

Pressure Relationships in the Thoracic Cavity

Intrapulmonary pressure (Ppul) pressure within the alveoli


Intrapleural pressure (Pip) pressure within the pleural cavity

Chapter 22, Respiratory System

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Pressure Relationships

Intrapulmonary pressure and intrapleural pressure fluctuate with the phases of breathing
Intrapulmonary pressure always eventually equalizes itself with atmospheric pressure Intrapleural pressure is always less than intrapulmonary pressure and atmospheric pressure

Chapter 22, Respiratory System

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Pressure Relationships
Two forces act to pull the lungs away from the thoracic wall, promoting lung collapse
Elasticity of lungs causes them to assume smallest possible size Surface tension of alveolar fluid draws alveoli to their smallest possible size

Opposing force elasticity of the chest wall pulls the thorax outward to enlarge the lungs
Chapter 22, Respiratory System 56

Pressure Relationships

Chapter 22, Respiratory System

Figure 22.12

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Lung Collapse

Caused by equalization of the intrapleural pressure with the intrapulmonary pressure

Transpulmonary pressure keeps the airways open


Transpulmonary pressure difference between the intrapulmonary and intrapleural pressures (Ppul Pip)

Chapter 22, Respiratory System

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Pulmonary Ventilation

A mechanical process that depends on volume changes in the thoracic cavity


Volume changes lead to pressure changes, which lead to the flow of gases to equalize pressure

Chapter 22, Respiratory System

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Boyles Law
Boyles law the relationship between the pressure and volume of gases
P 1 V 1 = P 2 V2

P = pressure of a gas in mm Hg
V = volume of a gas in cubic millimeters

Subscripts 1 and 2 represent the initial and resulting conditions, respectively


Chapter 22, Respiratory System 60

Inspiration
The diaphragm and external intercostal muscles (inspiratory muscles) contract and the rib cage rises
The lungs are stretched and intrapulmonary volume increases Intrapulmonary pressure drops below atmospheric pressure (1 mm Hg) Air flows into the lungs, down its pressure gradient, until intrapleural pressure = atmospheric pressure
Chapter 22, Respiratory System 61

Inspiration

Chapter 22, Respiratory System

Figure 22.13.1 62

Expiration
Inspiratory muscles relax and the rib cage descends due to gravity

Thoracic cavity volume decreases


Elastic lungs recoil passively and intrapulmonary volume decreases Intrapulmonary pressure rises above atmospheric pressure (+1 mm Hg) Gases flow out of the lungs down the pressure gradient until intrapulmonary pressure is 0
Chapter 22, Respiratory System 63

Expiration

Chapter 22, Respiratory System

Figure 22.13.2

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Physical Factors Influencing Ventilation: Airway Resistance


Friction is the major nonelastic source of resistance to airflow The relationship between flow (F), pressure (P), and resistance (R) is:

P F= R

Chapter 22, Respiratory System

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Physical Factors Influencing Ventilation: Airway Resistance


The amount of gas flowing into and out of the alveoli is directly proportional to P, the pressure gradient between the atmosphere and the alveoli Gas flow is inversely proportional to resistance with the greatest resistance being in the medium-sized bronchi

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Airway Resistance
As airway resistance rises, breathing movements become more strenuous
Severely constricted or obstructed bronchioles:
Can prevent life-sustaining ventilation Can occur during acute asthma attacks which stops ventilation

Epinephrine release via the sympathetic nervous system dilates bronchioles and reduces air resistance
Chapter 22, Respiratory System 67

Alveolar Surface Tension


Surface tension the attraction of liquid molecules to one another at a liquid-gas interface The liquid coating the alveolar surface is always acting to reduce the alveoli to the smallest possible size Surfactant, a detergent-like complex, reduces surface tension and helps keep the alveoli from collapsing
Chapter 22, Respiratory System 68

Lung Compliance
The ease with which lungs can be expanded
Specifically, the measure of the change in lung volume that occurs with a given change in transpulmonary pressure Determined by two main factors
Distensibility of the lung tissue and surrounding thoracic cage Surface tension of the alveoli
Chapter 22, Respiratory System 69

Factors That Diminish Lung Compliance


Scar tissue or fibrosis that reduces the natural resilience of the lungs

Blockage of the smaller respiratory passages with mucus or fluid


Reduced production of surfactant Decreased flexibility of the thoracic cage or its decreased ability to expand

Chapter 22, Respiratory System

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Factors That Diminish Lung Compliance

Examples include:
Deformities of thorax Ossification of the costal cartilage Paralysis of intercostal muscles

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Chapter 22, Respiratory System 71

The Respiratory System


Physiology

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Chapter 22, Respiratory System

Respiratory Volumes
Tidal volume (TV) air that moves into and out of the lungs with each breath (approximately 500 ml) Inspiratory reserve volume (IRV) air that can be inspired forcibly beyond the tidal volume (2100 3200 ml) Expiratory reserve volume (ERV) air that can be evacuated from the lungs after a tidal expiration (10001200 ml) Residual volume (RV) air left in the lungs after strenuous expiration (1200 ml)
Chapter 22, Respiratory System 73

Respiratory Capacities
Inspiratory capacity (IC) total amount of air that can be inspired after a tidal expiration (IRV + TV)
Functional residual capacity (FRC) amount of air remaining in the lungs after a tidal expiration (RV + ERV) Vital capacity (VC) the total amount of exchangeable air (TV + IRV + ERV) Total lung capacity (TLC) sum of all lung volumes (approximately 6000 ml in males)
Chapter 22, Respiratory System 74

Dead Space

Anatomical dead space volume of the conducting respiratory passages (150 ml)
Alveolar dead space alveoli that cease to act in gas exchange due to collapse or obstruction Total dead space sum of alveolar and anatomical dead spaces

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Pulmonary Function Tests


Spirometer an instrument consisting of a hollow bell inverted over water, used to evaluate respiratory function Spirometry can distinguish between:
Obstructive pulmonary disease increased airway resistance

Restrictive disorders reduction in total lung capacity from structural or functional lung changes
Chapter 22, Respiratory System 76

Pulmonary Function Tests

Total ventilation total amount of gas flow into or out of the respiratory tract in one minute Forced vital capacity (FVC) gas forcibly expelled after taking a deep breath Forced expiratory volume (FEV) the amount of gas expelled during specific time intervals of the FVC

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Pulmonary Function Tests

Increases in TLC, FRC, and RV may occur as a result of obstructive disease


Reduction in VC, TLC, FRC, and RV result from restrictive disease

Chapter 22, Respiratory System

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Alveolar Ventilation
Alveolar ventilation rate (AVR) measures the flow of fresh gases into and out of the alveoli during a particular time
AVR (ml/min) = frequency (breaths/min) X (TV dead space) (ml/breath)

Slow, deep breathing increases AVR and rapid, shallow breathing decreases AVR
Chapter 22, Respiratory System 79

Nonrespiratory Air Movements

Most result from reflex action


Examples include: coughing, sneezing, crying, laughing, hiccupping, and yawning

Chapter 22, Respiratory System

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Basic Properties of Gases: Daltons Law of Partial Pressures

Total pressure exerted by a mixture of gases is the sum of the pressures exerted independently by each gas in the mixture The partial pressure of each gas is directly proportional to its percentage in the mixture

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What is Composition of Air?


Air = 21% O2, 78% N2 and .04% CO2
Alveolar air = 14% O2, 78% N2 and 5.2% CO2 Expired air = 16% O2, 78% N2 and 4.5% CO2

Observations

alveolar air has less O2 since absorbed by blood mystery-----expired air has more O2 & less CO2 than alveolar air? Anatomical dead space = 150 ml of 500 ml of tidal volume

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Basic Properties of Gases: Henrys Law


When a mixture of gases is in contact with a liquid, each gas will dissolve in the liquid in proportion to its partial pressure The amount of gas that will dissolve in a liquid also depends upon its solubility Various gases in air have different solubilities:
Carbon dioxide is the most soluble
Oxygen is 1/20th as soluble as carbon dioxide

Nitrogen is practically insoluble in plasma


Chapter 22, Respiratory System 83

Hyperbaric Oxygenation
Clinical application of Henrys law
Use of pressure to dissolve more O2 in the blood
treatment for patients with anaerobic bacterial infections (tetanus and gangrene)
anaerobic bacteria die in the presence of O2

Hyperbaric chamber pressure raised to 3 to 4 atmospheres so that tissues absorb more O2


Used to treat heart disorders, carbon monoxide poisoning, cerebral edema, bone infections, gas embolisms & crush injuries
Chapter 22, Respiratory System 84

Composition of Alveolar Gas


The atmosphere is mostly oxygen and nitrogen, while alveoli contain more carbon dioxide and water vapor

These differences result from:


Gas exchanges in the lungs oxygen diffuses from the alveoli and carbon dioxide diffuses into the alveoli Humidification of air by conducting passages

The mixing of alveolar gas that occurs with each breath


Chapter 22, Respiratory System 85

External Respiration: Pulmonary Gas Exchange


Factors influencing the movement of oxygen and carbon dioxide across the respiratory membrane
Partial pressure gradients and gas solubilities Matching of alveolar ventilation and pulmonary blood perfusion

Structural characteristics of the respiratory membrane


Chapter 22, Respiratory System 86

Partial Pressure Gradients and Gas Solubilities


The partial pressure oxygen (PO2) of venous blood is 40 mm Hg; the partial pressure in the alveoli is 104 mm Hg
This steep gradient allows oxygen partial pressures to rapidly reach equilibrium (in 0.25 seconds), and thus blood can move three times as quickly (0.75 seconds) through the pulmonary capillary and still be adequately oxygenated
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Chapter 22, Respiratory System

Partial Pressure Gradients and Gas Solubilities

Although carbon dioxide has a lower partial pressure gradient:


It is 20 times more soluble in plasma than oxygen It diffuses in equal amounts with oxygen

Chapter 22, Respiratory System

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Partial Pressure Gradients

Chapter 22, Respiratory System

Figure 22.17 89

Chapter 22, Respiratory System

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Oxygenation of Blood

Chapter 22, Respiratory System

Figure 22.18

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Ventilation-Perfusion Coupling
Ventilation the amount of gas reaching the alveoli Perfusion the blood flow reaching the alveoli

Ventilation and perfusion must be tightly regulated for efficient gas exchange Changes in PCO2 in the alveoli cause changes in the diameters of the bronchioles
Passageways servicing areas where alveolar carbon dioxide is high dilate Those serving areas where alveolar carbon dioxide is low constrict
Chapter 22, Respiratory System 92

Ventilation-Perfusion Coupling

Chapter 22, Respiratory System

Figure 22.19

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Surface Area and Thickness of the Respiratory Membrane


Respiratory membranes:
Are only 0.5 to 1 m thick, allowing for efficient gas exchange Have a total surface area (in males) of about 60 m2 (40 times that of ones skin) Thicken if lungs become waterlogged and edematous, whereby gas exchange is inadequate and oxygen deprivation results Decrease in surface area with emphysema, when walls of adjacent alveoli break through
Chapter 22, Respiratory System 94

Internal Respiration
The factors promoting gas exchange between systemic capillaries and tissue cells are the same as those acting in the lungs
The partial pressures and diffusion gradients are reversed PO2 in tissue is always lower than in systemic arterial blood

PO2 of venous blood draining tissues is 40 mm Hg and PCO2 is 45 mm Hg


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Chapter 22, Respiratory System 95

Oxygen Transport

Molecular oxygen is carried in the blood:


Bound to hemoglobin (Hb) within red blood cells Dissolved in plasma

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Oxygen Transport: Role of Hemoglobin


Each Hb molecule binds four oxygen atoms in a rapid and reversible process

The hemoglobin-oxygen combination is called oxyhemoglobin (HbO2)


Hemoglobin that has released oxygen is called reduced hemoglobin (HHb) Lungs HHb + O2 HbO2 + H+

Tissues
Chapter 22, Respiratory System 97

Hemoglobin (Hb)
Saturated hemoglobin when all four hemes of the molecule are bound to oxygen Partially saturated hemoglobin when one to three hemes are bound to oxygen The rate that hemoglobin binds and releases oxygen is regulated by:
PO2, temperature, blood pH, PCO2, and the concentration of BPG (an organic chemical)
These factors ensure adequate delivery of oxygen to tissue cells
Chapter 22, Respiratory System 98

Influence of PO2 on Hemoglobin Saturation


Hemoglobin saturation plotted against PO2 produces a oxygen-hemoglobin dissociation curve
98% saturated arterial blood contains 20 ml oxygen per 100 ml blood (20 vol %) As arterial blood flows through capillaries, 5 ml oxygen are released The saturation of hemoglobin in arterial blood explains why breathing deeply increases the PO2 but has little effect on oxygen saturation in hemoglobin
Chapter 22, Respiratory System 99

Hemoglobin Saturation Curve

Hemoglobin is almost completely saturated at a PO2 of 70 mm Hg


Further increases in PO2 produce only small increases in oxygen binding Oxygen loading and delivery to tissue is adequate when PO2 is below normal levels

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Hemoglobin Saturation Curve

Only 2025% of bound oxygen is unloaded during one systemic circulation If oxygen levels in tissues drop:
More oxygen dissociates from hemoglobin and is used by cells Respiratory rate or cardiac output need not increase

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Hemoglobin Saturation Curve

Chapter 22, Respiratory System

Figure 22.20

102

Other Factors Influencing Hemoglobin Saturation


Temperature, H+, PCO2, and BPG
Modify the structure of hemoglobin and alter its affinity for oxygen Increases of these factors:

Decrease hemoglobins affinity for oxygen


Enhance oxygen unloading from the blood Decreases act in the opposite manner

These parameters are all high in systemic capillaries where oxygen unloading is the goal
Chapter 22, Respiratory System 103

Factors That Increase Release of Oxygen by Hemoglobin


As cells metabolize glucose, carbon dioxide is released into the blood causing:
Increases in PCO2 and H+ concentration in capillary blood Declining pH (acidosis), which weakens the hemoglobin-oxygen bond (Bohr effect)

Metabolizing cells have heat as a byproduct and the rise in temperature increases BPG synthesis

All these factors ensure oxygen unloading in the vicinity of working tissue cells
Chapter 22, Respiratory System 104

Hemoglobin and Oxygen Partial Pressure

Blood is almost fully saturated at pO2 of 60mm


people OK at high altitudes & with some disease

Between 40 & 20 mm Hg, large amounts of O2 are released as in areas of need like contracting muscle
muscle tissues
Chapter 22, Respiratory System

lungs

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pCO2 & Oxygen Release

As pCO2 rises with exercise, O2 is released more easily

CO2 converts to carbonic acid & becomes H+ and bicarbonate ions & lowers pH.

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Acidity & Oxygen Affinity for Hb

As H+ increases (decrease in pH), O2 affinity for Hb decreases


Bohr effect allows the blood to unload oxygen H+ binds to hemoglobin & alters it O2 left behind in needy tissues

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Temperature & Oxygen Release

As temperature increases, more O2 is released

Metabolic activity & heat increases

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Hemoglobin-Nitric Oxide Partnership


Nitric oxide (NO) is a vasodilator that plays a role in blood pressure regulation
Hemoglobin is a vasoconstrictor and a nitric oxide scavenger (heme destroys NO) However, as oxygen binds to hemoglobin:
Nitric oxide binds to a cysteine amino acid on hemoglobin
Bound nitric oxide is protected from degradation by hemoglobins iron
Chapter 22, Respiratory System 109

Hemoglobin-Nitric Oxide Partnership

The hemoglobin is released as oxygen is unloaded, causing vasodilation As deoxygenated hemoglobin picks up carbon dioxide, it also binds nitric oxide and carries these gases to the lungs for unloading

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Carbon Dioxide Transport

Carbon dioxide is transported in the blood in three forms


Dissolved in plasma 7 to 10% Chemically bound to hemoglobin 20% is carried in RBCs as carbaminohemoglobin

Bicarbonate ion in plasma 70% is transported as bicarbonate (HCO3)


Chapter 22, Respiratory System 111

Transport and Exchange of Carbon Dioxide


Carbon dioxide diffuses into RBCs and combines with water to form carbonic acid (H2CO3), which quickly dissociates into hydrogen ions and bicarbonate ions
CO2 Carbon dioxide + H2O Water

H2CO3 Carbonic acid

H+ Hydrogen ion

HCO3 Bicarbonate ion

In RBCs, carbonic anhydrase reversibly catalyzes the conversion of carbon dioxide and water to carbonic acid
Chapter 22, Respiratory System 112

Transport and Exchange of Carbon Dioxide

Chapter 22, Respiratory System

Figure 22.22a 113

Transport and Exchange of Carbon Dioxide

At the tissues:
Bicarbonate quickly diffuses from RBCs into the plasma The chloride shift to counterbalance the outrush of negative bicarbonate ions from the RBCs, chloride ions (Cl) move from the plasma into the erythrocytes

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Transport and Exchange of Carbon Dioxide

At the lungs, these processes are reversed


Bicarbonate ions move into the RBCs and bind with hydrogen ions to form carbonic acid Carbonic acid is then split by carbonic anhydrase to release carbon dioxide and water

Carbon dioxide then diffuses from the blood into the alveoli
Chapter 22, Respiratory System 115

Transport and Exchange of Carbon Dioxide

Chapter 22, Respiratory System

Figure 22.22b 116

Haldane Effect

The amount of carbon dioxide transported is markedly affected by the PO2 Haldane effect the lower the PO2 and hemoglobin saturation with oxygen, the more carbon dioxide can be carried in the blood

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Haldane Effect

At the tissues, as more carbon dioxide enters the blood:


More oxygen dissociates from hemoglobin (Bohr effect) More carbon dioxide combines with hemoglobin, and more bicarbonate ions are formed

This situation is reversed in pulmonary circulation


Chapter 22, Respiratory System 118

Haldane Effect

Chapter 22, Respiratory System

Figure 22.23 119

Influence of Carbon Dioxide on Blood pH


The carbonic acidbicarbonate buffer system resists blood pH changes If hydrogen ion concentrations in blood begin to rise, excess H+ is removed by combining with HCO3 If hydrogen ion concentrations begin to drop, carbonic acid dissociates, releasing H+

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Influence of Carbon Dioxide on Blood pH

Changes in respiratory rate can also: Alter blood pH

Provide a fast-acting system to adjust pH when it is disturbed by metabolic factors

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Chapter 22, Respiratory System 121

Control of Respiration: Medullary Respiratory Centers


The dorsal respiratory group (DRG), or inspiratory center:
Is located near the root of nerve IX Appears to be the pacesetting respiratory center Excites the inspiratory muscles and sets eupnea (12-15 breaths/minute)

Becomes dormant during expiration

The ventral respiratory group (VRG) is involved in forced inspiration and expiration
Chapter 22, Respiratory System 122

Control of Respiration: Medullary Respiratory Centers

Chapter 22, Respiratory System

Figure 22.24 123

Control of Respiration: Pons Respiratory Centers


Pons centers:
Influence and modify activity of the medullary centers

Smooth out inspiration and expiration transitions and vice versa

The pontine respiratory group (PRG) continuously inhibits the inspiration center
Chapter 22, Respiratory System 124

Respiratory Rhythm
A result of reciprocal inhibition of the interconnected neuronal networks in the medulla Other theories include
Inspiratory neurons are pacemakers and have intrinsic automaticity and rhythmicity
Stretch receptors in the lungs establish respiratory rhythm
125

Chapter 22, Respiratory System

Depth and Rate of Breathing

Inspiratory depth is determined by how actively the respiratory center stimulates the respiratory muscles
Rate of respiration is determined by how long the inspiratory center is active Respiratory centers in the pons and medulla are sensitive to both excitatory and inhibitory stimuli

Chapter 22, Respiratory System

126

Medullary Respiratory Centers

Chapter 22, Respiratory System

Figure 22.25 127

Depth and Rate of Breathing: Reflexes

Pulmonary irritant reflexes irritants promote reflexive constriction of air passages Inflation reflex (Hering-Breuer) stretch receptors in the lungs are stimulated by lung inflation Upon inflation, inhibitory signals are sent to the medullary inspiration center to end inhalation and allow expiration

Chapter 22, Respiratory System

128

Depth and Rate of Breathing: Higher Brain Centers


Hypothalamic controls act through the limbic system to modify rate and depth of respiration
Example: breath holding that occurs in anger

A rise in body temperature acts to increase respiratory rate

Cortical controls are direct signals from the cerebral motor cortex that bypass medullary controls
Examples: voluntary breath holding, taking a deep breath
Chapter 22, Respiratory System 129

Depth and Rate of Breathing: PCO2


Changing PCO2 levels are monitored by chemoreceptors of the brain stem
Carbon dioxide in the blood diffuses into the cerebrospinal fluid where it is hydrated Resulting carbonic acid dissociates, releasing hydrogen ions PCO2 levels rise (hypercapnia) resulting in increased depth and rate of breathing
Chapter 22, Respiratory System 130

Depth and Rate of Breathing: PCO2

Chapter 22, Respiratory System

Figure 22.26 131

Depth and Rate of Breathing: PCO2


Hyperventilation increased depth and rate of breathing that:
Quickly flushes carbon dioxide from the blood

Occurs in response to hypercapnia

Though a rise CO2 acts as the original stimulus, control of breathing at rest is regulated by the hydrogen ion concentration in the brain
132

Chapter 22, Respiratory System

Depth and Rate of Breathing: PCO2

Hypoventilation slow and shallow breathing due to abnormally low PCO2 levels
Apnea (breathing cessation) may occur until PCO2 levels rise

Chapter 22, Respiratory System

133

Depth and Rate of Breathing: PCO2


Arterial oxygen levels are monitored by the aortic and carotid bodies Substantial drops in arterial PO2 (to 60 mm Hg) are needed before oxygen levels become a major stimulus for increased ventilation If carbon dioxide is not removed (e.g., as in emphysema and chronic bronchitis), chemoreceptors become unresponsive to PCO2 chemical stimuli In such cases, PO2 levels become the principal respiratory stimulus (hypoxic drive)
Chapter 22, Respiratory System 134

Depth and Rate of Breathing: Arterial pH

Changes in arterial pH can modify respiratory rate even if carbon dioxide and oxygen levels are normal Increased ventilation in response to falling pH is mediated by peripheral chemoreceptors

Chapter 22, Respiratory System

135

Peripheral Chemoreceptors

Chapter 22, Respiratory System

Figure 22.27 136

Depth and Rate of Breathing: Arterial pH

Acidosis may reflect:


Carbon dioxide retention
Accumulation of lactic acid

Excess fatty acids in patients with diabetes mellitus

Respiratory system controls will attempt to raise the pH by increasing respiratory rate and depth

Chapter 22, Respiratory System

137

Respiratory Adjustments: Exercise


Respiratory adjustments are geared to both the intensity and duration of exercise
During vigorous exercise:
Ventilation can increase 20 fold
Breathing becomes deeper and more vigorous, but respiratory rate may not be significantly changed (hyperpnea)

Exercise-enhanced breathing is not prompted by an increase in PCO2 or a decrease in PO2 or pH


These levels remain surprisingly constant during exercise
Chapter 22, Respiratory System 138

Respiratory Adjustments: Exercise

As exercise begins:
Ventilation increases abruptly, rises slowly, and reaches a steady state

When exercise stops:


Ventilation declines suddenly, then gradually decreases to normal

Chapter 22, Respiratory System

139

Respiratory Adjustments: Exercise

Neural factors bring about the above changes, including:


Psychic stimuli
Cortical motor activation

Excitatory impulses from proprioceptors in muscles


InterActive Physiology: Respiratory System: Control of Respiration
Chapter 22, Respiratory System 140

PLAY

Respiratory Adjustments: High Altitude

The body responds to quick movement to high altitude (above 8000 ft) with symptoms of acute mountain sickness headache, shortness of breath, nausea, and dizziness

Chapter 22, Respiratory System

141

Respiratory Adjustments: High Altitude


Acclimatization respiratory and hematopoietic adjustments to altitude include:
Increased ventilation 2-3 L/min higher than at sea level Chemoreceptors become more responsive to PCO2

Substantial decline in PO2 stimulates peripheral chemoreceptors

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142

Pneumothorax
Pleural cavities are sealed cavities not open to the outside Injuries to the chest wall that let air enter the intrapleural space
causes a pneumothorax collapsed lung on same side as injury surface tension and recoil of elastic fibers causes the lung to collapse
Chapter 22, Respiratory System 143

Smokers Lowered Respiratory Efficiency


Smoker is easily winded with moderate exercise
nicotine constricts terminal bronchioles
carbon monoxide in smoke binds to hemoglobin irritants in smoke cause excess mucus secretion irritants inhibit movements of cilia in time destroys elastic fibers in lungs & leads to emphysema trapping of air in alveoli & reduced gas exchange

Every thirteen seconds someone dies from a smoking-related disease.


Chapter 22, Respiratory System 144

Chapter 22, Respiratory System

145

Chapter 22, Respiratory System

146

Chronic Obstructive Pulmonary Disease (COPD)


Exemplified by chronic bronchitis and obstructive emphysema Patients have a history of:
Smoking

Dyspnea, where labored breathing occurs and gets progressively worse


Coughing and frequent pulmonary infections

COPD victims develop respiratory failure accompanied by hypoxemia, carbon dioxide retention, and respiratory acidosis
Chapter 22, Respiratory System 147

Chronic Obstructive Pulmonary Disease


progressive airflow limitations caused by an abnormal inflammatory reaction to the chronic inhalation of particles

chronic bronchitis and emphysema

Signs of COPD are consequences of the anatomical changes caused by the disease:
barrel chest pursed-lip breathing productive cough cyanosis.
Chapter 22, Respiratory System 148

Pathogenesis of COPD

Chapter 22, Respiratory System

Figure 22.28 149

Asthma
Characterized by dyspnea, wheezing, and chest tightness
Active inflammation of the airways precedes bronchospasms Airway inflammation is an immune response caused by release of IL-4 and IL-5, which stimulate IgE and recruit inflammatory cells Airways thickened with inflammatory exudates magnify the effect of bronchospasms
Chapter 22, Respiratory System 150

Tuberculosis

Infectious disease caused by the bacterium Mycobacterium tuberculosis


Symptoms include fever, night sweats, weight loss, a racking cough, and splitting headache Treatment entails a 12-month course of antibiotics

Chapter 22, Respiratory System

151

Lung Cancer
Accounts for 1/3 of all cancer deaths in the U.S.
90% of all patients with lung cancer were smokers The three most common types are:
Squamous cell carcinoma (20-40% of cases) arises in bronchial epithelium

Adenocarcinoma (25-35% of cases) originates in peripheral lung area


Small cell carcinoma (20-25% of cases) contains lymphocyte-like cells that originate in the primary bronchi and subsequently metastasize
Chapter 22, Respiratory System 152

Developmental Aspects
Olfactory placodes invaginate into olfactory pits by the 4th week Laryngotracheal buds are present by the 5th week Mucosae of the bronchi and lung alveoli are present by the 8th week By the 28th week, a baby born prematurely can breathe on its own During fetal life, the lungs are filled with fluid and blood bypasses the lungs Gas exchange takes place via the placenta
Chapter 22, Respiratory System 153

Respiratory System Development

Chapter 22, Respiratory System

Figure 22.29

154

Developmental Aspects
At birth, respiratory centers are activated, alveoli inflate, and lungs begin to function

Respiratory rate is highest in newborns and slows until adulthood


Lungs continue to mature and more alveoli are formed until young adulthood Respiratory efficiency decreases in old age
Chapter 22, Respiratory System 155